One of the main threats posed by assisted dying laws is the danger that people living in abusive situations will be coerced into ending their lives. The Assisted Dying for Terminally Ill Adults (Scotland) Bill currently before Holyrood is no exception. Supporters of assisted dying play down this danger, saying that they see no evidence of coercion in jurisdictions where assisted dying is already lawful, and that providers of assisted dying in these places are trained to identify coercion should it ever occur. What’s more, the Holyrood Bill (proposed by Liam McArthur MSP), like the Leadbeater Bill in England, makes it a specific offence to coerce or pressure another person into requesting assisted dying.

In this article, we argue that none of this should reassure us: the threat of coercion under the proposed law is real and significant and must be taken more seriously.

Abuse and coercion in Scotland: high prevalence and low reporting

Those living with domestic abuse and coercive control are not a homogenous group. While domestic abuse is undoubtedly heavily gendered, factors like older age and disability also make people vulnerable to abuse and coercion, and those affected come from every community in Scotland, including minority ethnic and faith communities. An estimated one in three Scottish women live with domestic abuse and coercive control, and according to a poll by Hourglass there are as many as 225,000 older victims of abuse in Scotland.

We know that women are at serious risk of being killed by their abusive partners, and of dying by suicide as a result of domestic abuse: earlier this year, the number of deaths caused by domestic abuse in England and Wales was described by police as “staggering”. Professor Jane Monckton-Smith OBE, a professor of public protection and expert on interpersonal violence, has voiced grave concerns about the impact of assisted dying laws on victims of abuse, warning that “[a]ssisted dying could be coerced suicide, or it could be a staged suicide … both are highly likely in domestic abuse”.  Prof Monckton-Smith has criticised proponents of assisted dying for not taking this problem sufficiently seriously, writing: “So many victims already take their own lives pushed into it by relentless abuse. Domestic abuse escalates for terminally ill victims. But I’m not seeing this given attention.” Scottish domestic abuse experts have warned the committee scrutinising the McArthur Bill that the bill “risks offering a new, potentially lethal weapon to abusive men whose partners have been diagnosed with life-threatening or terminal illnesses”.

When supporters of assisted dying speak about ‘choice’ and ‘autonomy’, they should remember that these things are not the reality for women, older adults, and disabled people trapped in abusive and coercive situations.

Those offering reassurances about the risk of coercion betray a lack of knowledge and understanding of the realities and dynamics of coercive control, domestic and elder abuse. Many who live with violence, coercion and abuse are unable or unwilling to talk about it – living with fear and threat becomes normal and abused people deny, even to themselves, that the abuse is going on. Although over 61,000 incidents were reported to Police Scotland in 2023-2024, this still represents a low rate of reporting compared to the actual scale of the problem. 

Even after the Domestic Abuse (Scotland) Act 2018 criminalised domestic abuse and coercive control, a Scottish government survey in 2019-2020 found that, although 21 per cent of women over 16 had experienced domestic abuse, almost a third of those abused told no-one about the abuse they experienced, only 10 per cent disclosed the abuse to a doctor, and only 16 per cent of incidents became known to police somehow. All who experience abuse face considerable physical, emotional and cultural barriers to disclosure – those who disclose abuse or coercion risk all manner of unpleasant consequences, from embarrassment and shame to violent reprisals. Recent research has highlighted a number of particular factors that inhibit Scottish women from minority ethnic communities from disclosing abuse to health services and the police.

All of this means that we have a ‘hidden’ population of victims of abuse and coercion in Scotland: it will obviously include people who are or who will become terminally ill, and the abuse doesn’t stop after diagnosis.

Would abuse and coercion be routinely detected?

The ability of health professionals to detect coercion can be improved by training. In recent years, NHS Scotland has introduced training on domestic abuse and other forms of gender-based violence in a selected number of healthcare settings. These are extensive, resource-intensive, time-intensive national training programmes run by specialists. These programmes could presumably be adapted to train those involved in delivering assisted dying, but this would involve significant cost including the cost of providing clinical cover while GPs and other specialists undertake the training. 

Has the cost of extensively training professionals to spot coercion been factored into the overall cost of implementing the Assisted Dying Bill? In an under-resourced system, the temptation will be to follow the lead of some jurisdictions where assisted dying is already permitted, where doctors and other providers are ‘trained’ to spot coercion in the assisted dying context simply by undertaking a short online module. In Victoria, Australia, providers of assisted dying complete a mandatory six-to-eight hour online module covering all aspects of the process, with the content related to spotting coercion estimated to amount to only five minutes of this. This would be laughable if it weren’t so dangerous and tragic.

In any case, as already mentioned, despite the existence of thorough ‘abuse detection’ training in the NHS at present, the evidence shows that in Scotland, few incidents of abuse are actually disclosed to health professionals.

Abusers have an obvious incentive to conceal their crimes; but victims too may have reason to try to prevent abuse from coming to light. They may be motivated by a misplaced loyalty to the abuser and a wish to protect them from social and legal sanctions. They may be eager to prevent the breakup of the family unit, perhaps for the sake of children. They may be feeling misplaced shame having internalised years and possibly decades of criticism, and of being told that the abuse is their fault. Or they may even be so used to their situation that they now regard it as ‘normal’ and no longer see it as the abuse that it is. Coercive control and psychological abuse will obviously be extremely difficult to detect – even with the best available training – where the victim and the abuser are experienced in concealing it. In many cases, close family are unaware of abuse; professionals who do not know the patient except in a clinical context have even less chance, absent disclosure.

Read part two here