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

Liam McArthur’s bill to provide assisted suicide for the terminally ill is dividing Scotland, with new figures showing public reaction is almost 50/50.

The bill would allow “healthcare professionals” to assist in the suicide attempt of “a terminally ill adult who meets certain eligibility criteria.”

This is a topic that evokes strong opinions based on personal experience and grounded in deep religious and philosophical beliefs.

The debate should be conducted in this spirit, but you have to take sides, and you have to do it firmly. I am firmly against it.

There is no perfect death and no death system can ever be perfect. This applies to euthanasia as well as to the death penalty.

When the state interferes in the business of ending life, it brings with it all the shortcomings inherent in large bureaucracies.

Whatever its qualities, the NHS is a bureaucracy and vulnerable to mismanagement, systemic failures and a culture of cover-up.

But there must be no room for error in euthanasia, just as there is no room for error in execution.

When we look at other countries that take measures such as euthanasia, it is only fair to also look at the consequences.

Canada legalized physician-assisted suicide (MAID) in 2016; it was also initially limited to terminally ill patients.

The courts stated at the time that this treatment must be made available to patients with serious illnesses where death was “not reasonably foreseeable”.

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

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

Doctors participating in MAID now account for four percent of all deaths in Canada; in the province of Quebec, this figure rises to almost seven percent.

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

A 2023 study published in the journal Palliative Support Care “identified problems with the practice of MAID” and found an increasing number of people choosing to end their lives “due to suffering associated with a lack of access to medical, disability and social supports.”

The researchers concluded that Canada’s assisted dying system lacks the necessary safeguards, data collection and oversight mechanisms to protect Canadians from premature death. If it can happen in progressive, enlightened Canada, it can happen here, too.

All this is not intended to downplay the suffering of terminally ill patients who are confined to bed and spend their final days, weeks or even months in agony.

Do they not have the right to end their pain and to decide for themselves the conditions under which their lives should end?

Put this way, I understand the arguments for euthanasia and even have sympathy for them.

Not just because it’s an emotional issue, but because it’s a human one. Whenever we hear of a diagnosis of terminal cancer or motor neurone disease or something equally catastrophic, we try not to imagine ourselves or our loved ones in the same situation, but we can’t help it. It would only be possible by the grace of God.

However, this debate is not about who is the most compassionate and empathetic, but about the practical feasibility and moral acceptability of a state that, through its nationalized health care system, decides who is allowed to take their own life and who is not, and helps those affected to commit suicide.

And what we call “the state” is really just us, the sum of our voting and other preferences, the official formulation of who we are and what kind of country we want to be. The state does what it does in our name.

Therefore, even though euthanasia may seem like a private matter, it is actually something that affects us all.

It will be our Parliament that tells our NHS that doctors in our country can shirk their duty of care and instead assist in killing.

The issue of assisted suicide has sparked a heated debate in Scotland

That Scotland is a place where a doctor can be asked to give someone a drug to save their life one minute and then give someone a drug to end their life the next.

That both measures are clinically and morally equivalent and legitimate.

They are not. Terminating a human life, even if it is the patient’s wish, is not health care. It is killing. It may be done with the best of intentions, by doctors with an alphabet of letters after their names, to patients whose prognosis is grim and certain, but it is killing nonetheless.

We already know that, which is why the law provides exceptions so that women can have access to abortifacient medication or, less commonly these days, medical procedures that terminate a pregnancy.

Doing so outside of the circumstances established by law is a crime. Since the 1960s, there has been a shift in society away from anything that smacks of condemnation and towards a culture of autonomy, where we are all individuals with the right to make choices, regardless of long-standing moral or social constraints.

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

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

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

What safeguards could be put in place to ensure that euthanasia is only granted to those who wish to end their suffering and not to those who consider themselves a burden on their families?

In other countries, it is mainly older people who seek euthanasia – a population group that suffers disproportionately from chronic loneliness and is ashamed at the thought of being a burden to their children or other relatives for a long period of time.

The explanatory notes state: “No person, including qualified doctors or other health professionals, is obliged to take part in the procedure if he or she has a conscientious objection to doing so.”

But if assisted suicide becomes an NHS service, how long can a conscientious objection exemption be maintained?

What happens when patients in remote rural areas of Scotland who want to end their lives report difficulty in obtaining lethal drugs?

This might be possible in areas where there are fewer doctors and where the number of religious and/or socially conservative people is higher. There would probably be enormous pressure on conscientious objectors to participate in what is now considered “health care.”

What happens when the euthanasia lobby later declares that the safeguards built into McArthur’s bill are “traumatizing” and “degrading” for terminally ill patients and calls for the process to be “demedicalized” so that it becomes primarily a matter of patient choice and the role of doctors is reduced to that of signing a prescription?

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

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

Compassion would mean investing appropriately in palliative care to ensure that those who cannot recover can leave this life in due course with as much comfort and as little pain as possible. Life is precious and those who leave it should be treated as such.