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I was intrigued by that evidence. To some extent, it begs the question whether Police Scotland has the same concerns around double effect, palliative sedation, withdrawal of treatment and other treatments that are legal at the moment. The proposal that is set out in my bill would put in place, as I have said, the most rigorous and robustly regulated end-of-life choice that there is. The assessments around coercion and capacity are as robust as they can be, requiring not just one but two medical practitioners.

In response to the question, I would be interested to know whether Police Scotland has the same concerns in relation to what is legal at present, where there is just as much scope for complaints or legal challenges to be made. In comparison, my proposed system would be far more transparent, with the views of the patient absolutely at the centre and, if there were any concern among the doctors or if there were an onward referral to a specialist, the process would come to a halt. That would provide greater protection not just for the patient but for medics, who, as I said, seem to be put in a fairly invidious position in the choices that they are having to make.

As I say, all treatment and care options need to be discussed for there to be an informed decision. The rationale—that is, the reasons behind the individual coming to their decision—needs to be understood, but it needs to be an informed decision, and it can only be an informed decision where there is an understanding of the various options that are available. Those options would not stop at palliative care but would include social care, and there would be other factors that play on the lived experience of the individual.

Through the process that I propose to put in place, the discussions that would happen would provide safeguards that are not in place at present, for situations in which it is felt that an individual’s care needs are not being met. If an individual made a request of that nature, I am fairly sure that the co-ordinating medical professional would go to some lengths to ensure that those issues were addressed. In a sense, the safeguards that my bill would put in place do not exist at the moment.

As I said, if we do not pass the legislation, there is a risk that the status quo would continue to have outcomes that we, as a society, should not accept. Although the amendment that you are suggesting would probably be competent in the context of the bill, the issue would be better addressed by the requirement under section 7 of the bill that I have introduced, which requires the care options to be discussed and steps to be taken where medics feel that other support is necessary and can be put in place. That assessment will change over time; an original assessment of those options might well be accurate, but over the period of a terminal illness, other options, which were not necessarily considered at the outset, might be deemed to be more appropriate.

There would be an expectation, as there is with the way that conscientious objection works for abortion, for the medical professional to refer the patient on to somebody who can provide support. That is an important principle in the delivery of health and care services. It protects that choice on the part of the practitioner but does not put up unreasonable barriers to patients accessing the choice that they should have to get the support and treatment that they feel that they need.

Given the process that would be gone through before that point, there would be a fairly high degree of reassurance about intent and whether there was any coercion. If there was coercion, that would obviously bring the process to a halt. Those safeguards need to be seen as relevant to the point at which the medication is delivered and the assessment of intent and capacity is made.

I was interested to hear those concerns. I am not necessarily sure that the patient’s wish for a degree of privacy and discretion at the end of their life is something that we would want to see denied, but I am happy to look at any further clarifications that might be helpful in that regard.

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.

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.

As you will be aware, the schedules to the bill are, in effect, the forms for this and other aspects of the reporting requirements. It is important that death certificates reflect the underlying progressive advanced terminal illness that gave rise to the application, as well as the fact that medication had been administered to allow for an assisted death. For clarity and transparency, both those things need to be captured, which is what the schedules to the bill set out.

From my initial discussions with the chief medical officer, I recognise the legitimate concern that there may be some sensitivity about the way in which the information is expressed and the distinction between suicide and assisted dying, which goes back to an earlier point. The chief medical officer and his colleagues helpfully suggested that codes are used for registrations that may allow for that information to be captured in a way that respects and acknowledges the sensitivity of what we are discussing.

I am keen to explore that further, but it is important that we understand who is accessing the option of assisted death, what conditions are involved, when people are accessing it and their sociodemographic characteristics. We need as much information as possible—anonymised, of course. As we might touch on later, it will be crucial to report on and understand the picture of how the legislation is working in practice. There are the annual reports, which will feed into the five-year review that is also set out in the bill.

If we look at other jurisdictions, we see that there are a lot of similarities in who is accessing assisted dying, the reasons why they are doing so and the demographic profile, but to my mind it is absolutely essential that we gather information in Scotland. In fact, the only element of my proposals that changed between the initial consultation and when I brought the bill to Parliament was in respect of tightening up the data-reporting requirements that were envisaged. For public confidence, and for the confidence of patients and medics, the more robust those requirements are, the better.

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 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.

The evidence that the committee heard from Australia was very telling. There have not been examples of problems.

It is worth pointing out—the medics on the committee will understand this far better than I do—that the act of dying can involve quite distressing implications for the patient and for those family members who might be supporting them. We need to be cognisant of that in understanding how an assisted death would work.

The evidence from the witnesses in Australia was telling, as I said. There are historical reasons in the US for why issues might have arisen there—certainly in the early stages—around the regulation of medications and what could be used. As far as I can see, issues with access to those medications now appear to have been addressed. The more relevant evidence from more recent years comes from Australia, where there do not appear to be problems. Dr Ward might want to add to that.