As senior clinicians in Scotland, we are concerned that vulnerable patients will feel pressure to take their own lives, people with disabilities would feel their lives are valued less and suicide prevention will be undermined. [3] In Oregon, over half of those who choose assisted suicide cite feeling a burden on caregivers.[4]
We would be glad to speak with individual members of the Scottish Parliament about significant problems within the recommendations of the report.
- The report suggests two doctors, each with one year of experience, be licensed to end a patient’s life. Such a doctor would otherwise not be permitted to remove an appendix,[5] to hold a patient under the Mental Health Act,[6] to declare someone brainstem dead,[7] or even to discharge a patient home from hospital.[8] Yet they might administer a lethal medication to a patient who may be distressed or depressed, lack capacity, or simply need assessment and management by a senior, experienced professional?
- The report states cause of death would be the underlying illness. Medical certification of death is crucial for epidemiological data collection, governance, and external scrutiny. The cause of death must be that. It is imperative that patients understand what it is they are consenting to, and families are clear what has happened. The terms ‘assisted dying’ and ‘care navigator’ are deliberately euphemistic, chosen because they trade on the good name of palliative care.
- What shall we do when the patient vomits after taking the medication, has a seizure, or the patient does not die as anticipated?[9] What is the ‘rescue medication’ mentioned in the report? Is there a duty to resuscitate the patient or to kill them?
- The report gave selective coverage of other jurisdictions. Canada has been roundly criticized for introducing euthanasia for those who are disabled[10] and plans for the mentally ill have been paused because of international concern.[11] Yet the problem is the logical inevitability of the right to die. If on grounds of suffering, why only for terminal illness, why not for chronic illness? Or mental illness? Children, adolescents and those with dementia and psychiatric illness are now euthanized in the Benelux countries (but were excluded in the original legislation). Safeguards are exclusions by another name. In the presence of strong equality legislation, Canada has been unable to maintain a narrow law.[12]
The NHS is on its knees. Palliative care is woefully underfunded and many lack access to specialist provision. The thought of assisted suicide being introduced and managed safely at such a time is remarkably out of touch with the gravity of the current health crisis. This report is ill-timed, ill-conceived, and ill-judged. The current law is the safeguard we need.
We would be glad to discuss this further with you. Please contact Dr Gillian Wright at [email protected] to arrange this.
Yours sincerely
Prof Marie Fallon, Professor of Palliative Medicine, Edinburgh.
Prof David Galloway, Honorary Professor of Surgery and ex-President of the Royal College of Physicians and Surgeons of Glasgow.
Prof Iain McInnes CBE, Professor of Medicine, Glasgow
Prof Scott Murray MBE, Emeritus Professor of Primary Palliative Care, Edinburgh.
Prof Duncan Porter, Professor of Medicine, Glasgow
Prof D Robin Taylor, Professor of Medicine, Edinburgh.
Prof Jonathan Cavanagh, Professor of Psychiatry, Glasgow.
