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In looking at other jurisdictions, it is interesting to see the landscape that grows up around such legislation. Many charities and third sector organisations that have been campaigning for a change in the law have made it clear that they expect to continue to provide help, support and advice to people who might seek to access assisted dying. Those organisations might also be able to provide the sort of support that you are talking about. The need for that might be rare, but it would be good to think that, where such a need existed, it would be met.

The consistent feedback from jurisdictions in which assisted dying laws have been introduced is that the process of coming to terms with a loved one’s death and going through the grieving process thereafter is eased by knowing that that loved one had the choice, the control, the dignity and so on at the end of life that, at the moment, are absent here in Scotland, for a small but not insignificant number of people.

I need to keep reinforcing the point that we are talking about assisted dying because that is the focus of the bill. However, the vast majority of Scots will continue not to need an assisted death. They will be supported by palliative care, social care and other health and care services up to the point of death.

I have probably not said enough about conscientious objection. This is fundamentally about choice; it is about giving dying Scots the choice, should they wish it. However, that works both ways, and there absolutely needs to be a robust conscientious objection mechanism in place to allow medical professionals who would otherwise be involved to opt out of that involvement, subject to the expectation that they would then refer the patient to someone who could provide that support. That conscientious objection choice for the medic is fundamental.

My problem with an institutional objection is that the organisation in question might well involve and include individuals who are supportive of a change in the law. It then ceases to be about individual choice, because the risk is that barriers can be put in place to individuals who, despite meeting all the eligibility criteria and being protected by the safeguards that are in place, find that, as a result of an institutional opt-out, they are not able to access the choice. We have seen that happen in other jurisdictions, and it has proved problematic.

I think, though, that there are ways of managing that. I know from speaking to those involved in the hospice sector in New Zealand, for example, that there is a mixed picture with regard to the engagement of individual hospices. Although some might not directly be involved in the provision of assisted dying, they will allow practitioners into the hospice to help deliver the service. There might well be a way of having a more flexible approach that recognises the strong emotions and feelings that some people have around this issue, but which ensures that those emotions and feelings do not stand in the way of individuals who meet the eligibility criteria accessing the choice that I feel they need to have.

That takes us back to the issues that Mr Whittle raised earlier. Any discussion of the options exposes them and allows an opportunity to address them. The committee heard from witnesses in Australia that the quality and level of engagement with palliative care has gone up since the introduction of assisted dying, not only because additional investment has gone into that care but because conversations have raised awareness of palliative care and have led to discussion of and active engagement with what those options are and how they might be applied.

As I said in response to your initial question, there is probably no way to prevent an individual from bringing a legal challenge, but the mechanisms in the bill provide a high level of protection against such cases arising. Challenges tend to come from family members who have a difficulty with the decision that their relative has made. Conscientious objection exists in the medical profession and we can put that into the bill, but we cannot put into the bill protections for family members who are implacably opposed to the option and who therefore might have difficulty with a relative opting to go down that route.

I sat in on that evidence session and was interested to hear those comments. The phrase “ordinarily resident” is used to accommodate situations where individuals may be working outwith Scotland for a period. They might be on holiday—possibly a prolonged holiday—but to all intents and purposes are living in Scotland and registered with a medical practice here, which is also a requirement under the bill.

The terminology is fairly commonly used in law in Scotland, although perhaps less so in the criminal law, which is perhaps where Police Scotland comes into contact with the issue more often. I do not see the issue as problematic. The phrase tries to acknowledge that somebody may be resident in Scotland but, over a 12-month period, they may be outside it for weeks or months at a time, whether for work or personal reasons.

Again, MND Scotland was particularly strong on that point. Self-administration is integral to the proposals that I have made. On that same panel, I think that there was an acceptance that there are other means whereby that self-administration can take place, whether by signalling through eye movement or other mechanisms.

It is important to ensure that there is the capacity and intent, but the development of medical technologies is now allowing self-administration to happen in a way that would have been very difficult to conceive of a number of years ago. It is important that the self-administration criteria remain and I am confident that that can be achieved while not excluding those who meet the eligibility criteria in terms of advanced progressive terminal illness and mental capacity.

There is always value in having further conversations, but I think that the bill as it stands provides those protections.

The committee also heard from the Crown Office last week about the expectation that deaths that occur through the assisted dying process would be subject to oversight by the Lord Advocate. I know that the Crown Office was slightly uncomfortable in anticipating the Lord Advocate’s view in that regard, but I think that that would be a reasonable expectation and, again, it would provide a degree of reassurance.

I do not know whether any other colleagues want to come in on that.

I see what you mean—almost the other way round. I suppose that the safeguard is that two medics need to be satisfied that the patient meets the eligibility criteria—that they have an advanced progressive terminal illness and that they have the capacity to make the decision. We have covered the other safeguards. If the patient does not meet those criteria to the satisfaction of both medics, the option to go to another medical practitioner remains open to them, as we discussed earlier. However, it is difficult to see how the patient would satisfy them and a second medical practitioner that they meet the criteria. There is the option for an individual to seek a diagnosis, but medical professionals will make these assessments. If the patient does not meet the criteria, it is important for the patient, the medics and public confidence that the law, as it stands, remains extant. We cannot have situations in which people are being assisted to die in ways other than those that are set out in the bill. The criminal law continues to apply, as we heard from the Crown Office and Police Scotland last week.

It was an extensive session, but, as the Health, Social Care and Sport Committee is finding, I appear to be party to extensive evidence sessions on this topic.

To some extent, the issue emerged from the modelling that was used to predict the numbers. As I acknowledged to the Finance and Public Administration Committee, we could make an argument that, if rising numbers of people take up the option of assisted death, the associated costs will be higher, but, equally, drawing on the international evidence, we could make an argument that the costs will be lower.

With regard to the training costs, the numbers of people that are likely to be involved in training as a result of take-up are expected to be relatively small because a lot of that training is already taking place. As I said in response to Ms Whitham earlier, assessments of coercion and capacity are already being made. I absolutely acknowledge that there will perhaps be a requirement to update the training that is provided, but we are not talking about something that is wholly new to the medical profession.

To some extent, I am at a slight disadvantage with regard to the Scottish Government’s assessment of the costs. I have set out a financial memorandum that shows my working, but I am not clear about how the Scottish Government has developed its figures.

To go back to the point that was made by Ms Mochan about whether it should be an opt-in or an opt-out service, if it is assumed that everybody—every GP, nurse and consultant—needs to have training to deliver a service, it may well be that the costs will be greater than if an incremental approach is taken.

Again, that probably touches on the question about the implementation period for the bill. What is the expectation for that? What is the trajectory leading up to implementation and then in the initial years?

I think that there was collective agreement at the Finance and Public Administration Committee in relation to the financial memorandum that this was a very wicked problem to try and get your head around. There is not an example of a similar financial memorandum having been put in place in other jurisdictions. It was an exercise in trying to make some reasonable assumptions around take-up and extrapolating them over the first few years and then up to 20 years out.

I am pretty sure that the figures are based on just medical staff, but I will ask Nick Hawthorne to answer that.

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.