There’s an old saying that hard cases make bad law. When it comes to end-of-life decisions, this is never more true. No-one could fail to be moved by some of the very sad stories told about those who beg to be helped to die. Nevertheless, we must question the logic and we must consider the wider impact on society of allowing a change in the law to take place. It is a fundamental shift in what we understand the National Health Service to be about.

This debate is taking place at a very particular moment in our population history. We are frequently presented with demographic research which talks in terms of the “problem” of the increasing number of elderly people in society. This is frequently described as a “burden” on the health service. Caring for them is costly. Challenge the language and it is of course hurriedly amended, but there is a clear implication in the approach and it is that implication which should worry us profoundly. It is only a short jump to applying that same language to individuals. A costly burden and a problem to be solved. It is not only the elderly who would be included in this category because as health professionals and others are quick to point out, the most costly period of a person’s life is the last year or two before death, at whatever age that death happens.

Well, here’s a truth there’s no escaping. We are all going to die. We may be a bit more expensive to maintain in those last months, but that is just as much a part of our healthcare as our earlier years. What we need to do, therefore, is concentrate on doing the things which will make the last months we have as much part of our living as everything that has gone before.

Are there some conditions for which palliative care is still difficult to deliver? I’m not a medical expert, but if there are then shouldn’t we be seeking ways to research and improve such care until we find solutions? Any bets on the likelihood of that happening while there is another infinitely less expensive option?

And what price further research into the causes, cures and alleviation of the many illnesses of old age, already something of a Cinderella area? The Netherlands is often pointed to as a model for the introduction of assisted suicide as if somehow everything was rosy in the Dutch garden. That is simply not true. Research a few years ago concluded that guidelines there were consistently ignored and almost unenforceable. Half of Dutch doctors felt free to actually suggest euthanasia to their patients and an astonishing 25% revealed anonymously that they had terminated patients’ lives without an overt request.

As an example. the same study refers to the case of a Dutch nun “helpfully” euthanised by her doctor who decided that her religious scruples prevented her making what he felt would be the most sensible and entirely justified decision. There are many other such cases that point to flaws in the Dutch system that can’t be ignored. An examination of the reality in Oregon, the only US state to adopt this legal change, reveals a similar story of confusion and dubious decisions.

Dignity in dying is important. That is why we already accept that sometimes it is right to stand back and allow nature to take its course. There can be few families who have not, at some stage, had to respond to a hospital request for guidance on whether “Do Not Resuscitate” should be entered into a patient’s notes. The discontinuation of painful and pointless medical intervention that will only be effective for short time is, however, not the same thing as actively intervening to help nature along. Omission and commission are not the same in this context and to suggest they are is to be deliberately and dangerously misleading.

But what about the doctors in this country who have already taken the decision to help some patients die? We know that it happens and there is a case in the news right now involving a doctor charged with prescribing sleeping pills to a patient who said she wanted to end her life. The fact that it might already happen, however, does not provide an argument for legalising euthanasia. Once you do that, the exceptional becomes routine.

Growing numbers of health professionals are invoking the conscience opt-out provided in the abortion legislation and there is already a challenge to that in the House of Commons. Increasingly, “'conscience'” is being derided and sidelined and those who do want to rely on it are having their views dismissed. How much more sharp would that become if we introduce assisted suicide?

We as patients, the medical profession and society as a whole all stand to lose if this becomes the norm. Instead, I would prefer to see us demand better services for the elderly and the dying, services which recognise the needs of the whole individual — medical, physical, spiritual. Let’s put our money where our mouths are and alleviate the fears and concerns of Margo MacDonald and all those who may be worried about the future. That’s a far better way for society to go.

Roseanna Cunningham is the nationalist MSP for Perth and a former advocate.

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