The Assisted Dying for Terminally Ill Adults (Scotland) Bill.

College Statement on The Assisted Dying for Terminally Ill Adults (Scotland) Bill.

Introduction

The Royal College of Physicians of Edinburgh has no organisational position on the issue of assisted dying[1] in Scotland. We are aware that Fellows and Members have a diverse range of views, as do clinicians across Scotland and the rest of the UK. This was reflected in a 2020 BMA membership survey which indicated that 50% of doctors supported changing the law on prescribing drugs for eligible patients to self-administer to end their own life, but only 36% would participate in any way in the process. The survey found that BMA Members in Northern Ireland were generally more opposed than those in the other nations, but that no significant differences were found between members in England, Scotland and Wales.

As such, our role is neither to support nor oppose attempts to introduce legislation regarding this issue. However, we believe we should and can provide information that informs the professional, public and political debate on the matter.

We believe that the absence of any organisational position should make the information we provide explicitly impartial, and thus, trusted.

Proposed legislation on any matter must be open to detailed scrutiny and related debates be well informed. The purpose of this statement, which we intend to be the first of several, is to inform those debates, specifically by trying to ensure that relevant information is as widely available as is possible.

Specific points

1. In November 2022, a report entitled “Assisted Dying For Terminally Ill Adults (Scotland) Bill – Medical Advisory Group Report” was published. The report is detailed and includes references to the consultation responses and international perspectives. It was commissioned by the sponsor of the Bill, Mr Liam McArthur MSP. Its purpose was to explore issues relating to medical practice that might stem from introduction of Assisted Dying. We would recommend that all interested parties read and consider this document in its entirety.

1. The organisation Our Duty of Care has issued a response to the report. We would recommend that all interested parties read and consider this document in its entirety.

1. Doctors from a wide variety of clinical specialties are members or Fellows of this College. We would note that the proposed legislation in Scotland will affect them all. Whilst individual doctors will able to decline to participate in the assisted dying process, they will “have a duty to provide the patient with enough information to seek out another practitioner willing to provide the service (the ‘duty to refer’) or to a care navigator service.” As such, we would recommend that all doctors in clinical practice in Scotland form a view on the proposed legislation on the basis of this potential level of involvement.

1. Some of our members and Fellows are from the specialty of palliative care. A survey of palliative care specialists in Scotland was recently published and we would recommend that all interested parties read and consider this document in its entirety.

1. Professor Leonie Herx recently spoke at a meeting in Scotland about the experience of “Medical Assistance in Dying” in Canada. First introduced in Canada in 2016, the numbers of patients dying following MAiD rose to 10,000 in 2021, comprising 3% of all deaths in Canada that year. A media commentary on her perspective was published in the Herald.

1. Dr Cameron McLaren, a Medical Oncologist in Melbourne, Australia, spoke about his involvement in physician administered dying in this article in Australia’s The Age. 

The Assisted Dying for Terminally Ill Adults (Scotland) Bill is expected to be introduced to the Scottish Parliament imminently where it will begin to be examined in Committee.

[1] Note – we appreciate that there is not agreement on the use of the word “dying” or “suicide” in this context, but use “dying” here as this is the word used in the current Bill.