Ahead of a final vote by the Scottish Parliament expected to take place in March, the BGS has written to Members of the Scottish Parliament (MSPs) outlining our significant concerns with the Assisted Dying for Terminally Ill Adults (Scotland) Bill. The bill does not contain adequate safeguards to protect older people, the biggest group to be impacted, nor does it protect healthcare professionals who do not wish to participate in the assisted dying process. As the membership organisation representing professionals specialising in healthcare for older people, we urge MSPs to consider our concerns ahead of the stage three vote. It is essential that any change in the law includes robust safeguards and comprehensive protections for the healthcare workforce. Currently, this is not the case. The BGS has the following main concerns:
- There are inadequate safeguards to protect older people from harm
There are no safeguards within the bill that specifically protect older people from harm. Older people are at risk of abuse and coercion, and this is not always obvious to healthcare professionals. Ageism in society can also influence older people into thinking they are a burden. The BGS is concerned by international data which illustrates that up to half of people who choose an assisted death state that being a burden is one of the reasons for their choice. Therefore, it is vital that robust procedures are in place to safeguard older people, which the bill does not contain at this stage. The bill currently puts all responsibility on healthcare professionals to detect coercion, abuse, and unmet needs which may influence a person’s decision about an assisted death. The BGS strongly recommends the involvement of local authorities and multidisciplinary professionals, including social workers, in assessments to identify coercion, abuse or unmet social care needs that may not be visible in a clinical setting. As older people are the group most likely to be impacted by the bill, additional safeguards should include mandatory training for professionals involved in the process. This should cover ageism, older age abuse, and recognising when an older person may be feeling a burden. Strengthening these measures will help to reduce the risk of people feeling coerced into choosing an assisted death.
- Healthcare professionals who object to taking part in the assisted dying process are not protected
Healthcare professionals will have a range of diverse views on the issue of assisted dying. A survey of BGS members found that over half of respondents would be unwilling to take part in the assisted dying process. It is essential that their freedom to choose is protected and they have the right not to take part for any reason. We are deeply concerned that the Scottish Government has indicated it will remove important provisions from the bill relating to duties to participate, professional regulations, and employment protections. The government has suggested that these are reserved matters which will be addressed in secondary legislation after the bill has passed. As a result, there will be no clauses in the bill that protect healthcare professionals prior to it being scrutinised and voted on by the Scottish Parliament. We view this as unacceptable. Protections for healthcare professionals are central safeguarding components of the bill. Without setting them out clearly in primary legislation, the bill risks inadequate scrutiny and may fail to protect those central to its delivery.
- The complex end of life care needs of older people are not recognised
If assisted dying is legalised, the majority of those impacted will be older people, who account for 70% of deaths each year. Most older people will have multiple health conditions. They have specific health needs at the end of life which are different to those of younger people dying of one condition. There are insufficient provisions within the bill to recognise the needs of older adults with multiple health conditions; as the bill currently does not require a person to be assessed for all health, social, psychological, functional, and environmental needs. Introducing a holistic assessment may address treatable needs that would otherwise influence older people to choose an assisted death. This involves looking into all aspects of a person's life to assess whether they have needs that are not being met, that may be causing suffering. In geriatric medicine, this type of assessment is known as Comprehensive Geriatric Assessment (CGA) and is the cornerstone of good healthcare for older people. We view it as unacceptable that older people may choose an assisted death due to factors that could be addressed through a CGA.
CGA can identify palliative and end of life care needs, but these needs may not be met if the care is not available. Scotland’s health and social care system, including end of life care, is under-resourced. This means many people who may require services are unable to access them. The BGS is concerned that older people may be influenced to choose assisted dying because of the lack of good palliative and end of life care.
Due to the reasons outlined, the BGS urges MSPs to vote against the legalisation of assisted dying in Scotland. If it is passed, we strongly recommend the development of a code of practice on how to care for older people with complex needs who request an assisted death.
