HSS member Innes McOwan brings us up to date on the bill and shows how we can lend our support.

Now that the End of Life Assistance (Scotland) Bill has been published (January 2010) we can consider the proposed legislation in detail.

Fundamental Principles
By and large the Bill stays with the fundamental principles that underpinned the Consultation Paper (December 2008) wherein M/S MacDonald set out her intentions, viz –

1. The Bill is based on total respect for the dignity and autonomy of the individual. The ultimate decision will remain with the individual, and the individual alone.
2. The option of exercising the right to obtain assistance at the end of life will be strictly limited to specific categories of debility.
3. The final act would be carried out in controlled circumstances.
4. (It is not clear to me that the administration of the fatal dose would have to be administered by a Registered Medical Practitioner, although such a person would have to be present.)
5. Provision is made to ensure that vulnerable people are fully protected.

Motivation
The overarching motivation behind the Bill is one of compassion. How can we allow people to die in a condition that they find intolerable through extreme pain or extreme debility, when we posses the means to ease that final passage? The reality is that many people recognize when their own end is approaching and they ready themselves for that eventuality.

 There is now an online petition in support of the bill: please click here to register your support!

Enabling
This is enabling legislation –

• it enables the individual to seek assistance
• it enables appropriate individuals to provide that assistance.

It studiously avoids imposing its options on any one who does not want to avail themself of the assistance envisaged in the Bill. It is intended to give those who qualify and feel the need, an additional option that they can exercise when even the best hospice care or the best palliative care falls short of their needs. It is to supplement such care rather than supplant it.

The Vulnerable
The Bill also sets out to recognize the legitimate concerns regarding the need to protect those vulnerable people in society who may be subjected to pressure to go down this route against their own deepest wishes.

The Right to Life
This Bill in no way derogates every individual's right to life.      
 
Time Scale
It is anticipated that this Bill will be allocated to a Committee of the Scottish Parliament during February 2010, and that they will then call for submissions. Oral presentations could be called for during the period March/April of this year. This is a crucial stage of the process.
 
Action
What can we, as individuals, do to support the Bill?
Firstly be aware that those who oppose the Bill are organized and will be vociferous in their efforts to have this Bill defeated.
This could be a 'once in a lifetime' opportunity and we must act now.

1. Write or e-mail to your MSPs pressing them to support the Bill. You will have a Constituency Member plus several 'List' Members. You can check out they are on the Scottish Parliament’s web site.
2. Talk to friends and colleagues to encourage them to do likewise.
3. Engage with those who are uncertain or who are opposed to assuage their fears.
4. Make a written and/or an oral submission to the Parliamentary Committee (See above).
5. Sign the E petition.    
   

When communicating with your Parliamentary representatives, it is suggested you take the following points into consideration.

1. It will be more effective if you can compose your own note on this. Stereotyped letters from pressure groups are quickly recognized as such and may be discounted by the recipients.
2. It would be advantageous if you could relate this to personal experience. For instance a family member or a friend who suffered and may have been glad of the opportunity to avail themselves of this option or who would have been comforted simply by knowing that they could do so, if the need ever arose.
3. Make the point about public opinion (as measured in opinion polls) being in favour of legislation.
4. See this as an opportunity for Scotland to lead the way yet again – (Eg Smoking Restrictions & The Right to Roam).
5. There are more than adequate safeguards. No one is being told that their life is worthless.
6. International experience indicates that fewer people take their own life when they know that they can get assistance, if and when they need it.
7. It would surely be better to have this process transparent and regulated than not.
8. This is a humane and compassionate approach to what is a very difficult time for many people.     

Addressing the Concerns of those who have doubts about supporting the Bill.
The major areas of concern are

1. The need to protect the vulnerable.
2. The ‘right to life’ is inviolate
3. This is not necessary because we can provide good palliative care.
4. This will set us on a ‘slippery slope’
5. Only God should determine when a person will die.

To address each of these points in turn

1. We must protect the vulnerable and not tell anyone that their life is worthless. Absolutely! The whole process in the Bill is designed to ensure that the “designated practitioner” and the “psychiatrist” involved are entirely satisfied that the request for assistance is the free choice of the “requesting person” (ie. the patient), that it is their settled will, and that they have not been subjected to any pressure. This will be achieved by requiring 2 requests with a minimum time interval between and a psychiatric report at both stages. There is also every opportunity to revoke the request at any stage without having to give a reason. No one is being told that their life is worthless!
2. People have an inalienable right to life and we are setting a dangerous precedent in allowing one person to kill another. There is no argument about that. The Bill will not give anybody the freedom to kill another person in any circumstances. It is not an offence in Scotland to commit suicide. By doing so we choose to forego the right to life. What the Bill will do is de-criminalize the act of assisting someone to take their own life, when they have reached a stage of no longer having the capability to do so entirely by them self. The Bill will not in any way derogate the person’s right to life – and there is no precedent being set.
3. This is not necessary because we can provide good palliative care. It is a fundamental error to see this as some kind of alternative that would do away with the need for first class palliative care. There is a need for both the quality and the availability of palliative care to be improved. Sadly there are some cases where the best palliative care can  not meet the perceived needs of the patient or where the side effects are also intolerable. There will be situations where the patient invokes the procedure ‘just in case’ but does not actually implement it – there being comfort in the knowledge that they are free to do so, should the need arise.
4. This will set us on a “slippery slope”. The Bill has been drafted with the specific objective of ensuring that this will not happen. The terms and conditions laid down are very specific and as such should not be open to misinterpretation.
5. Only God should determine when a person shall die. This position is fully acceptable for anyone who holds a strong religious conviction. For those who are not so persuaded the argument does not hold. We make many medical interventions in our society, generally for the better.

Support
I have no hesitation in supporting this Bill and in recommending it to all who are interested in alleviating the needless suffering of those who wish to avail themselves of this option.

Innes McOwan

Link to the End of Life Assistance (Scotland) Bill and the supporting documents .