Scottish politicians are set to decide today on the most significant change to end-of-life law in generations, as the final vote on legalising assisted dying for terminally ill adults takes place in Holyrood.
The debate on the Assisted Dying for Terminally Ill Adults (Scotland) Bill is scheduled to begin around 7pm, with a vote expected by 10pm. This represents the furthest any such legislation has progressed in the Scottish Parliament, following a general principles vote last May which passed by 70 votes to 56.
A “Bulletproof” Bill With Strict Safeguards
The proposed legislation, introduced by Liberal Democrat MSP Liam McArthur, has been described by its sponsor as “the toughest and most comprehensively safeguarded assisted dying bill in the world.” Following five years of consultation and scrutiny, during which 175 amendments were accepted, Mr McArthur has called the final text “bulletproof”.
Under its provisions, only mentally competent adults aged 18 or over who are terminally ill would be eligible. The bill defines a terminally ill person as someone with an advanced, progressive condition from which they cannot recover, which is reasonably expected to cause premature death. Crucially, disability or mental disorder alone would not qualify someone.
Several strict safeguards are built into the process. An individual must be resident in Scotland for at least 12 months and be registered with a Scottish GP. Two independent doctors must then assess that the person is terminally ill, has mental capacity, and is acting voluntarily without coercion, including from financial concerns or feeling burdensome. The person must be made fully aware of all care options, including palliative care, and a waiting period for reflection is mandated.
If approved, a health professional could lawfully provide an approved substance which the eligible adult would choose to administer themselves. Assisting a death outside of these provisions would remain a crime.
Medical Concerns and Conscientious Objection
The bill’s journey has not been without controversy, particularly regarding protections for medical professionals. The removal of a specific section (Section 18) that provided statutory protections for clinicians opting out on grounds of conscience led to significant opposition.
The Royal College of Psychiatrists and the Royal Pharmaceutical Society stated this removal “drastically weakened essential safeguards,” with both organisations switching from a neutral stance to opposing the bill. The Scottish Government explained the section was removed as it was considered outside the parliament’s legislative competence, noting a Section 104 order of the Scotland Act may later be needed to ensure these protections.
While individual doctors would retain a right to conscientiously object, institutions like hospices and care homes have raised alarms. The Bishops’ Conference of Scotland has voiced strong disagreement, arguing institutions should not be compelled to participate in ending life if it violates their ethical principles.
Overwhelming Public Support Amidst Political Division
The parliamentary vote occurs against a backdrop of consistent and overwhelming public support for reform. A YouGov poll for Dignity in Dying found 77% of Scots supported the measure, with just 12% opposed. Another poll by Opinium Research indicated 78% support.
This support cuts across traditional divides, remaining high among different political affiliations and even religious groups. A majority of Church of Scotland members, Anglicans, and Roman Catholics polled backed the measure, reflecting shifting theological views; the Church of Scotland itself suspended its historic opposition to explore the issue further. A majority of respondents with life-limiting health conditions or disabilities also expressed support.
Despite this, political leaders are divided. Scottish Labour leader Anas Sarwar and Scottish Conservative leader Russell Findlay have both confirmed they will vote against the bill.
A Long Road to Reform
Today’s vote follows multiple failed attempts to change the law in Scotland, including bills brought by the late Margo MacDonald in 2010 and 2012, and by Patrick Harvie. The current law in Scotland holds that there is no specific crime of assisted suicide, but assisting a death can lead to prosecution for murder, culpable homicide, or reckless endangerment. Courts have indicated that providing assistance to someone acting voluntarily would not normally attract a homicide prosecution.
The wider UK context also informs the debate. A similar bill for England and Wales, introduced by Labour MP Kim Leadbeater, passed the Commons but has stalled in the House of Lords. Assisted suicide remains banned in England, Wales, and Northern Ireland, carrying a maximum 14-year prison sentence.
For proponents, the issue is one of autonomy and compassion. Liam McArthur has argued, “It is time to look terminally ill Scots in the eye and make this change.” He has stated that the issue is “not going away”, adding: “I think it’s safe to assume that as we go forward, there are more people who find themselves facing horrendous decisions at the end of life who are desperate for more choice.”
Opponents, however, warn of a “slippery slope”, fearing gradual expansion of eligibility and potential pressure on vulnerable people. They argue the state’s primary role is to protect life, not facilitate death.
If passed, Scotland would become the first part of the United Kingdom to legalise assisted dying, enacting a law that would be closely watched across the UK and beyond.
