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I do not think so. It is difficult to know on what basis I would try to develop a different approach to the financial memorandum. Earlier, we discussed whether it would be an opt-in or an opt-out model, which I can see having a sizeable bearing on the costs. However, on the basis of assessing the likely take-up and the associated costs, recognising that we are talking about patients who are going to be in the health system already, we are talking about a lot of the training being training that is already routine and delivered. It might need to be adapted, but it is certainly not a case of a standing start. It is also fair to say that there will be training models and modules that are available in other jurisdictions that would help to inform the training.

You cannot have a lift-and-shift approach, because the health and care system here is very different from those in Australia and the US, but at least they provides pointers to how you would deliver this. As I have said, I think that the financial memorandum remains a reasonable assessment of the likely costs.

Thank you, convener. I apologise for the state of my appearance. When cycling to the Parliament this morning, I hit a pothole and the bike went from under me—that is not an attempt to play the sympathy card with the committee, but it is certainly a reminder of the value of wearing a cycling helmet.

I will start by declaring relevant interests. I receive funding for an additional member of staff from three permissible donors: Friends at the End, Dignity in Dying and the Humanist Society Scotland. That support is currently for one day a week. The Humanist Society Scotland also funded the development, maintenance, domain cost and hosting of a website that I have used to publish materials relating to the bill, and Dignity in Dying paid for the costs associated with my visit to California last year as part of a cross-party delegation of MSPs that met various organisations and individuals in relation to the state’s End of Life Option Act. I refer members to my entry in the register of members’ interests for further details.

I introduced the Assisted Dying for Terminally Ill Adults (Scotland) Bill in March last year, following the usual member’s bill process and supported by the non-Government bills unit. The bill’s aim is to allow mentally competent terminally ill adults in Scotland to voluntarily choose to be provided with assistance by health professionals to end their own lives. It sets out eligibility criteria and processes for assessment, all of which contain, I believe, appropriate safeguards. The bill also includes requirements for data gathering, reporting and review.

The bill is the culmination of years of campaigning and work by individuals and organisations, including current and former members of the Parliament. Proposals and bills were previously introduced on the issue by Patrick Harvie, the late Margo MacDonald and Jeremy Purvis. I thank all those who have been involved in seeking a change in the law on this issue and who have supported me.

I am acutely aware of the weight of responsibility that comes with leading a bill on this issue, and of the responsibility that rests on every MSP. We owe it to our constituents—whatever their views—to consider and debate this issue thoroughly and respectfully to ensure that any bill that is passed is appropriate, safe and fit for purpose. I know that that responsibility is one that the committee has taken seriously, and I thank you for your detailed and robust scrutiny to date.

I appreciate that the committee has faced difficulties in taking oral evidence from people who will be most directly affected—that is, those with a terminal illness. However, I know that the committee received a large amount of powerful written testimony in response to its call for written evidence and that written testimony was also received in response to my consultation in 2021.

As members will be aware, the fundamental reason why the bill is before the Parliament is a belief in the need to give terminally ill adults more choice and control over their end of life and the means of avoiding the existential pain, suffering and symptoms that are often associated with terminal illness. It is worth emphasising, however, that the bill’s provisions will relate to a relatively small number of people each year.

I have paid close attention to the evidence that the committee has received. I have heard the support that has been expressed by many witnesses and I have also listened carefully to the concerns that have been raised by others. I am aware of areas of the bill that have attracted particular focus, such as the age at which assistance can be accessed and how capacity should be defined and assessed. I will continue to listen to views on those points and to consider whether the bill requires amendment.

Another area of focus has been the definition of terminal illness. The bill requires a person to have an illness, disease or condition that is worsening, that will continue to worsen, and that is at an advanced stage. The illness must be one that a person will not recover from and that is expected to result in their early death.

I do not believe that the definition should include reference to a prognosis period, and no strong case has been made for that. I remain confident that the definition gives clear effect to the policy intent, which is to capture terminally ill adults in the final stage of their illness.

I also listened carefully to views about the assessment process, and believe that the safeguards in the bill are sufficiently robust: a person must be deemed eligible by two doctors acting independently, and both doctors will be able to refer to specialists for their views on that particular terminal illness and on capacity. Involving other relevant practitioners, where appropriate, is also an option.

Regarding the end-of-life process, my policy is that the life-ending substance must be self-administered. I acknowledge that there have been some concerns about that but, as the committee has also heard, a variety of options may be available to support self-administration.

In all those areas, the approach that I have taken has been to achieve what I consider to be an appropriate balance between ensuring access to assistance in a timely fashion, within a manageable process, and ensuring that appropriate safeguards are in place to protect people—including those who may be vulnerable—as well as to respect the right of practitioners to choose not to participate.

I do not underestimate the sensitivity of the issue or the significance of making the proposed change. However, as the committee has heard—and given what we know about the experiences of those who endure a bad death despite the best efforts of palliative care or of those who feel forced to take matters into their own hands—doing nothing and keeping the status quo has consequences. We can, and must, do better, and the bill provides us with an historic opportunity to do so. I thank members for their patience and look forward to answering their questions.

In relation to interaction with UK responsibilities, the other matter, which gains less attention than the medication, is that of the regulation of professional bodies. However, similarly, that would need to be addressed in order for the fully functioning process of assisted dying to be put in place. That is not to say that the bill as it stands is not competent or that it cannot go through the full scrutiny process and be passed by the Parliament.

I can understand why the committee, MSPs, the wider public, and those with an interest in the matter are keen to have a clear understanding of how the powers are to be exercised. That would give us confidence as to how the bill would work in practice. I do not know whether Dr Ward wants to add anything on the specifics of the regulation of professional bodies.

The fact is that there are two practitioners, acting independently of each other, making the assessment of both terminal illness and capacity, and they will have the option, where it is felt to be necessary, to refer to a specialist in relation to either the terminal illness and/or the person’s capacity. Those safeguards go well beyond the safeguards that are in place for many, if not all, other treatments that are available to patients.

Ultimately, whether or not we agree with the choice that an individual makes, if they meet the eligibility criteria, it would be unreasonable to deny them the opportunity to make that choice and activate the provisions that are set out in the bill.

I am highly delighted that you have asked me that question. With regard to the finance committee’s letter to you, the thing that confused me a bit was the weight that was attached to the suggestion that Canada would be a more appropriate model. The point was certainly raised by one or two of those who gave evidence, but even a cursory scrutiny of the different models in place in Canada, as compared to those in Oregon and Victoria, would give you a pretty definitive answer as to why Oregon and Victoria were used.

I used both of those places because they used the terminal illness and mental capacity model, which was adopted in Oregon in 1996-97 and then more recently in Victoria, as the first of the Australian states. That means that we have probably the largest data sets on who is accessing the choice—and when, how, and so on—and we do not have to rely on an understanding of other demographic factors, or on whatever may be at play in the US, but not in Australia. Therefore, I think that it was a good comparator. No two assisted dying laws anywhere in the world are the same, but those two laws reflected the models that are most closely aligned to the bill that I have introduced and they give us the largest data set.

The eligibility criteria in Canada are far more extensive than the eligibility criteria in my bill, so it is difficult to see why you would use that as a model to understand who would access assisted dying and how, were it to be introduced in this country. I was slightly confused—not by the fact that that has been raised by witnesses but by the fact that the finance committee appeared to attach more weight to it than I think was justified.

As with capacity, the assessment in relation to coercion is made routinely by medical professionals, albeit in other contexts but still relating to treatment and care options. There is probably an argument for adapting the training that medics receive to reflect the context in which those assessments would be undertaken. However, the General Medical Council has set out very clear guidance on how to assess whether coercion is taking place. It has also set out very clear guidance on assessing domestic abuse and controlling or coercive behaviour.

Therefore, guidance is already in place, but I accept that it might need to be reviewed and an assessment made of whether changes are required, given the change in the law that the bill would introduce. However, I am fairly confident that an assessment of whether there is coercion can be made.

I would also observe that, at the moment, the point at which we assess whether coercion was involved happens post-mortem. We know that those who are facing what they feel is a bad and undignified death often take matters into their own hands. There might well be other instances in which coercion is at play, but, because the individual patient cannot have that conversation with their medic or other family members when there is coercion, that information does not emerge and the conversations do not happen. Information might emerge only after somebody has taken their own life.

I understand the concern about coercion, but my bill will put in place protections that currently do not exist for many people who are in a very vulnerable state near the end of their life.

The perception that those in the disability community are overwhelmingly opposed to a change in the law is not borne out by the evidence that the committee will have heard from Professor Colburn at the University of Glasgow. His fairly comprehensive research points to attitudes in the disability community and the international evidence on how assisted dying is accessed. Polling consistently shows that support for a change in the law to allow for assisted dying is every bit as strong among those in the disability community as it is in the population at large, at the mid-to-high 70 per cents in the main.

I understand the concern that people in the disability community often feel that their lives can be devalued, that access to the rights that they have is not realised consistently or that there are rights that they still do not have. I stand in solidarity with them with regard to improving that situation, but we do not improve it by denying terminally ill adults the right to an assisted death when they choose it. It would be wholly intolerable for somebody with a disability who had an advanced progressive terminal illness and mental capacity to be denied the same access as an able-bodied person to the choice that is set out in my bill—people in the disability community would rightly be up in arms in such an instance.

All I can do is offer the reassurance that having a disability alone does not make you eligible to access an assisted death—you need an advanced progressive terminal illness and mental capacity to be able to do so. If you have a disability as well, I see no reason why you should not be able to access an assisted death in the same way and, if further support is needed in order for you to be able to access it, so be it. As I have said, I think that the disability community broadly recognises that, which is why polling consistently shows very strong support for a change in the law.

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.

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 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.