My first reaction, case when it became obvious that Margo MacDonald’s PA wanted me to go through to Holyrood and interview her, visit was one of sheer terror. It seems silly, looking back on it now: it’s not that I was a stranger to interviewing at least my musical heroes by that time, and I’d done plenty of long-form pieces for the legal magazine I wrote and edited based around interviews. But a sit-down chat with possibly the only Scottish politician to command universal respect, somebody I idolised – and on a subject that, right from my undergraduate dissertation, had been a source of fascination and confusion for me either despite or because of the things I was raised to believe – was easily going to be the high point of my wee babba journalist career so far. In fact, as I said shortly after news of MacDonald’s death broke on Friday afternoon, it probably still is.
And of course it was daft to be so scared: some people just put you at ease right away, although even then – close to the end of her political career – being across from her during a debate would have been a different matter entirely. As it is, I just feel privileged I got the chance to meet her, never mind spend an hour discussing deep philosophical and moral questions. It’s a sad thing that she never lived to lend her reason and her expertise to the final months of the pre-referendum independence debate, but at least she inspired others to carry on fighting for the causes closest to her heart.
I found this piece, which appeared in The Specialist Paralegal, in a folder marked “historical” on my computer which I think I used to use as a portfolio. It would have been useful had I dated it, but I’m fairly certain the below conversation took place some time towards the end of 2008. I’d say please be gentle, given how early in my career this was written, but I doubt Margo would have been.
An Idea Whose Time Has Come
in the wake of several headline-grabbing cases, Margo MacDonald MSP talks to The Specialist Paralegal about her End of Life Choices Bill.
The old saying may tell us that nothing in life is certain but death and taxes, but as a nation we Brits don’t like to talk about that final inevitability. Indeed many of us haven’t even made a will, let alone considered the circumstances in which we might meet our end.
Despite this, even the most casual observer couldn’t have helped but notice the number of stories in the national press towards the end of 2008 which raised legal and moral questions about terminal illness and the end of life. In September, 23-year-old Daniel James died at the Dignitas clinic in Switzerland after a rugby accident left him paralysed; and in October, MS sufferer Debbie Purdy lost her High Court battle to clarify the law which could potentially see her husband jailed for fourteen years if he was to “assist” her suicide by helping her make the same journey. Meanwhile, Prime Minister Gordon Brown has publicly stated that he is opposed to passing legislation that could “put pressure on people to end their lives”.
For Scottish politician Margo MacDonald, however, the questions raised aren’t ones of public morals but rather private autonomy. Last year Ms MacDonald, 65, who suffers from Parkinson’s disease, launched a consultation on a private members’ bill which she hopes will get her colleagues debating some difficult questions.
“This consultation document is really to let everyone see what I’m proposing, what I’m still questioning, what I’ve found out – it’s to set the scene,” she explains. “At the end of the consultation period, I will ask MSPs if they think the contents of the proposal are worthy of debate – and I believe they have to be debated.
“I think by that time they will have had so much communication from their own constituents that a lot of them will agree to the debate, even if they don’t agree with the proposal.”
Assuming that she gets the backing of the eighteen MSPs needed to draft a Bill, Ms MacDonald predicts that the debate will continue until at least the end of this year. “During that time I imagine it won’t be the frenzy it has been this last year, but there will be other cases – of that I’m absolutely sure,” she says. “So I think the topic is not going to go away and we do have to, at the very least, work out what our attitudes are and clarify the law.”
Scotland, of course, has a separate criminal legal system to the rest of the UK, but recent news coverage has kickstarted the debate both north and south of the border and responses to the consultation aren’t limited to Scotland. “I’m going for physician assisted, not named person assisted as in Debbie Purdy’s case,” Ms McDonald says when asked how she would see the two jurisdictions interact should she ultimately be successful. “I don’t know what the consultation will say though, and I’d be quite interested to find out if there are people who would prefer it to be named person.
“I suspect that, here in Scotland, people prefer the idea of doctors if there are a sufficient number who are willing, and suitable. But no doctor can be forced, and not every doctor will be suitable – and the possibility of a register is something that I think I’ll find out as I go through the consultation process and speak with different groups of doctors.”
Although most of the details will be shaped as the consultation process gets underway, Ms McDonald has clearly given plenty of thought to how the scheme will work in practice and what safeguards will immediately be necessary. “Regardless of the actual system we end up with – whether it’s like in Oregon where you are given a prescription and the doctor stands back, or whether it’s like in the Netherlands, where the doctor might actually administer a fatal injection because you’ve asked for it – a very small number of people ultimately ask for this,” she explains. “While a higher propensity towards a progressive condition – for example, a high concentration of MS sufferers – might skew the figures slightly, it won’t be in any way that can’t be explained.
“Every patient has a record, and ultimately this will be another record. I think people will eventually realise that the main benefit to be derived from this proposed legislation for sufferers of a progressive condition like mine is that you have an insurance policy, so that if things get too intolerable you can go to a doctor who knows you, knows your history and will take you seriously.”
Basing her legislation on the autonomy of the individual, she is very clear that the capacity of that individual to make the decision to end his or her own life be carefully examined. It is clear that being able to deal with a doctor who knows the patient’s medical history has its advantages in this respect. “If you are someone who has a mental illness or depression, the doctor dealing with you would have to know that you had the capability to make that decision,” Ms MacDonald explains. “In that case, it would show up in the patient’s record if the doctor didn’t adhere to the appropriate guidelines that a psychiatrist has to be called in.
“You have a duty of care towards that person, to make sure that you at least give them the chance to try to tackle depression or mental illness. But if at the end of it they still say ‘no, I’ve had enough’ – and it is them that is saying ‘no’, and not a depressive illness – then they have the same rights as anybody else.”
Clearly not one to shy away from difficult questions about the scheme, Ms MacDonald also brings up the subject of some kind of lower age limit bearing in mind the recent decision allowing thirteen-year-old Hannah Jones, of Hereford, to refuse a potentially life-saving heart transplant. “I don’t feel that it diminishes the argument to discuss these things,” she says. “There’s no perfect, one size fits all approach, although ultimately one law has to apply to everybody. The refinements, and how that law is applied, will be difficult.”
Loss of control
Late last year, Ms MacDonald fronted a Panorama programme for the BBC on assisted suicide in which she spoke to campaigners, sufferers, religious figures – and those left behind after a family member had committed suicide. “With everybody I’ve spoken to, it’s not the pain that they mention first – it’s the loss of control over their own lives, that total dependency on other people with no hope of that ever mitigating,” she says. “And it’s not a temporary thing; it’s not something that people go into a huff or a mood about. And I’ve anticipated that this might happen to me.”
She does not shy away from the passionate and vocal arguments against the legalisation of physician assisted suicide, but admits that she “doesn’t get” the so-called ‘slippery slope’ argument. “My bill all depends on autonomy – without the person being able to say that they want to miss this last part out, it can’t work,” she says. “Under my legislation, the patient would have to in all cases activate the process, which is arguably more protection than we currently have. Nobody could say ‘we’ll just dehydrate and starve him, just let him slip away…’
“The reason why this is such a challenging piece of legislation is that it is absolutely at the interface of public policy and private morality. But if a society can consider that sort of thing calmly, and clearly, it’s good for them to grow.”
And perhaps now is the time for society to begin to ask these questions. A close personal friend of Cardinal Keith O’Brien, head of the Catholic Church in Scotland, who she interviewed for the Panorama programme, Ms MacDonald has stipulated that she has no intention of attempting to change the minds of those whose belief systems preclude the termination of life before its natural end.
“Why now?” she asks. “I think more of us are living longer, and modern news coverage has made people more aware. And perhaps there is a metaphysical reason – perhaps the time is now right. It’s possible that this is an idea that’s time has come.”
And with a recent YouGov survey in the Sunday Times showing that more than two-thirds (69%) of 2,000 respondents supporting a change in the law on assisted suicide, perhaps she is right.