Seòmar agus comataidhean

Will Mr McArthur give way?

I have lodged amendments 76 to 79 on behalf of the Royal College of Nursing Scotland. As you know, RCN Scotland maintains a neutral stance on assisted dying, but it has serious concerns about section 15, specifically the expectation that registered nurses acting as authorised health professionals will carry out complex assessments of capacity and coercion, and the possibility of nurses providing assistance while working alone.

Amendment 77 proposes that final assessments of capacity and coercion be carried out by a doctor. Such clinical judgments are complex, especially when time has passed—there might have been earlier assessments, and factors such as pain or medication might affect cognition. It might have been months since the co-ordinating and independent doctors undertook the assessments to determine eligibility, and capacity can fluctuate in a person who is terminally ill. Similarly, identifying coercion is inherently difficult, particularly without a structured framework.

Although some nurses in advanced practice roles have the relevant expertise, the bill is structured in such a way that those specialists are unlikely to be asked to act as authorised health professionals. Instead, nurses in more general settings, such as community care, general practices or hospital wards, might be expected to take on the role infrequently. RCN Scotland believes that assessing capacity in this context requires a depth of knowledge and experience that goes beyond the scope of practice of most registered nurses, and the amendment seeks to ensure that the final assessments are undertaken by either the co-ordinating doctor or another authorised doctor. The RCN believes that that is a safer and more appropriate approach.

Amendments 76, 78 and 79 address RCN Scotland’s serious concerns about lone working. The bill, as it currently stands, allows nurses to provide the approved substance alone, which RCN Scotland considers unsafe. The provision of assistance will take place in a highly sensitive and emotionally charged environment, where complex family dynamics might arise. Nurses might then face distressed families; individuals who are unable to self-administer and therefore cannot receive assistance; or unexpected reactions to the substance. Current practice for controlled drugs typically requires that two registered nurses prepare and administer them, and that safeguard should apply here, too.

These amendments would require a nurse acting as authorised health professional to be accompanied by another health professional. In practical terms, that would mean that a doctor would carry out the final assessments on capacity and coercion, and either they or a nurse accompanied by that doctor would then provide the substance. Where a nurse provides the substance, either the accompanying doctor remains present, or the doctor leaves and another health professional arrives to accompany the nurse while the person decides whether to use the substance, and if they have done so, has subsequently died.

Although the bill allows a nurse to be accompanied, it does not require it; instead, it leaves it up to individual nurses to advocate for themselves when they are asked to attend alone, and we do not regard that as acceptable. RCN Scotland believes that these amendments would introduce essential safeguards and must be incorporated into the bill.

I am moving the amendments in this group on behalf of Hospice UK, which, as members will know, represents the palliative care sector in Scotland.

My amendments 54, 55, 61 and 64 are a package that is designed to assess and mitigate any impact on the hospice and palliative care sector of the introduction of assisted dying in Scotland. Amendment 54 and consequential amendment 64 require an assessment of the impact on palliative end-of-life care services of assisted dying being legalised, and amendment 61 requires that a report be published prior to assisted dying being available.

My amendment 55 sets out the creation of a code of practice on how assisted dying would interact with hospices and other providers of palliative and end-of-life care. Additionally, my amendment 57 requires the five-year review in the bill to also consider the impact of the act on hospices and other providers of palliative and end-of-life care services.

If I may, I will set out briefly the reasons for the amendments. We all know that hospices have been under pressure on funding for years—they are stretched to breaking point. Demand is rising because we are all getting older and suffering from more complex health problems and care needs. Hospices need to grow to meet that rising demand but the reverse is happening. Their concern is that the bill will represent a significant change to people’s choices at the end of their lives, and they want to be sure that all staff and organisations, such as hospices, that care for people who have a terminal diagnosis at the end of life, will be supported through that change.

Amendments 54 and 55 therefore set out an approach to assessing and managing any impact on hospices and other providers. The approach aligns with the committee’s stage 1 recommendation that there needs to be careful consideration of how the bill, if it becomes law, will interact with all other key aspects of end-of-life care provision, including palliative care. The key aim of the amendments is to ensure that assisted dying coming into operation in Scotland does not have unintended consequences on palliative care services.

We know that palliative care services in jurisdictions where assisted dying has been legalised have experienced increased demands on time, with resources being diverted from palliative care to support people and families around assisted dying. That is a pragmatic assessment of where there might be implications for hospices.

I have lodged amendment 53 on behalf of Children’s Hospices Across Scotland. I always have sympathy with Miles Briggs but, on this occasion, I am not sure that he is suggesting the right approach. My amendment deals specifically with the necessary difference when we are dealing with children.

I genuinely believe that it would be unethical for medical practitioners to proactively raise the subject of assisted dying with young people under the age of 18 as part of anticipatory care planning. Anticipatory care planning is the process in which the future care needs of a young person with a life-shortening condition are discussed and planned for, and I think that the risk of coercion in that process is high. Healthcare professionals have a privileged relationship with young people and their families. They might have known a young person for a considerable period of time prior to that young person becoming potentially eligible for an assisted death. For that medical practitioner to proactively raise the possibility of assisted dying is not a neutral act: it might be perceived as a recommendation, even if it is presented neutrally. Raising assisted dying as an option for young people might also cast doubt on the efficacy of other treatments or measures, or on the ability of family members to provide support.

The reason that coercion is such a worry at that time in a young person’s life is that they may well be transitioning from children’s to adult services. That can be really hard, because many of the people who they know and rely on, such as health professionals, social care workers and voluntary sector organisations, are changing over. That makes the young person particularly vulnerable. My amendment does not prevent doctors answering questions if they are asked, but it prevents pre-planning for assisted dying before the age of 18. I urge support for amendment 53.

We are not talking about an everyday occurrence; this is something very unusual and highly sensitive. Furthermore, as you have acknowledged, significant numbers of people will not be impacted by your bill. Consequently, issues of access being limited for some terminally ill adults are not valid in this instance.

It is very difficult for a nurse who is placed alone to advocate for themselves and say that they do not want to carry out that role on their own, thereby causing unnecessary delay. What I am seeking should be built in from the start—it must be the expectation. If we want effective implementation of your bill, we need to assure those who are likely to be significant participants in it—that is, nurses—that we have their interests at heart.

I urge you to accept the amendments, because they do add to the bill.

Amendments 62 and 63 were lodged after discussion with CHAS—Children’s Hospices Across Scotland—which runs Robin house children’s hospice, in my constituency. The bill does not contain any details of the regulation, scrutiny or inspection of organisations that would provide an assisted dying service, nor of the reporting on the processes that they would operate. All of that happens in other types of care, so this would represent an unprecedented lack of regulation and scrutiny.

The requirement for regulatory arrangements needs to be made explicit in the bill, because we all want to ensure patient safety, and the quality of the service is a paramount consideration. Healthcare Improvement Scotland and the Care Inspectorate already ensure that non-NHS services are run by fit and proper people. They already have statutory powers to secure patient safety and significant experience of regulating the provision of social care and healthcare outwith the NHS. They are also accountable. To be clear, the amendments would not in any way prevent an assisted death in a person’s home; they would simply ensure that the organisation supporting that, if it was not an NHS service or a GP practice, met all the standards and was safe.

Amendments 73 and 84—amendment 84 is consequential—are to make it clear that a person is not considered terminally ill solely because they have a mental disorder.

Amendment 73 reflects the position of the Royal College of Psychiatrists in Scotland that mental disorders such as anorexia nervosa should not be classified as terminal conditions under the bill. It provides clarity and reassurance that the bill does not open the door to assisted dying for individuals whose suffering arises from mental illness alone. I believe that that safeguard is vital to prevent misinterpretation and to uphold the integrity of the bill’s intent, which is focused on those with a qualifying terminal physical illness.

I heard Liam McArthur’s earlier comments and, as amendment 24 captures the intent of my amendment, I will not move amendment 73.

No, I am not proposing a separate regulatory body; I am leaning into the current arrangements, and I am allowing for the circumstance that assisted dying might not be entirely delivered by the NHS, which is the case in other countries. It is a belt-and-braces approach that aims to make sure that we have the right regime in place, so that we are satisfied with the levels of scrutiny and regulation. I hope that that is clear.

Amendment 62 would allow the Scottish Government to bring forward regulations to prevent an assisted death from taking place in certain settings—for example, in care accommodation for people aged under 18, in a care service that is used primarily by children, in a drug and alcohol rehabilitation centre, in supported accommodation for people with mental health illnesses or in a women’s aid refuge. Those are all registered care settings, but providing assisted dying in them would clearly not be appropriate.

I also anticipate that the regulatory framework could make situations in which a person is asked to undertake an assisted death in a public place or outdoors a sensitive issue. The Scottish Government should bring forward the details in due course through secondary legislation. I also anticipate that secondary legislation will clarify whether the service can be provided privately on a for-profit basis. There are already legislative prohibitions on other types of care providers—for example, adoption agencies—operating for profit in Scotland.

In summary, the amendments are about ensuring that we have the right safeguards in place, that we allow only reputable and regulated organisations to be involved, and that a standard is set, that there is oversight of it and that we align that standard to existing bodies such as Healthcare Improvement Scotland and the Care Inspectorate, with which we are all familiar. I hope that members can support amendments 62 and 63, which provide for affirmative regulations.

I am capable of many things, convener, but that level of detail is not in my gift. I will be happy to provide the information later.

I am going to attempt the impossible, which is to try to get the committee to keep the petition open. As you rightly pointed out, the Wishaw neonatal unit was the best neonatal unit in the country—not Scotland, but the whole of the United Kingdom—in 2022. For some reason, the Scottish Government then decided that it should close.

You are quite right to reference an earlier report that was presented to the Scottish Government, which recommended that there should be three to five neonatal units to cover Scotland, instead of the seven or eight that we have now. Nobody disagrees with that. What we disagree with is that the Scottish Government opted to go for three units—one in Glasgow, one in Edinburgh and one in Aberdeen—and that Lanarkshire, the third-largest health board, which covers a population of 655,000 people, would have its neonatal unit removed. I have to say, in contradiction to what the minister contends, that the evidence was partial. There was no voice from NHS Lanarkshire sitting around the decision-making table, but there were representatives from Glasgow and Lothian.

The thing that we need to hold on to is that the Wishaw neonatal unit does not only deal with mums and babies from Lanarkshire; it deals with those covered by Greater Glasgow and Clyde, because the two Glasgow units that are currently there do not have enough capacity to cope with the mums and babies from Glasgow. Lanarkshire plays a key role for the whole of Scotland. It has been said that when the Wishaw neonatal unit closes and mums and babies cannot go to there, to Glasgow or, potentially, to Edinburgh, Aberdeen could be the default.

We think that there is not enough capacity in Glasgow to cope, so you would be putting the sickest babies in ambulances to make the two-and-a-half to three-hour journey to Aberdeen to be seen. It is entirely ridiculous, not just because of the risk, but because the sickest babies are likely to be in hospital for long periods. What happens to the mums and families who are rooted in their community in Lanarkshire? How do they spend time with the baby up in Aberdeen? That would be impossible and impractical.

It is not only the families who are very pragmatic in resisting these changes; it is the clinicians as well. The committee saw that very powerfully in its visit to the unit.

The solution, if I can posit one, is that we should have four units. It is common sense—it is not rocket science. I wonder whether we could invite the committee to write to the Government to suggest that it pauses any changes, that there should be a fully independent review and that it should consult the clinicians and the families affected in more than just a tokenistic way. Perhaps the committee could even invite the minister to come before the committee.

That would be a valuable conclusion to the committee’s visit. To be frank, if we do not keep the petition open, the Government will downgrade the neonatal unit between now and May, and that will not benefit anybody.