Willie Rennie's view of assisted dying legislation

I have wrestled for a long time with the issue of assisted dying.  It is the subject of a bill currently before the Scottish Parliament and expected to be debated and voted on in the Holyrood chamber in May.  I am naturally cautious, having voted against a different bill on the matter in 2015, but have been open to persuasion.

I have listened to constituents with a wide range of experiences from professional to personal views based on moral, religious and philosophical beliefs. I have attended numerous events in parliament to hear the views of those in favour and against. I hosted a public meeting in St. Andrews last month at which over 200 constituents heard from the proposer of the bill Liam McArthur MSP and Dr Sarah Mills, a GP in Cupar and a Lecturer at St. Andrews University, who is opposed to a change in the law and recently gave evidence to the Scottish Parliament’s Health Committee on the issue. I conducted a survey and asked for opinions and experiences.

Even though the bill is proposed by my Liberal Democrat colleague Liam McArthur I am not compelled to vote for it as this is a matter of personal conscience. Indeed, it is an issue and bill on which all parties have accepted the need to allow their MSPs to have a ‘free’ vote. I have, some say stubbornly, refused to state a position until now but I think now is the right time to set out my intentions. I believe I have heard almost all, if not all, the arguments for and against the principle of changing the law and the specific proposals in the bill itself so think constituents deserve to know now, well in advance of the debate and vote.

I have, on balance, determined that I will vote for the bill. It’s a finely balanced judgement as there are powerful arguments on both sides. I think that the release from suffering a painful and traumatic terminal illness is a choice that should be available to adults with capacity who choose it. Accessing an assisted death is not without its practical issues or moral and philosophical implications for wider society but the release from suffering is something that a caring society should be prepared to make available in limited circumstances and subject to strict safeguards.

We find talking about death an uncomfortable subject. We should discuss it more and that is something that the debate around this bill has allowed to happen, not just in relation to assisted dying but the range of end of life choices that should be available. For me it should be about quality of life not just length of life. Families and friends, not unreasonably, want to hold on to a loved one for as long as possible but as it comes to us all we should not shy away.

Which leads me to end of life care. Palliative care can be outstanding and can provide people a good and dignified death. However, we know that it doesn’t work for everyone, even where it can be accessed. We certainly need further investment in palliative and hospice care, not least to improve access, but we also need to offer the choice of an assisted death for the relatively small number who may opt for it. It is not a case of either/or, we need to do both.

Evidence from around the world shows that often people who have made a request for an assisted death and received the necessary authorisation don’t end up proceeding with it. There seems to be a comfort in knowing that you can end the suffering if it becomes intolerable even if you never actually use it.

There is also now a lot of evidence from other countries and states around the world that illustrate how such legislation permitting assisted dying based on a terminal illness and mental capacity, works in practice. Scotland would not be the first to give people this choice, indeed close to home Jersey and the Isle of Man are well advanced in the consideration of similar bills. And the evidence shows very clearly that once such a law is in place, public support for it remains strong. Most recently I have heard from parliamentarians in Australia who say there is no expression of regret that the law was introduced, and confidence in the process is high within the medical profession as well.

If introduced this law will have been agreed by a majority of Members of the Scottish Parliament but it won’t have been agreed in a rush. In the last twenty-five years this will have been at least the third time that it has been considered and Liam McArthur’s bill has been consulted on and debated for four years.

I think the proposed criteria are sufficiently restrictive. An assisted death would be available only to terminally ill adults with capacity. The Bill defines someone as terminally ill if they:

“[…]have an advanced and progressive disease, illness or condition from which they are unable to recover and that can reasonably be expected to cause their premature death.”

To be eligible a person would also need to be registered with a GP practice and have been ordinarily resident in Scotland for at least 12 months. They would have to be capable of self-administering the substance.

I don’t accept the argument that agreeing such a bill would be a slippery slope with the criteria expanding once the bill was passed because in this country it is parliament that agrees the law and it would have to be parliament that extended the criteria and no-one else. Moreover, as the House of Commons Health Committee concluded in a report on this issue last year, there are no examples internationally of a terminal illness/mental capacity model of assisted dying being expanded in terms of its eligibility criteria.

For those who oppose the bill on moral, philosophical or religious grounds I respect their beliefs and their motivation to prevent a change in the law, but ultimately this is a personal choice for those who wish to choose this option, which will also put in place safeguards that don’t currently exist.

That said, I have been greatly influenced by the arguments against the bill.

I do worry about the impact on the relationship between the doctor and the patient. Health professionals use their skills and knowledge to keep patients alive, but this would change with the bill. However, other countries have managed this change without a breakdown of the doctor/patient relationship. Indeed I have heard from doctors in the US and Australia who talk very positively about the experience and the impact it has on their relationship with not just patients, but wider families as well.

I also worry about what has been described as internal coercion. That is when people, at a low ebb, believe their life should be ended because they believe they are a burden.  I worry about how this will change our view of life. I worry about unintended consequences. I worry a lot which is why I have taken so long to decide. But I believe that the safeguards around mental capacity; the conversations and assessments that would need to take place; the option to refer to specialists, should that be necessary; and the direct, practical experience from other countries shows that these can be managed.

I am anxious about whether everyone will have the necessary knowledge and awareness of this option but that is not a unique problem and equally applies to many of our rights and responsibilities. Government has a duty to sensitively raise awareness just like it does on some many other areas that affect our lives, and I know this is something that voluntary and third sector organisations are well-placed to help with too.

I am likely to support raising the qualification age from 16 years old to 18 years old as a precautionary measure. The age of capacity varies for marriage, voting, the military and alcohol and tobacco purchases so there is no settled view on when someone is old enough to decide.  Therefore, my view is that we should be cautious, even though the numbers likely to be affected in this age bracket would be exceptionally low.

What is evident is that terminally ill people are finding ways of ending their lives to escape their suffering. And they are doing so now. Some can afford to travel to Switzerland but go much earlier than they would have preferred because they have to be capable of travel.  Others take their own lives through suicide, adding to the trauma not just for themselves but for those they leave behind. In such circumstances, there are rarely assessments made, few safeguards and little opportunity to intervene to discuss all the options available.  

What this bill would allow is for dignity in death where people have the option of planning their own departure in the way they would wish.

So I have decided to support the general principles of the bill at stage one which will allow for further debate and scrutiny of the detail through the three stages of the parliamentary process.  Of course, if I am not satisfied that some of the changes that need to be made, as with any bill passing through parliament, I will have the option of voting against its final adoption at Stage 3. However, at this point, my view on this issue has changed since last parliament considered such a bill and I now believe that people should have the choice that would be delivered through this bill.

I accept that this is a very sensitive issue and views on both sides are strongly held and passionately argued. Of course, if it were simple we would have decided a long time ago, but it is clear that this issue is not going to go away. Indeed, there are serious consequences from not changing the law. There will be people that disagree with my conclusion, but I hope I have been able to demonstrate that I have treated this important issue with the necessary care and sensitivity that it definitely deserves.