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You have summed it up well. You can make a strong argument for both 16 and 18, and the rationale for opting for 16 was on the basis of that being the age of adult capacity for making medical decisions. People who are 16 are deemed to have the capacity to make decisions about their treatment. There is a logic for 16; it is a very defensible case.

That said, I have heard the evidence that the committee has taken in relation to the case for 18. In other jurisdictions—whether in Australia or some of the US states—18 is the age at which an assisted death can be accessed, and the Terminally Ill Adults (End of Life) Bill that has been introduced at Westminster has a similar age limit.

It is an area on which I am keen to reflect further should the bill pass at stage 1 and as we look ahead to stage 2. As I say, I have taken cognisance of the evidence that the committee has heard, and the arguments for setting the age level at 18 are persuasive. The reason for opting for 16 is that that is the age at which individuals are deemed to have capacity to make a range of decisions in relation to their care and treatment.

There would absolutely need to be further engagement.

I would observe that the Children and Young People’s Commissioner Scotland has taken a close interest in the issue—in fact, successive children’s commissioners have done so and have expressed views. The Scottish Youth Parliament has had campaigns in support of a change in the law over successive sessions of that Parliament. The issue clearly engages younger people. It is often assumed that the issue kicks in solely for people later in life, but that is absolutely not the case.

You will probably see in the written evidence that you have received—I certainly saw it in the response to the consultation that I issued—that young people have very clear personal experience to draw on, often of older family members who have perhaps gone through a bad death, so they feel very invested in this. Therefore, if the age limit was to change, that would need to take account of any concerns that younger people might have.

The only other thing that I would add is that the numbers that are likely to seek to access an assisted death in any given year will be relatively low. I would have said that it would be around 1 per cent of the overall numbers who die in any given year. Therefore, the numbers at the younger end of the age spectrum will be exceptionally low, possibly even zero in a given year. That is not to say that it is not important to take those views into account, and I am very cognisant of some of the concerns that Children’s Hospices Across Scotland—CHAS—has raised with the committee. However, it is important to emphasise that the numbers involved are likely to be exceptionally low indeed.

I would probably question whether it would be competent to do that in the bill. That aside, I think that what might be problematic in the assumption that palliative care is for everybody is that it might almost be seen as a requirement for one to go through and exhaust all palliative care options before one has the right to choose an assisted death.

As I have said, from what we have seen internationally, it is overwhelmingly the case that those who access this choice are or have been in receipt of palliative care. Moreover, the committee heard from the witnesses in Australia that, as a result of the assisted dying legislation, there had, in a number of cases, been a significant uplift in investment in palliative care, too, which, one would hope, would address some of the access issues. Perhaps even more interesting, though, was the improved engagement with palliative care—I think that that was a very clear message from one of the witnesses.

What that reflects is that the discussions that need to take place about the reasons why an individual is making the request—and then the discussion that needs to take place around the options that are available—are leading to people having raised awareness of what palliative care options are available in a way that is perhaps not happening here at the moment. I would expect that to be the case in this instance.

As I say, I think that your suggestion would be problematic. I have been very supportive of your colleague Miles Briggs’s attempts to introduce a bill on the right to palliative care—that is an important campaign, which I have strongly supported. We need to put something in place that is competent and that improves access to palliative care through the debate that is opened up and the pressure that it builds to invest more in palliative care, but I think that amending the bill in the way that you suggest, Mr Whittle, would be problematic in the same way that saying “You are not able to access palliative options until you have exhausted all curative treatment options” would be.

Again, it is probably more appropriate to pick that up in guidance. On whether there would be an expectation that somebody in that position would refer the individual to their GP to seek support, that would seem to be the most logical option in those circumstances. That would be difficult to express in the bill, so it would be better for it to come through less in secondary legislation and more in guidance.

As I mentioned earlier, there will be training requirements for those who are directly involved, but there will be a wider training requirement with regard to raising awareness of what the change in the law means among those who are involved in health and care more generally. With regard to whether someone has a conscientious objection, it would be in their interests to understand the implications. However, as I said, that would probably be better expressed in guidance than in the bill.

I did, because I was aware that it had been an aspect of earlier bills that had come before the Westminster Parliament. However, I was not necessarily convinced that I could see what additional safeguard it would put in place.

The balance is always to ensure that the safeguards do what they are intended to do, and do not simply act as an unnecessary obstacle while not providing any protection. In that context, I understand that the committee that is looking at the bill at Westminster is likely to consider an amendment to remove that provision, although it remains to be seen whether that happens.

Again, I note that I drew a bit of reassurance—as I said to Dr Gulhane—from what the Crown Office said to the committee about the Lord Advocate’s oversight of deaths and assisted dying. That may offer the sort of reassurance that the public might have expected court oversight to provide.

As I said, it remains to be seen whether that aspect remains a part of the UK bill, but I am not convinced of the arguments for introducing it in Scotland, nor that it would add anything other than a delay to the process for those who meet all the eligibility criteria.

It is as you say, Dr Gulhane; that concern is very often raised. It is important that we avoid seeing the issue as a zero-sum game or an either/or choice. We need more investment in palliative care, particularly around access. There will always be improvements to palliative care that we will want to make, but the issue that arises more often than not is about access rather than quality.

There is also an issue around understanding that palliative care is not just at the specialist hospice end; it is more often delivered by doctors and nurses in other settings. It has been clear from the debate around my bill, and the overall debate around the health and care service, that the needs of palliative care are given less attention than needs in other parts of the health and care set-up. You can perhaps see why that is the case, given the pressures in other parts of the health service. One of the real positives about this debate is that it has shone a light on those issues, but it is not an either/or—we need both.

In the jurisdictions around the world that have a terminal illness model, and in the states in the US and Australia where a similar model has been introduced recently—this holds true for the more expansive models—the vast majority of people who are accessing an assisted death are in some form of palliative care or have had access to such care.

That demonstrates that those are people who have, to their mind, exhausted what palliative care can provide for them, and that accessing an assisted death is the choice that they opt for at that point. The most recent figures in relation to Oregon are that around 90 per cent are in receipt of palliative care or have had palliative care. In Victoria and Queensland in Australia, the figures are north of 80 per cent. Again, the picture is fairly consistent.

We need to improve access to palliative care. The debate around the bill has provided a platform for people in the palliative care sector to make that argument, but I caution against seeing it as an either/or choice, because, overwhelmingly, people who are accessing assisted dying in other jurisdictions with either similar models or other types of models are often in receipt of the best palliative care.

As palliative care practitioners would acknowledge, palliative care can do wonderful things, but it cannot always meet the needs of people with a terminal illness, and that is reflected in the figures.

That was probably one of the first conversations that I had. The Association of British Insurers has confirmed that assisted dying would not be considered to be suicide.

The issue of language has been at the very centre of this debate. There are those who seek to draw parallels between assisted dying and suicide. I reflect on a statement that was recently issued by a number of Australian organisations involved in suicide prevention and that said:

“We are concerned that suicide is being confused with voluntary assisted dying. The two are very distinct, and using the terms interchangeably can be damaging.

Suicide is when a person tragically and intentionally ends their own life ...

Voluntary assisted dying is not a choice between life and death. It is an end-of-life choice available to eligible terminally ill people who are already dying. It offers an element of control and comfort over how they die when death becomes inevitable and imminent ...

Both suicide prevention and voluntary assisted dying are as important as they are distinct. Confusing these terms can delay access to suicide prevention services for people in distress, and complicate care for those who are at end of life.”

I know that you have pursued with previous witnesses the fact that the suicide rate among terminally ill people across the UK is around two and a half times the rate in the population at large. We cannot know the details in every instance, but that does tend to suggest that, in the absence of the option that is reflected in my bill, many people are taking matters into their own hands. Meanwhile, others who have the financial wherewithal and physical capacity to access the services provided by Dignitas in Switzerland are doing so, but probably weeks or even months ahead of time in order to ensure that they have the physical capacity to do so. Even then, those individuals are not able to seek the support of medical professionals and even family members, for fear of exposing them to the risk of prosecution.

I understand why there is a concern about normalising this approach to death, but we are talking about people who are dying anyway, and this is about their choice, dignity and control regarding the timing and means of their death. It is not about suicide, which is a very different issue that must be tackled differently.

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.

The fact is that there are two practitioners, acting independently of each other, making the assessment of both terminal illness and capacity, and they will have the option, where it is felt to be necessary, to refer to a specialist in relation to either the terminal illness and/or the person’s capacity. Those safeguards go well beyond the safeguards that are in place for many, if not all, other treatments that are available to patients.

Ultimately, whether or not we agree with the choice that an individual makes, if they meet the eligibility criteria, it would be unreasonable to deny them the opportunity to make that choice and activate the provisions that are set out in the bill.

I was ploughing a lonely furrow at that point. The Isle of Man and Jersey have picked up the pace, and we obviously have seen developments at Westminster.

The argument is not unreasonable argument. Some of the issue is about public awareness, but some of it is about the preparedness of the medical profession to deliver assisted dying. Even though the legislation may be implemented, until the medical professionals involved have the training required in order to deliver assisted dying, it may be more difficult to access over those initial stages.

The issue is about awareness, but it is also about a degree of comfort with the process and not only an understanding of it in theory but an understanding of how it works in practice.

In states in Australia that adopted legislation later on, we have seen that numbers were higher in the first two or three years than they were in states such as Victoria, which were the earliest adopters. However, at that early adoption stage, legislation was in place in other jurisdictions, and I am sure that there were fairly extensive public awareness-raising campaigns.

As such, and as we agreed almost unanimously at the finance committee, predicting the numbers is highly problematic. I have set out my best estimates by drawing on the parallels between Oregon and Victoria, which give us the longest data set to try and base comparisons on.