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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 them, that would be an even more precarious assessment to make, given that that would depend very much on who is accessing assisted dying and the point in their terminal illness at which they access 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 receipt of treatment and care at the moment.

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?

The perception that those in the disability community are overwhelmingly opposed to a change in the law is not borne out by the evidence that the committee will have heard from Professor Colburn at the University of Glasgow. His fairly comprehensive research points to attitudes in the disability community and the international evidence on how assisted dying is accessed. Polling consistently shows that support for a change in the law to allow for assisted dying is every bit as strong among those in the disability community as it is in the population at large, at the mid-to-high 70 per cents in the main.

I understand the concern that people in the disability community often feel that their lives can be devalued, that access to the rights that they have is not realised consistently or that there are rights that they still do not have. I stand in solidarity with them with regard to improving that situation, but we do not improve it by denying terminally ill adults the right to an assisted death when they choose it. It would be wholly intolerable for somebody with a disability who had an advanced progressive terminal illness and mental capacity to be denied the same access as an able-bodied person to the choice that is set out in my bill—people in the disability community would rightly be up in arms in such an instance.

All I can do is offer the reassurance that having a disability alone does not make you eligible to access an assisted death—you need an advanced progressive terminal illness and mental capacity to be able to do so. If you have a disability as well, I see no reason why you should not be able to access an assisted death in the same way and, if further support is needed in order for you to be able to access it, so be it. As I have said, I think that the disability community broadly recognises that, which is why polling consistently shows very strong support for a change in the law.

I will bring Amanda Ward in on the specifics. The capacity assessment that would be required in order to be eligible relates to the choice of an assisted death, not to a broader capacity issue. It would be expected that support be provided to allow an individual to make that assessment, which, I would hope, would allow access to a wider range of individuals to meet the eligibility criteria to have that choice. Amanda, can you add anything to that?

You make an entirely valid point, Ms Harper. In jurisdictions with a terminal illness mental capacity model, it is pretty consistent across the board for around a third of those who apply for an assisted death to not end up taking it. It is fairly safe to assume that, in the main, that is because they find that the palliative or other care that they receive meets their needs all the way through to death.

I suppose that it was implicit in my quote from the woman with MND that it is about having the insurance policy of knowing that, if things get too much, the option of an assisted death is available. That, in itself, has a palliative benefit, because it provides a degree of reassurance. It allows the individual to get on with living their life and making the most of whatever time is still available to them, whether that is measured in years, months or days. The fear of what is to come cannot be overestimated. Whatever the physical aspects are, the existential suffering that those at the end of life go through is one of the worst aspects.

As you will know better than I, Ms Harper, pain management is pretty sophisticated. A lot of the pain can be managed. I have heard physicians in Australia say that they very rarely deal with issues of pain. It is the existential suffering that leads individuals to opt for an assisted death. The fact that such a high number of people make the choice but then do not go through with it indicates why it has been chosen and the benefits that come with simply having that insurance policy in the background.

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.

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.

As I say, all treatment and care options need to be discussed for there to be an informed decision. The rationale—that is, the reasons behind the individual coming to their decision—needs to be understood, but it needs to be an informed decision, and it can only be an informed decision where there is an understanding of the various options that are available. Those options would not stop at palliative care but include social care, and there would be other factors that play on the lived experience of the individual.

Through the process that I propose to put in place, the discussions that would happen would provide safeguards that are not in place at present, for situations in which it is felt that an individual’s care needs are not being met. If an individual makes a request of that nature, I am fairly sure that the co-ordinating medical professional would go to some lengths to ensure that those issues are addressed. In a sense, the safeguards that my bill would put in place do not exist at the moment.

As I said, if we do not pass the legislation, there is a risk that the status quo would continue to have outcomes that we, as a society, should not accept. Although the amendment that you are suggesting would probably be competent in the context of the bill, the issue would be better addressed by the requirement under section 7 of the bill that I have introduced, which requires the care options to be discussed and steps to be taken where medics feel that other support is necessary and can be put in place. That assessment will change over time; an original assessment of those options might well be accurate, but over the period of a terminal illness, other options, which were not necessarily considered at the outset, might be deemed to be more appropriate.