STEPHEN DAISLEY: Terminating a human life, even if carried out with the very best intentions, is not healthcare. It is killing

Liam McArthur’s Assisted Dying for Terminally Ill Adults Bill is dividing Scotland in two. New figures show public reaction is almost 50/50.

The bill would make it legal for “health care professionals” to assist in the voluntary suicide of “a terminally ill adult who meets certain eligibility criteria.”

It is a topic that elicits strong opinions, based on personal experiences and deep-rooted religious and philosophical beliefs.

The debate should take place in that spirit, but sides have to be chosen and they have to be chosen resolutely. I am resolutely against it.

There is no perfect death and no system of delivering death can ever be perfect. This is as true of euthanasia as it is of the death penalty.

When the state gets involved in ending lives, it brings with it all the flaws inherent in large bureaucracies.

Whatever the NHS’s qualities, it is a bureaucratic organisation prone to mismanagement, systematic errors and a culture of cover-up.

But with euthanasia there is no room for error, just as there is with execution.

When we look at other countries implementing policies such as euthanasia, it is only fair to look at their results as well.

Canada legalized medically assisted suicide (MAID) in 2016, but it too was initially limited to the terminally ill.

The courts subsequently ruled that the drug should be made available to patients with serious conditions where death was not “reasonably foreseeable.”

The House of Commons complied with and amended the law in 2021. The law was amended again, and from 2027, patients whose “only underlying medical condition” is a “mental health condition” will be eligible for MAID.

In the first year of MAID, 1,018 Canadians voluntarily euthanized themselves, but by 2022 that number had risen to 13,241, a 1,200 percent increase in six years.

Physicians participating in MAID now account for four percent of all deaths in Canada. In the province of Quebec, that number is nearly seven percent.

The most commonly cited “nature of suffering” in MAID claims is “loss of ability to perform meaningful life activities,” but “the perceived burden a patient feels on family, friends, or caregivers” was cited in 35 percent of cases.

A 2023 study published in the journal Palliative Support Care found that there are problems with the practice of MAID, with increasing cases of people choosing to end their lives “because of the suffering associated with a lack of access to medical, disability and social support.”

The researchers concluded that Canada’s euthanasia regime “lacks the safeguards, data collection, and oversight necessary to protect Canadians from premature death.” If it can happen in advanced, enlightened Canada, it can happen here.

All of this is not meant to trivialize the suffering of people who are terminally ill, bedridden and spending their last days, weeks or even months in fear of death.

Surely they have the right to end their pain and determine the terms under which their lives end?

When I look at it this way, I understand the plea for euthanasia and even sympathize with it.

Not only because it is an emotional issue, but also because it is a human issue. When we hear that someone has been diagnosed with stage four cancer or motor neuron disease or something catastrophic like that, we try not to imagine that we or our loved ones are in the same situation, but we can’t help it. But for the grace of God.

However, this debate is not about who is most compassionate or empathetic, but about the practical feasibility and moral acceptability of the state, through nationalized health care, determining who may and may not commit suicide and who may assist them in doing so.

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 kind of country we want to be. The state does what it does on our behalf.

Therefore, even though euthanasia may seem like a personal matter, it is something that concerns us all.

Our parliament will tell the NHS that doctors in our country can avoid their duty of care and instead help kill.

That Scotland is a country where one moment a doctor is called in to administer a drug to save someone’s life and the next moment someone is given a drug that ends their life.

That both actions are clinically and morally equivalent and legitimate.

They are not. Ending a human life, even at the patient’s request, is not health care. It is killing. It can be done with the best of intentions, by clinicians with an alphabet of letters after their names, to patients whose prognosis is grimly certain, but it is still killing.

We already know this. That’s why the law allows for exceptions so that women can have access to abortion-inducing drugs or, more rarely these days, medical procedures that end a pregnancy.

Doing this outside of the circumstances set out in law is a crime. Since the 1960s, there has been a societal movement away from anything that smacks of judgmentalism and toward a culture of autonomy in which we are all individuals who have the right to make choices, regardless of long-established moral or social constraints.

This has generally been a good thing, but even in a liberal society there are some things we should not do. Things that are basic principles of civilization. Things like artificially altering the course of life and death.

If you ask “what if” questions about such a proposal, you are likely to be accused of the “slippery slope fallacy.”

But the slippery slope is not always a fallacy. It is often a simple observation of how policy works and evolves. There are a number of slippery slope questions that need to be asked about this bill.

What safeguards could be built in to ensure that euthanasia assistance is only provided to people who want to end their suffering, and not to people who see themselves as a burden to their families?

In other countries, it is mainly the elderly who seek euthanasia. This population group suffers disproportionately from chronic loneliness and is ashamed of the thought of being a burden to their children or other family members for a long time.

The explanatory memorandum states that ‘there is no obligation for anyone, including registered doctors and other healthcare 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, how long will a conscientious objection last?

What happens when patients seeking to end their lives in remote and rural Scotland report problems obtaining lethal drugs?

This could be a real possibility in areas where there is both a lower density of physicians and a higher level of religiosity and/or social conservatism. It seems likely that there would be considerable pressure on conscientious objectors to participate in what would now be considered ‘health care’.

What happens when the euthanasia lobby a little further down the road declares the safeguards in McArthur’s bill “traumatizing” and “humiliating” for terminally ill patients and demands that the process be “demedicalized,” making it primarily a matter of patient choice and reducing the role of clinicians to that of signing a prescription?

I suspect we all know what would happen: Holyrood would abandon its security measures and congratulate itself on its courage and progressiveness.

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

Compassion would be to invest properly in palliative care to ensure that those who cannot recover can leave this life when their time comes, with as much comfort and as little pain as possible. Life is precious and those who leave it should be treated as such.