CHURCH OF SCOTLAND CHURCH AND SOCIETY COUNCIL EAGLAIS NA H-ALBA 121 George Street, Edinburgh, EH2 4YN. Tel: 0131 225 5722 Fax: 0131 240 2239 Email: churchandsociety@cofscotland.org.uk Web: www.churchofscotland.org.uk Charity Number: SCO11353 Official Response SUBJECT: Proposed End of Life Choices (Scotland) Bill REQUESTED BY: Margo Macdonald MSP, The Scottish Parliament, Edinburgh, EH99 1SP REFERENCE: OR - 05- 09 DATE: February 2009 The Church and Society Council of the Church of Scotland welcomes the opportunity to respond to the current consultation on the Proposed End of Life Choices (Scotland) Bill. Introduction In broad terms the Church and Society Council of the Church of Scotland welcomes all efforts to improve the quality of care available to all Scotland’s citizens. We therefore find the contents of this proposed Bill to be deeply disturbing, undermining as it does the accepted need to offer care and comfort to all- especially those who are placed in a vulnerable position as a result of age, incapacity or other circumstance. As we cannot accept the starting assumptions made in the proposed Bill, we find it difficult to address the individual consultation questions directly- questions which seem to be concerned with the minutiae of administering the process of assisted suicide. No attempt is made in the document to engage with the fundamental question about whether it is right to knowingly assist in the death of another human being, and to frame legislation to facilitate this. While we believe it is justifiable for there to be public debate on many of the issues raised by this proposed Bill, we believe the whole approach taken here to be fundamentally flawed. We reject the purpose of the proposed Bill that it is to enable physician assisted suicide and protect doctors from 'criminal litigation'. Healthcare is multidisciplinary and includes the physical, psychological, social and spiritual elements of care each with professionals expert in these fields. Legislation such as that proposed would also impact on nurses who would have responsibility for the practical care of the patient, pharmacists who would knowingly be making up lethal prescriptions, chaplains and social workers who would be responsible for the social, spiritual and religious care of individuals, their families and healthcare staff. We believe that any legislation which endorses the deliberate ending of a human life undermines us as a society. We do not accept the underlying assumption which is made, namely that there is a requirement that the law be changed to allow the legal termination of human life, and believe that society is better served by sacrificial love, whatever the cost. Response to Consultation Questions: Q1: What are your views on applicability requirements? We reject the starting assumption that it is right to knowingly assist in the death of another human. Therefore the question is irrelevant. Q2: From what minimum age should a person be able to specify an end of life choice? Please give reasons for your answer. Please see response to Q1 above. Q3: Do you feel a waiting period of 15 days is enough? If not, what would be a sufficient waiting period and why? Please see response to Q1 above. Q4: Do you have a view on what constitutes a “valid and documented request”? Please see response to Q1 above. Q5: Are there any other responsibilities you would add to the responsibilities of the attending physician? Please see response to Q1 above. Q6: Are there any other responsibilities you would add to the responsibilities of the consulting health professional? Please see response to Q1 above. Q7: If the proposed Bill did not specify a review committee, do you have any views on alternative arrangements or safeguards? Please see response to Q1 above. You are invited to make further comment on the proposals in the consultation document. What is being proposed? The proposed Bill as presented is very poorly thought- out, and at times it is unclear exactly what is being proposed. Throughout the document, it appears that physician assisted suicide (PAS) is the focus, but at times this is falsely conflated with other issues- for example, in section 2.2 the case of the legitimate withholding of medical intervention. These issues are so different- one involving a deliberate act to end a life, the other the decision not to act- as to make the comparison nonsensical. In addition, the constituency who would be eligible for PAS under this legislation is unclear: section 2.3 proposes three categories of person, the third of which is framed so broadly as to be virtually meaningless (would those “who find their lives to be intolerable” include, for example, people in prison, parents who have lost a child, or those who are clinically depressed?). We are also concerned that the context in which such a “conclusion” is being reached is likely to be one where objective reflection is difficult to achieve: it is known, for example, that assessing depression in those who are terminally ill is often very difficult. What are the practical implications of what is proposed? While not accepting the need for such a law, one of our major concerns is that any legislation allowing the deliberate killing of another person must be framed in a manner which prevents its abuse or misuse. The practical difficulties inherent in achieving this are significant; the evidence from other areas of the law, and from other jurisdictions where assisted suicide laws are already in place, are not encouraging. Much of what are presented as safeguards in the proposed Bill appear to be little more than administrative exercises, aimed at making the process which ends in the deliberate killing of a human being as efficient as possible. Assuming that PAS is what is being proposed, it has emerged from discussions with the author of the proposed Bill that only a subset of physicians would be licensed to carry out the required procedure, and that the patient whose life is to be terminated should be known to the physician who is killing them. A plethora of practical questions arise, for example: * What would the minimum required length for this “relationship” to ensure that it is properly established? A week? A month? A year? * Would there be a requirement on health boards, for example, that a minimum proportion of their staff were registered in this way? * There is also concern that some might feel under pressure (perceived or real) to accept PAS to avoid placing burdens of care on their loved ones. To what extent would the family or carer relationships form part of any assessments? Given that people study medicine in order to bring healing and wholeness to other human beings, and that what is proposed would result in them being called upon to deliberately terminate life, such legislation represents a seismic shift in the relationship between the clinician and the patient. In addition, as consulting physicians are currently required to offer patients the available choices (e.g. to continue treating a condition, or to agree not to treat), in the eventuality that the proposed legislation were passed, would the responsibility of the physician then be to offer termination as a third alternative? What does “autonomy” mean? One of the issues which repeatedly comes up in discussions around this issue, and an argument which is also deployed at various points in the proposed Bill, is the area of personal autonomy: “it’s my life, and I can choose how and when to end it”. This may be particularly true in the individualistic West, where personal choice is seen to pervade all areas of life. While it must be recognised that personal autonomy is indeed an important issue, we would hold that it is a dangerous fallacy to believe that a person can act independently of all others, with their actions having no consequences for anybody else. Interpersonal relationships are important: life is lived and death experienced as part of community. The idea of “burden” is, by its very nature, a comment on relationships and therefore not a statement of autonomy. Death, as a natural process, cannot be avoided: despite the inevitable sadness involved in saying farewell to a loved one, emphasis should be placed on ensuring that all participants in the process experience as fulfilled and comfortable a final journey as possible. Assisted suicide has already been made possible in a number of other jurisdictions. In the Netherlands, for example, an apparent fall in the number of assisted dying cases in fact resulted from an increase in the use of terminal deep sedation. (Deep sedation, defined as: “the use of pharmacological intervention intended to induce or maintain sedation (deep sleep) to reduce the palliative patient’s awareness of distressing and refractory symptoms”, is not equivalent to euthanasia when there is not the intention to induce or hasten death). Assisted dying is usually presented as a “dignified” death. This is not always the case- indeed, relatives are frequently discouraged from being present at the point of death. We would emphasise the need for all aspects of care to be improved; there is concern, however, that assisted dying legalisation has undermined, rather than enhanced, other aspects of end of life care. NHS Scotland has produced a plan for improvements in palliative care, “Living and Dying Well” to address the issue of current deficiencies. Clearly it would be a disgrace if vulnerable patients opted for assisted dying because of a lack of resources to give them an acceptable quality of life in their last months. Conclusion In common with many Christians, the Church of Scotland through the General Assembly has long opposed euthanasia- a position reaffirmed at the most recent General Assembly in May 2008. The worth and dignity of every human life needs to be emphasised and celebrated; in particular, the deliberate ending of life would be a matter to be deplored if it were to be seen as a means of saving resources, or that any person was perceived (or perceive themselves) as merely a burden. The Church of Scotland would strongly oppose the proposals put forward in this consultation document.