This document relates to the Assisted Dying for Terminally Ill Adults (Scotland) Bill (SP
Bill 46) as introduced in the Scottish Parliament on 27 March 2024
SP Bill 46–PM 1 Session 6 (2024)
Assisted Dying for Terminally Ill Adults
(Scotland) Bill
——————————
Policy Memorandum
Introduction
1. As required under Rule 9.3.3A of the Parliament’s Standing Orders, this Policy
Memorandum is published to accompany the Assisted Dying for Terminally Ill Adults
(Scotland) Bill introduced in the Scottish Parliament on 27 March 2024. It has been
prepared by the Parliament’s Non-Government Bills Unit on behalf of Liam McArthur
MSP, the Member who introduced the Bill. It does not form part of the Bill and has not
been endorsed by the Parliament.
2. The following other accompanying documents are published separately:
• Explanatory Notes (SP Bill 46–EN);
• a Financial Memorandum (SP Bill 46–FM);
• a Delegated Powers Memorandum (SP Bill 46–DPM);
• statements on legislative competence by the Presiding Officer and Liam
McArthur MSP (SP Bill 46–LC).
Policy objectives of the Bill
3. The aim of the Assisted Dying for Terminally Ill Adults (Scotland) Bill is to allow
mentally competent terminally ill eligible adults in Scotland to voluntarily choose to be
provided with assistance by health professionals to end their lives. The Bill establishes a
lawful process for an eligible person to access assisted dying, which is safe, controlled
and transparent, and which the Member believes will enable people to avoid the
existential pain, suffering and symptoms associated with terminal illness, which will in
turn afford the person autonomy, dignity and control over their end of life.
4. The Member believes that an individual’s personal autonomy to decide on their
medical care, and how their life should end in situations of terminal illness, should be
protected in law and that people in Scotland should have access to safe and
compassionate assisted dying if they choose, rather than face the potential of a
prolonged, painful and traumatic death. He believes that the current de facto prohibition
This document relates to the Assisted Dying for Terminally Ill Adults (Scotland) Bill (SP
Bill 46) as introduced in the Scottish Parliament on 27 March 2024
2
on such assistance has been proven to be unjust, unsafe, and unacceptable, causing
needless suffering for many dying people and their families.
5. The Member believes that the current legal position is unacceptably unclear as
there is currently no specific legislation in Scotland which makes assisted dying a
criminal offence, yet it is also possible to be prosecuted for offences such as murder or
culpable homicide for assisting the death of another person. The Bill improves legal
clarity by making it lawful for a person to voluntarily access assisted dying if they meet
the various criteria set out in the Bill and for health professionals to assist in that
process, while continuing to ensure that assisting death outwith the provisions of the Bill
remains unlawful.
6. The Member believes that the respect for personal autonomy should equally
apply to registered medical practitioners (doctors) and other health professionals (as is
the case with abortion and some other medical procedures) and therefore that they
should not have to participate in the provision of assistance if they conscientiously
object
1
to doing so. The Bill therefore provides that no-one should be compelled to
directly participate in assisted dying if they have a conscientious objection to doing so.
Operation and limited effect of the Bill
7. The Bill sets out the assisted dying process, including the provision of assistance
to end life. Section 15 sets out the end-of-life process, and how a terminally ill adult,
once assessed as eligible, can be provided with assistance to end their life. It enables
the Scottish Ministers, by way of regulations, to approve substances which can then be
provided to, and used by, a terminally ill adult to enable them to legally and voluntarily
end their life. Section 22 of the Bill (“Limitations on effect of Act”) puts it beyond doubt
that the Scottish Ministers can approve such substances by way of regulations only if
they are not regulated by or under the Misuse of Drugs Act 1971 or the Medicines Act
1968 or, if they are so regulated, their use for the purposes of assisted death has been
approved under those Acts. These are subject matters which are reserved to the UK
Parliament under the Scotland Act 1998.
8. The Member acknowledges that, in order to achieve a truly comprehensive
assisted dying scheme, something else would likely need to happen. This could be if for
example the use of certain regulated medicines or controlled drugs were to be brought
within the executive competence of the Scottish Ministers, or by way of a transfer of
legislative power through amendment of Schedule 5 (or Schedule 4) of the Scotland Act
1998. The Member understands there are various possible routes to ensure that,
including the agreement of a Section 30 Order under the Scotland Act 1998. A Section
30 Order is a type of subordinate or secondary legislation which can be used to
increase or restrict, temporarily or permanently, the Scottish Parliament’s legislative
competence. It does this by altering the list of reserved powers set out in Schedule 5,
1
Conscientious objection is understood as a person’s refusal to participate in medically indicated, legal,
and professionally accepted medical practices that conflict with their deeply held personal
convictions (whether they be of a religious, belief, moral or philosophical basis).
This document relates to the Assisted Dying for Terminally Ill Adults (Scotland) Bill (SP
Bill 46) as introduced in the Scottish Parliament on 27 March 2024
3
and/or the protections against modification set out in Schedule 4 of the Scotland Act.
Section 30 Orders can be initiated either by the Scottish or UK Governments but require
approval by the House of Commons, House of Lords and the Scottish Parliament before
becoming law.
9. The Member has had informal discussions with relevant parties in the Scottish
and UK Governments about a Section 30 Order being made and approved to allow the
Bill to operate comprehensively and will continue to have those discussions during the
Bill’s passage through the Scottish Parliament. Other options the Member is aware of
include an order under Section 63 of the Scotland Act, whereby the UK Government
would transfer the function of making the necessary regulations to the Scottish Ministers
(while the reservations would remain as they are – this requires approval by both the
UK and Scottish parliaments), or an order under Section 104 of the Scotland Act, which
would allow for consequential modifications to be made to reserved law in consequence
of an Act of the Scottish Parliament (all Section 104 Orders are laid before the UK
Parliament, those which amend primary legislation are debated in both houses). The UK
Government could also use existing powers under the Misuse of Drugs or the Medicines
Acts to permit the use of controlled drugs in Scotland for the purpose of the Bill.
10. The Member believes that, should the Scottish Parliament support the general
principles of the Bill at Stage 1 (that eligible terminally ill mentally competent adults in
Scotland should have access to a legal, safe and humane assisted death) that, given it
would be Parliament’s will for the Bill to proceed, the Scottish Government should work
with the UK Government to ensure that powers are made available to the Scottish
Parliament, or to the Scottish Ministers, as soon as possible.
Background
Legal position
11. In Scotland, there is no specific statutory offence of assisting someone’s death.
This is different from other parts of the United Kingdom. In England and Wales, under
the Suicide Act 1961,
2
and in Northern Ireland, under the Criminal Justice Act 1966,
3
it
is not a crime to take your own life, but it is a crime to encourage or assist suicide.
12. However, while assisted dying is not a specific criminal offence in Scotland, a
person assisting the death of another person could potentially be prosecuted for a range
of offences such as murder, culpable homicide, reckless endangerment, assault, breach
of the peace.
2
Section 2(1) of the Suicide Act 1961 (as amended by section 59(2) of the Coroners and Justice Act 2009).
3
Section 13 of the Criminal Justice Act (Northern Ireland) 1966.
This document relates to the Assisted Dying for Terminally Ill Adults (Scotland) Bill (SP
Bill 46) as introduced in the Scottish Parliament on 27 March 2024
4
13. Prosecutors in England and Wales,
4
and in Northern Ireland,
5
produced specific
guidelines on when they would choose to prosecute. The guidelines followed the legal
case of R (Purdy) v DPP,
6
which established that Human Rights legislation requires
prosecutors to issue guidance about the circumstances in which they will prosecute
people who assist others to take their own lives. Following consultation, the Crown
Prosecution Service (CPS) published updated prosecution guidance on homicide in
October 2023.
7
The guidance has been updated to assist prosecutors considering the
public interest when dealing with suspects in deaths arising out of mercy killings and
failed suicide pacts. The updated guidance amends relevant public interest factors on
mercy killing and suicide pacts in the context of mercy killings. While the CPS stated
that, “The homicide guidance, which has been refreshed as a whole, does not touch on
‘assisted dying’ or other similar scenarios which are treated separately in law” there can
be some similarities in instances of assisted dying/suicide, mercy killing and suicide
pacts. One of the amendments made to the public interest factors included a factor
against prosecution which states that, “The victim had reached a voluntary, clear,
settled and informed decision that they wished for their life to end.”.
14. The Lord Advocate in Scotland
8
has declined to produce any specific prosecution
guidelines.
9
The Court of Session in Scotland refused a challenge that this decision
contravened Convention rights.
10
However, it remains unclear what forms of assistance
to die a medic, family member or friend may give to a terminally ill person without fear of
being prosecuted.
Previous attempts to legislate in Scotland and the rest of the UK
15. Two previous Member’s Bills have been introduced in the Scottish Parliament
related to this general policy area, in 2010 and 2013 respectively.
11
Both Bills fell at
stage 1 of the Parliament’s legislation scrutiny process after failing to secure enough
votes from MSPs in support of the general principles of the Bill. Also, in 2005, Jeremy
Purvis MSP lodged a proposal for a Member’s Bill
12
to “…allow capable adults with a
terminal illness the means to die with dignity.” Mr Purvis consulted on a draft proposal,
4
CPS, Suicide: Policy for Prosecutors in Respect of Cases of Encouraging or Assisting Suicide See:
https://www.cps.gov.uk/legal-guidance/suicide-policy-prosecutors-respect-cases-encouraging-or-
assisting-suicide
5
PPS, Policy on Prosecuting the Offence of Assisted Suicide.
6
R (Purdy) v DPP [2009] UKHL 45.
7
Homicide: Murder, manslaughter, infanticide and causing or allowing the death or serious injury of a
child or vulnerable adult | The Crown Prosecution Service (cps.gov.uk).
8
The Lord Advocate in Scotland (currently Rt Hon Dorothy Bain KC) is the principal legal adviser of
the Scottish Government and the Crown in Scotland for civil and criminal matters that fall within
the devolved powers of the Scottish Parliament, and is the Ministerial head of the Crown Office and
Procurator Fiscal Service.
9
Elish Angolini declined to produce guidelines after the R (Purdy) v DPP 2009 case and subsequent Lord
Advocate’s (Frank Mulholland, James Wolffe) have upheld this.
10
Ross v Lord Advocate (2016) CSIH 12.
11
End of Life Assistance Scotland Bill | Scottish Parliament Website – introduced 20 January 2010; and
the Assisted Suicide (Scotland) Bill - Parliamentary Business : Scottish Parliament – introduced 13
November 2013.
12
Right to Die for the Terminally Ill Bill - Parliamentary Business : Scottish Parliament.
This document relates to the Assisted Dying for Terminally Ill Adults (Scotland) Bill (SP
Bill 46) as introduced in the Scottish Parliament on 27 March 2024
5
and lodged a final proposal to introduce a Bill, but did not gather sufficient support to
earn the right to introduce a Bill, and the proposal fell.
16. There are several key and fundamental differences between this Bill and the
previous Bills introduced in the Parliament, particularly in the details of the process for
accessing assisted dying and the extent of the safeguards in place to protect those
involved. In addition, previous Bills focussed on the decriminalisation of providing
assistance to a person to end their life, but did not establish a legal, health professional
led process for assisted dying to take place.
17. A significant difference between this Bill and previous Bills relates to who will be
able to access assisted dying. In terms of a qualifying medical condition, the 2010 Bill
allowed access not only to a person who was terminally ill but also to a person who was
“permanently physically incapacitated to such an extent as not to be able to live
independently and finds life intolerable”.
13
The 2013 Bill limited access to those with an
illness (from which there was “no prospect of any improvement in the person’s quality of
life”) that was either “terminal or life-shortening”, or a condition that was, for the person,
“progressive and either terminal or life-shortening”.
14
This Bill only permits access for
those who have an advanced and progressive terminal illness which is expected to
cause their premature death.
18. The previous Bills introduced in the Scottish Parliament also did not establish a
process which was to be delivered by healthcare professionals as this Bill does. The
previous Bills made no provision for how assisted dying would actually be facilitated in
practice (e.g. provision of a life ending substance by healthcare professionals) or for any
form of conscientious objection for healthcare professionals.
19. There have been several recent attempts at the UK Parliament to legislate for
assisted dying in England and Wales via Private Member’s Bills. These include Bills
introduced by Lord Falconer
15
(2014), Rob Marris
16
(2015), and Baroness Meacher
17
(2021). The Bills by Lord Falconer and Baroness Meacher both fell due to running out of
parliamentary time. Rob Marris’ Bill was defeated at its Second Reading.
20. In the current UK Parliament (2019-2025), in 2022, the House of Commons
Health and Social Care Committee launched an inquiry into Assisted dying/assisted
suicide.
18
A public call for views ended on 20 January 2023 and oral evidence sessions
began on 28 March 2023. The Committee stated, before its first oral evidence session,
that: “Questions are likely to examine Parliament’s role in the debate, protections for
vulnerable groups and research on the impact of assisted dying/assisted suicide. During
the inquiry, MPs are expected to consider, what conclusions can be drawn in evidence
13
End of Life Assistance (Scotland) Bill. Section 4(2)(b). Available at: b38s3-introd.pdf (parliament.scot).
14
Assisted Suicide (Scotland) Bill. Sections 8(4) and 8(5). Available at: Bill As Introduced Contents
(parliament.scot).
15
Assisted Dying Bill [HL] - Parliamentary Bills - UK Parliament.
16
Assisted Dying (No. 2) Bill - Parliamentary Bills - UK Parliament.
17
Assisted Dying Bill [HL] - Parliamentary Bills - UK Parliament.
18
Assisted dying/assisted suicide - Committees - UK Parliament.
This document relates to the Assisted Dying for Terminally Ill Adults (Scotland) Bill (SP
Bill 46) as introduced in the Scottish Parliament on 27 March 2024
6
from jurisdictions where assisted dying/assisted suicide is legal and whether there have
been any new developments since the House of Commons last considered legislation
on the subject in 2015.” At an evidence session on 4 July 2023,
19
Helen Whately MP,
the Minister of State at Department of Health and Social Care, told the Committee that
the UK Government is following progress of Liam McArthur’s Bill. The Committee
published its report on 29 February 2024.
20
Assisted dying/suicide and euthanasia legislation around the
world
21. It is estimated that between 200 and 350 million people in the world have legal
access to a form of assistance to die. The countries and jurisdictions that have legalised
a form of assisted dying or suicide are: ten American States (Oregon, California, Hawaii,
Washington, Colorado, Vermont, Montana, New Jersey, New Mexico, Maine),
Washington DC (a district - the capital of the US), all six Australian States
21
(Victoria,
Tasmania, Queensland, New South Wales, South Australia and Western Australia),
New Zealand, Canada, Colombia, Belgium, the Netherlands, Luxembourg, Switzerland
and Spain.
22. In addition, it is understood that many other countries and jurisdictions are
engaged in active considerations to legalise forms of assisted dying or suicide, including
Germany, Ireland, France, Portugal, Austria, Italy, and various other American States.
There has also recently been notable activity in parts of the British Isles, with the Isle of
Man and Jersey both taking significant steps towards legislating for forms of assisted
dying.
23. In November 2021, Jersey’s States Assembly became the first parliament in the
British Isles to decide ‘in principle’ that assisted dying should be allowed and make
arrangements for the provision of an assisted dying service
22
. An ‘in principle’ decision
means the States Assembly wants to receive more information before confirming how
an assisted dying service in Jersey should operate. A consultation on specific proposals
ran until 23 January 2023. The Council of Ministers agreed that the policy proposals
should be informed by experts via an external ethical review process, the results of
which were published in November 2023.
23
The States Assembly is scheduled to
debate assisted dying on 21 May 2024. If the proposals are approved by the States
Assembly work is expected to begin on drafting of an assisted dying law. Currently, it is
expected that, subject to approval, drafting could begin later in 2024, and may complete
12-18 months later. If a draft law is approved by the States Assembly, it is expected
19
committees.parliament.uk/oralevidence/13397/html/.
20
Assisted Dying/Assisted Suicide (parliament.uk).
21
In addition to the six federal states, Australia has two self-governing internal territories (Northern
Territory and Australian Capital Territory). Assisted dying is not legal in either territory – federal laws
prohibited either territory from being able to legislate to provide for assisted dying. However, these laws
were repealed in 2022 and it is understood that both territories are now considering legislating to
provide for a model of assisted dying.
22
Assisted dying in Jersey (gov.je).
23
Assisted Dying in Jersey Ethical Review Report.pdf (gov.je).
This document relates to the Assisted Dying for Terminally Ill Adults (Scotland) Bill (SP
Bill 46) as introduced in the Scottish Parliament on 27 March 2024
7
there would be an 18-month implementation period before assisted dying became
available.
24. The Assisted Dying Bill 2023
24
(a Private Members Bill) was introduced by Dr
Alex Allinson MHK in the Tynwald, the Parliament of the Isle of Man, in 2023. The Bill
had its first reading on 27 June 2023 and second reading on 31 October 2023. The Bill
was supported at its second reading and, following a debate on 7 November 2023, the
Bill is being scrutinised by an ad hoc Bill committee,
25
which was due to report to the
House of Keys (the directly elected part of the Tynwald) by the end of February 2024
(however, there have been reports that the report may be delayed until the end of
March 2024
26
). The Bill is then expected to be considered by the House of Keys to
debate the clauses of the Bill and put forward any amendments, before it receives a
Third Reading and then progresses to the Legislative Council. It is expected that the Bill
may be passed by the end of 2024, with assisted dying potentially being available in the
Isle of Man from 2025.
25. There are various differences in the models of assistance provided for in different
parts of the world. There are also parts of the world where forms of euthanasia are legal
in certain circumstances. In broad terms, some jurisdictions limit assisted dying to those
with a terminal illness who can be provided with the means to end their life which they
must administer themselves. Some jurisdictions have a wider approach, including not
limiting access to those with a terminal illness (assisted suicide) and/or by not requiring
the person to self-administer the end-of-life process (euthanasia). The latter is
sometimes the result of an inability to self-ingest and not simply because of
patient/practitioner preference.
26. Some jurisdictions have passed legislation and then passed subsequent
amending legislation to alter the criteria for accessing assisted dying. One example is
Canada,
27
which revised its law in 2021 following a court ruling which determined that
the initial law did not meet the Canadian Charter of Rights and Freedoms. The law was
amended to allow access to those with “a grievous and irremediable medical condition”.
Such a condition is described as being a serious illness, disease or disability. There has
been discussion in Canada about allowing access to those with a mental illness, but a
decision on this has been deferred until at least 2027. It should be noted that Canada
did not begin with legislation being limited to the terminally ill – its legislation always had
a wider eligibility. Some jurisdictions, such as Canada and the Netherlands, which have
altered the eligibility of access to assisted dying/suicide, started from a position of
eligibility not being limited to the terminally ill in the first place. Other jurisdictions which
legislated to limit access to the terminally ill from the start, such as the American states
of Oregon and California, and states across Australia, have not extended access
beyond those who are terminally ill.
24
Assisted Dying Bill 2023 (tynwald.org.im).
25
House of Keys Committee on the Assisted Dying Bill. Information available at:
Tynwald - House of Keys Committee on the Assisted Dying Bill
.
26
Proposed Isle of Man assisted dying laws report delayed - BBC News.
27
Medical assistance in dying - Canada.ca.
This document relates to the Assisted Dying for Terminally Ill Adults (Scotland) Bill (SP
Bill 46) as introduced in the Scottish Parliament on 27 March 2024
8
27. There have been examples of the law in other parts of the world being amended
in response to issues identified by Governments and health professionals in the
operation of legislation, such as in Oregon, which recently changed the process to allow
the waiting period to be shortened where life expectancy was expected to be shorter
than the required waiting period, and to residency requirements.
28. Liam McArthur’s Bill has most in common with the legislation and process in
Oregon, other American States, Australia, and New Zealand, where legislation follows
the model of self-administered assisted dying for the terminally ill with strict safeguards,
rather than, for example, the legislation in the Benelux
28
countries, which leans more
towards euthanasia, and where access extends beyond those who are terminally ill.
Public opinion
29. There have been several public polls carried out on the issue of assisted dying in
recent years which have shown strong levels of support for assisted dying to be
introduced in Scotland. A Populus survey for Dignity in Dying in 2019
29
showed 87%
support for assisted dying. In June 2021, the polling company Panelbase carried out a
survey on behalf of the Sunday Times newspaper,
30
which polled those aged 16 and
over and asked, “Whether or not you would want the choice for yourself, do you support
or oppose this proposal (as had been detailed in the newspaper – a proposal similar to
that made by Liam McArthur in the consultation on his proposed bill) for assisted dying
becoming law?”. Overall, 72% of respondents supported the proposal, 14% opposed it
and 14% said they didn’t know. In July 2023, a YouGov poll for Dignity in Dying
31
showed overall support for assisted dying in Scotland of 77%.
30. There has been significant and increased media coverage and societal
discussion and debate on the issue of assisted dying in Scotland and the rest of the UK
over the last two years. This largely seemed to be fuelled by the Bills
proposed/introduced in Jersey and the Isle and Man, as well as the proposals for this
Bill being lodged and activity (such as a committee inquiry) at the UK Parliament. An
aspect of this has also been various well-known people commenting on the issue. On
the back of some of those calling for assisted dying to be introduced in the UK (for
example, the broadcaster Dame Esther Rantzen) various media outlets conducted polls
asking whether assisted dying should be supported/introduced and/or began petitions
calling for the introduction of assisted dying. One example is a poll carried out by
Deltapoll, commissioned by the Daily Mirror newspaper, in which 71% of respondents
supported the introduction of assisted dying.
32
28
Netherlands, Belgium and Luxembourg.
29
Populus 2019, Dignity in Dying Scotland fieldwork 11-24th March 2019, at p.1 see: OmDignity-
Scotland- Q1+2.wyp (yonderconsulting.com).
30
ST-tables-for-publication-v2-050721.pdf (norstat.no).
31
YouGov/Dignity in Dying Scotland Survey Results 25-31 July 2023. Available at: Survey Report
(d3nkl3psvxxpe9.cloudfront.net).
32
Deltapoll-Mirror231229.xlsx.
This document relates to the Assisted Dying for Terminally Ill Adults (Scotland) Bill (SP
Bill 46) as introduced in the Scottish Parliament on 27 March 2024
9
Detail of the bill
31. The Bill allows terminally ill adults in Scotland to request, and, if eligible, be
provided with assistance to end their life, and establishes a process, delivered by health
professionals to enable people in Scotland to legally and safely access assisted dying.
This is restricted to those who meet various eligibility criteria set out in section 3 of the
Bill. To be eligible, a person must be: terminally ill; aged 16 or over; resident in Scotland
for at least 12 continuous months; registered with a GP in Scotland; and have the
mental capacity to make the request. Other parts of the process also require that a
person must have had health and social care information/options (for example palliative
and hospice care), and information about assisted dying, explained prior to making a
final decision on assisted dying and that the person makes the decision of their own free
will, without coercion or undue pressure (to the reasonable satisfaction of healthcare
professionals). It is fundamental to the Member’s policy that a person is making a
settled, voluntary choice to end their life, to be, if assessed as being eligible, legally
provided with assistance to do so, which they must administer themselves.
32. The meaning of “terminally ill” for the purposes of the Bill is a person who has an
advanced and progressive
33
disease, illness or condition
34
from which they are unable
to recover, and that can reasonably be expected to cause their premature death. While
the Bill does not define “terminally ill” by reference to a period of life expectancy, the
definition requires a person to be in an advanced stage of terminal illness (i.e. close to
death). Whilst the member has deep empathy for, and understanding of, people
suffering intolerably for many years who are not at the end of life, he believes
parameters must be drawn that are most appropriate for the diseases, illnesses and
conditions affecting the people of Scotland, and after careful reflection decided that
assisted dying for people in the end stages of life is most appropriate. It is not the
intention that people suffering from a progressive disease/illness/condition which is not
at an advanced stage but may be expected to cause their death (but which they may
live with for many months/years) would be able to access assisted dying.
33. The Bill includes numerous safeguards to ensure the process is proportionately
and appropriately safe and requires data to be collected and reported to inform
knowledge, understanding and any future decision-making. Relevant data on those
seeking, and receiving, an assisted death is to be provided to Public Health Scotland
and then relevant statistics reported to the Scottish Government by Public Health
Scotland. The Scottish Government must report annually on the provision of assisted
dying and a detailed review of the legislation must take place five years after it comes
into force.
33
i.e. a disease, illness or condition which is worsening, growing and/or spreading in the body.
34
The definition of “terminal illness” makes reference to “disease”, “illness” and “condition”. “Disease”
being the specific form of pathology, “illness” being the manifestation of that in certain cases and
“condition”, which includes disorders (such as a collection of physiological symptoms) and can describe
a state of health. All three terms are used across NHS materials and by health professionals and are
included in the definition for completeness.
This document relates to the Assisted Dying for Terminally Ill Adults (Scotland) Bill (SP
Bill 46) as introduced in the Scottish Parliament on 27 March 2024
10
34. No-one is required by or under the Bill to play an active participative role in the
assisted dying process if they have a conscientious objection to doing so. Those
participating will also be exempt from criminal or civil liability for carrying out activities
authorised in the Bill in line with the Bill’s provisions.
Eligibility and related safeguards
35. The eligibility criteria address various policy priorities and establish important
safeguards as follows:
• a person needs to be assessed by two doctors as being terminally ill. This will
prevent those not terminally ill from being able to access assisted dying and
helps addresses concerns from some groups and individuals that assisted dying
would pose a threat to, for example, those with a disability, or who are suffering
from a mental illness, or to older people;
• only adults, aged 16 and over, are able to access assisted dying. This will ensure
that only those who have reached the age of majority (i.e. have full legal
decision-making capacity) in Scots law can access assisted dying. This ensures
children aged under 16 will not be able to access assisted dying;
• a person must have been ordinarily resident in Scotland for a minimum period of
12 months. This will help to ensure that Scotland does not have a process which
encourages or easily facilitates those not normally resident in Scotland, such as
those from other parts of the UK where assisted dying remains illegal, to travel to
Scotland to have an assisted death. The Member believes that a minimum 12-
month residency requirement is proportionate and achieves a fair and reasonable
balance between limiting access to those usually resident in Scotland (being
reassured that the residency is permanent) and ensuring that access is available
to those who wish to access it. The Bill specifies that someone needs to be
“ordinarily” resident in Scotland for at least 12 months. This means a person
living in Scotland lawfully, voluntarily, and for settled purposes as part of the
regular order of their life for at least 12 months;
• a person must be registered with a GP in Scotland. This will ensure that only
those who are registered with a GP and therefore who are known to the NHS,
have medical records, and are likely receiving care will be able to access
assisted dying. It also provides an additional reassurance to the Doctors
managing the process as to the identity of an individual. Again, the Member
considers this strikes an appropriate balance between ensuring assisted dying is
accessible to those who need it without undue barriers, whilst ensuring that those
who wish to have an assisted death are known to the health service;
• a person must understand the decision they are making. It is essential that a
person deciding to have an assisted death understands the decision they are
making, which includes understanding their own situation (including medical
diagnosis, treatment and care) as well as the context of their decision (for
example, the effect their decision may have on family and friends). The Bill
therefore requires two doctors to be satisfied that a person has sufficient mental
capacity to make the decision (including being able to refer to a mental health
This document relates to the Assisted Dying for Terminally Ill Adults (Scotland) Bill (SP
Bill 46) as introduced in the Scottish Parliament on 27 March 2024
11
specialist if they have any doubts) and guards against a person without
appropriate mental capacity from being able to access assisted dying.
36. The eligibility criteria in the Bill therefore include inherent safeguards, ensuring
that only an appropriately narrow cohort of people will be able to access assisted dying
and protecting all others (such as those who are not terminally ill (including those who
may feel particularly vulnerable such as disabled or older people), those under 16, and
those who lack capacity) by not allowing them legal access to an assisted death.
37. The Bill allows for support to access assisted dying to be provided to those who
require it. A proxy (a solicitor, member of the Faculty of Advocates or Justice of the
Peace) can be appointed to sign a first and/or second declaration form on behalf of a
person who is not able to do so themselves due to a physical impairment. While not
specified in the Bill, the NHS already provides for interpreters to be provided to support
anyone who requires language assistance to communicate in matters relating to their
care.
35
Further safeguards
38. The process for accessing assisted dying and being given assistance to end life
contains numerous safeguards to ensure that an appropriate balance is achieved
between protecting all involved from any unintentional consequences and ensuring that
those who qualify for, and wish to have an assisted death, are able to do so without
undue bureaucratic hurdles and/or distressing delays which can result in further
suffering.
39. Several safeguards relating to the eligibility criteria have been set out previously
in this Memorandum. Additional safeguards in the Bill include that:
• two doctors (independent of each other) must determine that a person is eligible
and can be given assistance to end their life (the first of these is the “coordinating
doctor” which is the registered medical practitioner to whom the person has first
indicated that they are seeking an assisted death, and who has agreed to be the
coordinating doctor, who will provide consistency during the process);
• a person must make the decision of their own free will, without being coerced or
unduly pressured. The Bill therefore requires healthcare professionals to be
satisfied throughout the process that a person is acting of their own free will and
voluntarily wishes to proceed. Requiring doctors to be satisfied, throughout the
process, that coercion or inappropriate influence is not taking place (something
that healthcare professionals already have guidance on,
36
and experience in
assessing) will ensure an appropriate balance between a person being able to
access assisted death if they meet the criteria, and healthcare professionals
35
For example, see: NHS Scotland Interpreting, Communication Support and Translation National Policy.
Available here:
Interpreting, communication support and translation national policy
(healthscotland.scot).
36
Decision making and consent - professional standards - GMC (gmc-uk.org) and gmc-guidance-for-
doctors---decision-making-and-consent-english_pdf-84191055.pdf (gmc-uk.org).
This document relates to the Assisted Dying for Terminally Ill Adults (Scotland) Bill (SP
Bill 46) as introduced in the Scottish Parliament on 27 March 2024
12
being able to refuse assistance if they have concerns that the person is not
acting of their own free will. The Bill also makes it an offence to coerce or
pressure a person into making a first or second declaration to have an assisted
death;
• a person must have been informed of (and ideally have discussed) their situation,
and the options open to them (for example palliative, hospice and other care
options), with a registered medical practitioner before deciding to have an
assisted death. The Member believes it is of vital importance that a person
wishing to have an assisted death has made an informed decision, is aware of
their situation and all the options available to them and had the opportunity to ask
questions and explore options. It will also be possible for a person to discuss the
possibility of assisted dying with a registered medical practitioner before the
formal part of the process provided for by the Bill is undertaken, if they choose to
do so. The Member believes this initial conversation presents an opportunity for
RMPs to triage and signpost to other useful services that the patient may benefit
from before proceeding with assistant dying;
• if either doctor is unsure about the person’s illness and/or capacity to request an
assisted death, the person can be referred to an appropriate specialist (such as a
specialist in the particular disease, illness or condition, or to a psychiatrist or
psychologist or other mental health expert) to give an opinion which must be
taken into account (and assistance will only be provided if both doctors are
satisfied);
• before being assessed for eligibility, the person must sign a written declaration of
their request to have an assisted death, which must be witnessed and signed by
the coordinating doctor and another witness;
• a minimum waiting period of 14 days (unless death is expected in less than 14
days) must elapse before a person can sign a second declaration. This will allow
the person time to reflect on their decision. This timeframe can be shorter if the
person is expected to die within 14 days (but it must be at least a minimum of 48
hours in all circumstances);
• after the waiting period has elapsed, to proceed a person must sign a second,
final, declaration of their wish to have an assisted death. As with the first
declaration form, this must be witnessed and signed by the coordinating doctor
and another witness;
• the coordinating registered medical practitioner or an authorised health
professional
37
must bring the substance, check the person continues to retain
their capacity, wishes to proceed and is acting of their own free will;
• the person must administer the life-ending substance themselves, and the
coordinating registered medical practitioner or authorised health professional
must remain with the person until they have decided to take the substance and, if
so, until they have died;
37
A health professional (registered medical practitioner or registered nurse) authorised by the
coordinating registered medical practitioner for the purposes of the provision of assistance.
This document relates to the Assisted Dying for Terminally Ill Adults (Scotland) Bill (SP
Bill 46) as introduced in the Scottish Parliament on 27 March 2024
13
• the person can stop the process at any point and cancellations will be recorded
on a person’s medical records;
• it would continue to be a criminal offence to end someone’s life directly. There is
also no change in the law for any action to assisted dying outside of the process
provided for in the Bill;
• every assisted death must be recorded and reported for safety, monitoring, and
potential research purposes. Annual reports will be published on the operation of
assisted dying, and the legislation will be reviewed after 5 years.
Process for accessing assisted dying
40. The process those eligible for assisted dying must follow to be enabled to access
assistance to voluntarily end their life will ensure there is suitable accountability and
transparency, and that an appropriate balance is achieved between a person being able
to have an assisted death without undue delay and further suffering and ensuring
appropriate safeguarding measures are in place.
41. The process in the Bill broadly consists of a person indicating to a registered
medical practitioner (likely to be their GP or doctor in charge of their treatment and care)
that they wish to have an assisted death. If, provided the registered medical practitioner
is content to participate and following discussion, the person should wish to proceed,
they will be given (or be directed to) a first declaration form. The first declaration form
must be signed by the person seeking assistance to end their life, the doctor they spoke
to about having an assisted death – who becomes the “coordinating” doctor for the
assisted dying process (if they agree to participate) - and another witness. On the first
declaration form, a person is recording their personal details and declaring that they
wish, of their own free will, to proceed with the process for accessing an assisted death,
and having that declaration witnessed. The doctor and the witness should be satisfied
that the person is acting of their own free will and not being coerced or unduly
influenced. This is an opportunity for any initial and more obvious concerns about
coercion to be addressed, however, independent decision-making will be further,
formally assessed during the next stage of the process.
42. Following the signing of the first declaration form, the minimum waiting period
that must elapse before a second declaration can be signed begins. This is 14 days,
except in circumstances where death is expected by the assessing doctors to occur in
less than 14 days, in which circumstance the period may be shortened but must not be
shorter than 48 hours (this is to ensure time for some reflection). The medical
assessment process can also begin. The person will first be assessed by the
coordinating doctor to ensure that they meet all of the eligibility criteria explained
previously and are not being coerced or unduly influenced. If the coordinating doctor is
satisfied, they make a referral to a second, independent, doctor to assess the person to
determine whether they meet the eligibility criteria relating to terminal illness and
capacity and are not being coerced or unduly pressured. If either doctor is not satisfied
on one or more of the criteria relating to terminal diagnosis and capacity, additional
specialist assessment and input can be sought (for example, if there are doubts on
capacity a referral can be made to a psychiatrist or other mental capacity expert). If both
This document relates to the Assisted Dying for Terminally Ill Adults (Scotland) Bill (SP
Bill 46) as introduced in the Scottish Parliament on 27 March 2024
14
doctors determine that the person is eligible for assisted dying and is not being coerced
or unduly influenced, and the minimum waiting time has elapsed since the first
declaration was signed (14 days unless both doctors have agreed it should be at least
48 hours) then the person can sign a second, final, declaration form confirming they
wish an assisted death to take place. If either doctor is not satisfied, then the process
stops, and assistance to end life will not be provided (and existing palliative/end-of-life
care would continue).
43. The second, final, declaration form must be signed by the person, the
coordinating doctor and another witness, for the person to be allowed to proceed. This
provides a further opportunity for the process to be stopped if the doctor has concerns
around illness, capacity and/or free-will. If all the required parts of the process have
been met successfully, the person decides where and when they wish to die and
arrangements can be made for the person to be assisted to die on that day, by self-
administered means.
44. On the day of the assisted death, the coordinating registered medical practitioner
or a health professional authorised by that coordinating doctor will attend and provide
the person with an approved substance
38
which they will take to end their life. It may be
that other health professionals also attend if the coordinating registered medical
practitioner or authorised health professional think it necessary (the Bill defines a health
professional for this purpose as also including registered pharmacists, in addition to
registered nurses and registered medical practitioners). Before doing so, the
coordinating registered medical practitioner or authorised health professional must
check that the person wishes to proceed and consider again whether they have
capacity to make the decision and are doing so of their own free will. A person can
decide not to proceed at any time. Note that there is no time limit by which a person
who has made a second declaration must have decided on a date/time to have an
assisted death. This is not considered necessary because of the final checks required to
be made by the attending health professional present at the assisted death and
because a person can decide not to proceed at any point in the process. It is also
considered that including a time limit may put unnecessary pressure on the terminally ill
adult.
45. It will be for the Scottish Government to make regulations about which
substances/drugs are approved for use for assisted dying purposes (see the
commentary in this memorandum relating to the limitation on the effect of the Bill).
46. After a death resulting from assisted dying as provided for by the Bill, the
coordinating registered medical practitioner completes a “final statement” noting all
relevant details of the death (such as the date, time and cause of death, and the time
between taking the substance and death occurring). The cause of death listed should
be the underlying terminal illness the adult had, which is also the case with the death
38
An “approved substance” is one which has been approved for use in assisted dying by regulations laid
by the Scottish Ministers. See also the commentary in this memorandum relating to limitations on the
effect of the Bill.
This document relates to the Assisted Dying for Terminally Ill Adults (Scotland) Bill (SP
Bill 46) as introduced in the Scottish Parliament on 27 March 2024
15
certificate, which should also record the primary cause of death as the terminal illness
the adult had.
Involvement of healthcare professionals and Scottish Government
guidance
47. The Bill provides for specific roles for registered medical practitioners and health
professionals (defining a “health professional” for the purposes of the Bill as a registered
nurse and a registered pharmacist, as well as a registered medical practitioner).
48. The Interpretation and Legislative Reform (Scotland) Act 2010
39
defines a
“registered medical practitioner” as “… a fully registered person within the meaning of
the Medical Act 1983 (c.54)
40
who holds a licence to practise under that Act.” Under the
Medical Act 1983, the General Medical Council (GMC) manages the medical register.
41
49. Under the Nursing and Midwifery Order 2001,
42
the Nursing and Midwifery
Council (NMC) maintains a register of all nurses, midwives and specialist
community public health nurses and nursing associates eligible to practise within the
UK.
50. The Bill establishes the role of “coordinating registered medical practitioner” as
previously explained. The coordinating registered medical practitioner and an
independent registered medical practitioner are the doctors who will assess a terminally
ill adult’s eligibility to be provided with assistance to end their own life, and the Bill
allows the Scottish Ministers to regulate for any particular qualifications and/or
experience that a registered medical practitioner should have to perform these roles.
This will ensure that if a certain level of experience (for example, that a doctor should
have completed foundation year two, or that one of the who doctors should be a
specialist in the person’s terminal illness) is considered appropriate that Ministers can
require it, thus ensuring that the public and those wishing to access assisted dying can
have confidence that the process is carried out in the safest way possible.
51. As set out elsewhere in the Memorandum, the Member believes that it is
important that the concept of personal autonomy which underpins the Bill applies to
anyone directly involved in providing assistance, as well as to those who are terminally
ill. No-one, including registered medical practitioners and other health professionals,
should therefore be required to play a hands-on part in providing assisted dying if they
have a conscientious objection to doing so. This mirrors the approach taken to abortion
and some end of life care, where health professionals with a direct hands-on capacity in
the treatment process can opt out of participating if they have a contentious objection to
doing so.
39
Interpretation and Legislative Reform (Scotland) Act 2010 (legislation.gov.uk).
40
Medical Act 1983 (legislation.gov.uk).
41
A guide to the medical register - GMC (gmc-uk.org).
42
The Nursing and Midwifery Order 2001 (legislation.gov.uk).
This document relates to the Assisted Dying for Terminally Ill Adults (Scotland) Bill (SP
Bill 46) as introduced in the Scottish Parliament on 27 March 2024
16
52. If a person approaches a registered medical practitioner about having an
assisted death, and the practitioner objects to taking part, then, as is the case with
abortion the practitioner should refer the person to another registered medical
practitioner who is content to participate. The member understands that this is
consistent with established medical practice. Indeed, in the UK Supreme Court
judgment (Greater Glasgow Health Board (Appellant) v Doogan and another
(Respondents) (Scotland)
43
in the context of abortion, the justices held that:
44
“Whatever the outcome of the objectors’ stance, it is a feature of conscience clauses
generally within the health care profession that the conscientious objector be under an
obligation to refer the case to a professional who does not share that objection. This is a
necessary corollary of the professional’s duty of care towards the patient. Once she has
assumed care of the patient, she needs a good reason for failing to provide that care.
But when conscientious objection is the reason, another health care professional should
be found who does not share the objection.”
53. The Member anticipates that relevant regulatory bodies, such as the General
Medical Council (GMC - the independent regulator of doctors in the UK), or the NMC,
the Health and Care Professions Council (HCPC - a regulator of health and care
professions in the UK) and the General Pharmaceutical Council (GPhC - the
independent regulator for pharmacists, pharmacy technicians and pharmacy premises
in Great Britain) will ensure suitable training is provided for health professionals who will
be involved in supporting the assisted dying process to ensure that they are familiar with
the process set out in the Bill. Support may also be provided by relevant representative
and membership organisations, such as the British Medical Association (a trade union
for Doctors in the UK) and the Royal College of Nursing (RCN – a membership body for
registered nurses, midwives, health care assistants and nursing students), the Health
and Care (Staffing) (Scotland) Act 2019 places a duty on every Health Board in
Scotland, as well as the Common Services Agency for the Scottish Health Service, to
ensure staff are suitably trained. It is further expected that such organisation may issue
guidance relating to some of the clinical aspects of the Bill.
54. The Member also notes that some other jurisdictions that have legalised a form
of assisted dying have established (often via third sector initiative) support and
navigation networks for those involved in the process (including health professionals,
patients, and family and friends) and that something similar may emerge in Scotland
once the Bill has been passed and the Act is operational. It is understood that
organisations such as Friends at the End and Humanist Society Scotland have
indicated that they would support implementation/operation by providing guidance,
support, counselling, and other navigation for patients.
55. The Bill allows the Scottish Ministers to issue and publish guidance relevant to
the practical operation of the Bill and requires Ministers to consult with relevant others
as appropriate. The Member believes this is important as it will allow for collaboration
43
Greater Glasgow Health Board (Appellant) v Doogan and another (Respondents) (Scotland)
(supremecourt.uk).
44
Greater Glasgow Health Board (Appellant) v Doogan and another (Respondents) (Scotland)
(supremecourt.uk).
This document relates to the Assisted Dying for Terminally Ill Adults (Scotland) Bill (SP
Bill 46) as introduced in the Scottish Parliament on 27 March 2024
17
between Ministers and relevant bodies, such as the NHS and regulatory and
representational health organisations and third sector organisations and ensure that
practical experience of the operation of the Bill can help inform and establish helpful
practical guidelines.
Data collection, reporting and review
56. The data collected on first and second declarations (and any cancellation of
either of these), medical practitioner’s statements, and final statements, will form part of
a person’s medical records and therefore be subject to the same management
(including retention periods) as other personal health information held by the NHS in
Scotland.
45
57. The Member believes it is also important that relevant anonymised statistical data
is reported and published on access to, and use of, assisted dying in Scotland. It will be
important for transparency and to aid understanding to collect and report data such as:
• how many people are requesting assisted dying and why (broken down by
numbers accessing the first and second stages of the process);
• how many people are deemed eligible for assisted dying;
• how many people are being refused assisted dying and on what basis;
• how many people decided not to proceed, and for what reasons;
• how many assisted deaths take place;
• what substance or substances have been used to provide an assisted death;
• where the death took place; and
• anonymised personal data such as age, gender, ethnicity, nationality, area of
residence, and type of disease/illness/condition.
58. The Bill therefore requires the Scottish Ministers to make regulations which
provide for relevant data to be provided to Public Health Scotland
46
for the purpose of
producing assisted dying statistics, which Public Health Scotland is required to report
annually to the Scottish Government, and for the Scottish Government to publish the
data on an annual basis and lay a report before the Scottish Parliament. There are
several policy reasons for data to be collected and reported. Firstly, the Member wishes
assisted dying to be a transparent, accountable process, with relevant anonymised
statistical information recorded and made publicly available to all, in the public interest.
Secondly, the Member believes that the data collected will aid and inform knowledge
and understanding about the impact and effect of the legislation.
45
How the NHS handles your personal health information | NHS inform.
46
Public Health Scotland is the national public health body for Scotland. It is an NHS Health Board which
is jointly accountable to both the Scottish Government and the Convention of Scottish Local Authorities
(COSLA).
This document relates to the Assisted Dying for Terminally Ill Adults (Scotland) Bill (SP
Bill 46) as introduced in the Scottish Parliament on 27 March 2024
18
59. The Bill also requires the legislation to be reviewed after five years and for the
Scottish Government to publish a review report and lay it before the Scottish
Parliament. The five-year review report will be informed by the data collected and
published in the previous annual reports, and any other information gathered by, or on
behalf of, the Scottish Government, regarding the experiences of several years of
operation of assisted dying in Scotland. The review will give the Scottish Parliament, the
health and care professions, and Scottish society more widely, an opportunity to take
stock of the practical experience of assisted dying over a five-year period. The report
may contain recommendations and/or proposals for amending aspects of the process
as a result of the experience of health professionals, patients, and their support
networks.
60. The Bill aims to achieve an appropriate balance between collecting data to better
understand and inform consideration of the Bill’s implementation, while ensuring that
only necessary data is collected. Under the Bill, all data collection will be done through
Public Health Scotland, the body responsible at national level for the public health
domains of health improvement, health protection and health care improvement, and
which is already supported by a range of data and intelligence functions. Public Health
Scotland has extensive experience of gathering and using patient data for the purpose
of abortion statistics, and the member envisages that the data gathering for assisted
dying purposes will likely follow similar established routes. The Member notified and
consulted the Information Commissioner’s Office (ICO) as part of the consultation on his
draft proposal for a Member’s Bill. The ICO provided comments to the Member on his
proposal which have been taken into consideration in the drafting of the Bill’s provisions
relating to data collection and reporting (for example, by ensuring that reported data is
anonymised). As noted above, there are well-established processes for the
management of medical records within the health service.
Alternative approaches
61. As the Member is seeking a significant change to the law to allow for a regulated
process of assisted death in certain circumstances it was considered that there was no
credible alternative to primary legislation. As set out elsewhere in this Memorandum, the
Member does not accept that the law as it stands is either appropriate, in terms of it
currently being possible to assist a death and face prosecution, or is sufficiently clear,
well understood and supported by a majority of people in Scotland.
62. The need to legislate to bring about the desired policy change is further
evidenced by the number of other countries and jurisdictions legislating for assisted
dying around the world, and also by the previous attempts to legislate, both in Scotland
and in the rest of the United Kingdom. The proposed legislation in Jersey and the Isle of
Man, and considerations in the UK Parliament, are further evidence of the acceptance
that legislation is required to safely and legally provide for assisted dying.
63. The Member believes that the consistent provision of, and accessibility to, high
quality palliative care is essential for the people of Scotland, and that every effort should
This document relates to the Assisted Dying for Terminally Ill Adults (Scotland) Bill (SP
Bill 46) as introduced in the Scottish Parliament on 27 March 2024
19
be made to improve the quality of, and access to palliative care.
47
It should be noted,
however, that the Member does not consider that further investment in, and availability
of, palliative care in Scotland is an alternative to the provision of assisted dying as set
out in the Bill. The Member believes that assisted dying and palliative care are not
mutually exclusive, and that assisted dying should be an option for terminally ill adults
alongside the continued, and improved, provision of palliative care. He believes that
terminally ill adults in Scotland should have the option of both high quality and
accessible palliative care and being provided with assistance to end their life if they
wished. Experience from jurisdictions where a model of assisted dying is lawful is that a
high number of those who had an assisted death were receiving palliative care. A report
on Assisted Dying/Assisted Suicide published by the House of Commons Health and
Social Care Committee on 29 February 2024
48
stated, in paragraph 142, “In the
evidence we received we did not see any indications of palliative and end-of-life care
deteriorating in quality or provision following the introduction of AD/ AS; indeed the
introduction of AD/AS has been linked with an improvement in palliative care in several
jurisdictions.”.
64. Previous proposals for Member’s Bills in the Scottish Parliament have been
brought forward on the issue of assisted suicide. As explained elsewhere, while the
broad policy intention is similar (to allow those suffering from a disease/illness/condition
to be assisted to end their life) there are important policy differences between both of
those previous Bills, and this Bill. Among the most notable of those is that this Bill has
more rigorous criteria for accessing assisted dying (limited only to those adults with
capacity who are suffering from an advanced and progressive terminal illness) and
more stringent safeguards to protect all involved and to limit as far as possible any
potential concerns about abuse of the process.
65. Whilst the Member was not convinced that there were credible alternative
approaches to legislation to achieve his aims, he did consider various alternate/different
legislative options for delivering the policy. This included decisions such as limiting
assisted dying to those who are terminally ill only and ensuring that numerous
safeguards were established in every part of the process.
66. The Member also considered how to define terminal illness most appropriately for
the purposes of the Bill. It is not uncommon, in assisted dying legislation in other
jurisdictions, for the term to be defined by reference to a maximum period a person is
expected to live, such as six or twelve months. The Member consulted international
evidence which shows that even when a time limit is included, it does not alter the way
in which assisted dying is accessed, and that people still access it in their final
weeks/days of life and primarily for cancer. It has been shown
49
that including a time
limit can result in 'undesirable outcomes' for patients, without having the perceived
desired effect of acting as an additional safeguard. The Member believes that not
including a time frame means that a terminally ill adult would not be rushed into making
47
Palliative care aims to relieve suffering and improve quality of life for people with serious, often
terminal, illnesses.
48
Assisted Dying/Assisted Suicide (parliament.uk).
49
The University of New South Wales Law Journal. Who Is Eligible for Voluntary Assisted Dying? (2022).
Available at: Issue-451-White-et-al.pdf (unsw.edu.au)
.
This document relates to the Assisted Dying for Terminally Ill Adults (Scotland) Bill (SP
Bill 46) as introduced in the Scottish Parliament on 27 March 2024
20
a decision because time is running out, meaning exploring the option of assisted dying
is likely to be a more balanced and thoughtful process. It gives patients more time to
deliberate, discuss their options, and explore other therapies. It also reduces the risk of
the person losing capacity during the decision-making process and for safeguarding
checks to be carried out over a period of time instead of under a tight timeline. The
Member also considered that including an expected life expectancy within the definition
would place unreasonable pressure on healthcare professionals who will be assessing
people who wish to have an assisted death and could result in excluding some
terminally ill people from the process inappropriately.
67. The Bill does not define terminal illness by reference to an expected period of
time a person will live, but access is constrained by the need for a person’s condition to
be advanced and progressive. The Member also was mindful of responses to the
consultation on his draft proposal which included many comments about the difficulties
in prognosis and assessing how long a person may have to live. Therefore, rather than
defining terminal illness by a period of life expectancy, the member decided to focus on
whether a registered medical practitioner considers a person to have an advanced and
progressive illness from which they will not recover, and which is expected to cause
their premature death.
68. Another notable policy choice involved the body which is to be responsible for
collecting and reporting statistical data on assisted dying. The Member considered
either establishing a new body specifically for the role or adding the responsibility to an
existing body and decided that it would be most efficient and appropriate for a duty to be
placed on Public Health Scotland to perform the role.
Consultation
69. Liam McArthur consulted on a draft proposal
50
lodged on 22 September 2021.
The consultation
51
ran from 23 September 2021 until 22 December 2021. There were
14,038 responses
52
(the highest number of responses to date to a consultation on a
Member’s Bill in the Scottish Parliament), and a summary
53
of those responses was
published along with a final proposal
54
on 8 September 2022.
50
Proposed Assisted Dying for Terminally Ill Adults (Scotland) Bill. Details available at:
Proposed Assisted Dying for Terminally Ill Adults Scotland Bill | Scottish Parliament Website
.
51
Proposed Assisted Dying for Terminally Ill Adults (Scotland) Bill. Consultation document, available at:
Assisted Dying Consultation 2021 - FINAL (parliament.scot)
.
52
Proposed Assisted Dying for Terminally Ill Adults (Scotland) Bill. Consultation responses, available at:
https://www.assisteddying.scot/
.
53
Proposed Assisted Dying for Terminally Ill Adults (Scotland) Bill. Consultation summary, available at:
assisteddyingconsultationsummaryfinaldraft.pdf (parliament.scot)
.
54
Proposed Assisted Dying for Terminally Ill Adults (Scotland) Bill. Details available at:
Proposed Assisted Dying for Terminally Ill Adults Scotland Bill | Scottish Parliament Website
.
This document relates to the Assisted Dying for Terminally Ill Adults (Scotland) Bill (SP
Bill 46) as introduced in the Scottish Parliament on 27 March 2024
21
70. In addition to the 14,038 responses included in the summary, 3,352 emails
55
were sent to Liam McArthur (on the same day) by the organisation Right to Life, on
behalf of individual members of the organisation. These emails were all from the same
organisational email address (but copied to different email addresses, seemingly those
of individuals) and were all fully opposed to the proposal. Given the responses all came
from the same email address (that of the Right to Life organisation), and the
identical/very similar nature of the responses, they were not counted as individual
responses for the purposes of the summary and were not counted in the data presented
in the summary.
56
A summary of the views expressed in the campaign can be found on
page 7 of the summary,
57
and an example of the contents of the campaign can be
accessed online.
58
71. Eighty-one responses were from organisations and the remaining 13,957 were
from individuals (including academics, professionals and members of the public). 9,051
responses (64.5% of all submissions) were published and attributed, 3,665 (26% of all
submissions) were published anonymously, and 1,322 (9.5% of all submissions) were
not published at the request of the respondent.
72. Views on the proposal to introduce assisted dying for terminally ill competent
adults in Scotland were broadly polarised, with strong views expressed both in support
and opposition. Only 3% of respondents expressed a view other than full support or full
opposition. Among those that did were some representative organisations which did not
give a view as opinions amongst the relevant memberships were mixed. Views on the
details of the proposal, and how assisted dying should be implemented in Scotland,
were more nuanced, with a wide range of issues, questions, and concerns raised by
respondents on both sides of the debate.
73. A clear majority of respondents (10,687 - 76%) were fully supportive of the
proposal, with a further 244 - 2% partially supportive. Many respondents gave first hand
experiences of living with, and caring for, family, friends and patients with a terminal
illness who had experienced great pain and suffered what was often described as a
traumatic and undignified “bad death”. Many of these respondents believed that
assisted dying should be available for people in Scotland, as it is in other parts of the
world. They believed that a humane and compassionate society should take steps to
avoid people being required to endure unbearable pain and suffering and allow people
the autonomy to legally choose to end their lives in a safe, peaceful, and regulated
55
A proportion of these respondents also made incomplete responses via a Right to Life organised
webpage which linked to the Smart Survey hosting the consultation. To avoid duplication, and as most
were incomplete, the Smart Survey responses were discounted. Note that although 3,352 emails were
received, these were not verified so it is not known if this figure included multiple responses from the
same individual.
56
Note that if the 3352 responses that were part of the Right to Life campaign had been included in the
overall figures regarding consultation responses, they would read as follows: 17,390 responses;
61.45% fully supportive; 1.40% partially supportive; 0.28% neutral; 0.29% partially opposed; 36.38%
fully opposed; 0.17% unsure.
57
Proposed Assisted Dying for Terminally Ill Adults (Scotland) Bill. Consultation summary, page 7.
Available at: assisteddyingconsultationsummaryfinaldraft.pdf (parliament.scot)
.
58
Right-to-Life-campaign-example-submission-Assisted-Dying-for-Terminally-Ill-Adults-Scotland-Bill-
Consultation.pdf (assisteddying.scot).
This document relates to the Assisted Dying for Terminally Ill Adults (Scotland) Bill (SP
Bill 46) as introduced in the Scottish Parliament on 27 March 2024
22
manner. Some supportive respondents also stated that it would be comforting and
reassuring to know that assisted dying was an option, even though many may not
decide to take the option. Many supportive respondents believed the proposal was an
improvement on previous attempts to legislate for assisted dying and were fully satisfied
with the proposed safeguards set out in the consultation document. Many believed that
the proposal successfully balances the provision of access to assisted death for
competent terminally ill adults with a clear and appropriate set of safeguards built into
every step of the process, together with health professionals involved being able to
conscientiously object.
74. A proportion of those supportive of the fundamental principle of legalising
assisted dying put forward changes they wished to see to the specifics of the proposal.
One of the most common changes called for related to concerns about the intended
definition of “terminal illness” proposed in the consultation document. Many believed a
wider group of people should be able to choose an assisted death than the intended
definition would allow for, such as those with potentially longer-term degenerative
conditions, such as various neurological conditions and forms of dementia. A significant
number of respondents also raised concerns about the proposal that the life ending
substance must be self-administered, noting that some people who would wish to
choose an assisted death would not be able to take the medicine themselves. Many
respondents believed this to be potentially discriminatory and called for a health care
professional to be able to administer the drug in certain circumstances, or that there
should at least be clarity on how life would be ended in such circumstances.
75. A minority of the overall number of respondents (2,975 - 21%) were fully opposed
to the proposal, with a further 52 - 0.4% partially opposed. One of the most common
reasons given for opposing the proposal was a fundamental belief, often founded in a
particular religion, that human life is sacred and must not be purposefully ended under
any circumstances. A large number of those opposed also believed that no safeguards
would ever be able to prevent some people from feeling pressure to end their lives,
perhaps through fear of being a burden on family, friends, health care services and/or
wider society, or even being coerced for various reasons into deciding to choose an
assisted death. Fears were expressed that there could never be certainty that a
decision was being made solely of the individuals own free will. Many of those opposed
also stated their belief that legislating to give effect to the proposal would be a “slippery
slope” i.e. that any legislation passed would likely be amended in the future to weaken
safeguards and extend the option for assisted death beyond the competent terminally ill
adults currently proposed. Such responses often cited other countries and jurisdictions
where a form of assisted dying is legal, and where they believe such changes have
occurred over time. Fears were also expressed that the proposal would further
stigmatise and threaten some of the more vulnerable people in society, such as young
people, older people and people with a disability.
76. A majority of the organisations that responded to the consultation were fully
opposed to the proposal (47 organisations - 57.5% of organisations) the majority of
which (32 - 68% of organisations) were either specifically religious organisations, or
were organisations clearly linked to a particular religion. Of the individual respondents
that identified as members of the public (which represented 87% of individuals who
This document relates to the Assisted Dying for Terminally Ill Adults (Scotland) Bill (SP
Bill 46) as introduced in the Scottish Parliament on 27 March 2024
23
responded), a clear majority (over 80%) were fully supportive. There was a more even
split amongst those individuals who identified as being professionals with experience in
a relevant subject, with 50% of them fully supportive and 46.5% of them fully opposed.
Those professionals, both supportive and opposed, included a range of (current,
previous and retired) health care professionals (including GPs, doctors, nurses, and
social workers – including mental health specialists), religious figures (including priests,
ministers and rabbis), pharmacists, vets and legal professionals.
77. Following the close of the consultation, Liam McArthur, invited a group of senior
healthcare practitioners to form a working group to advise and inform him ahead of the
Bill being introduced. A Medical Advisory Group (MAG) was subsequently established,
chaired by Dr Sandesh Gulhane MSP, with ten other group members
(professionals/experts/academics). The MAG was formed to explore the healthcare
related issues of the proposed assisted dying bill and was asked to consider responses
to the Member’s consultation and take additional evidence relating to medical practice
and the role of health professionals and consider specific aspects of implementation,
such as patient pathways, per support and training and pharmaceutical requirements,
and to report its findings. The MAG report was finalised in November 2022 and
published on 12 December 2022.
59
The Terms of Reference included in the published
report stated: “This report outlines the issues, challenges and opportunities that the
medical profession would be presented with should assisted dying be legalised in
Scotland.” The report was considered as part of the drafting process of the Bill.
Effects on equal opportunities, human rights, island
communities, local government, sustainable development
etc.
Equal opportunities
78. The Bill provides for assisted dying to be accessible to any person that meets the
relevant criteria (a person must be aged 16 or over, terminally ill, mentally competent to
make the decision, resident in Scotland for at least 12 months, registered with a GP in
Scotland, have had care options explained to them, and be making the decision of their
own free will).
79. The consultation on the draft proposal for the Bill received responses from
organisations and individuals expressing concerns relating to various protected
characteristics on the basis that it made a particular group of people at greater risk of
choosing an assisted death due to a temporary period of depression, anxiety or other
mental health condition connected to the protected characteristic (for example,
examples were given of people struggling with their sexuality or undergoing gender
reassignment). As the Bill only allows access to assisted death to adults who are
terminally ill, it is not possible for a person to access assisted death only because of any
mental health condition. Therefore, there is no risk to anyone, including those with a
59
Medical-Advisory-Group-Report.pdf (assisteddying.scot).
This document relates to the Assisted Dying for Terminally Ill Adults (Scotland) Bill (SP
Bill 46) as introduced in the Scottish Parliament on 27 March 2024
24
particular protected characteristic, of being eligible for assisted dying solely on the basis
of having any mental health condition.
80. In terms of the characteristics protected by law in the Equality Act 2010, those
aged under 16 are directly impacted as, due to the focus on terminally ill adults, they will
automatically be excluded from access to assisted dying. The Member believes this is
entirely appropriate and consistent with many other age restricted activities and
practices under Scots law. The Member believes that those aged under 16 are being
protected by not being able to access assisted dying.
81. Access to assisted dying provided for in the Bill has the potential, either through
the actual provisions in the Bill, or in associated wider perception, to impact on various
protected characteristics as follows:
Age
82. In addition to assisted dying only being accessible to those adults aged 16 and
over, as outlined above, it is acknowledged that a significant proportion of those likely to
meet the criteria for assisted dying may be older people. Evidence and experience from
jurisdictions where a form of assisted dying is available shows that a high proportion of
those who request an assisted death are older. For example, in Oregon, from 1998-
2021, 75% of those who had an assisted death were aged 65 and over.
60
The Member
does not consider this to be a negative impact of the Bill, but a positive impact as it
means that, currently, a higher proportion of terminally ill older people are being denied
access to an assisted death if they wish to have one. The Member believes that,
therefore, a higher proportion of older people may be suffering pain, a loss of dignity,
autonomy and severe distress unnecessarily at the end of life and that the Bill will
increase the rights of older people in particular. The Member also believes that the
assisted dying process as set out in the Bill would be the most safeguarded end of life
procedure when considered alongside interventions like palliative sedation and double
effect (where pain relief is provided with the knowledge that end of life may be a
consequence) which the Member believes may happen without a person’s explicit
consent if it is considered treatment has become futile and not in the patient’s best
interests.
83. Some concern has been expressed that some older people may be more
vulnerable to being coerced or pressured into choosing to have an assisted death. It is
important to keep in mind that simply being of a certain age does not enable access to
assisted death. Only terminally ill people who meet all the other criteria are eligible.
Therefore, older people who are not terminally ill will not be able to access assisted
dying. Older people that are eligible will be protected by all of the safeguarding
measures included in the Bill, which cover issues such as capacity and coercion. The
Member considers that it would be unjustifiably discriminatory to restrict access, or
increase the barriers to, assisted dying for terminally ill adults on the basis of age alone.
60
Oregon Death with Dignity Act 2021: Data Summary. Available at: DWDA 2021 (oregon.gov).
This document relates to the Assisted Dying for Terminally Ill Adults (Scotland) Bill (SP
Bill 46) as introduced in the Scottish Parliament on 27 March 2024
25
Disability
84. An adult with a disability who is not terminally ill will not be able to access
assisted dying. The Bill will apply to any person with a disability that meets all the
criteria set out in the legislation for accessing assisted dying (i.e. being terminally ill,
aged 16 or over, mentally competent, registered with a doctor in Scotland, and having
been resident in Scotland for at least 12 months). Any person with a disability that does
not meet these criteria will not be eligible for assisted dying.
85. The Member acknowledges that there is concern amongst some disabled people
and organisations, which included responses made to the consultation on his draft
proposal by organisations representing people with disabilities, and from disabled
individuals, which were opposed to assisted dying. The main concerns of these
organisations and individuals included that disabled people face many inequalities
which can result in some feeling that their lives are of less value. Some responses to
the consultation felt that a lack of equality, including in the provision and availability of
care, could lead to disabled people being particularly and disproportionately vulnerable
to being coerced/pressured into choosing to have an assisted death (often stating that it
is impossible to ever be 100% sure that a person is acting of their own free will).
86. Some respondents were also concerned that allowing assisted dying to be
legalised in the way outlined in the proposal (i.e. with strict restrictions on who would be
eligible and with numerous safeguards, including on capacity and coercion) would be
the start of a “slippery slope”, and that by legislating for a certain cohort of people to be
able to be legally assisted to die would begin to normalise assisted dying/suicide more
generally and lead to the legislation being amended, or statute being added to, to allow
for wider forms of assisted dying and/or suicide and/or euthanasia. The fear being that it
may be made legally possible for someone who is not terminally ill, but has a disabling
condition, to be legally able to choose to die, and doing so because of
pressure/coercion (either directly or from wider society) and/or a belief that they are a
burden on those around them, or on society generally.
87. There were also responses made to the consultation by disabled individuals who
were fully supportive of the proposal, and the Member believes it is not accurate to
frame the debate on assisted dying by stating that all, or most, disabled people are
opposed to assisted dying. The Member also believes that it is crucial that the fears and
concerns expressed by some disabled groups and individuals are considered by
reference to what the Bill actually does, rather than any inaccurate perception of what
the Bill may do. The safeguards provided for mean that only a disabled person who had
an advanced and progressive terminal illness and met the other criteria would be able to
choose an assisted death, and that doctors will be required to be satisfied that a person
is capable of making a decision, understands their care options, and is not being
coerced. The University of Glasgow School of Humanities published a briefing on the
issue of disability and assisted dying laws in 2021
61
and concluded that:
61
University of Glasgow, School of Humanities (2021). Disability and Assisted Dying Laws Policy Briefing.
Available at: PolicyBriefingDisabilityAndAssistedDyingLaws.pdf
.
This document relates to the Assisted Dying for Terminally Ill Adults (Scotland) Bill (SP
Bill 46) as introduced in the Scottish Parliament on 27 March 2024
26
“… assisted dying laws should not be opposed on the basis of the views, welfare,
respect or healthcare of people with disabilities. Instead, respect for disabled people’s
autonomy gives some reason to legalize assisted dying, at least for people expected to
die within six months. This conclusion is supported by four key findings:
1. People with disabilities are not generally opposed to assisted dying laws.
2. Assisted dying laws do not harm people with disabilities.
3. Assisted dying laws do not show disrespect for people with disabilities.
4. Assisted dying laws don’t damage healthcare for people with disabilities.”
88. As well as agreeing with the conclusions reached in the briefing paper by the
University of Glasgow School of Humanities, the Member believes that any attempt to
prevent or limit access to assisted dying for a terminally ill person, or to introduce
additional barriers, purely on the grounds that they have a disability would be
discriminatory and unjustifiable.
89. The Bill also allows for a proxy to sign declaration forms if a person is unable,
due to having a physical impairment, to do so, and existing NHS policy will ensure that
interpreters will be provided for anyone who requires such assistance.
90. The Member believes that the Bill increases the rights of disabled people with a
terminal illness by ensuring that people with disabilities will have the same access to
assisted dying and ability to make a decision about when and how they wish to die as
people without a disability.
Gender
91. Data collected from jurisdictions where a form of assisted dying is in place shows
that, on average, slightly more men access assisted dying than women (around a 52% -
48% split). Research has shown that the lack of choice at the end of life
disproportionately and detrimentally affects women who continue to be the primary care
givers at the end of life.
62
Race
92. An American academic study, “Expanded definitions of the “good death”? Race,
ethnicity, and medical aid in dying”
63
stated that data in the US shows that the rates of
use of assisted dying are much higher for people identifying as white. Over almost
twenty years, only three percent of people who died after receiving assisted dying in
Oregon identify as any race other than white, whereas the most recent statistics on the
racial composition of the population of Oregon show 83% of the population identifying
as “White” and the remaining 17% as of various non-white races. In California, which is
62
Dying in Scotland: A Feminist Issue at: https://features.dignityindying.org.uk/dying-in-scotland.
63
Cain CL, McCleskey S. Expanded definitions of the ‘good death’? Race, ethnicity and medical aid in
dying. Sociol Health Illn. 2019;41(6):1175-1191. doi:10.1111/1467-9566.12903. Available at:
Expanded
definitions of the “good death”? Race, ethnicity, and medical aid in dying - PMC (nih.gov).
This document relates to the Assisted Dying for Terminally Ill Adults (Scotland) Bill (SP
Bill 46) as introduced in the Scottish Parliament on 27 March 2024
27
more racially and ethnically diverse than Oregon, the vast majority of those accessing
assisted dying are white. The authors of the study believed there were cultural,
structural, and interactional explanations for racial and ethnic variability in the use of
assisted dying in the US: that cultural and religious differences across racial and ethnic
groups affect preferences for end of life care and assisted dying; that people of colour
are not given equal access to information and quality care and therefore may not be
aware of the option of assisted dying; and that interactions with health professionals
may vary for different racial and ethnic groups.
93. The Member believes that this must be taken into account when considering how
best to raise awareness of assisted dying and how the process works (for example, it is
expected that, as is the case with any new health service, information and education will
be provided in a variety of accessible formats, including online and paper based). The
Member also believes that a fundamental principle of assisted dying is allowing people
to make an informed choice, and if certain people or groups choose not to access it, for
cultural, religious or any other reason, that is their decision.
Religion or belief
94. No person will be prevented from accessing an assisted death, if they meet the
required criteria, because of their religion or beliefs.
95. The Bill does not require healthcare professionals who would otherwise be
actively involved in providing assisted dying to a person to do so if they have an
objection on religious and/or belief grounds. It will therefore be possible for a healthcare
professional to conscientiously object on such grounds to providing a person with an
assisted death.
Human rights
96. Leading legal experts have described the existing law on assisted dying as
having an “alarming lack of clarity,” raising basic questions about whether it is
compatible with Scotland’s international obligations under the European Convention on
Human Rights.
64
97. The Member believes that the current law does not fully respect people’s rights to
control the timing and manner of their own deaths, and their right to a dignified death.
To that extent, in the Member’s view, the Bill proposal would enhance a person’s human
rights.
98. The Bill has implications for human rights under the European Convention on
Human Rights (ECHR) – particularly Article 2 (right to life), Article 8 (right to respect for
64
Herald Scotland (2015) “A troubling lack of clarity in Scots law regarding assisted suicide” See:
http://www.heraldscotland.com/opinion/13208016.A_troubling_lack_of_clarity_in_Scots_law_regarding_
a ssisted_suicide/.
This document relates to the Assisted Dying for Terminally Ill Adults (Scotland) Bill (SP
Bill 46) as introduced in the Scottish Parliament on 27 March 2024
28
private and family life), Article 9 (right to freedom of thought, conscience and religion)
and Article 14 (protection from discrimination).
99. There have been various cases brought before the European Court of Human
Rights (ECtHR) arguing that the prohibition or lack of availability of assisted dying is a
breach of the ECHR. Whilst these cases have not been upheld, the ECtHR has not
stated that assisted dying is either compatible or incompatible with the ECHR. The
approach of the ECtHR to date has been to recognise that countries/jurisdictions are
better placed than the Court to decide on nationally sensitive issues (this is known as
the “margin of appreciation”). There have been a number of decisions in Strasbourg as
well as in the domestic courts that confirm that the right to private and family life
includes the right to decide how and when to die, and in particular the right to avoid a
distressing and undignified end to life (provided that the decision is made freely). It has
also been well recognised by the courts including the UK Supreme Court that any
change in the law on assisted dying is a matter for Parliament.”.
100. Consequently, on 24 May 2023, the UK Parliament House of Commons Joint
Committee on Human Rights held an oral evidence session on the human rights legal
issues related to assisted dying. The Committee Chair subsequently wrote
65
to the
Chair of the Health and Social Care Committee to inform that Committee’s inquiry into
assisted dying/suicide. The letter notes that the evidence the Committee heard:
“… demonstrated the complexity of this area, and showed that, while it is vital that
discussions take proper account of our human rights framework, a human rights
analysis appears not to currently provide definitive answers as to whether current
legislation on assisted dying requires changes. It was clear from their evidence that as
things stand, the courts have concluded that whether there is a need for changes to the
law on assisted dying is a matter for Parliament, a conclusion with which we agree.”
Island communities
101. The Bill applies uniformly across Scotland and people on island communities will
have the same access to an assisted death as people on mainland Scotland.
102. It is acknowledged that there may be challenges for some people in remote and
rural parts of Scotland to obtain an assisted death due to the availability of relevant and
required healthcare professionals. It is also acknowledged that some healthcare
professionals not wishing to participate in providing an assisted death may impact more
on remote and rural parts of Scotland, including some island communities, more than on
more populated and accessible parts of the country.
103. It is accepted that it is possible that this could result in some people requesting
an assisted death but not receiving it within the usual and expected timeframes, or at
all. However, it was not considered appropriate to weaken or vary any of the safeguards
provided for in the Bill or to differentiate the way the process operates on the basis of
65
committees.parliament.uk/publications/40524/documents/197666/default/.
This document relates to the Assisted Dying for Terminally Ill Adults (Scotland) Bill (SP
Bill 46) as introduced in the Scottish Parliament on 27 March 2024
29
geographical location. The Member is reassured that experience from permissive
jurisdictions (including in jurisdictions larger than Scotland and with significant remote
and rural areas) is that healthcare professionals willing to play an active part in assisted
dying are willing to travel to remote areas to facilitate the process. For example, the
Queensland Voluntary Assisted Dying Review Board Annual Report 2023
66
and
Queensland Voluntary Assisted Dying support and pharmacy service reporting shows
that every hospital and health service area in Queensland has had patients accessing
assisted dying, and that health professionals travel all over the State to ensure access.
Local government
104. The Bill confers no powers or obligations on local authorities and has no other
direct impact on local government. No local authorities responded to the Member’s
consultation on his draft proposal for the Bill. Some terminally ill adults who request an
assisted death may be receiving palliative care or otherwise be being cared for in local
authority run care homes, but the processes set out in the Bill would not impact notably
on a local authority should this be the case as the process will be managed and
delivered by registered medical practitioners and health professionals rather than by
care professionals or other local authority staff.
Sustainable development
105. There is no reason to suppose that the changes the Bill makes could not be
sustained indefinitely. The Bill includes a requirement for the legislation to be reviewed
five years after it has been in operation. This will provide an opportunity to assess the
impact and effectiveness of the legislation in the first five years of assisted dying being
legally available to people in Scotland.
106. The Bill is not expected to have any significant environmental impact (for
example, in terms of resource or energy use). However, the Bill has the potential to
have a positive impact in many other areas relevant to sustainability, and the Member
believes that the Bill will support sustainable development issues by increasing
wellbeing, equity and access to justice, and will make a positive contribution to the
sustainable development of Scottish society in the years ahead and build towards a
more compassionate Scotland.
107. A fundamental aspect of sustainable development is ensuring that economic,
cultural and political systems do not favour some people while harming others, and the
Member believes that some people are being harmed by assisted dying not being
available, and therefore that the Bill will help to mitigate and redress that harm. It is also
thought that relationships and trust between doctors and patients in Scotland will likely
benefit as a result of assisted dying being legally available. Empowering some patients
to take control of their own dying would signal a shift away from paternalism to more
positive and autonomous patient centred decision making.
66
Voluntary Assisted Dying Review Board Annual Report 2022-2023 (health.qld.gov.au).
This document relates to the Assisted Dying for Terminally Ill Adults (Scotland) Bill (SP
Bill 46) as introduced in the Scottish Parliament on 27 March 2024
30
108. Responses to the consultation on the proposal for this Bill included thousands of
accounts of trauma experienced by individuals and their families and friends due to a
lack of end-of-life choice. This Bill, by providing that choice (whether it is taken up or
not), will help reduce anxiety and distress and improve wellbeing for those people and
ensure that their wishes are respected and honoured. The consultation also
demonstrated that some terminally ill people in Scotland travel abroad to access
assisted dying. The cost of this is thought to be at least £12,000 and therefore is not an
option for those not able to afford it. The Member believes the Bill will end the need for
people to travel abroad, an unsatisfactory, exclusive option, and ensure assisted dying
is available for all who are eligible in Scotland.
This document relates to the Assisted Dying for Terminally Ill Adults (Scotland) Bill (SP
Bill 46) as introduced in the Scottish Parliament on 27 March 2024
SP Bill 46–PM Session 6 (2024)
Assisted Dying for Terminally Ill Adults
(Scotland) Bill
Policy Memorandum
Parliamentary copyright. Scottish Parliamentary Corporate Body
Information on the Scottish Parliament’s copyright policy can be found on the website -
www.parliament.scot
Produced and published in Scotland by the Scottish Parliamentary Corporate Body.
All documents are available on the Scottish Parliament website at:
www.parliament.scot/documents
