What about the fact that the bill will make coercion a criminal offence?

The McArthur Bill, like the Leadbeater Bill in England, would make it a specific offence to coerce or pressure another person into requesting assisted dying. But there would need to be grounds for suspecting coercion before anyone could be investigated or prosecuted for these offences, and we have just explained why suspicion is unlikely to be aroused even in many cases where coercion is actually present.

All of this must cast a different light on claims that “fears about coercion of vulnerable people are misguided” and that there is no evidence of coercion in jurisdictions that permit assisted dying. The review procedures in those states tend to be a paper exercise after the fact based on self-reporting by doctors, and those conducting the reviews tend to be supporters of assisted dying and strongly committed to the practice. The former Attorney General of Victoria, Australia, has characterised the system of review in his State as ‘hear no evil, see no evil, speak no evil’. This is a common pattern in other jurisdictions. In Canada, the Office of the Chief Coroner identified over 400 potentially criminal breaches of the law or regulations on Medical Assistance in Dying, but did not refer any case to law enforcement.

In a rare case that was investigated by police in Oregon, Tami Sawyer was charged with criminally mistreating Thomas Middleton, a man who had come to live in her house, and made her a trustee of his finances, shortly before he ended his life under the Death with Dignity Act. After his death Sawyer sold the house, allegedly for $200,000, and transferred the money between a number of companies she owned. This came to light as part of a larger federal fraud investigation into Sawyer and her husband. However, despite the blatant criminal financial interest, there has been no investigation of whether Sawyer may have unduly influenced Middleton’s decision to die.

In the UK, Max Hill KC, a former director of public prosecutions, appeared at a news conference alongside Kim Leadbeater MP (the sponsor of the English equivalent of McArthur’s bill) earlier this year, where he stated: “There is really very little point in scrutinising, and looking for ‘bad cases’, after the death has occurred. What is the point of an investigation, even a prosecution, after someone has been coerced into ending their life?” It is astonishing to hear a former prosecutor question the value of investigating and prosecuting people following suspicious deaths, and it adds to the sense that the risks posed by assisted dying to vulnerable people are not being taken seriously enough by its supporters.

One of us highlighted in written evidence to the committee that scrutinised the McArthur Bill that although the bill mentions the risk of coercion by another person, it “ignores other forms of coercion that also matter: pressure exerted by society or social conditions, and pressure caused when a person internalises negative ideas about themself or their condition”. There is evidence from other jurisdictions of people choosing to die because of inadequate health or social care, or because they feel like a burden to others. This kind of internal coercion would be particularly difficult to prevent, or indeed detect.

The new crime of coercing someone to end their life would only address one form of coercion, and only in the unlikely event that it became visible to health professionals or others, and there was a will on the part of the authorities to take action.

If the Assisted Dying Bill becomes law, many Scots will come under external and/or internal coercion to end their lives. Lengthy waiting times for treatment (and particularly for accessing mental health services); NHS staff shortage; an underfunded and under-resourced social care sector, a national housing emergency; a palliative care sector reliant on charity; a benefits system that penalises those it should be supporting, including older adults and disabled people – any one of these would be a more appropriate use of parliamentary time and public attention than ‘assisted dying’. Scotland’s limited financial and resources and skilled workforce should be focused on assisting people to live.

Coerced deaths are inevitable

Opening the Stage 1 debate on the Assisted Dying for Terminally Ill Adults (Scotland) Bill, its author, Liam McArthur, said that Holyrood “cannot continue to leave this issue in the ‘too difficult’ box”. Supporters of the current bill are clearly impatient to see legal change, but are in denial about the scale of the risk that vulnerable people will be coerced to die (which is only one of the risks posed by the bill, but surely the most serious). Indeed, assisted dying campaigners seem more concerned about the risk that family members might ‘coerce’ a loved one by trying to talk them out of ending their life (something most of us would regard as perfectly natural and relatable). Successive Scottish parliaments have been rightly reluctant to ‘open the box’ and release assisted dying into Scottish society, and our current MSPs should be similarly reluctant. Given the scale of abuse, the low rates of disclosure, and the fact that training, however thorough, cannot reliably detect coercion, it is inevitable that coerced deaths will result if the Assisted Dying Bill becomes law.