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I am minded to reflect on the advice of the chief medical officers from across the UK about those who engage in this debate praying in aid patient experience from other jurisdictions but doing so without the consent of those patients and without necessarily knowing the full facts about what happened.

The bill has pretty robust protections regarding how the request and any assessments will be made. When those eligibility criteria are not met, the process will cease. It would still be possible for any patient who was deemed ineligible to access assisted dying to go to another medic and seek another opinion, but it is not immediately obvious why another medic would automatically come to a different opinion.

We have seen examples in other jurisdictions of what happens to those who are found not to be eligible. That does not stop them making an application, but the safeguards do what they are supposed to do, which is to prevent the patient from accessing the available services. That may be because they do not have capacity or because their terminal illness does not meet the requirements of the legislation. The safeguards in those countries do not stop someone making an application but should prevent them from being able to proceed with it.

We trust our medical professionals to make many life-altering or even life-ending decisions, and we ensure that they have the training to make the decisions that they must make. In this instance, we will require a second medical practitioner to make assessments, too. Ultimately, if the bill were put in place, it would be the most heavily safeguarded end-of-life choice available.

I definitely have that poacher-turned-gamekeeper feeling at the moment. I have sat where you are on many occasions, Mr Sweeney, and made precisely that argument—usually to Government ministers—about the importance of putting certain things in the bill.

I think that a balance needs to be struck. As I said in answer to earlier questions, I absolutely understand the desire to have as much clarity as possible about how the process would work. I do not think that it is in anybody’s interest to put things in the bill that would require to be changed by primary legislation if emerging evidence suggested that change was needed. That is why, through the explanatory notes and the policy memorandum, I have tried to flesh out the details as best I can. A lot of the detail sits more appropriately in either secondary legislation or, as I said earlier, in guidance, because that would allow the understanding of medicine, which is developing at pace, to be factored into how the bill would operate in practice.

No. As I said, the model was built on the assessment of take-up and the associated costs. I understand that the Scottish Government has taken a different approach to the modelling, which probably inevitably results in a far higher cost. However, as I said to the finance committee, the approach that we took to the financial memorandum was a reasonable attempt to assess those costs. I think that the finance committee also applied a degree of pressure on me to estimate the savings that would be made. As I said to that committee, that would be an even more precarious assessment to make, given that that would depend very much on who was accessing assisted dying and the point in their terminal illness at which they accessed it.

I think that it is a reasonable estimate of the financial costs, and I point to the fact that, broadly, the measure would be cost neutral, recognising that those who would access assisted dying are in receipt of treatment and care at the moment.

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.

I will not touch on the arguments about a slippery slope; all the evidence shows that there is not a jurisdiction with a terminal illness and mental capacity model in which the eligibility criteria has been expanded over time.

Rather, I want to highlight that, while the point is being made that disabled people are uniformly against assisted dying, all the polling evidence suggests that support for it among the disabled community as a whole broadly maps the position of the population at large.

I am aware that, back in 2022, Disability Scotland undertook a survey of its membership, which showed strong support for assisted dying among 57 per cent of its members and support among 20 per cent, with opposition at just over 10 per cent. I understand that there are anxieties in the disabled community, but I am interested in hearing the witnesses’ response to the argument that support, or interest in finding out more about the issue, is unlikely to be helped if the view of the legislation that is presented comes from the perspective of opposition, rather than challenging neutrality.

In the light of the position that members of the disabled community appear to take on the issue, is that not a more reasonable way of eliciting the views of disabled people? I put that question to Tressa Burke, because she spoke last, but I am sure that others will have a view on it, too.

Obviously, the numbers are driven by requests for assisted dying. It is worth pointing out that requests do not necessarily always result in people taking the medication or following through with the process. About a third of those who apply for an assisted death in jurisdictions such as Oregon and Victoria—this is fairly consistent across those jurisdictions with terminal illness mental capacity models—do not end up proceeding with it. A number of people who apply and express an interest do not go through with it.

You need to bear it in mind that the request is one part of the equation. The other part, which I touched on earlier, is the medical professionals who have the training to undertake the process. We might come to discuss the timeframe for implementation. Different jurisdictions have taken very different approaches—some have introduced the process within six months, which, to me, seems to be on the short side, while others have taken 18 months to two years. I suppose that the longer the lead-in time, the more opportunity you have to raise awareness, build confidence within the medical community and get practitioners signed up and trained to provide the service.

Even if the request or the interest in going down that route is there, it is very much dependent on the resources that are available to deliver it. With the best will in the world, although we will be able to lean on the experience of other jurisdictions with respect to the training that is provided and all the rest of it, that will also be a constraining factor on numbers.

The Dutch system operates very differently from the systems in Victoria and in Oregon, which are terminal illness mental capacity jurisdictions. That said, I absolutely acknowledge that a level of peer support through professional bodies will be necessary and desirable. We have seen that in all the jurisdictions where legislation has been introduced. However, I cannot think of anywhere where peer support has been introduced through the legislation, as opposed to having grown organically, but I certainly recognise that there is a need for such support.

At the same time, there is ample evidence from those jurisdictions that practitioners who are involved have found it to be one of the most rewarding elements of the work that they do. Providing a good death for their patient is difficult—it requires skills—but it is rewarding to see the comfort and the relief from suffering that they are able to provide, not just for the patient but for family members.

I acknowledge that the issue is there and I acknowledge that emotional support would need to be in place, as well as peer support through being able to exchange ideas or concerns about individual cases. If you do not see a lot of cases year to year, it is more difficult to manage your skills and develop your understanding and expertise. Having an exchange of information, albeit that patient confidentiality would need to pertain, is important, not just to the welfare of the medical professionals but to patient confidence in the skills of practitioners who are involved.

The question allows me to put on the public record, for the first time, my gratitude to CHAS. It has responded to the committee’s call for evidence, as it has to the Health, Social Care and Sport Committee, but also, from a personal perspective, I have had a number of meetings with CHAS, and I have found its input invaluable.

You are absolutely right about the complexity of the cases that CHAS deals with. It is worth stating up front that the overall number of people who would access assisted dying and who are of the age profile that CHAS deals with—regardless of whether you believe that the figure in the financial memorandum is an underestimate—will be extremely small, and there will possibly not even be one such patient in any given year. However, I think that CHAS’s concerns about the complexity of the support and treatment that it provides can be reflected in the process.

It is difficult to describe a separate pathway that would pertain to somebody who is 16, 18 or 20, but the on-going treatment and support that was being provided would need to dovetail with that process, and those providing that treatment and support would also need to be involved. The two medical professionals—the co-ordinating physician and the second medical professional—could not have had a prior involvement with the case. Those would still be the requirements, but that does not preclude others from being involved in the decisions. I find it inconceivable that decisions in relation to those who are in the care of CHAS would not continue to involve that mix of specialisms.

We should acknowledge that, albeit that two medical professionals would make the diagnosis and assessment, in instances where there was any doubt—whether that was around mental capacity or possibly terminal illness, although I suspect that it is more likely to relate to capacity—a referral to a specialist would have to take place. I imagine that those specialists would be involved, anyway, either as a co-ordinating physician or as a second physician but, where it was felt that there was benefit to be gained from a referral to a further specialist, that would and should happen.

The financial memorandum provides a number of ranges.