These Concerns Are Not Fringe

Dr Anni Donaldson writes:

MSPs are set to vote today on the highly controversial Assisted Dying Bill, which would allow terminally ill patients to legally end their own lives with a lethal substance provided by the NHS.

The topic is often framed as a matter of autonomy and compassion.

But when the proposed legislation came under scrutiny during the Stage 3 debates in Parliament last week, a hard question arose: How confident are we that every apparent “choice” to die will truly be free?

Of more than 60,000 recorded incidents of domestic abuse in Scotland per year, four in five of the victims are female.

In 2018, Scotland led the way in recognising ‘coercive control’ as a central feature of domestic abuse.

The Domestic Abuse (Scotland) Act rightly acknowledged that abuse is not confined to physical violence. It can involve patterns of psychological domination, isolation, humiliation and dependency often invisible to outsiders, but devastating in effect.

If we know coercive control exists and that it can erode a person’s sense of self-worth and agency, then a conflict exists at the heart of the assisted suicide debate. How can we ever truly be sure that a patient is truly making their own choice and not acting under implicit or explicit coercion?

A patient may present as composed, articulate and settled in their wish to die. But what if that “decision” has been shaped by months or years of being told they are a burden? What if illness has deepened their dependence on someone who exploits that dependence?

These concerns are not fringe.

Recent polling commissioned by women’s policy think-tank The Other Half found that more than half of Scots surveyed agreed that victims of domestic abuse could be pressured into choosing assisted suicide, with that number rising to almost 60 per cent among people with disabilities.

Six out of ten felt current safeguarding systems would not always be able to reliably identify domestic abuse in assisted suicide cases, compared with 17 per cent who disagreed.

Among people with disabilities, 61 per cent agreed that current safeguarding systems were insufficient.

Perhaps most notable, more than twice as many respondents agreed as disagreed that MSPs should reject assisted suicide legislation if it risks facilitating domestic abuse.

During the Third Reading, some well- intentioned amendments acknowledged patients need to be “assessed” to ensure their consent is voluntary. But these only go a small way to safeguarding the issue.

Meanwhile, those amendments that would have gone much further to enforcing the quality of these assessments have been rejected.

MSPs voted against Rhoda Grant’s proposal to ensure mandatory training for professionals involved in an assisted suicide, including specific training on identifying coercion and safeguarding disabled people and those with communication impairments.

What if that wish to die has been shaped by months or years of being told they are a burden?”

Stephen Kerr’s proposal to have government guidance ensuring explicit safeguards against coercion was also rejected, as well as his submission requiring professionals to “comply with” coercion-safeguarding guidance, rather than “have regard” to it.

The bill seriously lacks teeth. Superficial nods to safeguarding may salve the conscience of MSPs voting for this deadly law, but they will not prevent all victims of abuse from slipping through the net. It’s clear how the public feel about that.

Pressure from caregivers isn’t always malicious; often it is subtle or unintended.

That makes it notoriously hard to detect. But the consequences can still be devastating.

Oregon’s 2021 report on its assisted dying regime found that more than half of those who died by assisted suicide cited feeling like a burden on family, friends or caregivers as an end-of-life concern.

Physical pain was reported far less often than social or existential worries, such as loss of autonomy or dignity.

This pattern appears elsewhere.

A systematic review of studies from multiple assisted-dying jurisdictions found that between 19 and 65 per cent of terminally ill patients report feeling like a burden, a concern strongly linked to wishing to hasten death.

These findings suggest that assisted-dying decisions are often shaped less by pain than by powerful social and relational pressures. These dynamics are usually complicated, embedded and hard to detect.

This week, MSPs approved an amendment which would allow assisted suicide consultations to take place on Zoom.

The idea that an online exchange can undo the work of months or even years of sustained coercion is laughable.

MSPs must truly weigh up a matter of life and death.

If one person loses their life because they were coerced into an assisted suicide, that is one person too many.

MSPs must take responsibility to protect vulnerable Scots. / The only way to do so is reject this Bill outright, with a resounding “no”.

And Fiona Hamilton writes:

A peer and disability rights campaigner has emphasised the “inherent value of every single life” as she spearheads a last-ditch attempt to overturn the government’s abortion reforms.

Baroness Monckton of Dallington Forest claimed that the landmark legislation had not had enough public scrutiny and that there had not been enough consideration of the unborn child. She raised concerns about the risk that women would be coerced into late-term abortions, and that they would be vulnerable and alone during the procedure.

In June, the Commons passed the biggest change to abortion laws in a half a century, meaning that women would no longer be prosecuted for having a late termination. The measures are being scrutinised in the Lords this week — and Monckton, a Tory peer, has proposed an amendment that would block them.

“I think what really struck me was the fact that it only had 46 minutes of backbench time in the House of Commons,” she told The Times.

“There was no due diligence, there was no impact report, absolutely nothing. And it suddenly appeared, tacked on to the Crime and Policing Bill. There’s a very strident group of people [backing the law] and a lot of the Royal Colleges [of medicine] are for it.

“They say we should decriminalise women. In all the reports I’ve read, I have not read anything about the other person involved in this. I haven’t read about the child. But I think not only are we removing the life of the child, we’re removing the protection for the mother.”

Abortion is currently admissible in the first 24 weeks of pregnancy if certain criteria are met, and allowed after the usual time limit in the case of evidence of severe foetal anomaly, or if the pregnancy significantly threatens the mother’s life.

After the vote, women who terminate a pregnancy past 24 weeks, or without approval from two doctors, will no longer be criminally investigated or charged. However, anyone who assists a woman in getting an abortion outside of the law, including doctors, could still be prosecuted.

Supporters of the reform say that the fear of police action currently keeps women alone and, if something goes wrong, they will be more likely to seek medical help if there is no threat of prosecution. They say that abortion after 20 weeks makes up 0.1 per cent of all cases, largely due to serious medical reasons, and a criminal sanction is not in the public interest.

Monckton and other opponents, however, insist the changes leave women vulnerable. Because women can obtain pills through the post — a measure brought in during the coronavirus pandemic — Monckton believes there would be an increase in the number of late-term abortions. Women would be alone, she said, because prosecution still applied to medics and others who help, but after 20 weeks there were increased chances of complication using the pills.

“At home, on their own, with no medical support, nobody allowed to be with them — the poor woman,” Monckton said.

Monckton had a daughter, Savannah, before experiencing a stillbirth in April 1994, when she was supported by her close friend, Diana, the late Princess of Wales, who arranged for the baby, Natalia, to be buried in a walled garden at Kensington Place. The “hideous” experience has shaped her views, she said.

“You don’t really recover. It’s always with you. If you’re doing it deliberately … that’s desolate.”

Monckton’s other daughter, Domenica, 30, was born with Down’s syndrome. Diana became her godmother.

Monckton has been lauded for her campaigning work, and her charity, Team Domenica, helps young people with learning disabilities find and retain meaningful employment.

“What it teaches you is the inherent value of every human life,” Monckton said. “None of us are in any position to judge. My daughter is the happiest person I know a lot of the time.”

Monckton, a Catholic who is anti-abortion, says the tiny numbers of women who have been investigated and prosecuted for late terminations shows that the current law is working. She strongly believes the bill is a “seismic change” that has not been properly considered.

“It’s the viability. You can’t get away from the fact that this is a precious life. Every poll [shows] it’s against what the public think is right as well.”

While supporters say it is a moderate change, because it involves a small number of people, Monckton warns that “I do think it will be more. And the women are putting themselves in real danger as well.”

She also fears it will result in the coercion of women into late terminations by abusive partners.

“I think people see this as progress,” Monckton said, “and I see it as a very regressive step. How can a parliament responsible for making laws be so laissez-faire about such a seismic change?”

A vote in the Lords is expected on Wednesday.