Liam McArthur's opening speech in Assisted Dying debate

Please find below Liam McArthur's opening speech in this afternoon's assisted dying debate.

Almost four years on from announcing my intention to bring forward a bill to allow terminally ill, competent adults the choice of an assisted death, parliament finally has the chance to debate and vote on the general principles of that bill.

I confess I don’t recall having felt this nervous since I gave my maiden speech back in 2007.

Not because this will be – by some margin – the longest contribution I’ve ever made in this Chamber over 18 years as an MSP, though that is a thought.

But because I know how much this bill matters to those dying Scots and their families who are desperate to see the law changed to allow more choice, compassion and dignity at the end of life.  

And it’s their voices - their needs, their interests - that must be at the centre of this debate; at the heart of our considerations; and at the forefront of our minds as we come to vote later this evening.

I know there are colleagues – across this Chamber – who feel conflicted; who are wrestling with many profound, complex and sensitive issues; and who are anxious about making the wrong decision.

That is entirely understandable.

But the decision we’re being asked to make here is not on the final bill; it is on the general principles of a potential change in the law and whether parliament should be given more time to see if it can agree a bill that commands majority support.

If you simply believe a change should not happen – on the basis of faith, or whatever other reason – I regret but respect that.

However, if you accept that the current ban on assisted dying is resulting in too many bad deaths, traumatising patients as well as family and friends left behind.

If you recognise that legal uncertainty is placing patients, families and medics in an invidious position.

If you believe in the principle of allowing dying Scots more choice and control over the way in which they die – even if you feel my bill needs amended and safeguards strengthened.

Then you must vote to allow parliament the opportunity to consider amendments.

If at Stage 3, you remain unpersuaded, you are free to vote down this bill.

But it is surely not tenable for parliament, once again, to say this is all too difficult and to refuse to undertake the work required to see if a bill that commands majority support and public confidence can be agreed.

Before turning to the substance of what is in and not in my bill – let me first recognise the contributions of some of those who’ve helped get it to this point.

To my staff past and present who have performed heroics over the past four years doing much of the heavy lifting.

So too the campaign groups, Dignity in Dying, Friends at the End and the Humanist Society Scotland who have been magnificent in their support. I refer members to my register of interests as well the detailed declarations I have made to the finance and health committees that I made when giving evidence.

My thanks also go to the Non-Government Bills Unit, along with apologies for only belatedly coming to realise that they are a hidden gem in the way that this parliament operates.

I thank all the stakeholders and individuals, here and overseas in jurisdictions where assisted dying laws are operating safely and successfully, who have spared time to share with me their thoughts, insights and expertise. Too many to mention but all have been invaluable in informing my understanding of assisted dying and end of life care more widely.

And to the committees, in particular the health committee which I know was inundated with evidence written and oral but has worked its way through that and come up with a report which I think is detailed, thorough and balanced. I think they are owed a debt of gratitude.

Colleagues around this chamber who have been generous in taking time to speak. Over the past four year I have come to recognise the look of mild terror in the eyes of colleagues as I saunter into the canteen or the coffee lounge as it suddenly becomes clear that a short chat on assisted dying is now unavoidable.

It is no coincidence I think that invitations to parties have rather dried up over the past four years.

But whatever views colleagues may have, those discussions have never been any thing other than respectful and considered and I am so grateful.

I am confident too that this afternoon’s debate will be conducted in the same measured and respectful manner, doing justice to the seriousness and sensitivity of the issue but reflecting that whatever our views on whether to allow for the choice of an assisted death, we all come from the same place of wanting to reduce suffering and protect the vulnerable.

So what will the bill do?.

It would allow terminally ill, mentally competent adults in Scotland a choice - to be provided with assistance for them to end their own life and avoid a potentially painful and distressing death.

It’s a choice that for so long so many of our constituents have asked us to provide – clearly and safely – in Scots law.

It’s a choice they see being available to over 300m people – and rising – around the world.

No two assisted dying laws are the same, but the model I am proposing reflects the one legally available across Australia, in New Zealand and in many US States.

Closer to home, it’s recently been legislated for in the Isle of Man, is being progressed in Jersey, and is currently being debated at Westminster, where a Bill applying in England and Wales will have its third reading in the Commons on Friday.

We can learn from this international experience, but we need to get the detail right in reflecting our own circumstances, legal framework and health and care arrangements.

My bill sets out strict eligibility criteria, and processes for multiple assessments including specialist referrals, if necessary.

It contains what I believe are appropriate safeguards which balance this tightly controlled option with access and includes requirements on data gathering, reporting and review to ensure proper oversight.

To access assistance, you must be aged 16 or over, a resident and have lived in Scotland for at least 12 months, and be registered with a GP in Scotland.

Assessment would be required by at least two doctors, acting independently of each other, who would need to be satisfied that an individual had a terminal illness, be sufficiently mentally capable, and be acting of their own free will, without being coerced or pressured.

An individual would have to be made aware of all the treatment options available, to ensure any decision is fully informed and there would be time periods for reflection and consideration.

Having been deemed eligible, there would be no requirement to act on that decision within a specific timeframe. Indeed, we see in jurisdictions around the world, around a third of those who successfully apply for an assisted death don’t end up using it.

Often it is enough to know the option is there should it be needed – allowing the dying person peace of mind to get on with getting the most out of the rest of their life.

Should a person wish to proceed however, the medication would be prescribed by a pharmacist and delivered by a medical professional, who would check capacity and intent and remain present. It would then require to be self-administered by the individual.

Whilst there is clearly overwhelming public support for a change in the law across Scotland, throughout stage 1, I have engaged with, and listened closely to those with concerns.

I have reflected, for example, on concerns regarding the minimum age threshold and am persuaded of the case for amending the Bill at Stage 2 to raise this to 18.

Concerns have also been raised by some disability groups and campaigners about the impact they say this Bill would have on efforts to improve the rights and lives of those in the disability community.

I have taken those concerns seriously from the outset and done my best to engage and at this point I would like to pay tribute to Pam Duncan-Glancy for the time she has spent to discuss these issues. I know that we are fundamentally arriving at different points but I have been enormously grateful for her insight.

I know from family experience that for many in the disability community, they do face discrimination and a society that too often devalues them.

Disability campaigners who wrote to MSPs last week agree, pointing out “it is unacceptable that people with disabilities continue to face social stigma, inequalities and inadequate support, including at the end of life. These problems need urgent attention.”

They go on to say, “However, it would be a mistake to conclude that we should oppose legalising assisted dying for terminally ill people until those wider problems are fixed. It is paternalistic to imply that reducing choices will resolve inequalities”.

Denying dying Scots more choice will not enhance the lives of those with a disability. Nor do I believe it would be acceptable for a person with a disability, who meets the eligibility criteria under my bill, to be denied the same choice as anyone else.  

Importantly, that appears to be the view of a sizeable majority of those in the disability community, which polls confirm support a change in the law every bit as strongly as the population as whole.

That said, I am committed to continuing to engage with Pam Duncan Glancy - and if they wish, the groups who’ve been vocal in their opposition – to see what might be done at stage two to allay their concerns as far as possible.

I think that looking at the findings of Glasgow University Professor Ben Colburn’s research into the way in which these laws work in practice around the world, shows that no evidence assisted dying laws around the world harm people with disabilities, undermine access to healthcare, or promote disrespect towards people with disabilities.

Turning to the definition of terminal illness, the Bill requires a person to have an illness, disease or condition which is worsening, and will continue to worsen, and that is at an advanced stage.

The illness must be one a person will not recover from, and which is expected to result in their early death.  I don’t believe the definition should include a specific period of life expectancy and note the Committee agreed.

I remain confident the definition gives clear effect to the policy intent, which is to cover terminally ill adults in the final stage of their illness.

But these and other aspects of policy are for debate and agreement through amendments at stage 2 and 3.

And to those who argue that we should be focused solely on improving palliative care, I would make the point that it is not a case of either/or. We need both.

Investment in improving the quality of and access to palliative and hospice care, as well as good social care, is imperative. It will be what the vast majority of dying Scots continue to rely on even after any change in the law.

But we know there are those who find themselves beyond the reach of palliative care and who are desperate for more choice.

We know too that in jurisdictions with assisted dying laws in place, not only has this often gone hand in hand with increased investment, but also – as the Committee heard – an improved understanding of and engagement with palliative care.

So, as I say, we can and must do both.

And on the question of legislative competence, my view has not changed since introduction, when after careful consideration and on advice from legal officers, I signed a statement of competence. A view shared by the Presiding Officer.

Should parliament back the general principles this evening, though, I will engage with the Scottish and UK Governments and seek to facilitate discussions to ensure the will of this Parliament can indeed be fully delivered.

I echo the Committee’s report in welcoming the Scottish Government’s commitment, that should the Bill pass stage 1, to open dialogue with the UK Government, and to keep this Parliament updated.

Today we can take a significant step towards giving terminally ill adults across Scotland more choice.

It is a brave step, yes, but one that  I believe Scotland is ready to take.

As well as international evidence, my bill draws on understanding gained from previous attempts to change the law, led by colleagues, including Jeremy Purvis, Patrick Harvie, and the late Margo MacDonald.

15 years ago, Margo stood in this chamber, speaking in the stage 1 debate on her End of Life Assistance Bill and said:

“We, the Parliament that represents the wishes, beliefs, hopes and determination of our fellow countrymen and women, are doing something today that Parliaments are meant to do: we are trying to find an honourable, fair and equitable solution to a problem.”

15 years on, Margo’s words remain pertinent.

In bringing my remarks to a close As I said at the outset, it is the voices of dying Scots and their families that must be at the heart of today’s debate.

So let me quote Ani from North Uist, who was diagnosed with MND in 2022.

“I’m not afraid to die. I want to live, I want my life to continue but right now I am living with extreme anxiety about suffering.

“If I had the right to choose what is best for me I could let go of all the anxiety and fear. For me assisted dying is, funnily enough, a lifeline. I could let go of sleepless nights, stress filled days and constant anxiety ridden thoughts”.

The words of Ani show there are consequences too to not changing the law.

- the horrendous decisions and bad deaths faced by dying Scots;

- the trauma for them and those left behind;

- the higher suicide rates we see amongst those with a terminal illness;

- and those spending their life savings to go to Dignitas, earlier than necessary and far from home at the end.

But those are questions for another day; another debate; for Stage 3 when the final detail of this bill is known.

For now, Presiding Officer, what colleagues are being asked to do is back the general principles to allow this bill to go forward for further scrutiny and amendment.

In the context of the stories we are hearing ever more often, ever more loudly and ever more painfully from our constituents, that is surely not an unreasonable ask to make.

We can’t continue to leave this issue in the ‘too difficult’ box. That, Presiding Officer, would be unforgivable.

And I move that parliament agrees the general principles of the Assisted Dying for Terminally Ill (Adults) Scotland bill.