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As you will be aware, the schedules to the bill are effectively the forms for this and other aspects of the reporting requirements. It is important that death certificates reflect the underlying progressive advanced terminal illness that gave rise to the application, as well as the fact that medication had been administered to allow for an assisted death. For clarity and transparency, both those things need to be captured, which is what the schedules to the bill set out.

From my initial discussions with the chief medical officer, I recognise the legitimate concern that there may be some sensitivity about the way in which the information is expressed and the distinction between suicide and assisted dying, which goes back to an earlier point. The chief medical officer and his colleagues helpfully suggested that codes are used for registrations that may allow for that information to be captured in a way that respects and acknowledges the sensitivity of what we are discussing.

I am keen to explore that further, but it is important that we understand who is accessing the option of assisted death, what conditions are involved, when people are accessing it and their sociodemographic characteristics. We need as much information as possible—anonymised, of course. As we might touch on later, it will be crucial to report on and understand the picture of how the legislation is working in practice. There are the annual reports, which will feed into the five-year review that is also set out in the bill.

If we look at other jurisdictions, we see that there are a lot of similarities in who is accessing assisted dying, the reasons why they are doing so and the demographic profile, but to my mind it is absolutely essential that we gather information in Scotland. In fact, the only element of my proposals that changed between the initial consultation and when I brought the bill to Parliament was in respect of tightening up the data-reporting requirements that were envisaged. For public confidence, and for the confidence of patients and medics, the more robust those requirements are, the better.

In relation to interaction with UK responsibilities, the other matter, which gains less attention than the medication, is that of the regulation of professional bodies. However, similarly, that would need to be addressed in order for the fully functioning process of assisted dying to be put in place. That is not to say that the bill as it stands is not competent or that it cannot go through the full scrutiny process and be passed by the Parliament.

I can understand why the committee, MSPs, the wider public, and those with an interest in the matter are keen to have a clear understanding of how the powers are to be exercised. That would give us confidence as to how the bill would work in practice. I do not know whether Dr Ward wants to add anything on the specifics of the regulation of professional bodies.

I think that the only relevant point at which a reassessment would be required is the point at which medication might be provided to an individual who sought to act on their initial request. Such an individual would have been through the full process and would have made a second declaration. There is no time restriction on such a declaration—it would remain valid—but at the point at which medication might be provided, as I said earlier, there would still be a requirement to establish capacity and intent. Any change in that would prevent the process from proceeding.

It is important, for the reasons that were discussed with Ms Harper, that people can choose to pursue an assisted death at different stages. Some people might have the relative luxury of going through the process relatively early, in order to provide themselves with a degree of comfort and reassurance, but there are others whose diagnosis might come far closer to the point of death and who need to act with greater speed, so to speak. They will need to get things in order in a shorter timeframe. However, as I said, the point at which the medication is provided is the point at which capacity and intent would be established.

Individuals with a terminal illness will receive on-going support, whether that is from their GP or a consultant. They will almost certainly be in receipt of on-going treatment or palliative care, so those discussions will be on-going. Therefore, although I find it difficult to imagine a situation in which the issue will not arise in the background, I suspect that the focus will still be on the treatment and palliative options that are available, which might change over time. As the committee has heard on numerous occasions, it is not only the prognosis period that is difficult; the way in which the terminal illness develops over a period can be difficult to predict. The discussions will need to continue on an on-going basis.

I have sat in on the oral evidence sessions that the committee has held, and I was encouraged and reassured by the evidence that was taken from the panel that included witnesses from the British Medical Association and the Royal College of General Practitioners. They did not appear to have any concerns about the way in which terminal illness had been defined in the bill; I think that they were comfortable with the way in which that was set out and with the further explanation in the supporting documentation.

However, the question that you raise is one that does crop up. There are clearly many treatments that can be tried and applied, and some might have some benefit in slowing the progression of a terminal illness. Defining “terminally ill” on the basis of a “disease, illness or condition” from which the patient will not recover is important. That separates it out from some of the conditions that have been raised in evidence that, to my mind, would not meet the eligibility criteria, because there are options that would lead to a recovery. Whether the patient chooses to take those options is a matter for the individual patient, but such conditions would not meet the eligibility criteria that are set out in the bill.

Although it maybe did not feel that way at the time, it was helpful to hear from the Cabinet Secretary for Health and Social Care. Although the Presiding Officer has deemed the bill to be competent in the context of the Scottish Parliament’s powers, I have always acknowledged that putting in place a fully functioning process of assisted dying in Scotland will require matters that are the preserve of Westminster to be addressed, in particular in relation to medicines, the Misuse of Drugs Act 1971 and so on. However, as the committee heard on numerous occasions last week from Mr Gray, those matters can be resolved only at the point at which the Scottish Parliament decides that a change in the law is required.

I do not think that I am breaching any confidences by saying that I have had early and occasional discussions with the UK Government as well as the Scottish Government. Those discussions have really just been to keep the Governments updated on the bill’s progress. I think that it was June 2021 when I first announced that I was planning to introduce the bill, and it has been important to keep people up to date with what has been going on in the background and to reassure them that it would emerge at some point.

However, those discussions have taken place in the context of a recognition on both sides that the UK Government and the Scottish Government have, quite understandably and justifiably, taken a position of neutrality and are awaiting the outcome of the stage 1 vote, at which point the mechanisms that can address the issues of legislative competence can be addressed. I am confident that that can happen in a timely fashion.

It is worth bearing in mind that this is a sensitive issue that needs careful and sensitive handling. From the outset, I was very conscious that I did not want to use the bill as a mechanism to push the boundaries of constitutional arrangements, so, as Ms Bennett has articulated, I have operated in that framework. I am very confident that the mechanisms to resolve those issues exist. Given that a very similar bill is going through the Westminster Parliament, coincidentally at the same time as the bill that we are considering, I think that that enhances the opportunities to ensure that relatively speedy progress can be made in this area once the Scottish Parliament decides whether it is supportive of the general principles, in support of a change in the law.

In response to your question about the doctors being two GPs in the same practice, that would not be permitted. The doctors need to act independently of each other, and one of them must have had no prior relationship with the patient themselves. The second doctor will have the medical notes, but they will carry out their assessment of terminal illness and mental capacity.

Dr Ward, did you want to add anything?

I am minded to reflect on the advice of the chief medical officers from across the UK about those who engage in this debate praying in aid patient experience from other jurisdictions but doing so without the consent of those patients and without necessarily knowing the full facts about what happened.

The bill has pretty robust protections regarding how the request and any assessments will be made. When those eligibility criteria are not met, the process will cease. It would still be possible for any patient who was deemed ineligible to access assisted dying to go to another medic and seek another opinion, but it is not immediately obvious why another medic would automatically come to a different opinion.

We have seen examples in other jurisdictions of what happens to those who are found not to be eligible. That does not stop them making an application, but the safeguards do what they are supposed to do, which is to prevent the patient from accessing the available services. That may be because they do not have capacity or because their terminal illness does not meet the requirements of the legislation. The safeguards in those countries do not stop someone making an application but should prevent them from being able to proceed with it.

We trust our medical professionals to make many life-altering or even life-ending decisions, and we ensure that they have the training to make the decisions that they must make. In this instance, we will require a second medical practitioner to make assessments, too. Ultimately, if the bill were put in place, it would be the most heavily safeguarded end-of-life choice available.

I definitely have that poacher-turned-gamekeeper feeling at the moment. I have sat where you are on many occasions, Mr Sweeney, and made precisely that argument—usually to Government ministers—about the importance of putting certain things in the bill.

I think that a balance needs to be struck. As I said in answer to earlier questions, I absolutely understand the desire to have as much clarity as possible about how the process would work. I do not think that it is in anybody’s interest to put things in the bill that would require to be changed by primary legislation if emerging evidence suggested that change was needed. That is why, through the explanatory notes and the policy memorandum, I have tried to flesh out the details as best I can. A lot of the detail sits more appropriately in either secondary legislation or, as I said earlier, in guidance, because that would allow the understanding of medicine, which is developing at pace, to be factored into how the bill would operate in practice.

No. As I said, the model was built on the assessment of take-up and the associated costs. I understand that the Scottish Government has taken a different approach to the modelling, which probably inevitably results in a far higher cost. However, as I said to the finance committee, the approach that we took to the financial memorandum was a reasonable attempt to assess those costs. I think that the finance committee also applied a degree of pressure on me to estimate the savings that would be made. As I said to that committee, that would be an even more precarious assessment to make, given that that would depend very much on who was accessing assisted dying and the point in their terminal illness at which they accessed it.

I think that it is a reasonable estimate of the financial costs, and I point to the fact that, broadly, the measure would be cost neutral, recognising that those who would access assisted dying are in receipt of treatment and care at the moment.