STEPHEN DAISLEY: Ending a human life isn't healthcare, it's killing

Liam McArthur’s Assisted Dying for Terminally Ill Adults Bill divides Scotland down the middle. New figures show public responses split almost 50/50.

The Bill would make it legal for ‘health professionals’ to assist in the voluntary suicide of ‘a terminally ill adult who meets specified eligibility criteria’. 

This is a subject that inspires strong opinions, based on personal experiences, and drawing on deeply held religious and philosophical convictions. 

The debate should take place in that spirit, but sides must be taken and they must be taken firmly. I am firmly against.

There is no perfect death and no system for delivering death can ever be perfect. That is as true of euthanasia as it is of capital punishment. 

When the state becomes involved in the business of ending life, it brings with it all the flaws inherent to large bureaucracies. 

Whatever its qualities, the NHS is a bureaucracy and one prone to mismanagement, systemic error, and cover-up culture. 

But there can be no room for error with euthanasia, just as there can be none with execution.

If we look to other countries when adopting policies like euthanasia, it is only fair to look to their outcomes. 

Canada legalised medical assistance in dying (MAID) in 2016 and it too was initially limited to the terminally ill. 

The courts then said it had to be made available to patients with severe conditions where death was not ‘reasonably foreseeable’. 

The House of Commons complied and amended the law in 2021. The Act has been changed again and from 2027 patients whose ‘sole underlying medical condition’ is ‘mental illness’ will be eligible for MAID.

The first year of MAID saw 1,018 Canadians voluntarily euthanised but by 2022 that number had soared to 13,241, an increase of 1,200 per cent in six years. 

Doctors participating in MAID are now responsible for four per cent of all deaths in Canada, a figure that rises to almost seven per cent in the province of Quebec. 

The most commonly cited ‘nature of suffering’ in MAID applications is ‘loss of ability to engage in meaningful life activities’ but a patient’s ‘perceived burden on family, friends or caregivers’ was cited in 35 per cent of cases.

A 2023 study published in the journal Palliative Support Care ‘identified issues with MAID practice’ and found increasing accounts of people choosing to end their lives ‘due to suffering associated with a lack of access to medical, disability, and social support’. 

The researchers concluded that Canada’s euthanasia regime ‘is lacking the safeguards, data collection, and oversight necessary to protect Canadians against premature death’. If it can happen in advanced, enlightened Canada, it can happen here.

None of this is intended to downplay the suffering of people stricken with terminal illnesses, bed-bound and spending their final days, weeks, or even months in agony. 

Surely they have a right to put an end to their pain and decide the terms on which their life will end? 

When put in those terms, I understand and even sympathise with the case for euthanasia. 

Not only because it is an emotive issue but because it is a human one. Whenever we hear about someone’s diagnosis of Stage Four cancer or motor neurone disease or something similarly cataclysmic, we try not to imagine ourselves or our loved ones in the same situation but we can’t help it. There but for the grace of God.

However, this debate is not over who is the most compassionate or empathetic, it’s about the practical feasibility and moral acceptability of the state, through its nationalised healthcare service, deciding who may and may not take their own lives and helping them to conduct their suicide. 

And what we call ‘the state’ is really just us, the accumulation of our electoral and other preferences, the official articulation of who we are and the sort of country we want to be. The state does what it does on our behalf.

That is why, much as it might seem like euthanasia is a personal matter, it is actually something that affects all of us. 

It will be our parliament telling our NHS that in our country doctors can opt out of their duty to care and instead help to kill. 

That Scotland is a place where one minute a physician might be called upon to administer a drug to save someone’s life and in the next to hand someone a drug that will end their life. 

That both of those actions are clinically and morally equal and legitimate.

They are not. Terminating human life, even if by patient request, is not healthcare. It is killing. It might be done with the best of intentions, by clinicians with an alphabet of letters after their name, to patients whose prognosis is grimly certain, but it is still killing.

We know this already. It’s why the law permits exceptions so that women can access abortifacient drugs or, more rarely these days, medical procedures that will terminate a pregnancy. 

Doing so outwith the circumstances set out in law is a crime. Ever since the Sixties, there has been a societal lurch away from anything that smacks of judgmentalism and towards a culture of autonomy in which we are all individuals entitled to make choices regardless of long-established moral or social strictures.

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This has been, for the most part, a good thing but even in a liberal society there are some things that we should be prevented from doing. Things that are civilisational fundamentals. Things like artificially altering the course of life and death.

Asking ‘what if’ questions about a proposal such as this is likely to see you accused of ‘the slippery slope fallacy’. 

But the slippery slope is not always a logical fallacy. It is often a simple observation of how policy operates and evolves. There are a number of slippery slope questions to be asked of this Bill.

What possible safeguards could be built in that would ensure euthanasia assistance was granted only to those who want to end their suffering, as opposed to those who consider themselves a burden on their family?

In other countries, euthanasia is most commonly accessed by older people, a demographic disproportionately affected by chronic loneliness and ashamed at the thought of inconveniencing their children or other relatives for a sustained period of time.

The explanatory notes say there would be ‘no duty on anyone, including registered medical practitioners and other health professionals, to participate in the process if they have a conscientious objection to doing so’. 

But if euthanasia becomes a service provided by the NHS, for how long will a conscience exemption be sustainable?

What happens when patients wishing to end their lives in remote and rural Scotland begin reporting difficulty in accessing lethal drugs? 

This could be a real possibility in areas where there is both a lower density of doctors and a higher percentage of religiosity and/or social conservatism. It seems likely that a great deal of pressure would be brought to bear on conscientious objectors to participate in what would now be regarded as ‘healthcare’.

What happens when, a little further down the line, the euthanasia lobby declares the safeguards built into McArthur’s Bill ‘traumatising’ and ‘humiliating’ for terminally ill patients and demands the process be ‘demedicalised’, rendering it primarily a matter of patient choice with clinicians’ role reduced to that of a signature on a prescription?

I suspect we all know what would happen: Holyrood would ditch the safeguards and congratulate itself on its bravery and progressivism.

I respect those who see this issue differently. I believe they are good people who mean well and want to see the terminally ill treated with compassion. But I dissent vigorously from the notion that killing can ever be a form of compassion. 

Compassion would be to invest properly in palliative care to make sure those who cannot recover are able to leave this life when their time comes in as much comfort and as little pain as possible. Life is precious and those departing from it should be treated that way.