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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.

I was intrigued by that evidence. To some extent, it begs the question whether Police Scotland has the same concerns around double effect, palliative sedation, withdrawal of treatment and other treatments that are legal at the moment. The proposal that is set out in my bill would put in place, as I have said, the most rigorous and robustly regulated end-of-life choice that there is. The assessments around coercion and capacity are as robust as they can be, requiring not just one but two medical practitioners.

In response to the question, I would be interested to know whether Police Scotland has the same concerns in relation to what is legal at present, where there is just as much scope for complaints or legal challenges to be made. In comparison, my proposed system would be far more transparent, with the views of the patient absolutely at the centre and, if there were any concern among the doctors or if there were an onward referral to a specialist, the process would come to a halt. That would provide greater protection not just for the patient but for medics, who, as I said, seem to be put in a fairly invidious position in the choices that they are having to make.

The slippery slope argument is made consistently. I point the committee to the report published by the House of Commons Health and Social Care Committee in February last year, at the end of an 18-month inquiry into assisted dying and end-of-life choices, which concluded that there was no international evidence of a jurisdiction that has introduced a terminal illness mental capacity model that is similar to the one that I am proposing and that is being considered by Westminster, where the eligibility criteria have changed. That was confirmed in the evidence that the committee heard from the witnesses who are involved in the process in Australia.

The argument that one of the witnesses made to try to substantiate the claim of a slippery slope in Oregon is that different conditions among those accessing assisted dying were featuring to a greater or lesser extent, but that does not necessarily say anything other than that patient confidence and medic confidence in the procedures perhaps evolves over time, and that those with certain conditions find that the palliative care that is available meets their needs up to a point, but they find themselves beyond that point at a certain stage.

Although minor changes have been made to the residency requirement in Oregon—over the years it was found that the requirement did not provide any meaningful safeguard, so it was removed—the eligibility criteria on terminal illness and mental capacity have not changed.

I have always acknowledged that the models in Canada and the Netherlands are more expansive; they have always been more expansive models. In the Netherlands, that has been the case for many years.

The Canadian model, which is often cited, has evolved through court process, which is sometimes brought into the debate here as something of a risk, but the constitutional arrangements in Canada are very different from those in Scotland and in the UK. The legislation was introduced as a result of a case that was brought before the supreme court in Canada on the basis that the ban on assisted dying was unconstitutional. The Parliament then introduced legislation, which was not felt to go far enough, so it was then legally challenged on appeal, which was upheld, and the scope of the legislation was expanded.

The arrangements in Canada and the Netherlands, both of which enjoy overwhelming public support, are very different from what is being proposed here. As I say, there is no example of a terminal illness mental capacity model having been introduced, whether in the US, Australia or New Zealand, where the eligibility criteria have changed.

I do not think so. My proposals would put in place a heavily safeguarded and transparent process whereby the individual who makes the request would be supported to understand the available options and in which medics would identify where there are needs and where those needs are not being met. All of that would happen in a way that is simply not the case at the moment, when those individuals are being left entirely to their own devices, often alone, and are making horrendous choices and decisions for themselves that not only further traumatise them but, as we know, traumatise those whom they ultimately leave behind. There are certainly gaps in palliative care, mental health and broader health and care services.

As I said, the proposals will put in place a robustly safeguarded process that means that anybody who comes forward to make the request has the reassurance of knowing that the wider context for the choice that they are seeking to exercise has been tested to the nth degree. That can therefore bring a degree of further reassurance and safeguarding to things that are happening at the moment. Decisions on matters such as double effect, palliative sedation and all the rest of it are being taken by medics, sometimes placing them in an invidious position, often without the input of the patient and sometimes without even the input of family members. There is an opportunity here to provide not just a robust safeguard but a degree of transparency that will be to the benefit of patients, but also to the benefit of medical practitioners.

I invite Dr Ward to add to that.

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.

As you have described, it would be my expectation that the clause would apply to the people who are directly involved in the process, which I think is a proportionate approach to conscientious objection. A degree of caution needs to be exercised when drawing parallels between the process that is described here and abortion legislation. I think that the way in which the conscientious objection clause works is appropriate in the context of assisted dying.

Other people might be, at some stage, removed from the process. One of the examples that was given to me was of people in a hospital or a hospice setting who are aware that colleagues are, through the proposals in my bill, engaged in assisting somebody at the end of life, and might have an objection to that.

Extending that conscientious objection too extensively is problematic. It is about choice for those who are actively participating in the process. Extending it more widely runs the risk of putting up unnecessary and unjustified barriers to individual patients who meet all the eligibility criteria by denying them access to that choice.

That evidence was very interesting. It is also fair to say that the BMA and the Royal College of GPs seemed to be fairly relaxed about the way in which that part of the bill was expressed.

I recognise that this is an element of the bill on which the detail is probably more appropriately set out in secondary legislation and in guidance. Training would be required for doctors to undertake the work that is involved in providing support to patients around assisted dying—we touched on some of that earlier.

As it stands, the bill probably goes as far as it can in expressing who is likely to be involved in this process, but there is an opportunity there. My expectation is that the Government would work with the professional bodies to identify how best to express that through secondary legislation and guidance.

That would certainly be my view; I am conscious that others take a different view on that. I think that there is a way of ensuring that the information that is needed is captured appropriately.

As I said, I was reassured to some extent in my discussions with the CMO and his colleagues that there is a way of navigating the matter so that it is undertaken sensitively but makes absolutely sure that the relevant information is available so that we have the understanding that we need about how the legislation is working in practice.

That issue has been a really interesting element of the debate. As you will be aware, I have opted to place this very much within the framework of health and care services, because I think that that would be the most effective way of ensuring safeguards and a more effective and efficient way of delivering the service. The pathway for the patient needs to be as seamless as possible, with an assisted death being one of a series of end-of-life options.

One of the safeguards that is built into the process is the discussion that needs to take place between the co-ordinating physician and the patient to ensure that the patient is aware of all the options that are available—palliative care, social care or other types of health and care treatments—so that the decision is informed.

Things may change over time—as the committee has heard, prognoses are highly problematic, and more so in relation to some conditions than others. That is one of the reasons why I have not set a six-month timeframe, which is a feature in other jurisdictions. Things may change over time, and there may be an on-going conversation, but I think that it is safest for all concerned if this is embedded in the health and care service.

I find the idea of a stand-alone service problematic. Expecting somebody to be lifted and shifted out of a current pathway into another service at what is probably one of the most vulnerable points of their life—their final days—does not seem acceptable. I am perhaps more sympathetic to the notion of opt-in and opt-out, but I would need to understand how that would work in practice and how to avoid creating unnecessary obstacles to people accessing the option.

As for the numbers involved, the appropriate training would need to be given to people to carry out the work. As we see from other jurisdictions—I refer to evidence that I gave to the Finance and Public Administration Committee—the number of registered medics is around 400 in Victoria and Queensland. The number of people in Victoria who were actively involved in 2023-24 was around 300; in Queensland, the figure was around half that—about 120. The numbers are not terribly high.

There would be a wider expectation that training would be required of those who might not be as directly involved, but who would need to be aware of what the law is and of how they might signpost somebody who asked them for advice. Indeed, some people might want to do the training for their own peace of mind, so that they understand the legal provisions. There is a training requirement, but the number of patients involved is likely to be very small, certainly in the first couple of years; it will gradually increase as public awareness increases, as medic confidence increases and as medics get the training that they need in order to deliver the option.

I do not see any reason why, in Scotland, we would find difficulties with our capacity to deliver this option that have not been experienced in any of the other jurisdictions concerned, including those in Australia, New Zealand and the US, which operate a similar model.

I have been interested in those surveys. Going back to the response that I gave about how many people are likely to be involved in the process, as we see from jurisdictions with similar models, it is a relatively low number. It is likely to be a very low number in the first and second years, but over time, it is likely to increase.

At the end of last year, I spoke at the Hospice UK conference in Glasgow. It was clear to me from the exchanges there that there is a considerable amount of discussion and debate about the issue in the palliative care sector. There are certainly people who strongly oppose a change in the law, and people who are similarly strongly in favour of it. A great many people have questions and simply want to know how it would impact on the care that they deliver to their patients. As I said to them, I think that introducing the choice of an assisted death as one of a range of end-of-life choices allows them to do what they do well, which is meet the needs and limit the suffering of the people they support.

Attitudes to legislation before it is in place often change, and can change dramatically, after the legislation is introduced, when people have a clearer understanding of what the implications may be. I do not see any reason why the situation here in Scotland would be any different from that in states in Australia and the US where practitioners have engaged in the process and, as I said, have often found that one of the most rewarding things that they are able to do is give those whom they are supporting a good death. That seems to be at the heart of what palliative care is about.

I have heard the concerns, and I have tried to do my best to engage with the sector to provide a degree of reassurance. Obviously, the bill, which includes a conscientious objection clause, does not compel anybody to engage with the process, but I am confident that there will be sufficient doctors to support it. As I said, those numbers are likely to increase over time as understanding and confidence increase and as the training is rolled out to practitioners.