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That response more or less covered the question that I was going to ask.

Thank you for coming to this meeting, cabinet secretary, and for reflecting on the recommendations that were made by the people’s panel. It recommended that there should be an urgent examination of issues around poverty. In your response to its report, you advised that the Scottish Government is developing a population health framework to be published in the spring, which will

“consider what more can be done to mitigate against the social and economic drivers of ill health”.

Will you provide the committee with more detail of what that will look like?

Yes. Thank you, convener. I appreciate your patience in accommodating me this morning. I am here to speak in general terms in support of the petition. I believe that it merits further scrutiny by the committee, perhaps in collaboration with the Health, Social Care and Sport Committee, of which I am deputy convener.

There are significant issues with the capital investment programme across the NHS estate, not simply with capital budgets—finance is one thing—but with how efficiently investment is made and whether it is made in the right locations. An example that I encountered on a recent committee visit to the Isle of Skye was the recently reconstructed Broadford hospital, where clinicians said that the health board did not adhere to their feedback or guidance on how the hospital should be designed and laid out and that it could have been better optimised. They are now dealing with the consequences of that.

Similarly, we hear from surgeons that the focus on national treatment centres is not necessarily helpful in the context of underutilised operating theatres and that the capital investment might be better focused on the primary care estate, for example, which is often crumbling and decrepit.

It might be interesting for the committee to consider wider consultation with the clinicians who operate in those facilities on whether the capital investment programme that the 14 territorial health boards are developing is as good as it could be or whether it ought to be reviewed, taking greater cognisance of clinical feedback and design, so that we get the best use of that budget. The budget feels scarce but, even when it is spent, it is not necessarily realising the best benefits for the patients and the healthcare system.

Do you think that it might be worth considering the provision of further detail on dispute resolution mechanisms—for example, in circumstances in which interested parties, family members or people with power of attorney might have a concern about coercion?

It is hard to balance risks. There are risks in every aspect of human behaviour and situations are complex and varied.

It is clear that it will be an offence if someone is coerced into making a first or second declaration. Might one influence on a person’s thinking about whether to undertake an assisted death be the lack of provision of alternative medical treatments, such as palliative care? Could the denial of timely treatment act as a coercive influence on a person’s thinking, and might that lead to legal disputes about access to other treatments? Might family members consider the denial of those alternative treatments to be the stimulus that caused a person to undertake an assisted death and might that lead to a criminal case?

Thank you, Mr McArthur, for attending today. Witnesses raised further questions on the practical administration of a substance if someone were physically impaired and unable to administer it. Obviously, you mentioned proxy with regard to the certification, for example. Could you talk us through the practical application of administering a substance if someone were physically unable to do so due to paralysis and so on?

People from other jurisdictions, particularly Canada, have mentioned the phenomenon of so-called doctor shopping, when the fact that some clinicians are unwilling to participate nudges someone who is persistent in their desire towards clinicians who would be minded to accept that. If someone were accessing a cohort of clinicians who were minded to support their position, even when other clinicians had concerns, would that create an inevitable risk of coercion?

In last week’s evidence session, Police Scotland and the Crown Office and Procurator Fiscal Service seemed to be content that the current law and the bill would interact in a way that would not hinder prosecution in appropriate situations. Sections 19 and 20 of the bill deal with criminal liability and mirror the provision for civil liability. Section 19(1) states:

“It is not a crime to lawfully provide a terminally ill adult with assistance to end their own life”,

but section 19(2) states:

“Subsection (1) does not limit the circumstances in which a court can otherwise find that a person who has assisted another to end their own life has not committed an offence.”

The explanatory notes highlight that that would be in the context of complying with the bill’s provisions.

Could there be the risk of litigation or police complaints being made? Could the provisions be tested by people disputing their relative’s competence or in other scenarios in which things end up being augmented by case law?

When it comes to conditions for which the prognosis is hard to determine, there might well be a long period after someone has made it clear that they want to have an assisted death. They might have made the relevant provisions in accordance with the bill, but there could then be a long period in which scope existed for further pressure to be applied or for other influences to be exerted on the person’s thinking. Many people who have a terminal illness and expect to receive palliative care might want to make provision for an assisted death because they think that having the option to end their life on their terms might provide some comfort. In the end, that option might not be used, but making such provision could create an open-ended period in which many circumstances could change.

Could more detail be provided on situations in which there were such longer periods? Could there be intervals at which the desire for an assisted death was reassessed by relevant professionals, such as the co-ordinating doctor?

There are a lot of provisions in section 23 on guidance, and the Scottish ministers would be able to make secondary legislation to set out the detail on a lot of that. Might there be instances around this area when it would be preferable to set out provisions in the bill, rather than relying on ministers to augment the bill through secondary legislation?