Assisted Dying Bill: How suffering a spinal stroke made me think differently about vulnerable people

Both sides appeal to dignity, compassion and justice. Assisted dying, like other matters of conscience, cannot therefore be debated on party-political lines.

My own recent medical experience further developed my thinking around assisted dying, even though it was never something I considered for myself. On April 11, 2024, I suffered a ‘spinal stroke’ – a very rare condition, accounting for less than one per cent of all strokes. The resulting spinal cord injury (SCI) left me temporarily paralysed and unable to breathe properly without assistance.

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Intensive physiotherapy

I spent four weeks in intensive care in Aberdeen, sedated and on a ventilator. During that time, I contracted pneumonia which had to be cleared before I could transfer to the Spinal Injuries Unit in Glasgow to begin rehabilitation.

My SCI was incomplete, meaning some nerve recovery was possible (unlike a complete SCI in which function below the injury is lost), and I could focus on rebuilding my strength through intensive physiotherapy.

In those first couple of weeks out of the ICU, I required almost total personal care and had to relearn basic functions such as swallowing and eating solid food after having a tracheostomy tube removed. But, with the help of the fantastic NHS staff – to whom I will be eternally grateful – my mobility and strength started to return.

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I transitioned from a powered wheelchair to a manual one, then to standing and walking with various means of support. In November 2024, I walked out of the unit on crutches and drove myself home.

Almost 15 months later, I still use crutches or occasionally a wheelchair, depending on how long I need to be ‘on my feet’. But in those early days of rehab, my dependency on others was high, and it was difficult to predict how much mobility would eventually return and what life was going to be like for me and my family.

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Feelings of ‘being a burden’

I learned to think differently about dependence, vulnerability, and the subtle forms of pressure – spoken and unspoken – that people in fragile situations might face. I was also keenly aware of my fellow patients and other disabled people.

As an MP I was often approached by constituents, uncertain and anxious about the availability of suitably adapted housing and other long-term social care. Similarly, I saw patients end their inpatient rehab journey, only to be faced with the new stress of not being able to obtain an appropriate care package for going home.

Some mentioned feelings of “being a burden” – an expression often heard in this debate as one factor that may influence someone’s motivation to choose assisted dying. But the legalisation of assisted dying must never become an excuse for government not doing all it can to ensure adequate palliative and social care.

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I respect Liam McArthur MSP and recognise the good intentions behind his Assisted Dying for Terminally Ill Adults (Scotland) Bill. I also understand why many MSPs supported the Bill at stage one.

Many of the subsequent amendments have rightly focused on safeguards, such as preventing coercion, defining eligibility, assessing capacity, regulating services, and clarifying professional roles. These are not technical afterthoughts; they are key to whether such a system could operate safely.

I instinctively believe society works best when individuals are trusted to make decisions about their own lives, without state interference. If someone faces severe suffering with no prospect of recovery, why should the state determine how that life should end?

The ‘slippery slope’ is real

But sympathy for a principle is not the same as confidence in a system. Effective law-making requires the latter. People, often through circumstance, can be vulnerable to pressure, expectation or internalised guilt. Safeguards that appear robust on paper can be far more fragile in real life.

This is why concerns about the so-called ‘slippery slope’ cannot be dismissed. In other jurisdictions, eligibility has expanded beyond initial intentions, through legislation or court rulings. What had begun as an exceptional end-of-life measure was allowed to become something broader, with consequences not originally envisaged.

For me, the risk that eligibility could widen to include people with life-changing disabilities is not abstract.

Surveys by the Royal College of Physicians and Surgeons of Glasgow show overwhelming concern among doctors about identifying coercion, assessing capacity, and defining terminal illness. Many doubt that safeguards would be practical or workable in reality.

These are not ideological campaigners. They are the professionals who would be asked to implement the system. If they lack confidence in its operation, MSPs should listen carefully.

Empathising with the principle of assisted dying does not oblige anyone to support this particular Bill. Changing one’s position between stage one and stage three is not weakness or inconsistency. It can be an entirely responsible response to risks that remain unresolved.

An impossible task?

Speeches made in this debate have been passionate, reflective and sincere. Debates in both Holyrood and Westminster have been praised for their tone and depth. But the quality of a debate does not guarantee the quality of the resulting law.

Once legislation is passed, it is difficult to reverse or contain. The question facing MSPs at stage three is not whether assisted dying is morally acceptable in principle. It is whether this Bill can be made safe in practice – not just for today, but also for all future scenarios.

Moral certainty in individual cases will always be clear to those personally involved. But designing a law that will safely cover all eventualities is the real test. Perhaps an impossible one.

David Duguid was Scottish Conservative MP for Banff and Buchan, a UK Government minister, a government whip and trade envoy