For countless years, doctors have looked upon care of the dying as a duty and a privilege and during the course of my professional lifetime there has been remarkable progress in this field. Despite that, for many people, understandable fears about being a burden on loved-ones or loss of personal dignity still remain.

Ultimately, it is for the patient to decide if their suffering has
become intolerable. However, the administration of a drug, or the
withholding of treatment, on compassionate grounds, with the purpose of
hastening death, is currently illegal, even if the intention is to bring
the patient’s unbearable suffering to an end. At present, any
intervention by a doctor to achieve that has to be clandestine and
information on the scale of its use is difficult to obtain.
Nevertheless, independent research indicates that it does occur; and to a
significant extent..

A 2002 survey of 1000 Scottish healthcare
workers found that 40 of them had assisted suicide, either by providing
drugs or giving advice (1), and in 2009 independent research (2)
indicated that at least 1 in every 500 deaths in the UK which had been
attended by a medical practitioner were the result of voluntary
euthanasia by the doctor. That equates, approximately, to somewhere
between 50 and 100 deaths per year in Scotland. It is beyond reasonable
doubt that unreported and unregulated assistance given by doctors to
speed the dying process does take place in this country and it is
disingenuous to suggest otherwise.

Following the conviction of
Harold Shipman, the General Medical Council produced several documents
on end-of-life care. These included guidelines on the response doctors
must give, should patients make requests for assistance to end their
lives, or even wish to discuss the matter. They were explicitly
forbidden from doing so. As a result, some dying patients suffer
against their wishes or take matters into their own hands. It has
become harder to achieve an easy death.

We are conditioned to
look upon suicide as a mistake and a tragedy; and rightly so. Coming
about as the consequence of either serious mental illness or profound
emotional disturbance, how could it not be? It is the few remaining
suicides that constitute the real challenge to our understanding, those
which are undertaken by sane individuals who have calmly decided to end
their lives because of an incurable illness and intolerable suffering.
The intuitive response to that particular behaviour is to lump them in
with the others. This conflation should be resisted, for not all
suicides are the same. Although it cuts across the grain of our
conditioning, some may be justifiable.

There is a need to
recognise that such action can be appropriate even if, and here comes
the difficult bit, that conclusion runs contrary to our personal
beliefs. Showing tolerance towards the measured conduct of others, of
which we do not approve, is the hallmark of a civilised people. We
should not deny individuals the opportunity of making that choice, nor
condemn them for seeking relief. A society that allows its members to
take control over all aspects of their lives, including its end, truly
has come of age.

Experience gained elsewhere in the world, where
legislation already exists similar to what is being proposed here, has
shown that the law in this area can work safely and effectively.
Understandable concerns, including potentially vulnerable individuals
being exploited by unscrupulous relatives; or the trust patients place
in their doctors being damaged; or the possibility of overwhelming
numbers of patients coming forward to seek assistance, have all proved
to be unfounded.

This Bill brings clarity to a complex matter.
It tells doctors in Scotland what can properly and legally be done to
help their patients and, crucially, it puts the individual in charge of
their own destiny. It represents an enlightened response to an unmet
need. I sincerely hope that our legislators will grasp the opportunity
to allow that to take place. The Assisted Suicide Bill (Scotland) is to
be welcomed.

Dr Bob Scott

(1) J Med Ethics 2004; 30 :441-446 doi:10.1136/jme.2003.005090

Euthanasia: above ground, below ground : R S Magnusson

(2) Seale C (2009) End-of-life decisions in the UK involving medical practitioners. Palliative Medicine 23: 198-204