Questions and answers

What is assisted suicide?

Assisted suicide occurs when someone is helped to end their own life by suicide. The Bill allows for this to happen when it is the pre-declared wish of an adult of sound mind who is suffering from a terminal or life-shortening illness or condition which is causing intolerable distress.

Assisted suicide means the patient must be able to take the final step independently – that is to take, without help, a fatal dose of medicine provided by the person assisting. This means that no patient will be killed and no one will be put in the position of killing another person.

Who would be eligible for this procedure?

A Preliminary Declaration could be made by any registered patient 16 years or over. It would be retained in their medical records and quite possibly might never be acted upon. The patient could be in good health when making the Preliminary Declaration, but only those suffering from a terminal or life-shortening illness would be able to receive assistance to die by suicide. Two doctors would be required to certify eligibility. This would take into account a number of factors including the patient’s medical condition, their mental capability and the need to confirm that this was the patient’s settled will.

What safeguards would there be?

A number of safeguards are proposed to ensure that only those suffering from a terminal or life-shortening illness could undertake this process. They include:

Patients who wish to request assistance in ending their own life by suicide must complete three different stages to ensure they have fully considered their request.

We want to ensure that the Bill applies only to the people intended, and that sufficient safeguards are in place to protect vulnerable people. If you have additional suggestions, please email us.

What role would a doctor have?

A doctor’s role would be to provide information and decide, along with another doctor, if the person was eligible to proceed. They would not administer any life-ending drugs – that could only be carried out by the person concerned.

Doctors will have the absolute right to decline to be involved with the process, but will be asked to pass on any request to a colleague who would be willing to help.

Nurses or doctors who have cared for the patient would be barred from acting as witnesses for any of their statements.

When could this become law?

We hope that the Bill will be considered by the Health & Sport and Justice Committees of the Scottish Parliament before summer 2014. Assuming the Bill proceeds through all of its stages, it could become law in the first half of 2015.

Is what you are proposing not just euthanasia?

No. Euthanasia is when any person, including a doctor, takes action that directly causes the death of a patient. Not only do we not propose this, but the Bill also makes clear that euthanasia will remain a criminal act.

Assisted suicide requires the patient to be the one who takes the final action that ends their life. This may be pressing a button which administers a lethal drug or by other means.

Surely this legislation will lead to a “slippery slope” and lead to doctor assisted euthanasia?

The Bill is very focussed in what it allows. Any hint that the correct procedures were not being observed in an individual case would mean that the process would cease immediately.

Evidence from Oregon reveals that there has been no dramatic increase in numbers requesting assistance, from 16 in 1998 to 77 in 2012. This accounts for only 23 deaths out of 10,000 total deaths. Of 115 people who requested a prescription in 2012, 23 did not take the medicine and died of other causes.

This law will be used to intimidate older people into asking for assistance in committing suicide.

Relatives are specifically prohibited from witnessing any of the statements that a patient must provide. In addition, if a doctor formed the view that relatives were intimidating a patient, they would refuse to endorse the process.

It is not fair to put pressure on doctors who do not wish to help a patient commit suicide.

The Bill specifically prohibits doctors from doing anything to cause another person’s death. Doctors will only be asked to provide their opinion on the capability of a patient in a number of ways.

Doctors will have the absolute right to decline to be involved with the process, but will be asked to pass on any request to a colleague who would be willing to help.

It will be too easy to take advantage of vulnerable patients.

We believe that the safeguards that are being proposed with regards to the competence of the patient are adequate, and it is imperative that this is the case. If you feel there are additional conditions to be considered, then please email us.

This is the first step to state-sanctioned euthanasia.

Euthanasia, a doctor administering life-ending treatment, is prohibited by existing law, and it will remain so under our proposals. The Bill is tightly defined as to what can and cannot be done, and by whom.

Assisted suicide is against biblical teaching.

We understand that assisted suicide raises profound moral questions, but we believe they are for each individual to consider. Someone who feels it would be against their beliefs would obviously not wish to take this action but we believe those who do not share that view should be allowed to act according to their own moral beliefs.

Is Assisting Suicide compatible with medical ethics?

The decision as to whether or not life is worth living is made entirely by the patient. At the end of life, some people feel that the combination of weakness and dependence, and the impairment of bodily functions, perhaps combined with distressing physical symptoms, results in an unacceptable loss of dignity.

Assisted suicide is not euthanasia, and doctors will not be asked to do anything that contravenes their oath. Modern medicine occasionally brings a doctor’s obligation to preserve life into conflict with their inability to relieve a patient’s intolerable suffering.

It will be for each doctor to decide if their patient’s considered wish to end their life is appropriate, and something they can support. It may be more harmful to compel a patient to endure excessive distress than to provide them with the means to relieve it, but we believe the patient must be able to make choices about their own life and death.

What training can be sufficient to prepare the friend at the end proposed in the Bill to cope with the level of responsibility?

It will be for the Scottish Government to ensure that there is appropriate training for the facilitators and they must ensure a strict licensing regime. Licenses will be able to be revoked should facilitators act improperly.

Research undertaken during the preparation of this Bill included international comparisons. Facilitators (or friends at the end) operate very successfully in Switzerland, and we hope that any Scottish model would follow similar lines.

Approximately 20 Registered Celebrants of the Humanist Society Scotland have expressed an interest in applying to become Licensed Facilitators.

Will there be sanctions for doctors, nurses, or pharmacists who refuse to participate in the process?

No.

Who will decide what constitutes a terminal or life-shortening condition?

A patient will have to state clearly – on two separate occasions – that they believe they have a terminal or life-shortening condition. The first “Preliminary Declaration” can be made by someone who is in good health. Two doctors acting independently at stages 2 and 3 will also be required to state in writing that they believe the patient suffers from such a condition. You can find out more on the stages of the process here.

This will see Scotland becoming a “suicide tourism destination”, along with other countries such as Switzerland.

This is certainly not our intention and we would be happy to consider an amendment to the Bill to specifically rule this out. We believe that it is up to every individual jurisdiction to make its own judgements on what reflects the wishes of its own citizens.

The Bill sets out a process, which includes an initial registration with a person’s local GP, and that registration would be held with the person’s medical notes. This process alone means that it is highly unlikely that anyone could simply make a journey to Scotland to end his or her life.

If there are any questions that we have not answered then please contact us – we will answer any question as best we can, and be honest as to what we are proposing.

How will assisted suicide affect the relatives of those left behind?

Dame Cicely Saunders, one of the pioneers of the Hospice movement, said: “How people die remains in the memory of those who live on.”

Our campaign knows people very grateful that a loved one has had a peaceful death in the company of the family after saying their goodbyes, but also those other relatives who, sometimes having spent long hours at a hospital bed, have been advised to go home, only to receive a phone message to a few hours later that the patient has died.

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