I have been a supporter of legalising assisted dying since the late Margo MacDonald first proposed a change of the law in Scotland in 2010. When the revised bill (Assisted Suicide [Scotland] Bill 2013) was launched, I decided it was time to “put my head above the parapet” and become a public supporter. At that time there was a media perception that all doctors were against assisted dying as the BMA had recently voted against it. I coordinated a group of 11 doctors who were willing to sign a supportive letter to The Herald (a national Scottish newspaper with a supportive editorial team). An accompanying article hit the front page, and it was picked up by a number of other papers including The Times. Subsequently, we formed Doctors for Assisted Suicide, which is simply a group of Scottish doctors who are actively in support of a change in the law. The bill will finally be debated on Wednesday 27 May, with the first stage vote scheduled for 5 pm.
Why is it called the Assisted Suicide Bill?
The term assisted suicide sat uneasily with many of us at first. Margo was keen to ensure that we were legalising help to die where the patient commits the final act NOT a doctor killing a patient e.g. giving an injection. The patient HAS to be a mentally competent adult, have a terminal/life shortening disease, and be assessed by at least two separate doctors on two occasions i.e. four medical consultations altogether. The method of death has been kept deliberately vague to allow for all eventualities: the vast majority of patients can and would ingest a substance (barbiturate based currently) but not all, so there would have to be a means for them to start a syringe driver or a feeding pump. This differentiates our bill from the Netherlands and Belgium where euthanasia is legal (the doctor can actively deliver the means of death).
Will it be the slippery slope to euthanasia?
Oregon has had a similar law (Death with Dignity Act) to the one proposed for 17 years, and there is no sign of a wish it to change to include euthanasia or indeed for the mentally incompetent. Even though the numbers of participants in DWDA are increasing, they remain a tiny proportion of total deaths (<0.5%).
What about vulnerable groups?
The need for four medical consultations will protect the vulnerable as much as possible, and I believe more than the current unlegalised state. In countries where assisted suicide +/- euthanasia is legal there is no increased use of AS in any of the minority groups, including the disabled (J Med Ethics Oct 2007; 33(10): 591–597)
Do we need to legalise?
I believe that the public wish more control over how and when they die, and giving them the possibility of assisted suicide will give great comfort to some. If there was a reliable way to kill yourself and all people were capable of carrying it out then we wouldn’t need to change the law. In Scotland we know that currently approximately 50 patients with a terminal illness per year commit suicide—that’s one a week. We don’t know how many fail (and subsequently potentially cause themselves harm) nor how many ask, or would like to ask, others to help them if they themselves are physically incapable of carrying it out. Although travelling to Switzerland is an option, you have to do it when you are fit to fly, it costs about £3000, and it means dying in a rather soulless room, having been assessed by only one doctor. Doctors form the largest proportion of professionals attending Dignitas—we want it for ourselves, so why not for our patients?
We need to change the law to make sure we get the prescription right, to protect our vulnerable and to protect those who assist suicide on compassionate grounds. If a stage one vote is passed, the bill can be amended to improve it before it becomes law.
Competing interests: I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: I am secretary of Doctors for Assisted Suicide.
Gillian MacDougall has been an ENT consultant in Lothian since 2001, specialising in rhinology and voice disorders. As a senior house officer she spent six influential months caring for patients with head injuries in the Royal Infirmary of Edinburgh.