Can you imagine a country where a teenager’s suicide attempt – a cry for help – becomes a gateway to her being euthanised? Did you realise that this can already happen in Belgium?

Belgium allows minors of any age to be euthanised. A key aspect of Belgian euthanasia law is the element of unbearable suffering that that cannot be alleviated. The problem is that this is a subjective standard, not an objective one. How do you measure whether suffering is unbearable or not?

In reality, what a subjective standard means is that there are no real limits. So, for example, in young psychiatric patients, “the unbearable and persistent nature of suffering was frequently associated with past experiences” such as sexual abuse, neglect as a child, parental rejection, self-harm and suicide attempts.

The Belgian Euthanasia Commission has even noted that “the failed suicide attempts made the people concerned aware that there was also another, more dignified way of ending one’s life”. In other words, a teenager’s cry for help can lead to her being euthanised.

Were you aware that, in the Netherlands, the law permits children as young as twelve to be euthanised with parental consent? 16 year olds and over can consent themselves. Dutch law also permits children under 1 year old (including newborns) with disabilities such as spina bifida to be euthanised with parental consent under a eugenic policy called The Groningen protocol.

The Dutch Health Minister, Hugo de Jonge, is bringing forward plans to allow euthanasia for children between 1 and 12 years old. Rather than amend the statute law, which would prove controversial, he intends to amend the regulations to ensure doctors would have ‘more legal guarantees’ to be exempt from prosecution if they carry out an approved euthanasia on a child.

In Belgium, Lionel Roosemont explained what would sometimes happen with his disabled daughter. “We were walking with our child in a wheelchair and we would have people that we do not know, and they would come towards us and they would ask us, ‘Why don’t you have euthanasia with that child?’ …If today you go through Belgium you will not see many young children that have a handicap, because they were not left to be alive.”

Can you please find 4 minutes to watch this clip?
https://www.youtube.com/watch?v=8wIM6ENoqaI

It has been encouraging to see many Scottish politicians across all parties understand the need for, and commit to, improving our suicide prevention strategies and services. It is therefore extremely important that politicians consider the impact that legalising ‘state-assisted dying’ will have on wider society. How will you quantify what the impacts on suicide rates in Scotland might be if assisted suicide should become regarded by wider society as an acceptable solution?

One of the arguments that is being put forward at Westminster at present is that introducing assisted suicide or euthanasia will reduce suicides amongst those who are terminally ill. But evidence from some other countries shows the suicide rate amongst the general population has increased. In the Netherlands, suicides increased by 40% (2007 – 2016). The suicide rate in Oregon increased by 35% (2001 – 2018). In fact, the 2019 Oregon suicide rate was 35% higher than US national average.

Politicians must be very careful that they do not normalise suicide by changing the law on assisted suicide and sending out a message to wider society that suicide is an appropriate response to any form of physical or mental suffering. It is bizarrely inconsistent, on the one hand, to increase support and spending on suicide prevention strategies and, at the same time, on the other hand to undermine all that good work by introducing a mindset into the public domain that an appropriate response for those who are suffering is to end their lives.

What is the way forward for the future? It is to invest more in palliative care. We need to improve how we care for people, not kill them. Please support the proper funding of palliative care and oppose ‘state-assisted dying’ (assisted suicide and euthanasia).

I’m writing to ask you to consider some of the ‘unintended’ effects that legalising ‘State-assisted dying’ will obviously have on our NHS.

CORRUPTING THE HEALTH SERVICE:
Legal euthanasia makes killing the norm, not the exception. There is a danger of it corrupting the whole practice of medicine. After euthanasia was legalised in the Netherlands, the attitude of Dutch physicians towards pain treatments that shortened life changed. Continuous Deep Sedations, in which a patient is sedated for the final phase of life without hydration or food, rose from 5.6 per cent of all deaths in 2001 to over 22% of all deaths now. Dutch euthanasia deaths are now at roughly 6,500 per year, more than 4% of all deaths in Holland. Combining these figures means that over a quarter of all deaths in Holland are now medically induced. The whole culture of medicine has been changed. State killing has become the norm.

HOSPICES COULD BE FORCED TO CLOSE DUE TO FUNDING BEING AXED.
Some care providers in Canada are already seeing their funding threatened because they are unwilling to refer patients for euthanasia.

CONSCIENTIOUS OBJECTION RIGHTS WILL COME UNDER ATTACK.
Canadian healthcare professionals who wish to conscientiously object to being involved in the process have seen their rights eroded. To understand how conscientious objections rights in Scotland will come under attack from a change in the law, you just have to read the euthanasia lobby groups’ stated intentions. Sarah Wootton, the Chief Executive of Dignity in Dying, has written, “Every interaction with a clinician should prompt a review of people’s end-of-life wishes. Of course, some people may not want to discuss this subject, and the consequences of that should be explained and ultimately respected, but not providing the option to plan ahead should be viewed as clinical negligence, in the same way that withholding pain relief would be!”

Please protect the NHS from harmful and corrupting influences, protect the conscientious objection rights of healthcare professionals, and please support the proper funding palliative care and oppose ‘state-assisted dying’.

Did you know that an 85-year-old woman from northern Italy, Oriella Cazzanello, who was mentally and physically healthy, disappeared without telling her relatives where she was going and paid €10,000 for an assisted suicide in a Swiss Lifecircle Association clinic. She ended her life because she was lonely and ‘weighed down by aging and the inevitable loss of the looks of which she was proud.’ Her lawyer received her ashes and death certificate from the clinic and broke the news to her family.

Surely this can never be allowed to happen in Scotland? I am writing to you to ask if you will support the proper funding of palliative care and oppose the legalisation of euthanasia or assisted suicide in Scotland.

When does ‘choice’ for a few mean no real choice for many?

Personal autonomy—the choosing of the time and manner of one’s death— is fundamental to many of the campaigns to change the law. But even expressly stating that you don’t wish to be killed by euthanasia, is no guarantee that you won’t.
In Belgium, a review of involuntary euthanasia by Raphael Cohen-Almagor was published in the Journal of Medical Ethics in 2015. It found that 1 in 60 deaths had occurred without the patient’s explicit request. It was more common in the elderly, those in a coma and those with dementia.

In a recent case in the Netherlands, a Dutch woman with dementia had stated in an advance directive that she had wanted to be euthanised when the time came. But when a doctor came to inject her, she said NO three times, and resisted. The doctor put drugs in her coffee to partially sedate her but the woman continued to resist, so her son-in-law held her down while the doctor fatally injected her. Moreover, the patient had also stated that she wanted to decide “when” the time for death had come — which she never did. The termination “choice” was made by the doctor and/or family in violation of the patient’s advance directive.

The doctor involved, Dr Marinou Arends, was prosecuted for allegedly breaking the Dutch euthanasia law, but was cleared by the jury. In April 2020, the Supreme Court of the Netherlands which reviewed the case fully backed Dr Arends’ actions. The Court said that the “doctor did not need to verify the current desire for euthanasia [of the patient]”, effectively denying Dutch patients a last opportunity to change their minds. Dr Arends said after the hearing “It is good to get the confirmation: ‘do it, just do it”, and that she would do it again.

The terrible irony is that allowing euthanasia with the intention of enhancing patient autonomy would actually reduce the autonomy of those who are most vulnerable. Without proper funding for proper care the ability of the poor, the vulnerable and the marginalised to choose palliative care is restricted. It indeed looks like choice for a few will mean Hobson’s choice for the many.

Are you aware of the public debate about extending euthanasia to people who have lived ‘a completed life’ began in the Netherlands in 2016? A bill to extend euthanasia to healthy people who are “tired of living” came before the Dutch parliament for consideration in 2020. It proposed to allow anyone over the age of 75, who feels that they have come to the end of their life and has a persistent wish to die, to ask for euthanasia.

Thankfully, it seems as though this bill has stalled and will not be progressing in the short term.

Henk Reitsema, a Dutch anti-euthanasia campaigner, said “The next step is already very clear in the Netherlands and it’s a euthanasia pill which could be given by the pharmacist around the doctor, to not involve the medicals, to ‘de-medicalize’ euthanasia, so to speak. They are calling this pill the “Tired of Life” suggesting that we should kill people, not only because of medical or psychological conditions, but because of existential suffering like feeling lonely and tired of life. In the Netherlands, we’ve opened the Law so wide that any kind of real suffering is already long taken care of in that sense. We kill people if they claim to be suffering and don’t have hope. But we now need an extra inclusion for people who have nothing that they’re suffering from, except that they are existentially tired of life.”

I’m writing to ask you to oppose euthanasia and assisted suicide in order to prevent this kind of thing from happening here in Scotland.

I’m wondering how you might answer this question so I thought I would write and ask you. If state-assisted dying (assisted suicide or euthanasia) became legal, how will you determine whether someone choosing to end their life has not been subjected to undue influence?

As many as 500,000 older people in the UK are vulnerable to abuse, as estimated by the charity Action on Elder Abuse. “Usually, victims are women over the age of 70 years, who are dependent, frail and alone.”

Actively encouraging or assisting someone to commit suicide is against the law, for good reason. It acts as a deterrent against abuse, which is essential for the safety of society. And yet it is a law which is applied with great discretion, with justice and also with mercy. There are few prosecutions, but it is important that the law is there to be used not only when there is an abuse taking place but also to deter abuse. The law isn’t just about prosecutions. It’s also about deterrence.

Ultimately, one reason we don’t want the law to change is because detecting criminality becomes much harder if assisted suicide becomes legal. We want to protect people from the danger of abuse or the danger of pressure to take their lives prematurely.

Surely, we need to improve how we care for people, not kill them?

I’m writing to ask you if you will be willing to oppose ‘state-assisted dying’ (assisted suicide and euthanasia) being legalised in Scotland?

If the Scottish Parliament changes the law to allow assisted suicide, it is acquiescing with the view that some people do not deserve full legal protection. It is saying that some lives are of less value than others. Fears about assisted suicide among people who are vulnerable or who have disabilities or mental illness will likely grow. The value we presently place on helping people to live fulfilled and comfortable lives, regardless of their illness or disability, will inevitably be undermined.

In the Netherlands, for instance, the fastest growing category of people dying by euthanasia is those who are mentally ill but have no physical illness. There was a 500% increase in such cases there between 2012 and 2017.

In Belgium, euthanasia is available for people with depression, bipolar disorder, schizophrenia delusional disorders and even autism. In other jurisdictions, the initial eligibility criteria have been progressively extended to include children and patients with psychiatric illnesses or dementia.

Opposing Euthanasia and assisted suicide is the only way to prevent its future extension to people with non-terminal illnesses, disabilities and psychiatric conditions.

‘Safeguards’ inevitably involve making a choice and setting boundaries. They point to one person and say yes, you can have this right, to another and say no. Therefore, as soon as you accept the logic that some patients should have a healthcare right to take a lethal cocktail for themselves (assisted suicide), it arguably becomes discrimination to deny that same fatal dose of medication to another group of patients who meet the ‘safeguards’ but who need a doctor to administer it for them (euthanasia). Principles of equality suggest that it should be available for all. All it needs is the ‘right case’ to challenge the law in court.

Canada legalised assisted suicide and euthanasia through its ‘Medical Assistance in Dying (MAID)’ legislation in 2016. In 2019, the Quebec Superior Court struck down one of the original ‘safeguards’, the requirement that a person be terminally ill and approaching death before qualifying for euthanasia. Canadian politicians were given a short time limit to change the law to comply with the judgment.

However, Canada’s euthanasia law has now been extended and expanded far beyond even what was required by the court judgment. On the basis that restricting access to assisted suicide is discriminatory, other ‘safeguards’ have collapsed too. People suffering solely from psychological suffering or mental illnesses will be able to have their deaths facilitated by the state. The Canadian law used to require that doctors obtain confirmation of a patient’s wishes shortly before the lethal drugs are administered but now, doctors or nurse practitioners will be able to lethally inject a person who is incapable of consenting so long as that person had been previously approved. Mandatory waiting periods have even been removed in some circumstances.

The sad lesson from Canada is that if ‘safeguards’ are deemed to be discriminatory, it is impossible for them not to collapse in the future. It is only a matter of time.