Three powerful reasons why Scotland's Assisted Dying Bill should not be passed
Compassion cannot justify bad law and the current Bill falls short over conscientious objections by healthcare staff, protections against coercion, and cost
The issue of assisted dying has returned to the Scottish Parliament, and will dominate proceedings this week and next. At this stage, MSPs are not deciding the broad principle – that debate has already taken place. The question now is whether the specific legislation before them – Liam McArthur’s Bill – is sound, workable, and capable of protecting the public.
On that test, the Bill falls short. In its current form, it risks creating profound consequences for some of the most vulnerable members of society while placing medical professionals in ethically and practically difficult positions.
Support for assisted dying often arises from compassion. Many people have witnessed the suffering of loved ones during terminal illness and wish to prevent it. The principle of personal autonomy – that individuals should control decisions affecting their own lives – also carries significant weight. From this perspective, the case for assisted dying can appear compelling.
Subtle pressures of the real world
Yet the responsibility of legislators is not to craft laws around emotionally compelling cases alone. Laws must function in the world as it exists, with all its complexities and inequalities. Scotland, like every society, faces persistent social challenges that shape how individuals experience illness, vulnerability and dependency. Any legislation governing assisted dying must account for these realities.
One of the central weaknesses of the McArthur Bill lies in its assumptions about human decision-making. The legislation assumes that individuals make choices in isolation, free from external pressure. In reality, decisions are shaped by relationships, financial pressures and subtle expectations from those around us.
This is particularly significant for people facing serious illness. Individuals approaching the end of life may fear becoming a burden – emotionally, practically or financially – to their families or the healthcare system. Such feelings do not need to be explicitly expressed by others to influence a decision. Often the most powerful pressures are those that remain unspoken.
Coercion can be hard to detect
Supporters of the Bill argue that safeguards exist to prevent coercion. The legislation requires a medical practitioner to confirm that a request for assisted dying has not been made under pressure. However, the difficulty lies in the lack of detail about how such assessments are supposed to work.
The Bill requires doctors to rule out coercion but provides little guidance on the training, procedures or evidentiary standards required to do so. This omission is significant. Experience from other areas of law demonstrates how difficult it can be to detect coercion in practice.
During the passage of the Domestic Abuse (Scotland) Act 2018, specialists repeatedly emphasised that coercive control is notoriously difficult to identify. Victims often deny abuse when asked directly, and recognising patterns of control frequently requires specialist training and sustained engagement.
The “safeguards” in the proposed assisted dying legislation fall well short of this level of scrutiny. A system relying primarily on brief medical assessments cannot realistically claim to detect subtle or indirect forms of pressure. Given the gravity and irreversibility of assisted dying, this represents a serious weakness in the Bill’s framework.
Conscience, faith or ethical beliefs
Another concern relates to the issue of conscientious objection among healthcare professionals. Earlier drafts of the Bill contained provisions allowing medical practitioners to refuse participation in assisted dying procedures on grounds of conscience, faith or ethical belief. Amendments now propose removing this section from the Bill itself.
In practice, this risks exposing healthcare workers to pressure to participate in assisted dying processes. For many doctors and nurses, involvement in ending a patient’s life conflicts with deeply held beliefs. Without clear statutory protections, some could face professional disadvantage for refusing to take part.
Supporters of the amendment argue that protections for conscientious objection will still be introduced later through regulations. However, this approach raises important constitutional concerns. It would effectively transfer responsibility for defining these safeguards to ministers through secondary legislation at Westminster.
Unlike primary legislation, secondary legislation cannot be amended by parliamentarians. MPs are presented with a simple choice: approve or reject the regulations. In practical terms, this means that crucial safeguards affecting the rights of healthcare professionals would be drafted by civil servants and implemented with limited parliamentary scrutiny. For such a significant change in law, that is a troubling precedent, both democratically and constitutionally.
Another financial pressure on hard-pressed NHS
There is also considerable uncertainty about the financial implications of the policy. Although the Bill is accompanied by a financial memorandum, Neil Gray, the Cabinet Secretary for Health and Social Care, has suggested that the actual cost of implementing the system will exceed the figures currently provided. At the same time, government correspondence indicates that any expenditure would be drawn from the existing NHS budget.
In practice, this means resources would need to be diverted from other areas of healthcare. At a time when health services across Scotland face severe pressures – including staff shortages and long waiting times – introducing a new programme with unclear financial implications carries obvious risks.
Taken together, these concerns lead to a clear conclusion. At this stage, MSPs must focus not on the abstract principle of assisted dying, but on the practical question before them: whether the Bill provides a safe, coherent and democratically accountable framework for such a profound change in the law.
By that standard, the McArthur Bill falls short. Its safeguards against coercion are weakly defined, protections for healthcare professionals are left to secondary legislation, and the financial implications remain uncertain.
When the Bill returns for its final vote, MSPs should judge it on the quality of the legislation itself. On that test, the Bill before Holyrood does not meet the standard the Scottish public should expect.
Murdo Fraser is a Scottish Conservative MSP for Mid-Scotland and Fife
Comments
Want to join the conversation? Please or to comment on this article.