Hansard

I was about to say that social workers have contacted us ahead of today’s debate to say that they are deeply worried about the bill as it stands, including, specifically, the amendments that were agreed to at stage 2.

I and colleagues around the chamber—including, I am sure, my colleague Paul O’Kane—believe that we must listen to social workers. They are often asked to protect people. To do so against the background of legally ending someone’s life would be a big ask, and we should listen to them when they raise concerns.

Despite being a group of people who have contact with the state more often than many others, disabled people, and especially disabled women, are still more likely to experience domestic violence and abuse than others. In fact, they are twice as likely as non-disabled women to experience abuse. They are also more likely than non-disabled people to experience abuse from an adult family member. One in 10 domestic violence abuse cases is perpetrated by someone with a caring responsibility.

I am talking about some of the most regulated people in society. I say this not flippantly, but as an example: it is difficult for a disabled person to even get on a train without having to give their full name and phone number for staff to check whether they have booked assistance. This is a group of people who have a lot of contact with a lot of professionals in their lives, yet abuse and coercion towards them still go undetected. That goes to the heart of what members across the chamber, and in particular my colleague Paul O’Kane, have spoken of in relation to social workers’ concerns about the bill.

There is another angle of risk to highlight. When structural inequalities and dependency are present, as they often are for people at the end of their lives—or, for some, throughout their lives—no safeguards can fight the tide of internalised coercion or ableism. Such coercion is subtle, but it is deeply internalised and extremely difficult to detect.

There are many amendments on coercion, financial abuse, encouragement to choose assisted suicide et cetera that seek to remove the possibility of improper motives influencing the process. The reality is that disabled people’s experience is so deeply oppressed that seeking to remove those things simply by amending one bill is unrealistic. It would take sweeping change across all areas of public policy and all areas of life to protect disabled people from the internalised everyday ableism that they experience.

The subtle pressure faced by disabled people and those who live with dependency or live differently from others stems from cultural attitudes. We know that when it comes to people experiencing ill health, disabled people or people who have lost function in some way, those attitudes are not yet what we would all hope them to be.

I see these things every day. It is hard to believe that your way of life is acceptable when so many people tell you that it is not; that changes to make something accessible to you are too expensive; that there are not enough care funds to go around, so you should have lower expectations of the life that you want to live; or that surely a woman in your condition will not want a family. Those are the very real beliefs that many disabled people face every single day.

We saw that at its extreme during the Covid pandemic, when the lives of many groups of people were considered to be of less value and “Do not resuscitate” orders were placed on them without their consent. At that time, my husband and I were so scared of the value that society placed on our lives that we wrote to each other to say that we wanted to be resuscitated.

These fears are real. As I have said, even in a highly regulated environment, disabled people's experience of coercion and abuse goes undetected. We cannot detect it now, and we would be unlikely to detect it afterwards if the bill were to pass. If you are told every day that your life is of less value, you learn to believe it. When everything in this world says that you do not belong, you learn to believe it. You internalise it, just as many people internalise the negative attitudes that people have towards them.

For many reasons, people mask such feelings—the feelings of inadequacy and shame that they have come to believe. They can be impossible to detect, and people often do not tell you about them. Some people do not even detect such feelings in themselves until they see others living well.

Many people in Scotland have no choice or autonomy in their own lives. Some disabled people do not get to choose who enters their home to care for them, who helps them to put their clothes on and take them off, or what they have for their dinner. The absence of choice in all other aspects of life could make assisted dying attractive; indeed, it could be the only choice that some people have.

The everyday ableism, and the constant barriers that accumulate and can make life intolerable, can encourage—and, indeed, coerce—people to end their lives. We have seen it happen in other jurisdictions, and we have to protect against it. However, simply asking someone to say that they are exercising choice and autonomy is not protecting against it, and neither is asking a professional to make that judgment. Not only is that difficult, as we have heard members across the chamber say, but many people do not have the skills, or the time, to do it. It would also be asking a lot for health professionals to have the necessary understanding of the deep-seated inequality that every single disabled person faces, and the everyday ableism that they experience, to the extent necessary for those professionals to be assured that the person is acting with autonomy, within the terms of a bill such as this, and in making such a decision.

Taken together, the amendments in the group reflect a genuine effort to strengthen safeguards against coercion. I recognise that. However, they cannot resolve the deeper challenge that, when societal pressures, unmet care needs and personal vulnerability intersect, it becomes extremely difficult to be certain that a decision has been made entirely free from influence. For that reason, I remain deeply concerned that no set of procedural safeguards could fully eliminate the risk of coercion under legislation of this kind.