Assisted dying legalisation could become a lethal weapon for abusive men

As an academic who has spent my career focusing on the harrowing experiences of women in situations of domestic abuse, I am deeply concerned about the assisted dying legislation before Holyrood. The Assisted Dying for Terminally Ill Adults (Scotland) Bill, from Liberal Democrat MSP Liam McArthur, completely ignores the risks of a change in the law for women living with abusive and controlling partners.

 To date, no consideration appears to have been given to the ethical and life-threatening risks of assisted dying for Scottish women in abusive situations. This legislation relies on the consent, choice, free will and autonomy of the person wishing to end their life, but for too many women who are living with domestic abuse today, these principles simply do not exist in their daily lives. Assisted death could be a lethal weapon to abusive men whose partners have been diagnosed with life-threatening or terminal illnesses.

 The Scottish Government defines and recognises domestic abuse as a form of gendered violence perpetrated overwhelmingly by men against women. It comprises a pattern of violent and abusive behaviour that can include physical, emotional, psychological, sexual and financial abuse, perpetrated by one partner against another in an intimate relationship. Although fully criminalised in 2018, domestic abuse remains far too common in Scotland with one in four Scottish women having experienced it in their lifetime. It affects women of all ages and social classes everywhere in Scotland.

Disabled women are twice as likely to be abused as non-disabled women, with reporting rates among this group and among elderly women worryingly low. The Scottish Government’s crime figures show that it is overwhelmingly perpetrated in the home by men against women and that numbers are rising – 81 per cent of the 64,000 incidents reported to Police Scotland last year had a female victim and a male perpetrator. Femicide rates in Scotland show that most of the women murdered in Scotland are killed by a violent and controlling male partner or ex-partner.

Men’s violence and abuse and the ongoing trauma of coercive control has severe impacts on women’s physical and mental health that can lead to adverse, long-term health conditions. Decades of work examining the impact of coercive and controlling behaviour has shown that ‘coercive control’ is not merely persuasion, but a complete change in the perspective of the victim so that she truly believes that she is worthless, a burden to her partner or wider family, and would not be missed should she die.

 Women are regularly humiliated, demeaned, and told they would be “better off dead”, or, that they are a “useless mother”, or that the children would be better off without them. This abuse erodes women’s confidence, autonomy, and self-esteem. Cut off from support, women often come to believe these lies, fearing reprisals from their partner if they report the abuse, many choose to tell no one. This long term, relentless, dehumanising process can result in a woman believing that she is ‘disposable’.

Abusive partners, including those who are the primary carers of sick, elderly, or disabled women often act as gatekeepers to restrict or prevent women’s access to safety, justice and professionals in health and social care services. This can lead to conditions going untreated, resulting in avoidable complications or worse symptoms. Women with a coercive and controlling partner or ex-partner may thus be severely restricted in their capacity to give consent freely and willingly to treatments in their own best interests.

Domestic abuse will not cease for women who receive a diagnosis of terminal illness and the risk of her abusive partner controlling the assisted dying process are likely to be high. Women’s experiences of domestic abuse may be invisible to medical professionals – hidden in plain sight. Identifying domestic abuse, assessing the risks to terminally ill patients experiencing domestic abuse and ensuring that their consent is freely given would be a delicate process to embark on with a terminally ill woman living with abuse.

Medical professionals would require specialised skills, a detailed knowledge of the complex relational dynamics of domestic abuse, and an ability to assess the risk in the high stakes, irreversible and time-limited context of assisted dying. I am not convinced that doctors could fulfil this role, and it is certain that cases of abuse would be missed even if some training was mandated. The resource implications are substantial and may be beyond the current capacity of the NHS to fulfil when there are many more vital demands on staff.

The Assisted Dying Bill relies heavily on medical practitioners ensuring that a patient’s consent is freely given in the assisted dying process. Without expertise in identifying the interpersonal dynamics of domestic abuse and coercion, health practitioners involved in the process may unwittingly collude with an abuser in the ending of his partner’s life. MSPs weighing an assisted dying law in Scotland should be very fearful of this outcome.

 State-sanctioned assisted dying risks creating a conducive context and cover for abusive men to exercise new, irreversible power and control over their terminally ill female partners. I am deeply concerned that women diagnosed with terminal illnesses who are living with abusive partners may be coerced into consenting to an assisted death. This practice could become a domestic abuse perpetrator’s ultimate act of control.

Dr Anni Donaldson is an honorary research fellow at the University of Strathclyde who focuses on domestic abuse and violence against women and girls