The concerns that defeated the Scottish ‘assisted dying’ bill are UK-wide

The Terminally Ill Adults (End of Life) Bill has been described by many as one of the most significant shifts in the legal landscape of England and Wales in our generation. Whether this claim overstates the matter is open to debate. What is not in dispute, however, is that the Bill raises profound questions about the relationship between the state and those it governs. Unsurprisingly, its existence, proposals, and suggested amendments have generated extensive discussion and controversy. In this blog series, leading voices in the field of assisted dying reflect on the Bill, what it means for the state to sanction the deliberate and knowing ending of an individual’s life, and how we might tread a path forward.

Mary Neal University of Strathclyde

Keywords: Coercion Concerns; Palliative Care Access; Safeguards and Ethics; Scotland

The Assisted Dying for Terminally Ill Adults (Scotland) Bill was unexpectedly defeated on 17 March 2026 when MSPs voted against it by a margin of 69-57 at Stage Three, despite having supported it in principle at Stage One by a margin of 70-56. So what persuaded twelve MSPs who supported the bill in principle that it should not ultimately become law? Looking closely at what some of the MSPs who switched their votes actually said, it is clear that they were swayed in large part by concerns about various forms of coercion, and that the factors that led to the Scottish bill’s defeat are issues that Westminster must also take seriously.

Coercion by circumstances

One concern expressed by the MSPs who switched their votes was the idea that, if ‘assisted dying’ became legal, vulnerable people would choose it not because their condition itself was making life intolerable, but because of social circumstances like poverty, or lack of access to the care and support that would make living with their condition bearable. Some pointed out that legalising ‘assisted dying’ in a social context where some people were likely to feel it was their only option contradicted pro-bill arguments about ‘choice’, since ‘assisted dying’ can hardly be seen as a ‘choice’ in the absence of liveable alternatives.

Thus, Brian Whittle MSP noted that “assisted dying cannot be seen in isolation…it must be a real choice. It must be a choice that includes appropriate palliative care, social care and medical care. Without those elements of care, it is no choice at all.”[i] Likewise, when Màiri McAllan MSP changed her vote, she was thinking of “those living with disability who fear the effects of this Bill” and those “fighting for the social care they need, without which they can’t be said to have real choice.” Concern about the current state of palliative care was highlighted by Miles Briggs MSP , who plans to introduce a bill of his own that would give Scots a right to palliative care for the first time, and by Sharon Dowey MSP, who feared that “the debate [about assisted death] risked distracting from the need to improve palliative care.”

Coercion by other individuals 

Russell Findlay MSP perceived a “risk that people could be coerced into ending their own lives.” He noted that “[n]ot everyone is fortunate enough to have a loving and supportive family. There are already cases in which unscrupulous relatives, or ‘trusted’ medical or legal professionals, exploit elderly people for financial gain.” Audrey Nicoll MSP likewise feared vulnerable people coming under pressure to die because of the proposed legislation. MSPs had been warned by experts that the bill “risks offering a new, potentially lethal weapon to abusive men whose partners have been diagnosed with life-threatening or terminal illnesses.”

Some MSPs worried that the mere mention of an option by a doctor may inadvertently put pressure on a patient. The bill’s promoters had refused to accept amendments prohibiting doctors from raising the possibility of ‘assisted dying’ with their patients, and this was cited by some who switched their votes. It was a factor in Jamie Hepburn MSP’s decision,[ii] and Brian Whittle stated: “To my mind, a doctor proposing assisted dying to a patient as an option could compromise that trust and risk the patient feeling pressurised towards a choice that they may not otherwise make.”[iii]

Self-coercion

Some who switched their votes voiced concern about ‘self-coercion’ or ‘internal coercion’, sometimes summed up as ‘not wanting to be a burden’. This is the worry that people might choose ‘assisted dying’ to spare their families from having to care for them or watch them suffer. Russell Findlay noted that “even without any coercion from others, some elderly people may feel pressured to end their lives because they think they have become a ‘burden’ on loved ones.” Collette Stevenson MSP concluded: “I am not convinced that coercion — especially subtle or internal pressure — can be realistically identified or prevented in vulnerable individuals.” Likewise, Audrey Nicoll warned her colleagues in an open letter that “[t]he reality is that some individuals will be subject to coercion and pressure, whether directly or indirectly and in ways which may be subtle and difficult to enunciate.”

Coercion of health professionals and hospices

Russell Findlay and Jamie Hepburn[iv] indicated that the lack of a conscience clause in the final version of the bill was a factor in their decision to change their votes; the clause originally in the bill had been removed as legislatively incompetent. Although it had been promised that the UK government would insert some form of opt-out via a section 104 order after the bill had passed, MSPs were concerned that they were being asked to pass the bill into law without knowing (let alone being satisfied about) the terms of this opt-out. Jamie Hepburn also highlighted “the rejection of the amendments that sought to create institutional opt-out.”[v] Many MSPs felt that forcing hospices to allow ‘assisted dying’ on their premises, regardless of whether it profoundly contradicted their organisational ethos, was unacceptable. Miles Briggs noted that “the concerns of staff who work in our NHS and palliative care sector did inform my decision not to support this Bill.”

Some of the switching MSPs cited other factors besides coercion: for example, Russell Findlay was influenced by the risk that, once legalised, ‘assisted dying’ would be extended into other circumstances not envisaged by parliament; and Daniel Johnson MSP was concerned about a general lack of safeguards[vi] and the possibility of doctor error.[vii]

All of these risks had been present since the first version of the bill was published in March 2024. The initial, Stage One vote was a vote on the principle of the bill: a vote ‘For’ the bill would have been contingent, for some MSPs, on adequate safeguards being added during Stages Two and Three. The twelve MPs who changed their votes clearly were not satisfied that this had happened, with some (like Jamie Hepburn) even noting regret about the rejection of particular amendments.

Lessons for Westminster?

What is noteworthy about the concerns that led MSPs to reject Liam McArthur’s bill is that they are not particular to that bill (apart from the very specific issues relating to the legislative competence of the Scottish Parliament). Concerns around the coercion of vulnerable people – by self, by others, or by circumstances (such as lack of available support or palliative care) – have also been front and centre in the House of Lords recently, during scrutiny of the Leadbeater bill. These are not (as some pro-assisted dying voices have asserted) ‘secretly religious’ concerns, or cynical filibustering tactics dreamed up to scupper the Leadbeater bill: they are fundamental to the safety of any new law. McArthur, like Leadbeater, promoted his bill as “the most heavily safeguarded assisted dying law anywhere” (which cannot, logically, be true of both). Yet it was the perception of serious risk, and not any objection in principle, that ultimately led MSPs to reject it. As Daniel Johnson warned: “this is not an area where we can afford compromise – ‘good enough’ is not good enough.”[viii] If and when it confronts yet another ‘assisted dying’ bill, Westminster should take heed.

Notes

[i] Official Report, column 197.

[ii] Official Report, column 156.

[iii] Official Report, column 197.

[iv] Official Report, column 156.

[v] Official Report, column 156.

[vi] Official Report, columns 159, 182-183.

[vii] Official Report, columns 182-183.

[viii] Official Report, column 183.