Stronger The Longer You Look

Yesterday, the Covid-19 Inquiry has found that people with acute or chronic heart conditions“avoided or delayed attending healthcare setting during the pandemic” so as “to avoid putting pressure on the NHS”. Now imagine if there were assisted suicide “to avoid putting pressure on the NHS”.

Today, Lord Falconer rejected the notion of a minimum age, any minimum age, for a child interpreter whose parent was discussing assisted suicide with a doctor.

And from the country where it has gone furthest, so that there are even small signs of a turning of the tide, Ramona Coelho reminds us of what is still at stake:

A man diagnosed with metastatic cancer initially expressed interest in Medical Assistance in Dying (MAiD). Though the treating team determined he lacked capacity and was being sedated for pain management, a MAiD practitioner “vigorously rouse[d]” him to ask if he wanted MAiD. Withholding sedation, the practitioner accepted mouthing “yes,” nodding and blinking in response to questions as capable consent. The MAiD practitioner then facilitated a virtual second assessment, conducted in the same way, and MAiD was administered immediately after.

This active displacement of clinical care, as documented in government reports, is illustrative of a broader trend – MAiD is shifting the focus of medicine from the treatment of suffering to the elimination of the suffering patient. This shift does not reflect the intentions of every clinician, but it reflects structural pressures that are increasingly shaping practice. Canada is approaching 100,000 MAiD deaths since legalization 10 years ago. That number marks a quiet but profound transformation in how medicine understands suffering, autonomy and its own purpose. What was introduced as an exceptional measure is now a normalized part of clinical care.

Assisted dying is often framed as compassion for the suffering and preservation of a patient’s autonomy. But what happens when assisted dying becomes embedded in clinical decision-making and clinicians shift from focusing on healing to evaluating whether suffering justifies death? If practitioners are rushing to MAiD, even when other physicians have determined a lack of capacity to consent, does that sound like preserving autonomy?

In Canada, MAiD is legally exempt from homicide and assisted suicide laws under the Criminal Code. Health Canada maintains MAiD should not count as a cause of death, yet it is now Canada’s fourth leading cause of death. Many MAiD requests cite fear of being a burden, loneliness, or social isolation as drivers of suffering. These are not medical diseases but signals of social vulnerability. / MAiD should not count as a cause of death, yet it is now Canada’s fourth leading cause of death. / As a family physician caring for marginalized patients and as a member of Ontario’s MAiD Death Review Committee, I see how structural pressures appear in practice. Government reviews document similar patterns.

In one reported case, a man with cerebral palsy living in long-term care voluntarily stopped eating and drinking, leading to renal failure and dehydration. He was deemed eligible for MAiD under what is called Track 1 because his death was considered “reasonably foreseeable.” No psychiatric expertise was consulted despite evidence of psychosocial distress.

To provide MAiD, clinicians must assess whether the condition is grievous and irremediable, whether death is reasonably foreseeable for Track 1, and whether capacity and voluntariness are present. These are legal judgments layered onto clinical practice, leading to wide variation in clinician interpretation.

Interpretations of “reasonably foreseeable death” vary. Canadian law does not require terminal illness to meet that criterion. Some clinicians consider death foreseeable with a five-year prognosis. Others accept decisions to stop eating, drinking or taking medications as evidence of decline, making death foreseeable.

Social conditions also shape MAiD requests. Patients may seek assisted death after losing caregivers, entering long-term care or when they cannot access palliative or community supports. These situations should trigger aggressive efforts to improve care rather than being reframed as intolerable suffering requiring MAiD.

When people lack supports to live, assisted dying can become a structurally constrained choice rather than a voluntary one. A choice made in the absence of realistic alternatives is different from one made in the presence of robust supports.

Health Canada encourages proactive MAiD discussions and referrals for MAiD by objecting physicians. This creates clinical pathways that subtly direct patients toward assisted death rather than toward expanded care.

Over time, this changes professional identity. Medicine traditionally demands persistence with patients through uncertainty, slow recovery and complex suffering. MAiD introduces a different model, asking clinicians to decide when suffering should no longer be treated and when life may be ended instead. The deeper danger is cultural and professional. With MAiD’s integration into our system, medicine may shift from asking, “How do we treat suffering?” to “When is suffering severe enough to justify death?”

If Canada continues expanding assisted dying, it must answer hard questions. Are we expanding access to death faster than access to care? Are we ending lives prematurely when people could have flourished with adequate suicide prevention and support?

A health system that offers assisted death without ensuring access to housing, mental health care, disability supports, palliative care and community supports risks changing medicine in ways we may not recognize until it is too late.

Doing right by the law, and doing right by our patients: The ‘means available to relieve suffering’ safeguards in MAiD Canadians deserve access to robust and timely responses to their MAiD inquiries. Most important among these are conversations and supports intended to relieve suffering, that may ease or address the person’s desire to die.

And Kevin McKenna also strikes an important note:

The Scottish Parliament voted firmly last night to reject Liam McArthur’s Assisted Dying bill. It’s the third time legislation such as this has been defeated in the devolved era. Mr McArthur now says he’ll continue the struggle.

On the day a politician tried to impose a culture of death on Scotland, we were reminded once more of the state’s contempt for the living. A year after the country’s first drug consumption facility was opened, we learned that deaths from addiction in Scotland have risen by 8%.

When Scotland was first revealed to be the drug death capital of Europe, the outrage and sense of national shame dominated the national conversation for months. Now, we have become so numb to their effect that we simply shrug, look down and shuffle away. The annual increases in premature deaths of our most vulnerable people is one of the Scottish Government’s most catastrophic failures.

Last year, they were offered the chance to remedy this by passing the Right to Recovery Bill. Instead, the SNP and the Bearsden Bolsheviks in the Scottish Greens chose to reward the addiction quangos and the sprawling executive class that feeds on them.

Many of those who had voted in favour of Mr McArthur’s bill were responsible for killing the Right to Recovery bill. There’s grim symmetry in this. The addiction death numbers laid bare how the professional hand-wringers at Holyrood really view Scotland’s marginalised people. By choosing to allow them to keep themselves topped up with Class A narcotics the Scottish Government tells them that their lives, quite literally, are worthless. This was underscored a few months later when many of them chose to reject Ash Regan’s Prostitution Bill.

The people whom these laws would have protected are those most at risk of feeling worthless. They have no advocates. There’s no one to tell them that they’re valued and worthy of love in a country which denies them basic support and protection. As such, they’d have been among those most at risk of Liam McArthur’s icy tap on the shoulder.

Within minutes of his suicide bill being rejected by Holyrood, a nauseating narrative began predictably to emerge. You’d better get used to it. This was Holyrood at its finest, we’ll be told. The contributions from the floor were sensitive and thoughtful. It was so, so emotional. Look at the nice, kind politicians: people in their families get sick and die too. Bless them.

Let’s be honest here: there was little that was uplifting about this at all. It was a sickening display of narcissistic exceptionalism. A cohort of affluent, middle-class actors seeking group hugs and sympathy by weaponising the deaths of their loved ones to make a bad law that would principally target those with none of their choices and privileges.

And besides: how heartfelt can it be when you can’t speak about it without recourse to notes that have been diced and spliced by the party advisory? Do they think the pain of seeing their family members’ dying occurs at a level above and beyond that endured by millions of families without the resources and funds to choose a neat and tidy, pre-packed death?

In other countries where Assisted Dying has swollen to become a state-sponsored instrument of eugenics, the feeling of being a burden on your family and society has featured heavily in those seeking death. Those living in multi-deprivation, or who feel dehumanised by a violent partner (usually male) are especially vulnerable to these feelings.

Those living with the reality of mental and physical impairment also face jeopardy. When cost considerations are factored into our valuation of human life, the vulnerable and infirm, especially those with no-one to speak for them, begin to feel that their existence is subject to the approval of the state.

The Glasgow Disability Alliance, like all the other groups representing disabled people, opposed this bill. They said it would “mark a huge change in society and create an existential threat to disabled people”.

If you’re inclined to join the adulation and emotionalism about how our MSPs conducted themselves last night, consider this: 57 of them chose to disregard the lived experience and fears of Scotland’s disabled community and voted instead for a primitive bill that would have made these people feel less human.

If you encounter any of these 57 during the Scottish election, feel free to quiz them on this. Most of them will talk about social justice and health inequality and homelessness and child poverty during their hustings events. Ask them how they reconcile this with their eagerness to back legislation which would, inevitably, come for those living the reality of such conditions.

The arrogance of LibDem MSP Liam McArthur became a factor in the failure of his bill. In his overweening confidence he and his supporters rejected qualifications that might have made it palatable, such as provisions for conscientious objection of healthcare professionals or specialist training in identifying coercion. Hospices and care homes would not be permitted to opt out from offering suicide.

This betrayed the fundamental inhumanity at the root of Mr McArthur’s bill. Some Christian churches operate several of these facilities, representing a significant cost saving to the state. He and his supporters would rather see these shut down than countenance any resistance to the state’s diktat.

Those hoping that Scotland can now concentrate on improving palliative care for those approaching the end of their lives are kidding themselves. This country’s ruling elite have consistently refused to help the living who are suffering the ravages of addiction and women driven into prostitution by poverty and male cruelty.

Do you really think that the Scottish Greens and the SNP will spend money on helping those at the end of their lives? Behave yourselves. Assisted Dying was always an attractive, cost-effective alternative than having to spend money on people they loathed when they were in good health.

I pity Liam McArthur. What a bleak existence he must lead. Imagine studying hard to gain your honours degree at one of the world’s finest universities and then labouring for years to persuade the public that you’ll serve their needs better than your opponents. And when you become a decision-maker in your country’s legislative chamber, you dedicate five years of your life to this desolate and barren undertaking.

Mr McArthur has pledged to continue his campaign. I would entreat him instead to use his talents and privileges improving the lives of the living, especially those lacking influence, money and basic human dignity.

But writing from Canada, Jonathon Van Maren is much more upbeat:

On Tuesday, the Scottish Parliament voted to reject a bill to legalize assisted suicide in a 69-57 vote, with one abstention. The failure of the suicide bill comes after a massive push by euthanasia campaigners to shepherd the legislation across the finish line; just days ago, sponsoring MSP Liam McArthur insisted that the bill was “bullet-proof” after 175 amendments were accepted during the final week of deliberations.

This is the second major loss for suicide campaigners in less than six months, with another significant defeat likely looming. On November 23, Slovenia’s assisted suicide law was overturned by national referendum after a stunning campaign reversed public opinion in less than two months—53% of those who participated voted against assisted suicide. Meanwhile, Labour MP Kim Leadbeater’s assisted suicide bill is tied up in the House of Lords, with over 1,200 amendments tabled and time running out.

Assisted suicide—always referred to by soothingly Orwellian phrases such as “medical assistance in dying”—is broadly popular according to polling in most Western countries. Suicide groups and their political allies quote these data relentlessly. But over the past decade, an indisputable case study has loomed large over the debate: Canada.

In 2016, Canada legalized assisted suicide for adults with “enduring and intolerable suffering” and a “reasonably foreseeable death.” But safeguard after safeguard was torn down by the House of Commons and the courts; in 2021, assisted suicide was legalized for those struggling with mental illness (a law to stop this practice is being debated in Parliament). Canada is on track for 100,000 euthanasia deaths by this summer and has become an international cautionary tale.

Scottish MSPs who voted against the bill cited Canada’s grim expansions —which have been condemned by the UN Committee on the Rights of Persons with Disabilities—as one of their key fears. Canada was cited by the Church of Scotland in its opposition to the bill. Inclusion Scotland, one of the disability rights organizations opposing the bill, noted that “in Canada … we note with concern that there has been divestment in palliative care facilities in favour of medical assistance to die.”

The Royal College of Physicians of Edinburgh noted in a statement (quoted in an open letter signed by a range of Scottish luminaries and published in The Herald) that the Canadian example exposes the likelihood of future expansion:

The College is very concerned to note the speed with which Canada has moved from legislation similar to the proposed Assisted Dying Bill to legislation which allows euthanasia by lethal injection for individuals irrespective of capacity and irrespective of terminal illness.

Scottish MSPs heard horror stories directly from Canadians. Last spring, Alicia Duncan of British Columbia traveled to Scotland to tell her mother’s story. In 2020, Donna Duncan suffered a concussion after a car accident; her mental health suffered, and her daughters found out she was scheduled for assisted suicide in October 2021, just two days before she was scheduled to be killed. They managed to commit her to a psychiatric ward, but after forty-eight hours, Donna was assessed again and killed four hours later.

Because Donna had been starving herself, she was determined to have a “reasonably foreseeable death” and thus be in the same category as someone who was terminally ill. “The Scottish bill echoed many of these same standards, and in some areas appeared even weaker,” Duncan told me. “Safeguards that appear clear on paper can become dangerously subjective in practice, particularly for vulnerable people.”

MSPs were horrified by her story. “It was a very emotional meeting,” she told me. “They were shocked, and very grateful for my testimony. One MSP and I spoke of her concerns about coercion, which I had also emphasized. Another had tears in her eyes as I spoke. It’s one thing to look at a bill, but it is another to hear the real-life implications and the trauma it can cause others.” Alicia Duncan was diagnosed with PTSD after her mother’s death.

Suicide campaigners in Scotland faced pushback from across civil society. Organizations raising concerns about the bill or opposing outright included the Royal College of Psychiatrists in Scotland, the Royal College of GPs Scotland, the Association for Palliative Medicine, the British Geriatrics Society, the Royal Pharmaceutical Society, the Medical and Dental Defence Union of Scotland, the Royal College of Physicians and Surgeons of Glasgow, Alzheimer Scotland, and the Glasgow Disability Alliance, among others.

The failure of Scotland’s suicide bill is significant. Scotland is very secular and notoriously progressive. But with incontrovertible case studies illustrating where suicide regimes inevitably lead—Canada being the most prominent among them—resistance to assisted suicide bills has stiffened as politicians are forced to confront the consequences of their votes. Suicide campaigners who countenance safeguards because they see new laws as merely a first step to a more permissive euthanasia regime are seeing their soothing lies confronted with cold hard truths and mounting corpse counts.

Thank God that MSPs in Scotland and voters in Slovenia saw that clearly. Now, it is time for the House of Lords to terminate Kim Leadbeater’s deadly bill. A defeat for the suicide campaigners is a victory for the vulnerable.

And writing from England, Robert Clarke is delighted:

On Tuesday evening, the Scottish parliament voted 69 to 57 to reject the Assisted Dying for Terminally Ill Adults (Scotland) Bill. There was respect in Holyrood for the enormity of the question – and firm resolve when it came to answering it. The message sent by MSPs is one that every MP in Westminster needs to hear.

Scotland’s rejection of assisted dying is particularly significant considering the political makeup of its parliament. More than 70 per cent of seats in Holyrood are held by centre-left or left-wing parties, which tend to be more supportive of assisted suicide. Yet the bill was defeated across party lines, by MSPs who examined the evidence and concluded that no amendment had made it ‘safe’. It was a vote for our common humanity, for hope over despair.

What killed the bill was scrutiny. When it passed the committee stage last year, the margin was 70 to 56 in favour. Over the months that followed, as MSPs confronted the detail, support faded. By the final debate, the leaders of all three of Scotland’s largest parties opposed it. The pattern is clear: the closer you look at assisted-suicide laws, the harder they are to support.

Jeremy Balfour, an independent MSP who was born with no left arm and a right arm that ends at the elbow, gave one of the standout speeches of the evening:

‘Imagine being told by many people, including a number of politicians, that you are a burden on society, and the benefits that you rely on to survive could be better spent elsewhere. I want you to imagine that you’ve heard on numerous occasions the words, “I’d rather die than live like you”. How do you think you would feel watching this debate? I think you would rightly feel terrified.’

Balfour’s fear is not hypothetical. Supporters of Kim Leadbeater’s assisted-dying bill, which is currently being debated in the UK parliament, like to cite Oregon’s Death with Dignity Act as a model for Britain. This has now been in place for over 25 years. In its early years, around a third of assisted-suicide patients cited being a burden as a concern. By 2019, that figure had risen to nearly 60 per cent. In 2022, one third of Canadians who ended their lives under the country’s Medical Assistance in Dying law cited ‘being a burden’ as among their reasons. This is hardly evidence of autonomous choice. Vulnerability is driving these decisions.

The Scottish result reflects a trajectory we are seeing internationally. In Slovenia last November, voters who had backed assisted suicide in a 2024 referendum rejected the actual legislation once they saw what it contained. In Westminster, the Leadbeater bill passed the Commons, but it is now stalling in the Lords under growing opposition. The longest-serving MPs have tended to be the most consistently opposed to assisted dying. The more legislators learn, the clearer their opposition becomes to these laws.

The public polling that proponents of assisted dying lean on so heavily deserves the same scrutiny. Dignity in Dying has made much of polling that suggests a majority of Brits support assisted dying. But a different picture emerges when you dig into the data. More in Common found that, while only 13 per cent oppose assisted suicide in principle, 58 per cent are concerned that elderly people may seek it out because they feel like a burden, or because they are pressured into it. This reflects sympathy for an abstract idea that erodes when real consequences are exposed.

The Leadbeater bill now seems certain to run out of parliamentary time – there remain more than 850 amendments to be debated in only five allocated sitting days. Its supporters will no doubt blame the clock for its failure. But bills that command real confidence get moved through – indeed, it is telling that the Labour government has refused to allocate it anymore time. The Leadbeater bill is stalling because parliament is doing exactly what Holyrood did: examining the detail and finding it unsafe.

Scrutiny is what will kill assisted dying: the case against these laws only gets stronger the longer you look.