Political Editor Alistair Grant and Political Correspondent Rachel Amery sit down with Liam McArthur MSP to discuss his assisted dying legislation.
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00:00 Hello, I'm Alistair Grant, the Political Editor of the Scotsman, and we're here in the office
00:10 of Liam McArthur, the Liberal Democrat MSP, whose bill to legalise assisted dying for
00:16 the terminally ill and mentally competent has been officially introduced and published
00:20 today. Liam, it'd be probably quite useful for you to explain exactly what your bill
00:26 does and what safeguards it contains. Well, it's built on a terminal illness mental
00:31 capacity model that we've seen introduced in states and countries around the world.
00:36 Initially in the state of Oregon in the United States, and subsequently in around a dozen
00:42 further states in the US and more recently in Australia and New Zealand. It would provide
00:50 that access to an assisted death for somebody with an advanced progressive terminal illness
00:55 and capacity to make the decision around assisted death. It would require two doctors to make
01:01 that diagnosis of terminal illness and mental capacity. The doctor would also seek to understand
01:07 the rationale, the motivation behind it in order to ensure that there hasn't been undue
01:11 pressure or coercion applied. And also to talk through the range of options that may
01:17 be available, including palliative care, hospice care and the like to make sure that the decision
01:22 being made is an informed one. There would be a residency requirement of 12 months, an
01:29 individual would have to have been resident in Scotland and registered with a GP practice.
01:33 There'd also be a waiting period of two weeks from the point at which the application for
01:38 an assisted death was made to when any medication could be applied. So those are the sorts of
01:44 safeguards as I say that we've seen implemented safely and successfully in jurisdictions around
01:50 the world. No two systems are the same, no two laws are the same, but broadly speaking
01:55 that terminal illness model is one that has been proven successful as I say over recent
02:01 years.
02:02 I mean, what prompted you to do this? Why did you think this was an important bill to
02:06 be bringing forward?
02:07 I've been a long time supporter of a change in the law. I remember sitting in on a members
02:12 business debate that was being led by my former colleague Jeremy Purvis, who sought to bring
02:17 forward his own bill back in the second session of parliament. He couldn't secure support
02:24 in order to introduce the bill, but as a result I think of listening in and participating
02:28 in that debate, Margo MacDonald decided she wanted to bring forward a bill and obviously
02:33 we had that process leading up to the vote in 2010 and then subsequently her second bill
02:39 that Patrick Harvie picked up and we voted on in 2015. Throughout that process I've supported
02:45 those attempts to change the law and it's brought about I think by a recognition that
02:52 the ban on assisted dying is leaving a small but significant number of Scots in an intolerable
02:58 position at the end of life and despite the best efforts of palliative care, they are
03:03 enduring difficult, protracted and often painful deaths. We know that those who have the financial
03:11 means and the physical capacity have the option of going to Switzerland to access the services
03:17 provided by Dignitas, but for many more we know that either they endure this banned death
03:22 or they take matters into their own hands, either refusing food and liquids or else taking
03:28 even more drastic action and that is hugely traumatic both for them but particularly for
03:34 those that they leave behind, whose abiding memory is those final days, weeks and the
03:38 way in which their loved one passed away. You were mentioning the few other times it's
03:43 come to Parliament because this is now the third time that the bill has officially come
03:46 forward. Why is it so much more popular now? The front page of the Scotsman on the Thursday
03:51 that this has been published was a survey saying that 78% of the public are in favour
03:56 of this, so why do you think it's changed so much this time around? Well I think the
04:00 public support has always been there, even thinking back to 2015, there was pretty overwhelming
04:05 public support even then, that's been around I would say for the best part of the last
04:10 two decades. I think the intensity of that support has increased, I think it matters
04:14 more to people and I think that broadly reflects the fact that more and more people have a
04:19 personal experience of losing a family member or a close personal friend in very difficult
04:24 circumstances and it's brought home to them why a change in the law is needed, that the
04:29 ban on assisted dying is failing too many terminally ill Scots. I think one campaigner
04:36 once suggested to me recently that everyone is one bad death away from supporting assisted
04:42 dying, so that public support has been pretty solid for some time now, we see it now across
04:47 every part of the country. I think what's different now is that that's translating into
04:53 greater political support, I think the political mood is changing and it's catching up with
04:58 where the public have been for some time. Some of that is due to seeing legislation
05:03 successfully implemented in other jurisdictions around the world, some of it is to do with
05:08 I think the shift in opinion within the medical community, we see the BNA and a number of
05:13 the Royal Colleges moving from a position of opposition last time to neutrality. They'll
05:18 be challenging, I know they'll have issues on the part of their members, but that position
05:21 in neutrality I think is not insignificant and I think very many MSP colleagues themselves
05:28 have a personal experience of losing a loved one in difficult circumstances and that is
05:33 shaping and influencing the way in which they approach this debate.
05:37 There are high profile figures, Humza Yousaf, Anas Sarwar, who always say that they are
05:42 yet to be persuaded by this. I think Humza Yousaf very recently saying he's not convinced
05:46 by it. How are you going to go about persuading those people?
05:50 I think I need to realise that I won't be able to persuade all of my MSP colleagues,
05:55 I'm confident I can persuade a majority of them to back the principles of the Bill. I've
06:00 had a number of conversations with Humza Yousaf over the last year or so, in fact back to
06:07 the time when he was then Health Secretary. I think by his own admission he's been on
06:11 a bit of a journey but he isn't persuaded. I think if the Bill were to be voted on today
06:15 he would undoubtedly vote against it. I think there's a challenge for me to try and allay
06:21 the concerns that he has and other colleagues have. I will be successful in many instances
06:28 but I know that there are those who have concerns that I will not be able to allay and who will
06:37 not be supportive of the Bill. I think what is interesting is that this is a debate that
06:43 cuts across party political divisions. There are many within Humza Yousaf's party, including
06:49 around his cabinet table and his ministerial team, who have been long-term advocates of
06:53 a change in the law. Many of his backbenchers as well, who in a sense have been leading
06:59 the campaign. Similarly in the Conservative Party and the Labour Party, as well as Greens
07:04 and Liberal Democrats. I think that's a strength of the issue, a strength of the campaign.
07:10 But another aspect of the debate is that it is genuinely and generally being conducted
07:15 in a pretty respectful and measured fashion. That I think is to the credit of both those
07:20 who are supportive and opposed and the very many colleagues who are undecided or conflicted.
07:27 I look forward to continuing in a similar vein over the coming months in an attempt
07:33 as I say to persuade a majority of my colleagues to support the general principles.
07:38 I wanted to ask you as well about comments by Pam Duncan-Glancy, the Labour MSP, who
07:43 is a wheelchair user. She's warned in the past that legalising assisted dying would
07:48 be dangerous for disabled people and she's far from alone in having those kinds of fears.
07:54 What do you say to her and others who are worried about the impact on disabled people?
07:59 Again, Pam is somebody I've been able to have various conversations with over the recent
08:04 times and I genuinely respect her, not just in terms of the issues she prosecutes on behalf
08:12 of the disability community, but more generally she is an enormously powerful advocate. She's
08:18 probably somebody I wouldn't necessarily be expecting to change their views on this issue,
08:23 but the engagement I've had with her has been incredibly useful for me in better understanding
08:29 the root cause of the concerns that she has. I think genuinely that point that she and
08:35 others make about the way in which society doesn't value the lives of many of those in
08:42 the disabled community is spot on. I have some personal experience of that, albeit at
08:48 a removed distance, and I understand that. I think this debate can expose some of those
08:55 issues but it can't resolve them. Ultimately, the only way of accessing an assisted death
09:00 under the Bill I've introduced to Parliament is if somebody has an advanced progressive
09:05 terminal illness and mental capacity. Having a disability wouldn't be a criteria that would
09:14 allow access to an assisted death. However, if a disabled person had a progressive and
09:20 advanced terminal illness and capacity and had chosen an assisted death, I see no reason
09:25 why they should be denied it. I think that would be wholly unacceptable. All the polling
09:31 suggests that actually within the disabled community, the level of support for a change
09:37 in the law in this area is every bit as strong as it is in the population as a whole.
09:42 If we go through just a few of the other points that some people have raised as being potential
09:46 issues coming forward with this. If we go to age, first of all, now remind me is it
09:51 16 that it's proposing from? So if there's a young person who's 15 turning 16, let's
09:56 say, and they do have a terminal diagnosis, is that too young? Are they too young to be
10:01 making that kind of decision?
10:02 I think there'll need to be a genuine debate around this. As I say, I opted for 16 in my
10:07 Bill age of majority, but I fully expect this to be an area that the lead committee taking
10:13 evidence will want to scrutinise. I've had discussions with a range of different stakeholder
10:20 organisations, including Chas, who I know have concerns about age limits. So I'm open
10:26 to having those discussions. I need to, I think, understand the nature of the concerns
10:31 and how they might be addressed. But in a sense, what we're talking about here is a
10:36 process that allows for far more open, regulated and safeguarded discussions around how we
10:46 die. And I think that is to be welcomed. I mean, it will allow a discussion around palliative
10:53 care, which we may come on to cover. But having those discussions about how we die and improving
11:02 the quality of death, I think are absolutely invaluable. We spend an awful lot of time
11:06 in this Parliament discussing how we improve the quality of life. We don't spend nearly
11:10 enough time talking about how we improve the quality of death. And so some of the discussions
11:15 my bill opens up, I think will shine a light on those issues.
11:21 What about some of those with mental health issues? For example, if someone is terminally
11:26 ill but suffers from depression, would they qualify?
11:31 I think part of the capacity assessment is not a general capacity. It is a capacity to
11:37 make the decision around an assisted death and therefore a medical professional would
11:40 need to satisfy themselves. There wasn't an issue there that was impeding that capacity.
11:46 If there was any concern around it, either of the two doctors that would need to make
11:51 the diagnosis could make a referral to a specialist. And those are the sorts of assessments that
11:58 medics are making pretty routinely in terms of, in relation to a range of procedures.
12:04 So I think it is a concern that I understand. It needs to be reflected in the debate that
12:12 we have. If there are other things that can be done in terms of improving the safeguards,
12:17 I am certainly open to hearing what those might be. Although, as I say, if you look
12:22 at the jurisdictions where a terminal illness mental capacity model has been introduced,
12:28 now is there any expansion in those criteria and those sorts of issues around mental health
12:35 are treated sensitively and I think very effectively.
12:39 You mentioned earlier about palliative care, so you are right that is one of our questions
12:42 today. There has been a survey done of palliative care doctors and I think it was about 95%,
12:48 it was a very vast majority, said that they wouldn't want to be prescribing this or carrying
12:53 out this procedure themselves and they have worries about how funding will happen for
12:58 palliative care as well. What are your responses there?
13:01 I think a number of points to make there. I probably wouldn't expect those in the palliative
13:06 care sector to be in the vanguard of campaigning for a change in the law around assisted dying.
13:10 I think that would be unlikely. I think what we have seen in terms of jurisdictions around
13:16 the world is that those that come to it with a degree of anxiety, once they see it operating
13:24 in practice are reassured that it can be and is safely protected using the safeguards I
13:31 have talked about. I think the debate within the palliative care sector as well is a bit
13:36 more nuanced than that. I think in a sense what they want a reassurance around is in
13:43 a sense that the relationship that they have with the patients that they are caring for,
13:48 and again I entirely understand that, but in a sense what we have seen around the world
13:54 is a medical profession who have very legitimate questions. I talked earlier about various
13:59 organisations moving from a position of opposition to neutrality. That neutrality doesn't mean
14:04 that they will not be very challenging in the questions that they ask, and that is right
14:09 and proper. So if there are more things we can do to provide that reassurance, I am all
14:14 for trying to address that. I think some of that though may come through in terms of secondary
14:20 legislation and guidance that will provide the training and the support etc that those
14:25 in the palliative care sector absolutely need to have.
14:29 Are you worried at all about having enough doctors who are willing to carry this out
14:33 because there is a big difference between supporting it and actually being the person
14:37 to carry these procedures out. Are you worried about that at all?
14:42 Again I can't see any reason why that would be a problem in Scotland in a way that we
14:47 haven't seen it being a problem in any of the other states and jurisdictions and countries
14:51 where it has been introduced. As I say I think there would need to be a lead in time prior
14:57 to the introduction to make sure that medical professionals do feel comfortable with the
15:02 role they are being asked to perform. But the numbers that would be involved in this
15:07 in terms of the number of patients coming forward asking for an assisted death, I think
15:12 would be relatively small. I mean they are a small number but a significant proportion
15:17 of the terminally ill and therefore the number of medical professionals that would be actively
15:22 involved in this process is likely again to be relatively small. Now I appreciate that
15:28 beyond that there will be those that are impacted by it, they may not be directly involved but
15:34 will feel that they need reassurance. But as I say I don't see there is any reason why
15:40 the medical profession in Scotland would be any less willing to engage in this process
15:48 subject to I think a conscientious objection that would allow those who really, whether
15:54 for faith reasons or whatever, would have the opportunity to exempt themselves, albeit
16:00 with the requirement that it would be expected to signpost the patient to somebody who could
16:05 actually provide the support that we are looking for.
16:08 One of the arguments you often hear in this debate is this idea of a slippery slope, that
16:12 this is opening up a potentially dangerous can of worms and affecting all sorts of deep
16:18 existential questions about the value of life. What do you make of that argument, that to
16:22 go down this road in the first place is dangerous?
16:26 Well as I say I think what we have seen in all of the jurisdictions where a terminal
16:29 illness mental capacity model has been introduced, there has been no extension of the eligibility
16:35 criteria over the years. There are no two laws around the world that are identical,
16:40 but there are two broad models. There is the terminal illness mental capacity model first
16:45 introduced in Oregon in the late 1990s, subsequently rolled out in a number of, a dozen or so states
16:51 in the US and more recently in Australia and New Zealand. That is the model I am looking
16:57 to introduce here in Scotland. There is then a more expansive permissive model that has
17:04 been in place for some time in the Netherlands, in Belgium and more recently in Canada. And
17:10 while there has been no expansion of the criteria in the terminal illness model, there has been
17:15 no retrenchment from the more permissive models into a terminal illness model. So those circumstances,
17:22 I think each legislature needs to decide what is the approach that commands public support
17:31 in their countries and in their states. There has been no example of a law introduced that
17:37 has then been repealed and I think all the polling evidence in those countries and states
17:42 suggest that they command strong public support. So I think we can learn the lessons from those
17:52 international examples, but we will need to find a way forward on this that meets our
17:58 needs and circumstances. But again, I think the House of Commons Health Committee in a
18:04 report published last month after an 18 month inquiry on these issues recognised and came
18:10 to the conclusion that there really is no evidence of the so-called slippery slope.
18:15 I am sure this is an issue we will be hearing a lot about in the coming months. Is there
18:19 any kind of expectation as to when this law would be passed if it did manage to get through
18:23 Holyrood? I think in terms of managing people's expectations about when I was going to be
18:27 in a position to introduce it, I think my credibility on making those sorts of projections
18:32 is shot to pieces. Obviously, I am very conscious that there are those out there amongst the
18:40 public who are desperate to see this law changed, particularly those with a terminal illness
18:45 or who are caring for somebody with a terminal illness. But the sensitivity, the complexity
18:51 of these issues absolutely demands that Parliament exercises its scrutiny function robustly and
18:58 thoroughly. I have every confidence it will do that. It will go to a lead committee, we
19:03 will take written and then oral evidence before coming up with a stage 1 report that MSPs will
19:08 vote on, in a sense on the general principles of the bill. That is where the previous two
19:13 bills obviously were founded. I hope that now with the shift in the political mood that
19:19 we will get beyond that and we will get into the task of amending the legislation, ironing
19:26 out issues where colleagues have concerns. The sooner that happens the better, but we
19:33 cannot cut corners with this. The time needs to be taken to do the due diligence on it
19:39 to make sure that what we come up with is legislation that is fit for purpose.
19:43 So an understandably lengthy and detailed process ahead. Liam McArthur, thanks very
19:48 much for your time. Very welcome.
19:50 Thank you.