Monday, April 15, 2024

Journal of Medical Ethics article: Scottish Support for assisted suicide is weakening.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Scottish Parliament
An article by David Albert Jones was published in the Journal of Medical Ethics on April 15, 2024 explaining that support for assisted suicide in Scotland is weakening.
On 27 March 2024, Liam McArthur introduced his Assisted Dying for Terminally Ill Adults (Scotland) Bill. He said that he was “absolutely convinced” that the legislation would be passed as “there is growing public support for the policy”. Similarly, when the Bill was proposed in 2022 it was argued that public opinion “seems to be shifting in favour of a law change.” Again, a recent article in defence of the Bill appealed to the “increasing and now overwhelming” support in Scotland for a change in the law. This was based on “several polls” cited in the Policy Memorandum that accompanied the Bill.

The Memorandum cites four polls giving 87% (March 2019), 72% (June 2021), 77% (July 2023) and 71% (December 2023) support for “assisted dying”. In addition, a more recent poll (March 2024) of 4,132 adults in Scotland showed 78% in favour.

It is noteworthy that the three polls commissioned by Dignity in Dying Scotland (March 2019, July 2023 and March 2024), generated the highest figures for support. This is in part because the questions referred to terminal illness and included other reassurances. They also asked if people “strongly support[ed]” assisted dying or only “somewhat” or “tend[ed] to” support. Asking in this way ensures that people who are ambivalent but tend to be in favour on balance or in principle are included as supporters.
Jones explains that strong support for assisted suicide is declining:
These polls thus measured how many “strongly support[ed]” legalising assisted dying. This was 55% in 2019, 45% in 2023, and 40% in 2024. It is evident that the level of strong support has declined and that a majority of Scots are no longer strongly in favour, but are ambivalent to some degree or are opposed.
Jones explains that the public is confused by the meaning of the term - assisted dying:
To measure change in support over time, it is important to use the same question and to conduct multiple repeated polling. YouGov provides a bimonthly “tracker” (August 2019 to April 2024) for the questions: “Do you think the law should or should not be changed to allow someone to assist in the suicide of someone suffering from a terminal illness?” and “Do you think the law should or should not be changed to allow someone to assist in the suicide of someone suffering from a painful, incurable but NOT terminal illness?

Support in Scotland in April 2024, as measured by these questions, was 71% and 41% respectively. This is lower than the polls quoted above in part because of the reference to “assisted suicide” rather than “assisted dying”. There is evidence that many people are confused about what is included in “assisted dying”. A survey conducted in 2021 found that most people thought that this meant either “giving people who are dying the right to stop life-prolonging treatment” (42%) or “providing hospice-type care to people who are dying” (10%).

In any case, the usefulness of the tracker lies less in the snapshot of support and more in capturing change over time. These trackers, each repeated 31 times over five years, clearly show that support for assisted suicide in Scotland has declined measurably.
Support for assisted suicide is less than 50% when it applies to people who are not terminally ill and yet Scotland's euthanasia bill permits people who are not terminally ill to be killed by euthanasia. Jones explains:
The second tracker also shows that support is well under 50% if assisted suicide would be provided to people who are not terminally ill. It might seem that the Assisted Dying for Terminally Ill Adults (Scotland) Bill is indeed restricted to people who are terminally ill. However, unlike similar legislation in the United States, New Zealand or Australia, the Scottish Bill defines “terminal illness” with no reference to a person being close to death. The term is used to cover anyone with an advanced progressive condition that would be expected to shorten life if not treated. This would include conditions such as type 1 diabetes. It is unclear if this is what the public understands by the term “terminal illness”.
Jones ends his article by stating that support for assisted suicide is not overwhelming and it is not growing:
Public support for legalisation of assisted suicide in Scotland is thus neither “overwhelming” nor “growing”. Less than half strongly support a change in the law. Less than half want their MP to vote to change in the law. Less than half support assisted suicide for non-terminal conditions (as the proposed Bill seems to include). Few if any regard assisted dying / assisted suicide as being among the most important issues facing Scotland and all indications are that Scottish support for its legalisation has declined markedly in recent years.

MSPs should assess for themselves the merits and/or dangers of the proposed Bill without fearing that they will be out of step with public opinion. Indeed, if they feel ambivalent or hesitant on this issue then they are probably reflecting the views of most people in Scotland.

1 comment:



The results of any survey of doctors
depends on how the question is asked.
When asked about "euthanasia"
or "physician-assisted suicide",
doctors mostly answer NO.
But if a broader question is asked, such as:
"Should doctors ever recommend life-ending decisions?"
then a majority of doctors answer YES.

If there is enough space available in the survey,
these "life-ending decisions" can be explained:
(1) recommending comfort-care only,
(2) inducing terminal coma,
(3) ending curative treatments and life-supports,
(4) withdrawing water and other fluids.

Because these methods of managing dying
are all well-established in terminal medical care,

The most controversial method of managing dying
allows doctors to prescribe gentle poison for dying patients
---for the explicit purpose of causing immediate death.
Doctors are equally divided (pro and con)
about prescribing poison to bring life to a speedy end.


Here is a chapter exploring these five pathways:
"Do We Already Have the Right-to-Die?
Medical Methods of Managing Dying":

Each of these five pathway
is illustrated by a common end-of-life disease or condition.
How often is each pathway towards death used?


Ch. G (2) Getting docs' support---rev. 4-17-2024