Medical leaders from Canada were in the Scottish Parliament last week to set out how the medical assistance in dying (MAID) system has worked there since being introduced two years ago and how splits in the profession were overcome.
Dr Sandy Buchman, president-elect of the Canadian Medical Association (CMA), and a practitioner of MAID in Toronto, said the dilemma for physicians is “as difficult as you can get” in medicine.
But he told MSPs: “I’ve learned from clinical experience that sometimes the only way to alleviate a patient’s suffering is to allow them to choose an assisted death.”
He addressed an event at Holyrood last week organised by Dignity in Dying Scotland which is campaigning for the measure to be brought back before the Scottish Parliament, after being twice rejected in recent years. MSPs from across the political spectrum attended.
Sir Graeme Catto, a former chair of the General Medical Council (GMC), told the meeting that the measure will eventually be introduced in Scotland and the rest of the UK – but advocates must win over “hearts and minds”.
Supporters are preparing to launch a new campaign in Scotland next year focused on the experience of people with terminal conditions in an effort to persuade sceptics. The majority of Scots back the change, polling suggests, but opposition among groups such as churches, disability groups and particularly the medical profession have thwarted attempts to pass legislation at Holyrood after this was twice instigated by the late Margo MacDonald.
Buchman, a palliative care doctor based in Toronto, has provided medical assistance to die to more than 20 terminally ill patients in the two-and-a-half years since it was introduced in Canada.
Speaking to Scotland on Sunday, he said: “It’s not an easy decision to become a provider of assistance in dying.
“It took the better part of more than two years to sort through my deepest emotions.”
He added: “Every case is difficult – every single case is a challenge. I never see this as an easy decision. It’s as difficult as you can make in medicine.
“No-one I know takes it lightly. But I look to medicine to alleviate suffering.
“Ultimately I have decided that helping eligible patients who wanted choice over the manner and timing of their death was an intention of what I was doing all along – that is relieving suffering.
“This is a choice that I have made personally, this is a matter of conscience which should unequivocally be respected.”
The opposition of doctors and the health profession was seen as a roadblock to change. MSPs heard that the medical profession in Canada was split over the issue after it became clear that the issue was to be introduced following the “Carter case”, a successful Supreme Court challenge against the ban which was previously in place.
Dr Jeff Blackmer, vice-president of professionalism at the CMA, said: “It was very divisive in the medical profession. We had to move away from a dichotomous, pro-con, yes-no debate to a place where the profession can say if society chooses to change the law because it is society’s prerogative, here’s how we as a profession will participate and react.
“That’s the message that we’re trying to help our colleagues here and in other jurisdictions understand – that it’s important for doctors to take part.”
In Buchman’s own practice of about 20 home-based palliative care specialists, including “conscientious objectors” who don’t participate in assisted dying, this has manifested itself in an atmosphere of “non-judgment and mutual respect”.
Other concerns in Scotland centred on the prospect of vulnerable groups, such as elderly and disabled patients, coming under pressure to seek assisted dying.
Among the scenarios set out were that they may feel a burden on their families, but the Canadian experience suggests there has been “no evidence” of this.
“There are many safeguards built in, we assess for any coercion and our antennae is always up and especially for anyone that might be perceived as vulnerable,” Buchman added.
“All sick people who are living with a terminal illness are vulnerable.
“What’s important is that we do all those assessments, formal requests are signed and witnessed. We’re always on the lookout.”
It is not illegal to attempt suicide in Scotland, but helping someone take their own life could lead to prosecution.
As well as Canada, assisted dying is legal in a number of US and Australian states, the Netherlands, Belgium and Luxembourg.
Professor Catto insisted it is now only a matter of time before it is legalised here.
“Legislation of this sort will come in in Scotland, it will come in in England,” he told MSPs.
“But it requires all of us to believe in this, to take forward the arguments rationally.”
But he warned: “Appealing to the head is one things, but we need to get the hearts, as well as the minds of the population behind this.”
Legislation seems unlikely in the current Parliamentary term which ends in 2021 after failed attempts in 2010 and 2015.
Support grew among MSPs in those five years, with the initial legislation falling by 85-16 and the margin narrowing to 82-36.
Liberal Democrat MSP Alex Cole-Hamilton, who chaired last week’s meeting, said support at Holyrood is continuing to rise.
“There is a growing cross-party coalition of MSPs who are hungry for change in this area,” he said.
“But we also recognise that having had two failed bills in relatively quick succession, we need to be certain that we can carry parliament with us on a third and final attempt.
“Patience is important because if we rush ahead too swiftly we risk losing the ultimate prize of giving people in abject pain and suffering the right to determine the time and manner of their passing.”
Dignity in Dying Scotland says 80 per cent of the Scottish public want to see a change in the law on assisted dying.
“Currently there are too many bad deaths,” said director Ally Thomson.
“Dignity in Dying Scotland is actively working with MSPs from all parties and all parts of the country to bring the right bill to Parliament.
“More and more people are getting in touch with their MSP to make their views known that this is a human rights issue directly affecting them and their families and calling on them to support a more compassionate law.
“There is an increasing momentum for change inside and outside the Parliament.”