Isabelle Kerr, of Rape Crisis, warns Scotland’s assisted dying plans cannot protect women from coercion.

MSPs will debate one of the most profound Bills ever considered in the Scottish Parliament – Liam McArthur’s Assisted Dying for Terminally Ill Adults Bill - on March 17. If this legislation passes, it will fundamentally change the way our health service cares for patients who are thought to be in the final months of their lives. For the first time ever, individuals would have the right to seek help from doctors to end their own lives. It’s a debate that elicits strong views among the public at large, and deep emotion.

The Bill continues to divide MSPs. It passed a stage one vote last year by 70 votes to 56 but it is thought that the final vote will be much closer. MSPs continue to highlight concerns about the Bill’s eligibility criteria and proposed safeguards, as well as the more technical issue of its legal competence. Last month, it was reported that MSPs will not have their say on provisions to do with medical professionals, including a proposed right of conscientious objection. As this area falls under reserved powers, UK Ministers will decide what happens without oversight from the Scottish Parliament.

This latter concern will be causing disquiet among medical groups in Scotland, which have previously sought to amend the legislation and may wish to do so again before a final decision is made. It seems likely that provisions relating to medics’ conscientious objection and employment will be removed from the Bill before a final vote to make it legally competent, meaning that amendments from medical organisations lodged at Holyrood will be of no effect. This is a serious problem for the Bill’s proposer.

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Much has been written about the moral and ethical considerations at play in the debate about this Bill. I have not shared my personal view on the principle of assisted dying and I don’t intend to do so here. In a sense, it’s immaterial what I think. MSPs have their own deeply held views. What I would like to do is shed light on an area that needs it: the prospect of coercion under an assisted dying system and what might be possible in terms of protecting vulnerable groups. I know MSPs are interested in this matter.

For most of my working life I have been working on the frontline of violence against women and girls. I joined Strathclyde Rape Crisis Centre in 1981, became a founder member of Aberdeen Rape Crisis Centre in the mid-1980s, worked with the Glasgow Violence Against Women Partnership from the year 2000, and finally spent 15 years heading up Glasgow and Clyde Rape Crisis between 2006 and 2021.

My work has given me in depth knowledge of domestic abuse and coercive control – crimes that are highly relevant to the Bill at Holyrood. As my colleague Anni Donaldson has observed, an assisted dying regime will create new risks for women in abusive situations. It is unrealistic to assume that domestic abuse will cease when a woman receives a diagnosis of terminal illness and an assisted dying regime could provide a conducive context for an abuser’s ultimate act of control. Sadly, there is a growing catalogue of evidence from other countries suggesting that vulnerable people are being pressured towards assisted death, by those close to them and even medics.

Legislating for an assisted dying system relies on obtaining the consent and free, autonomous choice of the person wishing to end their life. However, for too many women, these principles are simply non-existent in their daily lives. Women may be coerced into pursuing assisted death by an abusive partner. And they may ‘self-coerce’ – seek to end their life because years of belittling and cruelty have led them to believe that they are worthless. I have seen many women who feel like this over the years.

The Bill’s proposers are aware of this issue and have sought to address it in the provisions of the Bill. They propose that doctors should look out for the signs of coercion as part of their assessments of patients who apply for assisted death. Whilst it is welcome to see this factored into the legislation, there are serious problems with this approach. Firstly, it assumes that busy doctors will have the capacity and expertise to spot the signs of abuse. My experience tells me that they won’t in most cases.

Even experts struggle to identify and evidence coercive and controlling behaviour, which is part of the reason conviction rates in Scotland are so low. Doctors aren’t trained to the level required to provide proper assessments and training them to this end won’t be seen as practicable by expert groups. Given that any doctor – including family doctors around Scotland – are in view, this is an enormous task.

It's also important to stress that doctors are already overwhelmed by other duties. The Royal College of General Practitioners has said that assessing coercion is beyond the capacity of its members, warning: “We do not believe that this work can or should be incorporated into an already very busy and stressed service”.

Busy doctors won’t be able to provide a satisfactory level of oversight, and even the best attempts to spot coercion will lead to cases being missed through human error. MSPs need to realise that coercion will occur under an assisted dying law. In my view, the real questions are who will be coerced to die, and how many such deaths will be missed. MSPs must grapple with this dilemma as they consider the Bill.

The second – and equally fundamental – problem is that, given the competence issue with the Bill, provisions requiring coercion to be assessed by doctors may have to be stripped out before a final vote. The way assessments would be carried out and by whom could be left to the UK Government to decide, independent of Holyrood. MSPs need to ask themselves if they are comfortable with this lack of control.

This is a complex issue. Strong arguments are put forwards by both sides of the debate. However, the success of legislation often boils down to its workability. I feel duty bound to point out that the Assisted Dying Bill at Holyrood is not workable in its approach to detecting coercion. Women in abusive situations could be collateral damage.

Isabelle Kerr is Centre Manager at the STAR Centre, Ayrshire’s Rape Crisis Centre.

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