In Parliament

Below you can read the text of my speech during the debate on Assisted Dying for Terminally Ill Adults (Scotland) Bill: Stage 1

I thank Liam McArthur for the exceptional way in which he has conducted himself in this debate, and I thank members of the Health, Social Care and Sport Committee for their efforts.

The only thing that is clear about today’s debate is that, irrespective of how we vote as members, many of our constituents will be left deeply disappointed. The sheer number of emails that we have received and the range of views in them are testament to that.

Although the debate on assisted dying should not be a polarised one, that can be challenging when the reality is that parliamentarians are being presented with a binary choice today. In considering the bill, we are all wrestling with providing autonomy and choice for terminally ill people who have advanced and progressive diseases, illnesses or conditions. However, that must be weighed against a series of other considerations. For example, considerations regarding potential coercion and the lack of choice for some who have terminal conditions give me real cause for concern.

The Scottish Association of Social Work captured much of my concern when it stated:

“The Bill focuses almost exclusively on physical conditions, neglecting the equally crucial role that relationships, financial circumstances, home environment and social networks ... play in such a decision.”

Coercion can be very subtle and difficult to detect. This is no slight on medical professionals, but I am not sure that they are best placed to identify it, and I note that social workers would like social work to have a mandatory role in the process, including in determining the potential for coercion.

The Scottish Partnership for Palliative Care said that

“It is important to acknowledge openly that there may be trade offs between”

different goals. For example, maximising choice for some

“may increase the risk of coercion of vulnerable people”

and groups,

“since procedural safeguards are seldom fully effective”.

It added:

“SPPC does not believe that all risks can be eliminated.”

On the inequalities that exist with regard to the actual choices that people have, I ask members to consider the Marie Curie dying in the margins project. The exhibition was on display in the Parliament, and we debated the study, which clearly demonstrated the impacts of poverty, inappropriate housing and the varying levels of support networks. Among many other things, those impact on the life experiences and choices that are open to those who have a terminal diagnosis and require palliative and end-of-life support.

I chair the cross-party group on palliative care in our Parliament. I am confident that access to high-quality and specialist palliative care exists. There can be a good death. However, I am not confident that access to that is consistent or sufficient. For example, we have to do far better on hospice at home care.

The public funds that support our palliative care sector need to be significantly increased, and it is the same elsewhere in the UK. We must make common cause to demonstrate political will and increase those funds. Our hospice sector deserves greater financial sustainability, and we also need greater consistency in how we support those who are approaching the end of life with care at home.

Although I welcome the increased attention that palliative care is receiving, it should not take a bill on assisted dying to garner greater attention for it. It stands on its own merits, but it has not been a priority for this Parliament, and that applies across the parties.

I am concerned that, when the Association for Palliative Medicine surveyed its members, who are palliative care specialists, 86 per cent of respondents stated that assisted dying would have a negative impact on services and 81 per cent considered that it would negatively impact recruitment to palliative medicine.

I have various other concerns but, in the time that I have left, I want to talk about how the bill could fundamentally change the relationship between doctors and patients. Concerns have been raised by some that doctors may be under a legal duty—case law was cited—to proactively raise the subject of assisted dying with eligible patients. That would lead to a real dilemma for doctors when terminally ill people ask, “Have we explored all the possible treatment options? What else is there, doctor?” How is a clinician supposed to answer that? Could the trust in those clinicians be undermined? Would such a duty normalise assisted dying? Is that something that we should do? I suppose that we are debating that in Parliament this afternoon.

On balance—it is on balance—I will not support the bill at stage 1 this evening. I expect to hear forceful arguments for why we should support it, but I am not sure that we could amend the bill to identify and tackle the underlying inequalities and realities in society. For me, that is crucial. As a Parliament, we must reach a decision, on balance, on whether to proceed with the bill. I look forward to hearing further from friends and colleagues on both sides of the debate.