A change in the law would allow honest conversations around dying to happen. Healthcare professionals could discuss options with patients who raise the question of assistance to die, exploring reasons for requesting assistance and what palliative and supportive options are available. In our response we address concerns around the mechanisms of the proposed system and question what is meant by the eligibility criteria of either being terminally ill or ‘having a terminal condition’.
There is a clear distinction between assisted dying and assisted suicide. Dignity in Dying campaigns for the legalisation of assisted dying for terminally ill adults only. Assisted dying refers only to terminally ill, mentally competent adults and allows the dying patient, after meeting strict legal safeguards, to self-administer life-ending medication. The provisions in the proposed Bill go beyond this, incorporating assisted suicide for those with a terminal condition (who may not be dying and have no prognosis of time until death). We believe further discussion about what defines a ‘terminal condition’ is needed.
The Bill proposes that an individual has to formalise, in writing, an ‘intent’ to discuss assisted suicide (whether they have a terminal condition or are perfectly healthy) before discussions can take place. We feel that this pre-registration system is an unnecessary step which could hinder situations where an individual wants to discuss assistance, but hasn’t filled in the necessary forms (especially in the case of an individual with a short prognosis of, for example, 6 weeks). In US State of Oregon, where assisted dying was legalised in 1997, the patient has to take the first steps and initiate the conversation with their doctor. It is illegal for the doctor to initiate this conversation. We feel that this would be a better approach.
We support ensuring that the individual has capacity (which is initially assessed when the patient requests assistance) when they take the life-ending medication. This is addressed by Margo by proposing a 28 day cut off from the second formal request for assistance to die, which is designed to act as a ‘time guarantee’ that the person should still have capacity. As a consequence, if the individual has not taken the medication within this period they have to start the process of applying for assistance again. However, we question whether this is the best way of ensuring that the person has capacity.
A simpler way of ensuring capacity at the point of medication is outlined in the Commission on Assisted Dying report, which proposes an on-the-spot capacity assessment “At the time that the doctor or other suitably qualified professional brings the lethal medication to the patient, he or she should be able to satisfy him or herself that at that moment the patient has capacity to make the decision to end his or her life.”
In conclusion, whilst we support the principle of the proposed Bill (people should not have to suffer against their wishes at the end of life), we have some concerns with who would be eligible for assistance and the mechanisms of the process. But what is clear, is that public consultation and debate is moving us closer to the point where we can legislate to provide both greater choice and protection at the end of life. For that Margo MacDonald MSP deserves our heartfelt thanks.