Support for assisted dying in Scotland could translate into legislation

The New Year brings the likelihood of assisted dying legislation being debated by the Scottish Parliament. Will Scotland be the first of the four UK nations to legalise assisted dying?

The consultation on the proposed Assisted Dying for Terminally Ill Adults (Scotland) Bill closes on 22 December 2021. While we are some way off the Bill becoming law, there has been a shift in attitudes in Scotland on this issue. Previous attempts to change the law in Scotland in 2010 and 2013 both failed. The prospects now are different: although this is a private member's Bill, MSPs including the former health minister have voiced their support.

The Bill would allow a person suffering a terminal illness to end their life, by means of medication provided for that purpose by a doctor. The individual would sign a declaration in the presence of two doctors – the "attending" doctor and an "independent" doctor. The attending doctor is the doctor from whom the person has requested assistance to end their life. 

There will undoubtedly be many impassioned responses to the Bill from those on both sides of the argument. One aspect that will perhaps get insufficient attention is the impact this will have on medical professionals.

The proposal is that two independent doctors must agree that the person has a terminal illness, has capacity to make decisions, and has reached a clear and settled intention on an informed basis, without coercion or duress. While doctors can be reasonably expected to answer the first two questions, how are they to interrogate the third? What if the patient disagrees with their assessment; can their decision be challenged? What of families who may disagree? Could this leave doctors open to litigation or regulatory action? Courts find the concepts of duress and coercion complex enough – how are doctors to address them?

What about a doctor who does not wish to engage in such a discussion? The consultation document indicates that doctors can conscientiously object to participating. However, General Medical Council (GMC) guidance indicates that a doctor's personal belief must not deny patients access to appropriate medical treatment or services, or cause patients distress. Will the GMC agree that conscientiously objecting does not amount to a breach of their professional duties, even if they are the attending doctor?

It will be important that draft legislation is accompanied by careful consideration of the impact on the medical profession by the GMC. And if Scotland leads, how long until England follows?

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