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Who Has the Right to Die?

On 27 March 2024, Liberal-Democrat MSP Liam McArthur proposed a bill to allow terminally ill adults to self administer life-ending medication. McArthur has set his sights on a debate this autumn and a 2025 floor vote, saying that current Scottish law is “failing too many terminally ill Scots at the end of life.” While public opinion overwhelmingly supports a reform of Scotland’s laws around medically assisted dying–a recent poll found 78% of Scots showed support for a law like McArthur’s–powerful religious groups vehemently oppose any such bill. A joint statement by the Church of Scotland and the Scottish Roman Catholic Church cautioned that any expansion of medically assisted dying “means an individual can lose their value to society because of illness or disability.” While McArthur insists the bill is narrowly tailored to avoid unnecessary deaths, requiring two doctors to confirm a patient’s terminal condition and decision-making capacity, the bill’s opposition warn of a slippery slope that could lead to assisted suicide being used as a ‘way out’ for society’s most vulnerable. 


Across the pond, Canada’s Medical Assistance in Dying (MAID) law serves as a model for some, and a failure for others. In 2015, Canada’s Supreme Court ruled that prohibitions on  medically assisted dying were unconstitutional when a patient’s condition was irremediable and causing great suffering, writing that it “deprive[s] these adults of their right to life, liberty and security.” They required the Canadian Parliament to create a legal pathway for adults to end their lives, and MAID delivered in 2016. Canadians successfully receiving medically assisted termination of life have increased from just over 1,000 in 2016 to more than 13,000 in 2023. 


A small but growing number of these cases are non-terminal patients whose natural deaths are ‘not reasonably foreseeable.’ Canada removed the requirement that a patient’s life expectancy be less than six months in 2021, only requiring patients’ conditions to be chronic, incurable, and causing ‘enduring physical and psychological suffering.” More than 95% of MAID approved patients still meet the criteria of ‘natural death [being] reasonably foreseeable, but critics of the law still fear the repercussions of allowing non-terminal patients the choice to end their lives, when their life expectancy may be much longer. Opponents of McArthur’s proposal and Canada’s MAID law point to data that suggests non-terminal MAID deaths may increase to 15%. Following Canada’s 2021 MAID expansion, the UN Special Rapporteur on the Rights of People with Disabilities released a statement condemning the law, saying, “Disability should never be a ground or justification to end someone’s life directly or indirectly.”


In 2024, Canada’s law has come back under scrutiny, as MAID was set to be expanded further in March to include mental illness. The expansion was delayed by a Parliamentary committee for the third time, postponing the rollout until 2027 after finding that Canada’s mental health practitioners are not prepared to assess patients. The Center for Addiction and Mental Health, Canada’s leading practice for psychological disorders, wrote in a statement that they are “​​particularly concerned about the lack of consensus among health care practitioners on when a mental illness can be considered ‘irremediable’ for the purposes of MAID.” Other opponents of the expansion fear that struggles to find adequate medical care or housing, rather than a genuine desire to end suffering, may encourage patients to seek medically assisted death. Though this outcome is speculative, the reasoning may be allowable under the relaxed MAID requirements. 


These fears are not without backing; in the Netherlands for example, psychiatric diseases are acceptable grounds to seek medically assisted death. A firestorm broke out over this legislation in 2022, when some medical experts suggested a new diagnosis of ‘terminal anorexia,' under which patients could seek medically assisted death; several patients have already done so in the Netherlands under their assisted suicide legislation. Jennifer Gaudiani, a pioneer in the eating disorder field who originally proposed the new diagnosis, suggested that, under MAID laws, the mental suffering caused by anorexia would be cause to approve a patient’s request for medically assisted dying. 


This outraged many eating disorder specialists and sufferers; in Emmelein Clein’s book, Dead Weight: Essays on Hunger and Harm, she voices her fears that “People with [anorexia] might soon be offered a diagnosis that affirms their conviction that their life isn’t worth saving, a diagnosis as deadly as their disease,” if laws that allow for medically assisted dying continue to allow eating disorder patients to be approved or are expanded to do so. Dutch researcher Eric von Furth of the Rivierduinen Eating Disorders Clinic further echoed this sentiment and added to concerns of the opponents of MAID’s expansion in Canada. He stipulates that patients may not actually want to die when seeking medically assisted death, saying, “It’s not that they wanted to die [but] that they find living very hard. That’s a big difference.”


Back in Scotland, MSP McArthur has been careful to distance his proposals from Canada’s MAID law and its associated controversy, comparing his law to that of the state of Oregon in the United States which only allows for medically assisted dying when a patient is terminally physically ill. Still, the struggle to balance respect for life with unalienable personal rights, and compassion in the face of suffering underpins all debates around legislation that will give people the right to die. McArthur’s bill is far more than words on paper; it carries a weight that, if not balanced correctly in either direction, will lead to the undue suffering of  Scotland’s most vulnerable.


Image Credit: SST / Alamy Live News

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