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As I said to Mr Doris, I am happy to have those discussions. It would probably be helpful to see where the bill is at the end of stage 2 and what further refinements are necessary. I would be happy to work with Mr MacGregor and the Scottish Association of Social Work, which I have, as he suggested, had the benefit of speaking to on a couple of occasions.

In relation to the required social work assessment, I have lodged amendments that, if agreed to, would see assessing doctors being able to make inquiries and seek the views of health, social care and social work professionals, as well as those who have provided, or are providing, care to the person. I believe that those are appropriate safeguards that will ensure that only those with the capacity to make the decision are deemed eligible to receive assistance.

I would urge caution against adding processes that duplicate what is already in the bill and risk adding burdensome processes that could delay those seeking assistance from accessing it while not necessarily offering meaningful additional protection. I appreciate the attempt in subsection (5) in amendment 226 to set out reasonable timescales, but I again caution against mandating additional processes that could potentially add undue delays to the process.

I also consider that, in line with existing clinical practice, health professionals can—and do—undertake such approaches to the local authority where that is warranted. Nothing in the bill would prevent that practice from continuing should it be felt necessary in relation to particular patients.

Should amendment 226 be agreed to, it would be sensible that the registered medical practitioner must take account of any assessment made by the local authority, as is set out in amendment 233. I also note that aspects of the amendments in this group overlap with processes and requirements that are already considered and provided for in the bill.

As I said, I am happy to continue to work with Bob Doris and Fulton MacGregor, at the end of stage 2 and ahead of stage 3, to see whether we can make further refinements and improvements. I thank them for lodging and speaking to their amendments.

Some of that will have to be captured in training, but, as I said earlier, it is unreasonable to expect all GPs or consultants to be specialists in the areas that have been referred to. That is why the option to refer on is available under the bill, the need for which would emerge from discussions with the individual. To an extent, there is a balance to be struck between what a medical professional believes that an individual should take forward, in their own best interests, and the right of the individual to say, “I understand that, but that might not be for me,” for a variety of reasons. It is about getting the balance right, and it is an uncomfortable balance for legislators, because it leaves the option open. However, patient-centred care is at the heart of the principles and ethos of the bill.

On the other amendments in the group, although, for the most part, I understand the reasoning behind them, many appear to duplicate each other or ask for very similar information to be included, as both Daniel Johnson and Bob Doris acknowledged.

Pam Duncan-Glancy’s amendment 229 would require that, in carrying out their assessment, the co-ordinating registered medical practitioner must ask the person who they are assessing what their primary reason is for seeking an assisted death. If it is determined that the reason is not related to the person’s terminal illness or otherwise falls outwith the bill’s provisions, the assessment must cease immediately and not proceed. I understand the reasoning behind the amendment, and I again remind the committee that section 7 of the bill requires discussions to take place with those requesting assistance about their illness and available care and support, so that they can make an informed choice.

Amendment 69, in my name, would further strengthen the safeguards in that regard, and section 24 already addresses the reasons for choosing an assisted death or, indeed, the reasons for withdrawing that request. I am concerned that amendment 229 might go further than is desirable in placing subjective eligibility judgments in the assessment process; therefore, I do not support that amendment.

That is a helpful issue to raise, and that is why we need the training requirement to be developed by those who are operating in the area. There will be areas where face-to-face engagement is crucial and areas where it will not be felt to be essential. Ultimately, we need to ensure that the professionals who have the relevant expertise inform the way in which guidance will be taken forward.

The amendments in this group, which have a great deal of overlap for wholly understandable reasons, have facilitated a useful debate, if not about what will be in the bill then, certainly, about what the Parliament should expect in subsequent elements of the process. I press amendment 65.

Amendment 65 agreed to.

Amendment 224 moved—[Paul Sweeney]—and agreed to.

Amendment 66 moved—[Daniel Johnson].

I thank Daniel Johnson for taking the intervention and for setting out a reflection on the hospice sector that I fully recognise. I understand the concerns that have been expressed, but would he accept that the hospice sector is made up of hospice communities that do not simply include those who are directly employed in those hospices but stretch rather wider? Within those communities, there will invariably be those who are very concerned about what is proposed in the bill and would not want to participate at all; there will be others who are very comfortable with it and see it as an extension of the sorts of patient-centred support that they already provide; and there will be others who are uncertain, as I know many colleagues are, and who will want to see the detail of the bill and how it might impact on them before they make a decision one way or the other.

The risk in introducing an institutional or organisational conscientious objection is that we would remove from individuals in the hospice community the choice to participate, if they wish to, with the strict safeguards that are in place, and we would allow, essentially, a veto on that choice by those who are opposed to it, for reasons that I fully respect, who would be under no duty to provide anything that is set out in the bill. Does the member accept that that cutting across individual choice is something that we should steer clear of if at all possible?

There are deliverability challenges, but the other issues that the Government has raised in relation to the interaction with the existing adult support and protection system go beyond simply technical issues. I am always happy to work with Bob Doris on those and related issues. However, as I will come to suggest, the amendments that I have lodged in this area open up the potential for much of what Bob Doris and Fulton MacGregor are seeking to achieve, and in a proportionate and appropriate way.

Mr Doris earlier made a point about the non-medical nature of assessments relating to coercion—and, I would argue, capacity—that aim to provide a better understanding of the full range of options that are available to an individual who may be seeking to make a request of this nature. The point is well appreciated and well understood, but that will not be appropriate in every instance, which is the slight issue here. If there is a blanket approach, the way in which we target and support those assessments will be diluted, which will potentially put individuals at risk in a way that would not be the case with my amendments.

Again, I understand the intention behind the suggestion. My concern is that putting such a provision in the bill would make it more likely that individuals would be reluctant to declare, or be open with the medical professionals about, such circumstances. Therefore, the amendment is unlikely to provide the very protection that Pam Duncan-Glancy—understandably and justifiably—seeks to pursue.

I will turn to amendments 88, 89, 92, 101 to 103, 109, 110, 113 and 114, all in the name of Bob Doris, some of which set out what information should be included in the co-ordinating registered medical practitioner’s statement as set out in schedule 2. I understand that the amendments relate to his amendment 100, which would require an assessing registered medical practitioner who is carrying out an assessment under section 6 to request a statement from the relevant local authority as to whether the person seeking an assisted death is a known adult at risk. In the interests of time, I will not rehearse the concerns that were expressed in relation to similar amendments in the earlier group, but, for many of the same reasons, I urge the committee not to support those amendments.

Bob Doris’s amendments 90, 106, 100, 111 and 115 provide that, in carrying out an assessment under section 6 of the bill, RMPs must

“enquire about and discuss the person’s reasons”

for seeking an assisted death and that the reason must be recorded in the appropriate statements in schedule 2. I appreciate the reasons for lodging those amendments, but I am mindful of the need to respect privacy and to avoid placing pressure on those who wish to request assistance. Section 7(1) requires discussion of a person’s diagnosis and prognosis, as well as other treatment options, making it likely that what those amendments provide for is already covered. However, I am content to support Bob Doris’s amendments, which might help to reinforce those provisions.

I am less convinced by Mr Doris’s amendments 91 and 94. The bill allows for discretion to be applied by assessing doctors in line with their professional judgment in explaining and discussing certain matters that are set out in section 7(1). The BMA has strongly advocated that approach in the context of similar amendments tabled in relation to the bill at Westminster.

Regarding Mr Doris’s amendments 95, 96, 98 and 99, again, the bill allows assessing doctors to exercise their professional judgment and discretion in determining whether to seek input from specialists regarding assessment of a person’s illness and/or capacity. The amendments would require the assessing doctors to make such referrals if they had doubt about a person’s illness or about their capacity to make the decision. I believe that that would be the consequence of the existing provisions in the bill, but, on balance, I see no harm in supporting the amendments.

I am afraid that that is not the case with amendment 116, which would provide that, at first declaration, the co-ordinating registered medical professional must refer the person to a palliative care specialist for a palliative care and social needs assessment. The bill requires options to be discussed and would not prevent the registered medical practitioner from recommending a palliative care assessment. However, for the reasons that we have already discussed, including last week in relation to earlier amendments, that must remain a choice for the terminally ill adult, so I urge the committee to reject amendment 116 if it is moved.

I am conscious of the time. I will take Brian Whittle’s intervention and maybe let Mr Doris in later.

I thank Bob Doris and Fulton MacGregor for setting out their rationale for amendments that would add elements to the assessment process. I understand very well, not least from my discussions with the SPPC and the Scottish Association of Social Work, the intention behind the amendments.

Amendments 100 to 103 and 92, and consequential amendments 133 and 134, in the name of Bob Doris, would require a registered medical practitioner who is carrying out an assessment under section 6 to request a statement from the relevant local authority as to whether the person who is seeking an assisted death is a known adult at risk. Amendment 101 sets out the circumstances in which the assessing practitioner would be required to refer the person for an assessment by a registered social worker, and amendment 92 would require that the person be informed that they can request to be referred for such an assessment.

The Scottish Government commented on amendment 100 and related amendments, stating:

“The proposed amendments, taken together, present deliverability challenges as drafted, and issues with their compatibility with the existing Adult Support and Protection system, including the legislation underpinning it. They seem to conflate a general social work assessment/referral with an Adult Support and Protection (ASP) referral, which is only triggered under specific statutory criteria. Requiring that medical practitioners ‘must’ refer or request statements from local authorities may also create legal and operational issues considering, in particular, interaction with existing duties to co-operate with ASP processes under the ASP Act, in particular as they apply to GP independent contractors.”

As I said, the Government also points to deliverability challenges.

Similarly, Fulton MacGregor’s amendments 226 and 233 would require that, at the point of the first declaration, the co-ordinating registered medical practitioner must request information from the relevant local authority as to whether the person who made the declaration is vulnerable, lacks capacity or might be experiencing coercion or abuse. The Scottish Government noted its concerns with those amendments, stating:

“There may be technical issues with this amendment, for example it provides for ‘vulnerable’ to be determined with reference to a number of other Acts not all of which make reference to such terminology”.

The issues that are highlighted in the amendment are extremely important and they will be crucial in relation to the assessments that are made of particular individuals, not across the board. Again, one needs to take into account whether that would be more appropriately set out in the bill or best left to secondary legislation or guidance. I believe that those issues are better reflected in guidance. I do not think that it is a resource issue; it is about ensuring that the profession is able to have input to the way in which training is designed and taken forward.

I turn to Jackie Baillie’s amendments 66, 68, 70, 71A and 72. I ask for those amendments not to be moved. I have spoken to my amendments on training, and I ask members to support those instead. My amendments seek to allow Scottish ministers to regulate for training, in addition to qualifications and experience, that is relevant to the co-ordinating registered medical practitioner, the independent registered medical practitioner and the authorised health professional, and they would require all regulations to be consulted on.

Jackie Baillie’s amendment 49 would require any regulations made in relation to the qualifications and experience that the co-ordinating practitioner should have to include minimum training standards and qualifications and experience that are required specifically to deal with a person aged between 18 and 24 or a person with a fluctuating illness and/or an unpredictable prognosis. The amendment would also require Scottish ministers to review the regulations in relation to qualifications and experience, but not training, from time to time.

I am sympathetic to the amendment, not least due to my engagement with Children’s Hospices Across Scotland over the past few years, but I draw members’ attention to my amendments on training. They will allow ministers to set out what training, as well as what qualifications and experience, a person must have to be the co-ordinating practitioner, independent registered medical practitioner or authorised health professional.

I note that, as Jackie Baillie’s amendment stands, the co-ordinating registered medical practitioner would be subject to the requirement, but not the independent registered medical practitioner. I also note that the part of the amendment in relation to minimum training standards that are required may overlap with Jackie Baillie’s amendments 66 and 71, which also provide for the co-ordinating practitioner to have completed training to be specified by ministers in regulations.

In relation to the part of the amendment that relates to specific qualifications and experience that would be required in relation to those aged under 25, I note that the regulation-making powers in the bill will allow ministers to specify that if it is felt necessary. The bill requires ministers to consult relevant persons ahead of laying any such regulations in order to ensure that what medical professionals consider necessary is properly reflected. That is the case in the amendment, which is concerned with specific training and experience in relation to diseases, illnesses or conditions of a fluctuating nature and with unpredictable prognoses.

On that basis, I ask for amendment 49 not to be moved and I ask Jackie Baillie to consider how the bill as amended stands after stage 2. As ever, I am happy to work with her ahead of stage 3 on any further aspects that may need to be addressed.

I turn to Mr Whittle’s amendment 155. Section 6(6) of the bill sets out the circumstances in which an independent registered medical practitioner may carry out an assessment under section 6(3). Amendment 155 seeks to add the requirements that the independent registered medical practitioner must not have consulted the co-ordinating registered medical practitioner on the case, have been provided with access to any notes prepared by the co-ordinating practitioner on their assessment, or have been provided with any other notes prepared by the co-ordinating registered medical practitioner since the date of the first declaration.

With regard to maintaining the independence of the two doctors, I believe that steps would be taken to ensure that as a matter of existing practice. Again, I believe that consistency in the principles and approach with other areas of medicine is important. However, I am open to further discussion with Mr Whittle on that.

I consider Mr Whittle’s amendment 196 and Paul Sweeney’s amendments 254, 255 and 270 to be unnecessary, due to the amendments that I have lodged on training.

I look forward to hearing members’ comments and I will respond to them if appropriate.

I move amendment 65.

I appreciate Mr Doris’s point. If additional information could usefully be added to the process, I am happy to consider it. In relation to schedule 2, a practitioner would already need to be satisfied that quite a lot of details had been met before those forms were signed.

Stuart McMillan’s amendment 117A amends Bob Doris’s amendment 117 and states that, if a report under Mr Doris’s amendment sets out why a statement has not been made,

“no registered medical practitioner may carry out an assessment in relation to the same request before the end of the period of six months beginning with the day the report is recorded in the patient’s medical records.”

I cannot support the amendment, which appears to be arbitrary and disproportionate and does not appear to take account of the potential for circumstances to change.

I now turn to Jackie Baillie’s amendments 50, 51, 58 and 59. Amendment 51 would require both assessing doctors, if the person being assessed was under 25, to refer the person to a social worker and a psychiatrist and to take account of their specialist opinions. The amendment would also allow Scottish ministers to make regulations on any qualifications that the social worker or psychiatrist must have, and it would provide that the regulations must be consulted on. Amendment 59 would requires the first regulations made to be subject to the affirmative procedure, and amendment 58 would require subsequent regulations to be made under the negative procedure. Amendment 50 would add to section 6 the requirement that the assessing doctors carry out the steps that are set out in amendment 51.

I note the Scottish Government’s concerns regarding the potential time commitment for practitioners and the risk of creating barriers to access for individuals in the affected groups, which could potentially result in delays or inequitable access. Daniel Johnson sought to address that in his remarks, but I think that it would still be a matter of concern. As I have said, the way in which the process will work for younger adults, who are likely to be living with, or who have been living with, complex conditions for some time—this was set out very well by Mr Johnson—will reflect that complexity and will invariably involve a wider range of medical and other professionals, who, in turn, will require the appropriate training. A separately established and distinct process might be seen as arbitrary and open to challenge, so it might be better to set out in the relevant guidance what Jackie Baillie seeks to achieve, including in relation to training. I remain willing to work with Jackie Baillie and Daniel Johnson on those issues ahead of stage 3.

In the meantime, I have no objection to Jackie Baillie’s amendment 93, which would require the assessing doctors to inform the terminally ill adult that they could be referred for a palliative care assessment. The bill already requires assessing doctors to explain and discuss with the person their diagnosis, prognosis, available treatment, palliative care and other care that is available. My amendment 29 would require them also to discuss psychological support and symptom management. Although amendment 93 appears to replicate part of that, I have no objection to it.

Jackie Baillie’s amendment 75 would enable assessing RMPs to refer a person who is being assessed for an additional second opinion in a psychiatric assessment on capacity. The amendment would also allow the person being assessed to request a second opinion in relation to their capacity. In either circumstance, the referral would have to be to someone on the register of psychiatrists, which would be established by amendment 80, which we have already debated, and the assessment would have to be taken into account by medical professionals. I refer members to the comments that I made earlier on that issue. I also note that the Government has stated that, should amendment 75 be passed, it could raise concerns around consistency and increase the risk of “doctor shopping”. The Government also suggests that

“This may also place significant strain on staff resources, as additional referrals and second opinions would require more specialist availability and coordination.”

Let me turn to Pam Duncan-Glancy’s amendments 231, 234, 235 and 236. Amendment 231 might be a helpful addition to the list of things that assessing doctors should explain to and discuss with the person being assessed. However, assessing doctors would benefit from having discretion in such matters. For example, the inquiries and discussion provided for by amendment 231 would not be appropriate in every case being assessed, as I am sure Ms Duncan-Glancy would accept.

I appreciate the intention behind amendment 234 in seeking to ensure that any terminally ill adult who requests assistance and who has a disability has access to the support that they need. I also appreciate that the amendment frames any referral as being discretionary for the assessing doctors. There might be issues to consider in relation to which disability organisations could be involved in something of that nature, how reasonable it is to expect them to be involved in the way that is envisaged and how well placed they would be to provide support.

That brings us to amendment 236, which would require ministers to ensure that disability organisations are adequately resourced to provide that support function. It is obviously for the cabinet secretary and the Scottish Government to comment on duties that amendments would place on the Government to deliver funding. However, that consideration might add to concerns about whether such an amendment would make a proportionate difference to the bill and to the robust safeguarding measures that are already in place and that can be delivered.

With regard to amendments 234 and 236, the Scottish Government has stated:

“... this would require discussion with disability organisations to understand in what form this support would take; how it would be funded; and how it could be delivered consistently”.

The Government further notes that amendment 236

“would place an open-ended, and potentially significant, resourcing ask on Government.”

Amendment 235 also aims to provide support to any terminally ill adult with a disability and, again, allows discretion, so the provision can be used if deemed necessary or helpful. However, I again have concerns about how that would fit within the overall assisted dying process provided for by the bill, and I am also unsure how well positioned local authorities are to meaningfully provide the kind of assessment that is provided for and envisaged by the amendment.

Stuart McMillan’s amendment 232 appears to duplicate the policy intent of the provision in section 7(2) of the bill, which allows the assessing doctors, if they have any doubts about whether an illness is terminal, to refer to an expert in the particular illness in question.

On Mr Balfour’s amendment 157, I note that section 7 sets out further provision for assessments to be carried out by registered medical practitioners. Amendment 157 would add a requirement that the registered medical practitioner must refer the person seeking an assisted death to a registered social worker and a registered medical practitioner who is registered in the specialism of psychiatry for an assessment and must take account of any view provided following that assessment.

In terms of amendments that relate to a required social work assessment, I have lodged amendments that, if agreed to, would see assessing doctors being able to make inquiries and seek the views of health, social care and social work professionals and those who have provided or are providing care to the person. I further note that the bill does not limit assessing doctors to seeking the views of only one specialist on either illness or capacity, so there is nothing to prevent other opinions being sought if that is considered necessary. I therefore do not believe that amendment 157 is required, and nor are the consequential amendments 159 and 160.

Sue Webber’s amendment 158 would add a requirement that the medical practitioner must inform the person of any potential side effects of using approved substances that may be provided to assist them to end their own life and of any potential risks or complications, including pain. I would expect such information to be shared by the RMPs as part of the requirement under section 1 of the bill, which requires assessing doctors to explain to and discuss with the person seeking assistance

“the nature of the substance that might be provided to assist the person to end their own life (including how it will bring about death).”

I therefore consider that the amendment may not be essential, but I certainly do not oppose it.

I note Daniel Johnson’s comments about his amendments 5 and 6 being generally probing amendments. Amendment 5 would require the assessing doctors’ statements to record how long they have known the person, and amendment 6 is consequential. I am not necessarily clear as to what extent that would strengthen the bill, as it would simply record, and only for the co-ordinating registered medical practitioner statement, how long they had known the terminally ill adult. I have always acknowledged that there may be a value in the co-ordinating practitioner having a pre-existing relationship with the terminally ill adult, particularly when assessing for coercion. Indeed, the explanatory notes accompanying the bill state:

“It is expected that this will usually be the terminally ill adult’s GP or primary care doctor.”

However, I understand the rationale behind the amendments and there is probably scope for further discussion ahead of stage 3.

Finally, I will address Paul Sweeney’s amendments 239, 240, 241 and 273, regarding the establishment of an assisted dying panel to determine eligibility once the assessing doctors have both made statements of eligibility, as is set out in the bill. I note that the amendments would prevent a terminally ill adult from making a second declaration until the panel had granted a certificate of eligibility and would require the panel to hear from one or more of the assessing doctors and the terminally ill adult and others. In my view, the amendments would add a burdensome and unnecessary step to the assessment process, which is already robustly and proportionately safeguarded. Two doctors must assess eligibility with input from others, if and as required, before a person is allowed to be provided with assistance. Having to then pass to a further panel would inevitably delay the process and potentially deny assistance to many who met the eligibility criteria. As such, I cannot support the establishment of an additional review panel, which I believe would not strengthen safeguards but would rather act as a potential barrier to those accessing the choice that they wish, having met the stringent eligibility criteria set out in the bill.

Apologies for the length of time that I have taken to speak to the group, but I hope that that is helpful to the committee.