Published1 hour agoShareclose panelShare pageCopy linkAbout sharingImage source, Getty ImagesBy James CookScotland editorScotland could become the first UK nation to provide terminally-ill people with assistance to end their lives if a bill that has been introduced at Holyrood is approved.Supporters of the legislation say it would ease suffering.Opponents worry that some terminally-ill people could feel under pressure to end their lives.The Assisted Dying Bill is drafted by the Lib Dem MSP, Liam McArthur, who expects it to be debated this autumn.The bill was published on Thursday and will potentially be voted on next year.What are assisted dying, assisted suicide and euthanasia?’Political mood has changed’ on assisted dying – MSPStarmer supports assisted dying law change The Scottish government says ministers and SNP backbenchers will not be instructed how to vote, as the matter is an issue of individual conscience.First Minister Humza Yousaf, who is a Muslim, has indicated that he is likely to vote against the bill, which is also opposed by the Church of Scotland, the Catholic Church in Scotland, and the Scottish Association of Mosques. Under the proposals, a patient could only request medical assistance to end their life if they had a terminal illness and had been ruled mentally fit to make the decision by two doctors.Mr McArthur says “the terminal illness would need to be advanced and progressive” and the medics would have to ensure there was “no coercion.”In addition, the patient must be aged 16 or over, a resident of Scotland for at least 12 months, and must administer the life-ending medication themselves.In Scotland, it is not illegal to attempt suicide but helping someone take their own life could lead to prosecution for crimes such as murder, culpable homicide or offences under the Misuse of Drugs Act 1971.In England and Wales, the Suicide Act 1961 makes it an offence to encourage or assist the suicide or attempted suicide of another person. In 2015, the House of Commons decided against changing the law by 330 votes to 118.In Northern Ireland, a similar offence is set out in the Criminal Justice Act 1966.A number of countries have legalised some form of assisted dying – Dignity in Dying says more than 200 million people around the world have access.This includes Switzerland, perhaps best known for its Dignitas facility, Australia, Canada, Spain, Colombia and 11 states in the US where it is known as “physician-assisted dying”. Laws vary by country.This will be the third time that the Scottish Parliament has considered the issue.In 2010, MSPs rejected Margo MacDonald’s End of Life Assistance Bill by 85 votes to 16.The independent MSP, who had Parkinson’s Disease, died in 2014 and the cause was taken up by Patrick Harvie of the Scottish Greens.The following year, his Assisted Suicide Bill was rejected by 82 votes to 36. The title of Mr McArthur’s bill — Assisted Dying rather than Assisted Suicide — reflects a change in approach from campaigners.Critics such as Dr Fiona MacCormick of the Association for Palliative Medicine (APM) say the new terminology is “harmful and unhelpful,” adding, “they’ve used very euphemistic language to talk about suicide.”Mr McArthur says he would “strongly disagree,” because “we’re talking about people with a terminal illness, and the fact they are going to die has already been established.”The MSP for Orkney Islands believes there has been a significant “mood shift” among his fellow parliamentarians since the issue was last debated and is hopeful that his proposal will be approved.A new poll, carried out by Opinium Research for the campaign group Dignity in Dying, suggests clear public support for the proposal, with 78% of respondents in Scotland saying they supported “making it legal for someone to seek ‘assisted dying’ in the UK.”Gillie Davison is among those supporters – her husband Steve died of throat cancer last April, at the age of 56.Ms Davison, from Hawick in the Scottish Borders, says even high-quality palliative care did not ease his suffering in the final days and hours.”It wasn’t a good death because he was distressed and he was upset,” she explains.”It wasn’t what he wanted. He wanted that choice.”She believes an assisted dying bill would have allowed her husband to “go to sleep” peacefully at home and could prevent other families from enduring a similarly “devastating” experience in future.Changing the law, she says, would be “compassionate and kind.”But Dr MacCormick says she is concerned about the potential for inaccurate diagnosis and prognosis, undetected coercion, and fluctuating mental capacity in seriously-ill patients.”As a palliative care doctor, when I see patients who are suffering, I don’t see the answer to their suffering as being to end the life of the sufferer,” she says.But some terminally-ill patients say they would find the option reassuring even if they did not use it.In 2015, at the age of 26, Mandie Malcolm from Falkirk was diagnosed with breast cancer which had spread to other parts of her body.She was told that her life expectancy was two to five years.Now 34, Ms Malcolm is still alive thanks to advances in cancer treatment but, she says, she lies awake at night worrying about how her life will end.Until starting a new drug, she says, she was “bedridden for weeks and in huge amounts of pain.”I really worry about my death. I worry that I’m going to suffer, horrifically, basically, and it does scare me,” she explains.Ms Malcolm is strongly in favour of the assisted dying law, which she says would mean she could stop worrying about “dying a brutal death” and “enjoy the good times.””It would mean everything to me and my family,” she adds.But campaigners against the measure point to laws enacted in Belgium and Canada where qualifying criteria have been loosened over time, leading to a sharp rise in the number of “assisted” deaths. Mr McArthur says his proposed law is not modelled on those “permissive and expansive models” but on places such as the US state of Oregon where “the eligibility criteria has not changed at all” since becoming law in 1997.He is supported by the broadcaster and campaigner, Dame Esther Rantzen, who recently revealed that she was considering travelling to Switzerland – where assisted suicide has been legal since 1942 – to die after being diagnosed with incurable lung cancer.She says: “I want to congratulate the Scottish Parliament for prioritising this debate so that they can carefully consider this crucial issue and scrutinise this historic Assisted Dying Bill.”Audrey Birt from Edinburgh also has terminal cancer, the latest of five breast cancer diagnoses over 30 years, and has spent the past 12 years “in and out of hospital.”But she does not want assistance to end her life and has concerns that, if the law is changed, some patients might feel that they must do so to help their families.”In Scotland,” she says, “we don’t like to be a burden.”That’s the aspect I worry about — that there may be pressure,” she explains.Instead Ms Birt, who is 68 years old, says there should be increased investment in palliative care, which she receives at St Columba’s Hospice in Edinburgh.”After coming here and being more aware of what’s on offer, I do wonder if it was available to everyone, would that take away some of the fear that is behind the bill?” she asks.Helen Malo of the charity Hospice UK says her organisation is neutral on the bill but wants better funding of palliative care.Hospices support more than 21,000 people in Scotland each year, she says. But they are struggling, with only a third of their funding coming from the state, the rest from charitable donations, and rising costs.”One in four people do not get access to specialist palliative care,” adds Ms Malo, who says that, as the nation ages, demand is expected to increase by a fifth by 2040.”There are fewer specialist palliative care doctors in Scotland than there are MSPs,” says Dr MacCormick of the APM.Without adequate palliative care, she says, the worry is that assisted suicide “is not just a choice. It becomes a suggestion, which then becomes an expectation and that our vulnerable patients are at risk.”Supporters of the bill say they too want more funding for hospices and are prepared for a debate about how and if such a commitment could be woven into the bill.They also know that moral, religious and practical objections must be overcome if the momentous change they propose is to become law.More on this story’Political mood has changed’ on assisted dying – MSPPublished3 days agoWe need assisted dying vote after report – RantzenPublished29 FebruaryCould Scotland legalise assisted dying?Published8 September 2022Assisted dying bill is focus of Holyrood eventPublished18 May 2023Doctors criticise assisted dying bill in ScotlandPublished5 July 2021

Published2 hours agoShareclose panelShare pageCopy linkAbout sharingBy James CookScotland editorScotland has the highest drugs death rate in Europe, with narcotics claiming more than 100 lives on average every month.The Scottish government is proposing to decriminalise the possession of drugs for personal use to “help and support people rather than criminalise and stigmatise them”.But the UK government, which controls drugs policy, has rejected the plan as dangerous and says it has no intention of giving the Scottish Parliament the power to enact the new policy.So what is decriminalisation – and would it work?In setting out their proposals, Scottish National Party (SNP) ministers cited Portugal, which relaxed its drug laws in 2001, as a potential model.Despite having almost double the population of Scotland – 10.3 million compared with 5.5 million – Portugal has far fewer drug deaths. There were just 74 in 2021 compared with 1,330 in Scotland, where the figures for 2022 are set to be published on Tuesday.The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) makes comparisons using drug deaths of people aged 15-64 years-old. On that measure, National Records of Scotland says Scotland had 327 deaths per million people in 2020, the most recent year for which the breakdown is available, while the EMCDDA says Portugal had nine deaths per million.This video can not be playedTo play this video you need to enable JavaScript in your browser.Statisticians say there are some methodological differences between the two nations but the figures are broadly comparable.Portugal’s architect of decriminalisation, João Goulão, argues that adopting a similar policy in Scotland could save lives.”We are dealing with a health condition, with a disease, and we do not criminalise other diseases,” he tells BBC News.We meet Dr Goulão in the Portuguese capital, Lisbon, at the General Directorate for Intervention on Addictive Behaviours and Dependencies, where he oversees national drugs policy.Globally, many advocates of drug liberalisation praise the framework which the former GP helped to design.In Portugal, drug trafficking and dealing remain criminal offences. Possession of up to 10 days’ supply for personal use of any drug, including heroin and cocaine, is not criminal – but it is not legal either and is dealt with as an administrative matter.If a user is detained, and if there is no evidence that they are supplying narcotics, the police can confiscate their drugs and refer them to a Commission for the Dissuasion of Drug Use. This is a panel usually made up of a legal expert, a health professional and a social worker.Image source, Getty ImagesThere is one commission for each of the country’s 18 districts. Overseen by Portugal’s health, rather than justice, ministry, they try to establish if a drug user is an occasional recreational consumer or someone struggling with addiction.The panels have a variety of options available to them, including referring the user for treatment or counselling; levying fines for repeat appearances; imposing sanctions such as revoking a driving licence, a gun licence, or the right to practise in a licensed profession; and applying restrictions on visiting certain places or associating with certain people.However, in around four out of five cases, after a discussion with the user about their drug use, no action is taken.In the last year for which figures are available, nine out of ten participants were male and 45% were aged between 16 and 24.The number of people appearing before the commissions rose from 4,850 in 2002 to 11,995 in 2017 before falling back to 6,628 in 2021.The head of the commissions, Nuno Capaz, says that reflects the changing rate at which police referred users, rather than a shift in drug use.Dr Goulão says there have been challenges with funding and recruitment of staff in recent years which have made the job of the panels more difficult, but he insists Portugal is in a much better place than it was before decriminalisation.Then, he says, the nation was in the grip of heroin and HIV epidemics, with drugs deaths running at around 350 per year.At one point, one per cent of the entire population — some 100,000 people — had used heroin, estimates Dr Goulão.”It was difficult to find a Portuguese family that had no problems related to drugs,” he adds.Illicit drug use had exploded after the overthrow, on 25 April 1974, of the right-wing Estado Novo (New State) dictatorship, in a peaceful coup which became known as the Carnation Revolution. The restoration of democracy saw a closed, conservative and Catholic country rapidly opening up to the world.It also led to the return of tens of thousands of Portuguese soldiers who had been fighting to retain colonies in Angola, Guinea-Bissau and Mozambique.Luis Miguel Pereira recalls how, as the troops came home, drugs flooded into the country.He started using at the age of 14, he says. Nearly four decades later, he is HIV-positive and remains hooked on cocaine and heroin.”I need it,” he says, simply.As a child, Mr Pereira says, he had a good life, studying and playing football, “but when I start to take drugs, everything changes.””It’s like a prison,” he says. “You are locked inside of the drugs. You wake up thinking drugs. You lay down thinking drugs. It’s the only thought that you think in your mind.”By the late 1990s the left-wing government of António Guterres – who is now Secretary-General of the United Nations – had begun to take steps towards liberalisation. In November 2000, it passed law number 30/2000, which enacted decriminalisation from 1 July 2001.”The initial impact was amazing,” says Rui Moreira, who was running a nightclub at the time but is now the independent mayor of Porto. “It was great.””It was very influential. We were giving them methadone. We were supplying them with medical help. We started controlling HIV. We started distributing free syringes through pharmacies.”These days the most obvious embodiment of this ‘harm reduction’ approach are Portugal’s two drug consumption rooms, one in Porto which opened exactly one year ago, the other in Lisbon, which has been running since 2021.In the Porto centre, co-ordinator Diana Castro explains that nurses, a psychologist, a social worker and a doctor are on hand to assist and advise users.In just nine months, she says, it has helped 1,600 people.”Every day we are saving lives,” she added.The mayor of Porto supports the facility and remains in favour of decriminalisation, but he tells us that he also has concerns.Time, says Mr Moreira, has revealed some nasty side effects of law 30/2000.First, he argues, it normalised dangerous drug use among young people, entrenching criminal behaviour by those desperate to feed their addiction and supporting profits for drug dealers.And as hard drugs began to lose their stigma, users could even be seen shooting up outside schools – where it was forbidden to advertise ice cream or sweets, he adds.These side effects are not everywhere, by any means. Many parts of this industrial powerhouse turned tourist hotspot on the Douro estuary are bright, clean and bustling with visitors.But look for evidence of drug taking in Portugal’s second city, and you can certainly find it.Outside São Bento railway station, in the historic centre of this Unesco World Heritage site, syringes lie discarded on the cobbles.A short drive away, a group of drug users, stripped to the waist, huddle in the shade under a public stairway.And in Porto’s noisy margins, under the flight path of Francisco Sá Carneiro airport, the atmosphere outside the drug consumption room in the neighbourhood of Pasteleira is edgy, as Tony prepares to smoke crack cocaine.”I’m here every day,” he tells me, in his native Portuguese.Tony’s aquiline features and grey curls lend him the air of a senator in Ancient Rome.But given that Tony, 61, says he has been taking drugs for 40 years, perhaps his most remarkable feature is a beating heart.”I only do coke,” he says but then adds: “I take methadone. And I only take heroin when I run out of methadone.””Even if the law decriminalises consumption… the police are very aggressive with us,” adds Tony.”We’re treated like garbage. It’s not fair.”Not long after chatting to Tony outside the facility, our guide tells us abruptly that we must leave.A look-out has apparently summoned a more senior member of a drug trafficking gang and Pasteleira is no longer considered safe for us or for those with us.We return to the area a few hours later, accompanied by Porto’s municipal police chief, Superintendent Antonio da Silva. He takes us to a rabbit warren of a housing scheme, its high walls crisscrossed by shaded alleyways.A few months ago, says Mr da Silva, standing here would not have been possible.”This was a stronghold of drug dealing in Porto,” he explains, describing it as a “complete nightmare” full of dealers and users.Faced with angry residents who felt trapped in their own homes, the national police moved in and cleared out the criminals.Drug trafficking is a “big problem” in Portugal says Commander Rui Mendes, head of Porto CID at the national police force, which carried out the operation.”The traffic dealers are very well organised,” he adds.”You can make 500 arrests but sometimes I feel you can do a thousand and it would be the same because the profits are too high for them,” says Mr Mendes.Mr da Silva supports decriminalisation but he agrees that the fight is never ending. Asked if the operation in Pasteleira simply pushed the problem elsewhere, he replies: “Definitely.””We can make arrests,” he adds, but “the police will not solve the social problem of drug addiction.”The drug consumption room in Lisbon, like its counterpart in Porto, is also under a noisy flight path on the margins of the city, with drug users sheltering from the blazing sun beside a dual carriageway, barely visible in shadows cast by concrete and steel.Roberta Reis, who runs it, agrees with Mr da Silva that decriminalisation has worked. “A history of success,” is how she describes the policy.Ms Reis says harm reduction has led to a fall in cases of hepatitis B and C, tuberculosis, and HIV.”You can educate people to use [drugs] in a safer way,” she adds.This is a common view here. Decriminalisation feels settled in Portugal. There is no mainstream call for the policy to be reversed.The mayor of Porto, Rui Moreira, does want changes though. As well as improving housing, cleaning up public spaces, and offering more opportunities for young people, he is calling for criminalisation of drug use in certain areas, such as near schools and civic centres.There are limits to the comparisons between Portugal and Scotland. No two countries are the same. Scotland has a particularly acute problem with benzodiazepines.The outgoing chief constable of Police Scotland, Sir Iain Livingstone, recently told Today on BBC Radio 4, that officers had, in effect, been operating a de facto decriminalisation policy.”For many years now, those that use drugs and addicts have not been subject to criminal sanctions,” he said.”My greater concern,” added Sir Iain, “rather than the decriminalisation of drugs, is actually making sure there’s enough support services.”On that point at least there appears to be some agreement.Antonio da Silva recalls being “absolutely shocked” by Scotland’s death rate.”Scotland is by far the worst… It’s something that should make us think about what is going wrong there,” he says.”Must do something,” agrees João Goulão, although he has a word of caution for policymakers in Edinburgh and London.”Decriminalisation by itself gives you nothing,” he warns, “but all the health responses — treatment, harm reduction — are much more efficient within a decriminalised environment than they were before.”More on this storyMy daughter wouldn’t have died if drugs were legalPublished11 MayIncrease in suspected drugs deaths across ScotlandPublished24 JanuaryScotland’s first rehab clinic for parents opensPublished21 November 2022