Seòmar agus comataidhean

Stuart McMillan referenced the Republic of Ireland. He would recognise that there is a constitutional provision in Ireland that says that, when there are to be amendments to the constitution, they are decided on by referendums. There is a variation of opinion in the state about whether that is the best way to decide elements of the constitution, which is obviously very different from the approach here. Crucially, a detailed citizens assembly process takes place before the development of a referendum there, which allows the question to be designed and the campaigning sides and all of that to be considered, for example. Does the member accept that we do not have that infrastructure here?

I agree with many of the amendments that Fulton MacGregor has lodged—indeed, I spoke to that yesterday evening.

I do not mean to conduct a debate through Fulton MacGregor in response to Emma Harper’s intervention, but—[Interruption.] I do not think that this sort of barracking is very helpful, given the seriousness of the issues that we are discussing.

I will not get into the debate about the Western Australian issue, because I did not raise it in the chamber. However, if we are talking about exam-level conditions for training—and all the things that Emma Harper has laid out, which she says that she has evidence of—none of that is in the bill. There is no requirement in the bill for education for professionals at any level. I would also put on the record that my amendment, which seeks to bring in mandatory training for practitioners, will potentially not be backed.

Does Fulton MacGregor, as a social work professional himself, recognise the concerns that social workers are raising that, if his amendments are not agreed to, the social work profession would not have confidence in the legislation—not because of their stance on assisted dying itself, but because the system would be wrong?

Mr McArthur seems to accept the broad concept that such inquiries are an important innovation for how we understand all the circumstances that surround a person’s life and their decision. I wonder why he thinks that they should not be mandatory. If there is nothing to worry about and we agree that they are a positive thing, surely they should be done as a matter of curse. If there are no concerns, that would be identified quickly and the person could move on.

I recognise that Friday is a working day, and I think that colleagues would all recognise that they work on Fridays. However, people were planning to do something different on Friday and had made arrangements based on that. Part of my day on Friday involved caring for my son. I will now not be able to do that, because it would preclude me from doing my job here. The arrangements that I have in my region would be different because I would be closer to home.

The point that Jeremy Balfour and other colleagues have made is that they have made arrangements in relation to their caring responsibilities that keep them more local. Coming to Edinburgh is different from those arrangements, and I ask Christine Grahame to reflect on that.

Will the member take an intervention?

I do not intend to detain members for long by speaking on the broader issues and themes that surround amendment 157, because many of them were raised during the proceedings yesterday evening when we discussed the important role that social work and multidisciplinary approaches should play in the process.

The bill’s current wording states that a registered medical practitioner carrying out an assessment must

“consider making enquiries of a health professional, social care professional or social work professional with qualifications in, or experience of, a matter relevant to the person being assessed”.

Amendment 157 would instead make it a requirement for a registered medical practitioner carrying out an assessment

“to make enquiries of at least one health professional, social care professional or social work professional who holds qualifications or has demonstrable experience relevant to the condition, care needs or circumstances of the person being assessed”.

At a very basic level, my amendment seeks to strengthen the assessment process by replacing the discretionary power that is in the bill as amended with a mandatory requirement. That would ensure that assessments were being informed by appropriate multidisciplinary expertise. It would promote greater consistency in practice and reduce the risk that relevant safeguarding or welfare considerations might be overlooked. I lodged amendment 157 because of all the issues that I have raised and the need for expert professionals to be part of the assessment process of individuals who might demonstrate certain vulnerabilities.

I do not intend to say too much about my amendment 156, because my points have been largely covered in colleagues’ amendments. A number of amendments in the group seek to do the same thing: mandate that regulations are laid on the training to be offered to medical professionals to identify

“coercion, undue influence and coercive control”

and

“situations of dependency arising from illness, disability, age, social care needs or caring arrangements.”

Those are the words of my amendment.

In the debate on the previous group, in the wider debate that we had on coercion and coercive control and in the debate on this group, we have identified that medical practitioners do not always have the specialist training that is required to recognise the complex and often conflicting issues that arise in cases of abuse and in the patterns of behaviour that are associated with coercive control. Such patterns have to be monitored over a longer time. Colleagues have highlighted the challenges that arise from the fact that a patient’s relationship with their general practitioner is not what it was many years ago, when patients were more likely to see the same practitioner consistently. That issue has to be looked at more broadly.

That is why I have raised the need for wider multidisciplinary input, including from social workers and other professionals, which will help to identify coercive control much more easily.

Looking at the evidence that has been provided on other jurisdictions, I note that the Jersey review panel’s recent examination of assisted dying safeguards concluded that assessments should draw on as broad a range of professional expertise as possible. It acknowledges that medical training alone cannot provide what is required to identify coercion or coercive control. I say that to back up my previous point about social work, but also to make it clear that training is important and it is going to be required. It will allow us to deal with some of the issues that have been raised about the capacity of medical professionals to identify these pernicious issues.

As I said, I do not intend to labour points that have already been made. I am grateful for the time that I have had to add to the debate.

I will reflect on much of what my colleague Michael Marra has outlined about the challenge in the bill around coercion and the need to try to deal with coercion at this late stage in the process. For many colleagues across the chamber, it is a significant hole in the bill that coercion and the potential for coercion have not been appropriately addressed throughout the process.

My amendments in the group seek to strengthen the safeguards to ensure that declarations under the legislation will be genuinely voluntary. The amendments would require that practitioners are satisfied that a declaration has been made without coercion or undue influence. The bill does not specify how coercion should be identified, nor would it ensure that practitioners have training or are able to access relevant expertise on coercion, which I will come to when we debate amendments in the next group.

My amendment 172 would require practitioners to take

“all reasonable steps to identify whether the person has been subject to coercion, pressure or undue influence”,

including through private assessment, consideration of social and caregiving circumstances and, where appropriate, consultation with safeguarding experts.

My amendment 156 would require that practitioners receive training on

“the identification of … coercion, undue influence and coercive control”,

including in contexts of

“dependency arising from illness, disability, age, social care needs or caring arrangements.”

I have sought to construct reasonable amendments that can command support. However, I recognise what my colleague Michael Marra said about how difficult it will be to identify coercion and how pressurising it could be for GPs to have to take that forward. For much of my life before I became an MSP I worked with people who have a learning disability, and I recognise many of the things that Mr Marra said about women’s experiences of coercive control. The people I worked with were often vulnerable and did not have a strong family network, and many of them had lived much of their lives in institutional settings before this Parliament sought to move people into the community and tried to give them a life with choice and control. Many of those people had become vulnerable through the institutionalising of the way in which they lived their lives. Many of them were vulnerable and would not be able to identify it to somebody if they were being coerced into doing something.

For me, that sits at the heart of the bill. It is about whether we can provide adequate safeguards for the most vulnerable people in our community and society and whether we can at least equip the medical professionals who will carry out assessments and deal with the issues to be able to do that in the most direct way possible. That would be in private and in a one-to-one setting, and they must be adequately trained to do that.

I put on the record that I have had interaction with the social work profession on many of the issues that are raised in amendments in the group, and I declare an interest as I am married to a registered social worker. It is clear that the social work profession is rejecting the bill not because of the issue at hand, on which it has a neutral position because social workers take different views on whether to support assisted dying, but fundamentally because, as it has pointed out, it is concerned that we appear to be forgetting about the important role that social work processes play in identifying coercion, coercive control, abuse and all the other issues that I have outlined.

I have met both Social Work Scotland and the Scottish Association of Social Work, and they are clear that they are very concerned about the lack of regard that is given in the bill to existing adult support and protection processes and to the creation of new processes. I acknowledge the amendments that Brian Whittle and others have lodged to try to sustain those social work processes and provide for them to be followed.

We need to take clear cognisance of the fact that the bill might not be able to square the circle on coercion by creating robust enough safeguards to protect the most vulnerable in society. Social work professionals, who are often tasked with the most difficult decisions in our society about children and young people, older people and people who have a disability are experts in their field. They are trained, they know their communities and they know all the risks that exist in that space and how to identify them. If they are saying that they do not have confidence in the bill, we have to sit up and take notice of that.

I recognise that that can be the case. It would not be unusual for there to be a considered and compassionate approach to such circumstances and to ensure that appropriate alternative provision can be considered.

Mr Marra is helpfully moving me on to that point, which I will move to now in the interest of time. There is serious concern in the Catholic Church in Scotland that those organisations would cease to exist. As I said in my opening remarks, the Little Sisters of the Poor have cared for people in this country since 1863. More than 160 years of work in this country may be at risk because of the way in which the legislation has been drafted.

The funding of such organisations is also largely dependent on the provision of social care through acts of this Parliament, which gives them the funding that is required to do so. Removing that funding would make them financially unviable, even if they were to choose to continue in some form. Members have referred to other examples of places in which legislation on assisted dying has been passed, after which religious groups have found it hard to operate.

18:30