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For most doctors I have spoken to about my amendments, it has been about their professional judgment. They know their patients best. Depending on where someone is on whatever pathway they are on, whether they have a six-month terminal diagnosis for whatever condition and comorbidities—it is important to look at those—doctors will be dealing with that patient on a daily basis and so they will want to know whether it is appropriate for them to raise the issue. I hope that amendment 195 will provide that clarity for professionals.

BMA members have discussed the fact that some patients find it difficult to bring up sensitive subjects during consultations. I believe that doctors are skilled at reading between the lines of what a patient wants to say.

For clarity, it relates to all doctors who would operate within the scope of the bill. That legal clarity is important, as it would provide protections for medical practitioners, regardless of whether they choose to raise the option of assisted dying. It is an important ask from medical professionals that this is in the bill.

That would apply to all medical professionals and the eligibility created by the bill would also provide the legal framework for having those conversations. We are talking about the circumstance of a skilled doctor gently opening the door to those conversations, if they felt that that would be appropriate for a patient, and then allowing the patient to walk through into a safe space where they can discuss what is on their mind. The idea of eligibility in the bill is still being debated and looked at, but that would point towards whether a referral can be made.

Any prohibition on raising the idea of assisted dying would tie doctors’ hands and would create uncertainty and legal risks that would inhibit effective doctor-patient communication and understanding, which we all know is important.

I apologise for going on at length, but amendment 195 is important because it is important to consider those sensitive conversations and to ensure that our professionals have a space where they feel they can raise the subject.

It is important to create a framework so that professionals can assess whether the patient in front of them is actually eligible. The conversations are important, too, and will enable them to decide whether that can be taken forward.

There should be flexibility. In some cases, patients will have researched the subject themselves and will come in order to have those conversations. In other cases—which is why the legal framework is important—medical professionals need the option to feel safe enough to raise assisted dying, if they think that that is appropriate. I understand that there is a juxtaposition in the amendment, but it is important for the bill to provide clarity for the medical world.

I move amendment 195.

The proposal in amendment 195 is from BMA Scotland. It is quite a sensitive issue in the sense that it is about sensitive conversations that people will have with their GP.

The amendment comes in two parts. It provides first, that there is no duty for doctors to raise assisted dying with patients, and secondly, that there is no prohibition against it. Similar provisions are included in legislative proposals in other parts of the UK and Crown dependencies. I note that the Health, Social Care and Sport Committee recognised the need to explore the wording of the bill further to provide legal clarity and protections for medical practitioners around whether they choose to raise assisted dying with their patients.

The first part of amendment 195 addresses concerns that BMA Scotland members have with the scope of information that must be provided when discussing treatment options with a patient. It is BMA Scotland’s view that assisted dying is not a treatment option in the conventional sense. Therefore, the 2015 Supreme Court judgment of Montgomery v Lanarkshire Health Board, concerning the scope of information that must be provided when seeking consent to treatment, and the judgment in McCulloch v Forth Valley Health Board in 2023, which provides that doctors have the duty to raise treatment options with patients, are not relevant here.

There is, however, no guarantee that a court would take a similar or the same view should a complaint be made because a doctor did not raise the option of assisted dying. For the avoidance of doubt and to provide further clarity, doctors would like there to be a specific provision in the bill that there is no duty on doctors to raise assisted dying with their patients.

Doctors must be allowed to use their clinical and professional judgment to decide whether discussing assisted dying is appropriate, based on the individual needs of each patient, wherever they are in their treatment journey, as well as on their mental and emotional state. We cannot risk having a system where every doctor a patient sees brings up the question of assisted dying because they are fearful of being criticised if they do not do so.

Equally, BMA members would not want to be prohibited from raising the option of assisted dying when that is right for an individual patient. That forms the second part of amendment 195. It was discussed as part of an earlier amendment from Pam Duncan-Glancy on the prohibition of doctors raising the issue of assisted dying. Doctors should be able to talk to their patients about all reasonable and legal available options. A provision that limits or hinders open discussion about any aspect of death and dying is likely to be detrimental to patient care and would prevent doctors from being able to deliver.

I lodged amendments 200 and 214 on behalf of BMA Scotland and the Royal College of General Practitioners Scotland, which represent all branches of practice of the doctors who will be associated with carrying out the functions in the bill. The purpose of the amendments is to create a review panel to monitor all assisted deaths as they occur, to ensure that the correct process has been followed and to make recommendations for how the process and service can be improved, including, but not limited to, from a medical perspective. The provisions would ensure that the documentation from each case is brought together and analysed to ensure the compassionate, safe and practical operation of the act.

Review committees are common in other jurisdictions where assisted dying is provided. Having a system of routine monitoring and review of individual cases is important for those who are providing assisted dying to patients. Patients might want to access that, but it is also important for maintaining public trust and confidence in the system.

In healthcare, it is normal to discuss cases, to take on best practice and to learn from experience. An assisted dying service, should it come about through legislation, should be no different. Under amendment 200, the review panel would report to the chief medical officer. I urge the committee to support amendments 200 and 214.

I think that, somewhere in the 37 amendments that are in this group, we are probably all trying to achieve the same thing. Members will be aware that, in March 2024, I consulted on a proposal for a member’s bill to give people of all ages who are living with terminal illness and residing in Scotland the legal right to palliative care. I am grateful to Marie Curie UK and others for their support with that consultation; the support that I received is noted in my entry in the register of interests. To go back to Bob Doris’s earlier point on the cross-party group on palliative care, a lot of the conversations in the Parliament about the current situation of our palliative care sector and the support and additional investment it needs are really important.

I am disappointed that I have not been able to use the bill as a legislative vehicle in establishing that right to palliative care, which many people would support. The amendments that I have tried to pursue around that have been deemed inadmissible. However, I have not given up. Amendments 21 and 22 provide for reporting on discussions with individuals about social care services and access to palliative care services, and on referrals to such services. Amendment 23, which I believe could specifically help to progress the arguments for the legal right to palliative care, would provide a review and assessment by ministers of the availability of palliative care services.

I am very grateful to those who have engaged with my proposal for a member’s bill to give a legal right to palliative care. I hope that, with the election less than six months away, the consultation and debate around this bill will also look towards the next session of the Parliament. I hope that the debate will influence all our parties when forming their manifestos for that election and impress upon them the need for a new funding model and vision for palliative care services in Scotland.

I want to set this in context, on the basis of having spoken to medical practitioners, who want this legal clarity. Say that you were a GP, and I came to you and said, “I have a terminal condition. I want to go to Switzerland—I want to go to Dignitas.” How would you provide information to me about what would be legally available in Scotland—if the bill passes? That issue being raised with professionals is a real-world experience.

Do you see that proactively taking place? We know that many schools have not been inspected for a long time. In relation to the bill, if incidents are reported on—you have suggested that that reporting would be council-wide, not school-specific—that involves a piece of work proactively taking place. I am not sure that leaving it to be part of a wider school inspection would provide the live support to address incidents and potential training needs.

I have raised this next point several times when we have taken evidence. The committee has been interested to hear about the Care Inspectorate and the reduction that there has been in the use of restraint. That might be around the conversation that your bill has taken forward. The Care Inspectorate can provide support and challenge to care settings shortly after a report of restraint is made. When you were drafting the bill, did you consider a similar role for His Majesty’s Inspectorate of Education in providing support? Do you see it having that proactive role?