tag:theconversation.com,2011:/us/topics/margo-macdonald-9557/articlesMargo MacDonald – The Conversation2015-05-29T14:23:39Ztag:theconversation.com,2011:article/425602015-05-29T14:23:39Z2015-05-29T14:23:39ZThe battle over assisted dying in the UK is far from over<figure><img src="https://images.theconversation.com/files/83372/original/image-20150529-15214-oniawm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Where next for supporters of end-of-life choice?</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&autocomplete_id=14328950505615360000&search_tracking_id=pXRsT4W3PSUElktmgpQbzg&searchterm=euthanasia&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=164722760">Robert Kneschke</a></span></figcaption></figure><p>The <a href="http://www.bbc.co.uk/news/uk-scotland-scotland-politics-32887408">Scottish parliament’s decision</a> by 36 votes to 82 to reject assisted suicide is the second time it has done so. As <a href="http://www.scottish.parliament.uk/S4_MembersBills/Final_version_as_lodged.pdf">in 2011</a>, the current bill was introduced by the late <a href="https://theconversation.com/margo-macdonald-independent-scot-1943-2014-25299">Margo MacDonald MSP</a>, only to be taken forward this time by Scottish Green co-convener <a href="http://www.patrickharviemsp.com">Patrick Harvie</a> after her death last year. And like 2011, it would be wrong to assume we have heard the last of it. </p>
<p>This most recent bill set out criteria which would have permitted those who were suffering from a life-shortening or terminal illness to receive assistance to end their life. There is an important distinction to be made between euthanasia and assisted suicide. In euthanasia the responsibility for overseeing death rests with a person other than the one who wishes to end their life. With assisted suicide, the person completes the final act themselves, but with the assistance of another. </p>
<p>The bill’s drafting represented some improvement on the 2011 version, though it is never going to be universally accepted when it is such a politically, morally and ethically sensitive subject. It provided that a “licensed facilitator” – not necessarily a healthcare professional – be appointed to provide “comfort and reassurance” and “practical assistance” for people with “terminal” or “life-shortening” conditions. </p>
<p>The parliamentary debate highlighted concerns over how to interpret these definitions. Such concerns are valid. There is a whole spectrum of what may be construed as assistance. To date, the law has not recognised helping someone to travel to another country to die as assistance, for example. But would putting pills into a person’s hands or mouth, or giving them a glass or water have been permitted within the provisions of the bill? </p>
<p>The definition of “life-shortening” was another major issue. Could it include someone with type-2 diabetes for example? Many of the politicians were understandably concerned that this definition could have permitted assisted suicide in a much wider set of circumstances than they thought reasonable.</p>
<p>They also raised concerns about distinguishing between euthanasia and assisted suicide, and the challenges of ensuring equality and protection to those living with a disability. And more broadly in relation to definitions, there were many references during the debate to the conclusion of <a href="http://www.scottish.parliament.uk/S4_HealthandSportCommittee/Reports/her15-06w.pdf">the report</a> of the Health and Sport Committee that the bill had “significant flaws”. </p>
<p><strong>The Scottish parliament debate</strong> </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/GywGBUkQPus?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<h2>The current position</h2>
<p>Aside from the debate over the bill, the law is arguably not clear enough on what constitutes “causing” the death of another by providing the means of suicide. It is a question of when this amounts to culpable homicide or murder – as reflected by the uncertainty around what is meant by “assistance”, for instance. This was a recurring concern during the scrutiny of the Scottish bill both by the health and sport and <a href="http://www.scottish.parliament.uk/newsandmediacentre/85271.aspx">justice</a> committees. Yet during the parliamentary debate on May 27, Scottish health secretary Shona Robison <a href="http://www.bbc.co.uk/news/live/uk-scotland-scotland-politics-32802416">said</a>: “the government believes that the current law is clear, and it is not lawful to assist someone to commit suicide, and the government has no plans to change that”. This is not a view shared by all, it must be said, <a href="http://www.heraldscotland.com/news/home-news/top-legal-experts-call-for-clarity-over-the-shameful-right-to-die-legislation.122016109">including many</a> senior Scottish academics. </p>
<p>One reason for the perception of uncertainty in Scotland is that the courts have yet to consider the issue. In England, a series of court cases have considered whether the present law on assisting a suicide is incompatible with <a href="http://www.equalityhumanrights.com/sites/default/files/documents/humanrights/hrr_article_8.pdf">article 8</a> of the <a href="http://www.echr.coe.int/Documents/Convention_ENG.pdf">Convention of Human Rights</a>, the right to respect for private and family life. One of the outcomes has been a <a href="http://www.cps.gov.uk/publications/prosecution/assisted_suicide.html">set of guidelines</a> from the Director of Public Prosecutions on what the law permits – an equivalent to which Scotland lacks. </p>
<p>In June 2014, in the case of Nicklinson and others, the UK Supreme Court <a href="https://theconversation.com/uk-moves-to-join-countries-with-some-form-of-assisted-dying-but-a-way-to-go-yet-36311">concluded that</a> the law was inconsistent with article 8 of the convention, but it was the role of parliament to decide what to do about it. Westminster had such an opportunity following Lord Falconer’s <a href="http://services.parliament.uk/bills/2014-15/assisteddying.html">Assisted Dying Bill</a>, which proposed to provide “competent” adults who have less than six months to live with assistance to end their own life at their own request (you can read about the differences with the Scottish proposal <a href="https://theconversation.com/uk-moves-to-join-countries-with-some-form-of-assisted-dying-but-a-way-to-go-yet-36311">here</a>). But after months of deliberation and many amendments – filibustering by opponents, effectively – its passage ran out of time during the previous parliamentary session. Lord Falconer <a href="http://www.theguardian.com/society/2015/jan/17/assisted-dying-bill-held-up-in-the-house-of-lords">has said that</a> he will attempt to have a further bill introduced at a future session. </p>
<p>Back in Scotland, however, a court ruling on assisted dying is now in the offing. Gordon Ross, who suffers from a severe debilitating illness, <a href="http://www.bbc.co.uk/news/uk-scotland-32726294">has taken</a> his case to the Court of Session in Edinburgh requesting that the Lord Advocate issue guidance which makes clear whether any person who helps Ross end his life would be charged with an offence. The decision will be known in the next four to six weeks. </p>
<h2>Back from the dead?</h2>
<p>Following the parliamentary debate, one also senses unfinished business at Holyrood. While the majority of MSPs have said in a free vote that the bill could not continue because it was fundamentally flawed, is that really the case? Yes, there were issues with interpretation of some key terms and it is vital that the parameters of what constitutes “assistance” should be transparent and robust. But are these reasons for the bill to collapse altogether? </p>
<p>Patrick Harvie thinks not. He has repeatedly pointed out to colleagues that the parliamentary process would allow for further refinements, scrutiny and valuable debate to take place. There is certainly an argument that many of the definition problems could have been resolved after the first reading, had it passed. </p>
<p>Finally, while I am always nervous about polls and statistics and their potential to be interpreted to suit a particular view, there <a href="http://www.heraldscotland.com/politics/scottish-politics/almost-thr.1432469329">does seem to be</a> a significant swell of public support for legalising assisted dying under certain conditions. Medical law has <a href="http://jme.bmj.com/content/28/4/232.full">already acknowledged</a> an individual’s autonomy to make decisions concerning the end of their life. So while the Scottish parliament may have spoken again, this is a discussion which will endure. It is not and should not be over.</p><img src="https://counter.theconversation.com/content/42560/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alison Britton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The defeat of the Scottish Assisted Dying Bill may be a blow for supporters, but it is not terminal.Alison Britton, Professor of Healthcare and Medical Law, Glasgow Caledonian UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/363112015-01-16T13:21:48Z2015-01-16T13:21:48ZUK moves to join countries with some form of assisted dying – but a way to go yet<figure><img src="https://images.theconversation.com/files/69126/original/image-20150115-5198-1sr6bep.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">UK legislation still has various hurdles to overcome</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&search_tracking_id=c2si0KHLjO2kCYzrLDXLJQ&searchterm=euthanasia&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=123384046">Robert Kneschke</a></span></figcaption></figure><p>The debate on the role of law and ethics at the end of life is an enduring one. In 1971, such debate was focused almost solely upon the Netherlands when a rural physician called Truus Postma <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1796690/">facilitated</a> the death of her severely handicapped mother, Margina van Boven-Grevelink, following her repeated, explicit requests for euthanasia. </p>
<p>Although Postma was convicted two years later, the court’s judgment determined when a doctor would not be required to keep a patient alive contrary to their will in what was the world’s first test case. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/69116/original/image-20150115-5206-4dkmux.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/69116/original/image-20150115-5206-4dkmux.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/69116/original/image-20150115-5206-4dkmux.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/69116/original/image-20150115-5206-4dkmux.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/69116/original/image-20150115-5206-4dkmux.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/69116/original/image-20150115-5206-4dkmux.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/69116/original/image-20150115-5206-4dkmux.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/69116/original/image-20150115-5206-4dkmux.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Truus Postma in 1973.</span>
<span class="attribution"><a class="source" href="http://commons.wikimedia.org/wiki/File:Truus_Postma_(1973).jpg#mediaviewer/File:Truus_Postma_(1973).jpg">Nationaal Archief</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>A set of criteria developed through <a href="http://bne.catholic.net.au/qbc/downloads/downloader.php?euthanasia/euthanasia-in-the-netherlands.pdf">a number of cases</a> in the country during the 1980s and <a href="http://www.euthanasiecommissie.nl/Images/Wet%20toetsing%20levensbeeindiging%20op%20verzoek%20en%20hulp%20bij%20zelfdoding%20Engels_tcm52-36287.pdf">resulted in</a> the Termination of Life on Request and Assistance with Suicide (Review Procedures) Act 2001. This did not legalise end-of-life assistance but instead provided statutory defences to prosecution, subject to certain procedures being followed. </p>
<h2>Assisted dying now</h2>
<p>Today the Netherlands has been joined by Belgium, Luxembourg and Switzerland; the US states of Oregon, Washington, Montana and Vermont; and most recently the Canadian state of Quebec as jurisdictions which have enacted legal provision to permit assistance at the end of life. In the UK, <a href="http://www.scottish.parliament.uk/parliamentarybusiness/Bills/69604.aspx">Scotland</a>, <a href="http://www.dignityindying.org.uk/assisted-dying/lord-falconers-assisted-dying-bill/">England and Wales</a> are developing bills that propose to bring similar provisions to this country for the first time. </p>
<p>The provisions in the different jurisdictions vary but have similarities too. They have mostly had to address recurring concerns such as what form a request for assistance to end life should take; whether there should be a minimum age; how the consultation and referral process will be monitored; how capacity is to be determined; who will oversee reporting and scrutiny; who will provide such assistance; and above all, how transparency, accountability and equity are to be ensured. </p>
<p>Many jurisdictions have experienced difficulty with terminology and definitions. For example, how can it be shown that a person’s suffering is at a point that it can no longer be endured? Legislative proposals have included descriptions such as “unbearable”, “intolerable”, “unrelievable”, “hopeless”, “intractable” and “irremediable”, and it has been questioned whether any of these words capture the essence of what an individual may feel at that moment and, if so, how it be adequately reflected in legal provision. </p>
<h2>Euthanasia vs assisted suicide</h2>
<p>Among regimes that permit assisted dying, they don’t always permit both euthanasia and assisted suicide, the <a href="http://www.worldrtd.net/qanda/what-difference-between-assisted-dying-and-euthanasia">distinction between the two</a> being about who is doing the killing (though more on the fineness of the distinction below). Euthanasia involves administering the lethal drugs, while assisted suicide is about making the means available to the patient to administer themselves. Where both types of assisted death are available, <a href="http://ukpollingreport.co.uk/blog/archives/212">surveys have shown</a> that individuals usually choose euthanasia, placing the responsibility for the dying process onto another. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/69127/original/image-20150115-5170-12eq2pa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/69127/original/image-20150115-5170-12eq2pa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/69127/original/image-20150115-5170-12eq2pa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/69127/original/image-20150115-5170-12eq2pa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/69127/original/image-20150115-5170-12eq2pa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/69127/original/image-20150115-5170-12eq2pa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/69127/original/image-20150115-5170-12eq2pa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/69127/original/image-20150115-5170-12eq2pa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The assisted dying that different jurisdictions permit varies widely.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&search_tracking_id=c2si0KHLjO2kCYzrLDXLJQ&searchterm=euthanasia&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=123384046">Robert Kneschke</a></span>
</figcaption>
</figure>
<p>The Netherlands and Luxembourg permit both euthanasia and assisted suicide. Belgium allows only doctors to perform euthanasia. Assisted suicide is not explicitly covered but there appears to be acceptance that it would be permitted within the provisions. All four American states permit only physician-assisted suicide, which is broadly the route now being proposed in Scotland, whereas England and Wales have seen proposals for assisted dying. </p>
<p>Switzerland permits assisted suicide but excludes euthanasia. The law does not require a physician to be involved, nor does it require the recipient to be a Swiss national. This latter aspect of Swiss law is unique and the <a href="http://www.dignitas.ch/index.php?option=com_content&view=article&id=22&lang=en">Dignitas clinic in Zurich</a> has been the focus of much discussion around what is referred to as “suicide tourism”. </p>
<h2>The European human rights conundrum</h2>
<p>During the committee hearings on the Scottish bill this week, the Law Society of Scotland <a href="http://news.stv.tv/scotland-decides/news/306301-proposed-assisted-suicide-law-could-breach-human-rights-laws/">indicated that</a> it could be in breach of the <a href="http://news.stv.tv/scotland-decides/news/306301-proposed-assisted-suicide-law-could-breach-human-rights-laws/">European Convention on Human Rights (ECHR)</a>. This stems from <a href="http://www.legislation.gov.uk/ukpga/1998/46/section/57">rules that</a> that prohibit the Scottish government from passing laws that are incompatible with the convention. </p>
<p>One potential area of incompatibility is <a href="http://www.echr.coe.int/Documents/Convention_ENG.pdf">Article 2</a>, which protects the right to life. The English case of <a href="http://www.theguardian.com/society/2002/apr/29/health.medicineandhealth">Diane Pretty in 2002</a> noted that the right to life could not, without a distortion of language, be interpreted as conferring a “right” to die. Understandably, states place great emphasis on the value of human life and their obligation to protect this may outweigh an individual’s right for assistance to end life. </p>
<p>It is worth pointing out in the this context that most legislation in place does not confer a personal right to seek assistance to die, however. It is arguably broader than that, since it creates an environment where, under certain conditions, it is lawful for that help to be provided. That might be a key distinction for reconciling ECHR Article 2 and the forthcoming UK laws, assuming they are enacted. </p>
<p>Through a series of English cases, there has been much legal discussion on whether the present law on assisting a suicide is incompatible with <a href="http://www.echr.coe.int/Documents/Convention_ENG.pdf">Article 8</a> of the convention (right to respect for private and family life). In June 2014, in the case of <a href="https://www.supremecourt.uk/decided-cases/docs/UKSC_2013_0235_Judgment.pdf">Nicklinson and others</a>, the UK Supreme Court concluded that it was the role of parliament to decide whether current law was incompatible with the provisions of Article 8. This is what is currently happening as both the Westminster and Scottish parliaments consider their proposed assisted dying legislation. </p>
<h2>The problem of ‘practical assistance’</h2>
<p>When legislation was passed in Oregon in 1997, some of the first challenges came from those who argued that if they wished to end their lives the law prevented them because they lacked the ability to hold the medication in their hands or put in it their mouths and ingest it. This was particularly an issue with people with progressive neurological diseases. </p>
<p>So one important question for the UK legislators will be, if assistance is provided, at what point does it cease to be assistance and instead become euthanasia – the primary responsibility having passed to another to bring about death? There is whole spectrum of what may be construed as assistance – helping someone travel to another country to die might be included for example, though to date the law has not recognised this as assistance. But is holding a person’s head up, or putting pills into their hands or mouths, or giving them a glass of water, euthanasia or assisted suicide? </p>
<p>Other issues are vital too. There is the question of the protection of those who are vulnerable. And society will need to ensure that any law, if introduced, applies equally and transparently to all. In short, as the UK moves towards joining the group of countries who permit some form of assisted dying, there is still much that needs carefully considered first.</p><img src="https://counter.theconversation.com/content/36311/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alison Britton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The debate on the role of law and ethics at the end of life is an enduring one. In 1971, such debate was focused almost solely upon the Netherlands when a rural physician called Truus Postma facilitated…Alison Britton, Professor of Healthcare and Medical Law, Glasgow Caledonian UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/252992014-04-04T22:08:12Z2014-04-04T22:08:12ZMargo MacDonald, independent Scot, 1943-2014<p>The Scottish Parliament prides itself in the number of visitors it receives. They might hope for a sighting of the first minister, but Margo MacDonald was the member the public was keenest to actually meet on tours of Holyrood. </p>
<p>This larger-than-life character first came to prominence as a by-election candidate for the Scottish National Party in Glasgow Govan in 1973. She had joined the SNP in 1966, a year before Winnie Ewing secured the SNP’s first by-election victory in Hamilton. MacDonald was heavily involved in Ewing’s campaign, even though their relationship was always difficult.</p>
<p>There were two by-elections the day Margo MacDonald won Govan. The SNP’s hopes had initially focused on Edinburgh North where Billy Wolfe, then party leader, was the candidate. Not for the last time, Margo upstaged the SNP establishment by taking Govan from Labour while Wolfe won less than half Margo’s share of the vote.</p>
<h2>First taste of victory</h2>
<p>She took up her seat in the UK Parliament alongside Donald Stewart, then the only SNP MP (for the Western Isles). But she was out of Westminster within three months when Govan returned to Labour at the February 1974 election. </p>
<p>She failed to win it back that October even though her party made significant advances, taking 11 of Scotland’s 72 seats with 30% of the vote. Her compensation was election as deputy leader. She was in charge of strategy and became the public face of the party in the lead-up to the March 1979 devolution referendum and the general election later that year.</p>
<p>She became a favourite of journalists and broadcasters seeking comment at this febrile time in Scottish politics. The SNP led in the polls and seemed unstoppable for a period. </p>
<p>“It’s Scotland’s Oil” may have been the brainchild of others in the SNP but MacDonald became the messenger. She never missed an opportunity to hammer home the message that oil could be used to tackle Scotland’s deep social and economic problems. But her success in getting the message across came at a cost: the SNP came to be seen to rely too heavily on this one resource.</p>
<h2>Common touch</h2>
<p>Rather than learning her trade in Glasgow University’s students’ union with numerous contemporaries, MacDonald had been a trainee physical education teacher. Her demotic style meant though she was a powerful communicator who spoke the language of the public, she suffered from the snobbish elitism found across all political parties in the 1970s. </p>
<p>But speaking the language of the playground rather than the classroom was no impediment in articulating complex ideas. MacDonald’s uncompromising refusal to translate her speech contributed in no small way to the democratisation of political debate, one of the most under-acknowledged achievements in Scottish politics. </p>
<p>MacDonald saw independence as more than a constitutional project. To her, it was the only way to confront social injustice. Her maiden speech in the Commons noted that her predecessor, John Rankin of Labour Cooperative, had referred to housing problems, slums and unemployment in 1945 and that the “same shameful facts are still all too self-evident in Govan’ 30 years later.” </p>
<p>Tam Galbraith, Glasgow’s last Tory MP, followed her stating that even if what he had heard did not please his ears, “everything that my eye saw was a delight”. She brought passion and commitment to all her causes and tackled Scotland’s boorish male-dominated politics with her own coquettish personal style, albeit she was easily slighted at times. </p>
<p>These prejudices were as evident in her own party as in her opponents’. When the SNP’s advances were reversed later in the 1970s, she became the focus of criticism. When MacDonald stood in Hamilton in another by-election in 1978, she was defeated by future Nato Secretary General George Robertson. </p>
<p>Tensions intensified over strategy between the 11 MPs and the SNP leadership based in Scotland, still under Billy Wolfe. MacDonald spent a period as director of homeless charity Shelter in Scotland between 1978 and 1981 but the climate made it particularly difficult to combine this with SNP activities. </p>
<p>She was the main SNP casualty of the referendum failure and the general election results in the 1979, where she failed to take Glasgow Shettleston. She was then heavily defeated as deputy leader. </p>
<h2>Enter the ‘79 Group</h2>
<p>MacDonald was instrumental in setting up the ’79 Group following the election, arguing for socialism and republicanism at its inaugural meeting. She faced suspension from the party when it voted to prohibit internal groups in 1982, but resigned before she could be suspended. Some would say she never developed the hard shell necessary for the macho world of Scottish politics. </p>
<p>If her political life declined from the latter half of the 1970s, her personal life gave her comfort. Jim Sillars had been a Labour MP but set up his breakaway Scottish Labour Party, supporting independence and socialism, in 1976. </p>
<p>There had been speculation that MacDonald might join. Instead, Sillars joined the SNP after losing his seat in 1979. The couple married and MacDonald set out on a new career as a journalist while Sillars went on to build a career as an SNP politician, following his wife both to become SNP MP for Govan in a by-election in 1988, and deputy party leader. But as Sillars’ second political career declined after he lost Govan in 1992, MacDonald started to become engaged again.</p>
<p>MacDonald developed a very personal style of broadcast journalism, with a particular focus on social justice. As the prospect of a Scottish parliament became more likely as the nineties went on, she made the transition back into politics. </p>
<h2>Back to the fold</h2>
<p>She returned to the SNP, standing at the head of the party’s list in Lothian in 1999. Alex Salmond gave her responsibility for raising questions about the Holyrood parliament building, which was becoming a major issue as the cost escalated. </p>
<p>But as had happened in the 1970s, MacDonald’s skill in communicating a message outstripped its usefulness for the party leadership. Senior people in the party thought that the criticism of the building project undermined not only the building but the very idea of the parliament.</p>
<p>As the 2003 election approached, MacDonald failed to appreciate that popularity with the electorate was not the same as popularity with her party’s grass roots. She fell from top slot to fifth place in internal elections for the SNP’s Lothian list, effectively being de-selected. </p>
<p>She attacked her colleagues bitterly and stood as an independent. She was returned and re-elected in 2007 and 2011. Her formal status as an independent merely acknowledged what she had always been. </p>
<p>Her campaigns in Holyrood were extensions of what she had long articulated in her journalism and before. Her advocacy of tolerance zones for prostitution in Edinburgh was informed by the same skills that she had deployed as a journalist. </p>
<h2>The right to die</h2>
<p>MacDonald also became a fierce advocate of assisted dying. Her campaigns were often rooted in the personal, but this one more than any, since she had been diagnosed with Parkinson’s disease. </p>
<p>In a moving contribution, she told parliament: “I don’t want to burden any doctor. I don’t want to burden any friend of family member.” </p>
<p>Her attempt to legislate in this area failed in 2010 but she continued to pursue the matter, pushing a second assisted dying bill through Holyrood at the time of her passing. </p>
<p>She was keenly aware of the characters of the national movement of which she was a part and knew the remark of fellow nationalist, republican and socialist Oliver Brown: “I regret the day I compromised the unity of my party by admitting a second member.” </p>
<p>Margo MacDonald was never one for compromise. The public respected her for this even when it disagreed with her.</p><img src="https://counter.theconversation.com/content/25299/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>James Mitchell receives funding from the Economic and Social Research Council.</span></em></p>The Scottish Parliament prides itself in the number of visitors it receives. They might hope for a sighting of the first minister, but Margo MacDonald was the member the public was keenest to actually…James Mitchell, Professor of Public Policy, The University of EdinburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/247372014-03-25T14:50:45Z2014-03-25T14:50:45ZAssisted suicide bill is laudable, but poorly drafted<figure><img src="https://images.theconversation.com/files/44596/original/nd576z5y-1395694605.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Scotland is considering an assisted suicide bill.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/29027365@N03/3258223713/in/photolist-5XVfoV-2vMhjY-dv44tR-dv44DZ-dv45b4-dv44Zi-dv44QV-6XRzA5-74wLvp-74wNUa-rWP6j-bKmPrn-dZJ9c9-6rVTRP-rgj2j-eh684M-6aVtfx-6aVtWr-6aVrHv-6aZBoJ-kVwNM-58P62C-avxoau-avxo8A-avxnTd-avxnZW-avuJrM-avxnRu-avxnUw-avxo2j-avuJxz-avx4vz-avx4yT-avzGZh-7x4A7H-7yhhh5-7yhhqb-7ydrxg-avvJdX-avzxkW-avvJh8-avwPFp-avzsYh-avynEj-avvJg6-avwAKX-avynFf-avwAMz-avyrsG-avzf37">Matt</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>A bill on physician-assisted suicide is being considered by the Scottish parliament. It is the <a href="http://www.bbc.co.uk/news/uk-scotland-scotland-politics-24927805">second attempt</a> by independent member Margo MacDonald, who has Parkinson’s disease, to get such a law onto the statute book. </p>
<p>The <a href="http://www.scottish.parliament.uk/parliamentarybusiness/Bills/69604.aspx">Assisted Suicide (Scotland) Bill</a> would decriminalise physician-assisted suicide (PAS) for registered medical patients in Scotland over the age of 16 who regard their quality of life as unacceptable as a result of an illness or progressive condition that they consider terminal or life-shortening. Unlike MacDonald’s previous bill, it expressly prohibits euthanasia – the deliberate killing of another to avoid future suffering.</p>
<p>Scots Law does not have a specific criminal offence banning encouragement or assistance to suicide, unlike in England and Wales, where Lord Falconer is sponsoring an assisted suicide bill that is <a href="http://www.telegraph.co.uk/news/politics/10685362/Assisted-suicide-moves-closer-as-Government-allows-free-vote.html">due to be read</a> in the Lords later in the year.</p>
<p>But helping someone to commit suicide, for example by deliberately supplying medication used to lethal effect, could potentially be treated as a serious crime. It might lead to prosecution for culpable homicide – the Scottish equivalent of manslaughter – or even murder. </p>
<h2>Medical records</h2>
<p>Macdonald’s bill envisages a complex procedure for people who want a physician to help them commit suicide. Along with the eligibility criteria mentioned above, they have to make a witnessed “preliminary declaration” stating that they would consider suicide. This must be endorsed by a physician, who enters the declaration into the person’s medical records. </p>
<p>At least seven days later, the patient has to request PAS, which would have to be approved by two physicians. At least 14 days after this request, the patient would be required to make a second request, which would need to be approved in the same way. They then would have 14 days within which to carry out their wish to die; otherwise their request would expire – although the process could start again.</p>
<p>The reaction to the bill has been mixed, particularly among physicians. In recent letters to the Glasgow-based Herald newspaper, a number of doctors argued <a href="http://www.heraldscotland.com/news/health/doctors-reveal-backing-for-assisted-suicide-legislation.23652370">in favour</a> of legalisation, while <a href="http://www.heraldscotland.com/comment/letters/doctors-oppose-assisted-suicide.23736442">others have maintained</a> that there is little support among the medical profession. One of the arguments against the bill has been that PAS cannot be effectively regulated. </p>
<h2>The case for</h2>
<p>I believe that we should support PAS and the Bill in principle. Like many proponents of assisted dying, I start from two basic principles: people should not have to endure unbearable and hopeless suffering, and when they do, they should have the choice to end their lives. </p>
<p>The claim that PAS can’t be safely regulated does not withstand scrutiny. The <a href="http://www.commissiononassisteddying.co.uk/wp-content/uploads/2012/01/Penney-Lewis-briefing-paper.pdf">evidence</a> from jurisdictions which allow assisted dying such as the Netherlands, Belgium, Switzerland, Washington State and Oregon is that safeguards are respected. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/44597/original/5ycz2kbc-1395694851.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/44597/original/5ycz2kbc-1395694851.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/44597/original/5ycz2kbc-1395694851.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/44597/original/5ycz2kbc-1395694851.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/44597/original/5ycz2kbc-1395694851.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/44597/original/5ycz2kbc-1395694851.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/44597/original/5ycz2kbc-1395694851.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/44597/original/5ycz2kbc-1395694851.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Margo MacDonald MSP has long campaigned for assisted suicide.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/19432794@N00/3937758761/in/photolist-6ZY3ur-7FKdyC-jQRpeF-iNJjRf-eUwhYY-gZrc1k-9ZqEXD-8VTdPt-jQRrPa-jQSknt-jQTLmA-k9Fd1E-k9FdWN-k9FfhJ-k9DtCK-jQSm3B-k4UaP9-k4SgCM-5Kkwn6-jQSnaX-k4RPiV">Greener Leith</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Opponents often argue that we cannot allow PAS because immoral killings will result – the so-called “slippery slope argument”. It is notoriously difficult to prove one way or the other, but the evidence that does exist from the jurisdictions that allow assisted dying tends against the argument. </p>
<p>Having said all that, the Scottish bill needs improvements. It would benefit from redrafting, especially since its predecessor was criticised for being overly complex and providing insufficient safeguards. Legislation that gives people rights and responsibilities should be easy to understand and apply. At present, the bill is a mess of cross-referencing and repetition. </p>
<p>The requirement that the request for PAS is made without pressure from others, known in legal speak as “voluntariness”, is absent from the text of the bill. It features only in the standard form declarations that the person requesting PAS, the witness and physicians must complete. Such an important requirement must be at the heart of the law. </p>
<h2>Loose words</h2>
<p>Elsewhere the bill is ambiguous. It refers to an illness or progressive condition that is “for the person” terminal or life-shortening. But it makes little sense to leave it entirely up to the person to decide whether these criteria have been met, since anyone could request PAS. As the bill stands, the doctor is only required to validate the “belief” of the sufferer rather than the condition itself. </p>
<p>The legislators might also reconsider whether the preliminary declaration actually provides any safeguards beyond the first and second requests for PAS. You could achieve the same effect by having a longer “cooling off period” between the first and second requests – 21 days for instance. There is also a risk that the preliminary declaration deters seriously unwell people from PAS by requiring them to jump through more bureaucratic hoops than they are able to manage. </p>
<p>Another issue is the bill’s failure clearly to define the responsibilities of physicians. Unlike in Belgium, Oregon and Washington State there is no conscience clause, which would give physicians the right to refuse to provide assistance. </p>
<p>But if such a clause is introduced, it must stipulate that the physician has a duty to refer the patient to another who will give assistance. Otherwise a doctor would be under no obligation to make clear that their refusal was conscience-based, which might lead a person to think that they were not eligible for PAS. And having been rejected for PAS by their regular physician, it can be daunting for patients to request PAS from another that they do not know. Were the bill to create a duty to refer in the event of conscientious objection, this problem might be eased. </p>
<p>Neither is there a requirement that the two physicians endorsing each of the requests be independent from one another. For example the Belgian euthanasia law requires that the second physician have no prior relationship with the treating physician or patient. </p>
<p>The Scottish proposal does not include a system for monitoring PAS. It would be highly desirable to have a reporting requirement that would help us to develop a picture of who receives PAS and for what reasons. Ideally, there would be publicly available annual reports that consider difficult cases to help guide physicians – in line with what is operated in the Netherlands.</p>
<p>Perhaps of most concern is the time limit of 14 days after the second request during which lethal medication must be taken. A 14-day time limit may well be distressing (as well as impractical), and may encourage people to end their lives sooner than they would otherwise choose.</p>
<p>In Oregon, a significant proportion of the people who receive a prescription for lethal medication under the Death with Dignity Act <a href="http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year16.pdf">never take it</a>. This is perhaps because PAS functions like a security blanket: having lethal medication on hand gives comfort. </p>
<p>It allows people to live out their lives safe in the knowledge that they can die quickly and peacefully if they so choose. To lose the security blanket might be to lose that which is most important – PAS allows people not only to die well, but to live well too.</p>
<p>It would be naive to believe that MacDonald’s bill would succeed if all these issues were addressed. Experience of the previous attempts in Scotland and in England and Wales has shown that politicians become queasy in the face of a well-organised opposition lobby. But if MacDonald and her supporters want to maximise their chances, there is more work still to be done. </p><img src="https://counter.theconversation.com/content/24737/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Isra Black receives funding from the Arts and Humanities Resarch Council for his doctoral research. In 2011,
Isra coauthored a briefing paper on 'The effectiveness of legal safeguards in jurisdictions that allow assisted dying' with Professor Penney Lewis (King's College London), which was commissioned by Demos for the Commission on Assisted Dying.</span></em></p>A bill on physician-assisted suicide is being considered by the Scottish parliament. It is the second attempt by independent member Margo MacDonald, who has Parkinson’s disease, to get such a law onto…Isra Black, PhD candidate, King's College LondonLicensed as Creative Commons – attribution, no derivatives.