Seòmar agus comataidhean

As I said, I cannot respond to every individual case in the Parliament. I go back to my point that my broad understanding is that Friday is a working day. We have needed to tweak the schedule. I have been inconvenienced over and over in the past few days, and I accept that. [Interruption.]

There are many amendments in the group with which I agree and some with which I disagree, but, mercifully, I will speak to only one of them: amendment 154, in the name of Douglas Ross, which I support. My support for the amendment has nothing to do with his proxy declaration for independence yesterday.

17:30

I think that the issue that amendment 154 addresses is very important. As a firm supporter of the bill, I want to put on the record that, for me, when it comes to end-of-life assistance and palliative care, it is not an either/or. Both should be available. It is about what is appropriate for the individual, so I very much welcome nailing this down.

Douglas Ross’s amendment says that, when assessing a declaration, the doctor “must”—it would be mandatory, which is great—discuss available “palliative care options”. That is excellent, because we know that palliative care comes in many forms. It is not necessarily given in the hospice or the hospital; it could also be given at home by Macmillan nurses. There are many ways and different times that it can be delivered to the individual. We must ensure that the person understands all that and that the discussion that the doctor has with the patient is formally recorded. I absolutely support that.

I hope that, if the bill is agreed to, there is a huge improvement in palliative care, so that it is not a case of somebody thinking, “Palliative care is not available or suitable for me; therefore, this is what I must do.” I want both choices—for myself and for everybody else.

So, for probably the first and last time, Mr Ross, I support you.

I will comment on the face-to-face patient-doctor relationship, which Mr Whittle and Mr Johnson raised. I do not know whether Daniel Johnson agrees, but I surmise that, once a person is diagnosed with a terminal illness, the relationship becomes much more personal and face to face, and is not restricted just to phone calls between 8 o’clock and 10 o’clock and getting lines from the doctor. The issue has to be addressed, but the GP and the patient will, in many cases, have much more of a relationship once the diagnosis has been confirmed.

I have had to cancel meetings. I had to cancel my final surgery in Peebles, which meant a lot to me after 27 years, but that is nothing.

The other issue that I want to raise is that we cannot arrange this so that we are reprinting the Assisted Dying for Terminally Ill Adults (Scotland) Bill as amended a few days or even a day before we debate it. There must be sufficient time for members to consider the bill as amended, because there are lots of amendments coming from different places. I do not know what the bill will look like at the final stage. I would certainly like to have time to reflect on and consider it before I am involved in voting on the bill as amended.

21:45

I hear Mr O’Kane’s point. Obviously, I do not know about everybody’s domestic circumstances, but members may be able to consider whether they can work remotely, which was not available in previous sessions of the Parliament.

I am a bit bewildered about the issue of caring responsibilities. I regard Friday as a working day, just as being in the Parliament today and tomorrow are working days.

I do not have the obligations that Keith Brown has, which are much more important than mine, and so all that I have been required to do is cancel my surgeries and rearranged meetings that would have followed on from them. Because Friday is a working day, I always have arrangements to be in my constituency and to be about, as many of us do. Therefore, I do not understand the distinction between Tuesday, Wednesday and Thursday and Friday, which is just another working day for me.

We have a responsibility in this Parliament. We have had very—

I am satisfied with the bill as it is drafted as regards section 3(2)(b), which is about capacity. Capacity is well understood in Scots law. When people make a will or grant a power of attorney, or even when they buy a house, they need to demonstrate to an agent that they have capacity, that they are not being coerced, that they fully understand the consequences and so on.

The definition in the bill is that people:

“are capable of … understanding information and advice about making the request, … making a decision, … communicating the decision, … understanding the decision, and … retaining the memory of the decision.”

That covers the areas that Emma Roddick has quite rightly brought to the Parliament’s attention. However, the definition of capacity has already been well tested in Scots law, and we do not need to—forgive me for saying this—clutter it with the amendments that have been suggested.

I put my cards on the table: I support the bill, but I want it to be as robust as possible. I fully accept that there are members who will not support the bill no matter what we do to it, and I respect that, whether it is for religious reasons, reasons to do with disabilities or whatever.

I will address the issues of coercion and undue influence, which belong in a trio of issues along with capacity. As I said when speaking about capacity, those concepts and values are well established in Scots law, and many examples of what they constitute have come before the courts. When we are making legislation, we must make it clear that the terms we are using have a background and foundation in case law, should that be required.

20:30

I am going to refer to the places in the bill where I think it addresses the issues of undue influence and coercion. I will not be supporting amendment 144, but I am sympathetic to Bob Doris’s amendments 25, 27 and 33 and broadly support them because they deal with the practitioner making inquiries or having regard to guidance as to whether they might be looking at someone who is suffering from undue influence or coercion. Professional training is important there.

Section 4 deals with the “first declaration” made by a terminally ill adult. Subsection (2)(a) states that that first declaration must be

“in the form set out in schedule 1”

and if we go to schedule 1 we see the wording:

“I make this declaration voluntarily and, in particular, I have not been coerced or pressured by any other person into making it.”

That would not be enough on its own, but we can look at the other sections of the bill. Section 6 is titled “Medical practitioners’ assessments” and states that

“The coordinating registered medical practitioner must”—

so that is mandatory—

“as soon as reasonably practicable”

do several things, one of which is that

“If, having carried out that assessment, the coordinating registered medical practitioner is satisfied as to the matters mentioned”

in another section, which I will come to,

“that practitioner must refer the person to another registered medical practitioner (the ‘independent registered medical practitioner’) for that other practitioner to carry out the assessment mentioned”.

Below that, subsection (4)(c) states that the person must have “made the declaration voluntarily” and that they have not been

“coerced or pressured by any other person into making it.”

That wording is not just in that provision; it is in section 8, which is titled “Medical practitioners’ statements”. Section 8(1)(c) states that the person must have “made the declaration voluntarily” and that they have not been

“coerced or pressured by any other person into making it”,

and 8(2)(c) also refers to someone who has

“made the declaration voluntarily and has not been coerced or pressured by any other person into making it.”

Without labouring the point too much, I note that if we go on to the schedules we will find schedule 1, which I have already referred to, and schedule 2, where the medical practitioner must agree to the statement that

“To the best of my knowledge, they are making the request to be lawfully provided with assistance to end their own life voluntarily and, in particular, have not been coerced or pressured by any other person into making it.”

Overleaf, at paragraph 2 of the independent registered medical practitioner’s statement, we find the words:

“To the best of my knowledge, they are making the request to be lawfully provided with assistance to end their own life voluntarily and, in particular, have not been coerced or pressured by any other person into making it.”

I will finish with one final bit, from the second declaration to be made by the person seeking assisted dying:

“I make this declaration voluntarily and, in particular, I have not been coerced or pressured by any other person into making it.”

There are a whole lot of hurdles.

Will Michael Matheson take an intervention?

Those are not simply repetitions. They are undertakings by medical practitioners and by the applicant that, to the best of their knowledge, they have acted voluntarily. Two medical practitioners, independent of each other, will make those statements.

I think that Bob Doris’s particular amendments are useful, and I will certainly consider voting for them because they require guidance and training for practitioners. However, in the Parliament, we sometimes do a great disservice to medical practitioners, who we somehow think will just go through the process willy-nilly when somebody comes in front of them. I am sure that most GPs have knowledge about coercion. If they had a concern, they would hesitate and test it, and they may well make an inquiry about the case that is in front of them. We are asking a lot of GPs, and if a medical practitioner were to go about it in some casual, superficial manner, he or she would be up before the BMA, let alone anything else.

The provisions seem pretty rigorous to me, but I understand that they will not persuade people in the Parliament who have been against the bill from the beginning, which is fine. However, if you are wavering because you feel that the bill will somehow make vulnerable people more vulnerable, I assure you that I would not vote for it if I thought that it would do so.

I am voting for the bill because I think that, to the best of my testing of the legislation and the amendments so far—there may be others—the bill is fairly robust. We are talking about robust stuff, and the bill would lay the onus on the practitioner to get it right.