Chamber and committees

This group of amendments largely seeks to strengthen recording and reporting provisions in sections 23A, 24 and 26 of the bill. Safeguarding is at the heart of the amendments. I will begin with my amendments, before speaking to other amendments in the group.

My amendments 275, 276, and 277 relate to duties on Scottish ministers to provide accessible information about assisted dying in the event that it becomes legalised. Amendment 275 specifies the content of the information that Scottish ministers must provide in the important section 23A of the bill. It seeks to ensure that all information is comprehensive, accurate and balanced and that it must include guidance on independent advice, safeguards against coercion or abuse, available alternatives such as palliative care, and resources for suicide prevention and immediate support.

Building on the concerns that were raised by my colleague Emma Roddick in discussion of group 2, bolstering suicide prevention in the context of assisted dying is highly relevant for vulnerable individuals such as people with disabilities, who are more vulnerable to suicide ideation due to their disability. I draw members’ attention to the legal opinion by leading lawyer Tom Cross KC, who found the bill to fall short of safeguarding those individuals. Amendment 275 seeks to clarify what accessible information must be provided by Scottish ministers, and it would require information to be set out on suicide prevention, including how to access immediate support. That will be essential for vulnerable people such as those with depression, who may be eligible under the bill if they fit the eligibility criteria. Along with amendments 276 and 277, the amendment promotes informed decision making and seeks to ensure that lawful assistance to end-of-life services is accompanied by clear guidance on support and protection, as well as going some way to offering a level of protection to vulnerable individuals.

Amendment 276 would require that all information provided under section 23A is comprehensive and that it explicitly covers the legal, medical, social and ethical aspects of assisted dying. It would ensure that terminally ill adults, health professionals and the public receive full and balanced guidance, preventing selective or partial information and supporting informed decision making. Again, accessible and balanced information is important for vulnerable individuals, particularly those with learning disabilities, given the general misunderstanding among the public about what assisted dying means. Polling by Whitestone Insight shows that around one in three people who support assisted dying believe that it would mean hospice or palliative care, or the right to stop life-prolonging treatment. Clear, direct, balanced and non-euphemistic language is essential for any Government guidance.

Amendment 277 would require Scottish ministers to monitor and report on compliance, and it would ensure that information is regularly reviewed, updated and publicly reported. It would establish procedures to correct deficiencies, which would prevent the provision of incomplete or biased information and guarantee that all recipients, including terminally ill adults, professionals and the public have access to accurate and comprehensive guidance. Therefore, it is a simple improvement that would give section 23A of the bill greater effect and I commend it to members.

Although section 23A is an important provision in principle, as it stands, it is too weak and poorly defined to be of greatest effect as a safeguard. Therefore, I trust that members will feel able to support amendments 275 to 277.

Stuart McMillan’s amendment 279 would strengthen the reporting requirement that is placed on Public Health Scotland by removing the reference to information being provided only

“in so far as known to Public Health Scotland”.

I strongly support that amendment.

Amendments 280, 59 to 61, 115, 62, 281 to 283 and 63 would all extend reporting by Public Health Scotland on matters including the assessment process, first declarations, the provision of social care, side effects and adverse reactions, clinical recommendations to ministers and the operation of the period of reflection.

Emma Roddick’s amendments 284 and 287 would require reports to include detailed information about safeguarding concerns, including the outcomes of any safeguarding investigations. Amendment 287 would require reporting to go beyond just raw numbers and include a full analysis and comparison of data—for example, trends over time, risks to patient safety and whether the provision of assisted dying is creating or worsening inequalities for particular groups, such as older or disabled people.

Bob Doris’s amendment 64 would insert additional characteristics, such as deprivation and housing status. Murdo Fraser’s amendment 295 would insert a requirement to report on the impact of assisted dying provision on suicide prevention services, while Stephen Kerr’s amendment 296 would insert a similar provision that relates to the impact of assisted dying provision on palliative care services.

The only amendment on which I seek some clarity is Liam McArthur’s amendment 57, which relates to reporting on assessments broken down by eligibility or otherwise. It seems straightforward, but I am keen to hear the context and rationale for that amendment from Liam McArthur.

All the amendments in the group are about safeguarding. They would enhance reporting, which would allow for effective scrutiny and monitoring of the bill’s operation.

I move amendment 275.

I do not consider that to be acceptable whatsoever. The point that I am trying to make is that we want to ensure that the bill includes the most robust safeguards. My contention is that clear, accurate and comprehensive reporting would be a significant part of that provision.

Amendment 295, in the name of Murdo Fraser, and my amendment 275 would better ensure that suicide prevention support for those who are vulnerable is available to people who are considering taking their own lives. Having reviews would mean that the Government would be better equipped to take corrective measures when issues arose, if the bill was passed. Safeguarding must be at the heart of any legislation that relates to the use of lethal drugs.

I will pick up on a couple of the points that were made during members’ contributions. Returning to amendment 64, I completely agree with the points that Bob Doris made about the importance of having qualitative data rather than just numbers. That is worth drawing out in the debate, although I acknowledge the points that have been made about the difficulty and the practicalities that might be involved in collecting the data that is set out in amendment 64. I am also drawn to Bob Doris’s comments about amendment 296, which I will certainly reflect on.

In closing, although I urge members to support the amendments in this group, I must warn that they can go only so far in pushing back against the incrementalism that could arise if we chose to endorse people taking their lives by voting to pass the bill.

I press amendment 275.

In opening the debate on this group of amendments, I described them as “straightforward.” However, that might have been to unintentionally understate the crucial importance of data and reporting, given that we know that, where assisted dying is legalised, reporting provisions have sometimes, sadly, served as mechanisms for either widening eligibility and relaxing safeguards or not taking corrective action when major issues are flagged. It is crucial that relevant and accurate information is captured, so that vulnerable individuals who could be harmed by assisted dying legislation—those with physical and learning disabilities, people with eating disorders, victims of domestic abuse, those in poverty and many others—remain protected by robust safeguards and so that the operation of the legislation does not drift over time.

Jackie Baillie’s amendment 280 would require the number of persons aged 18 or under who requested assistance to end their lives under this regime to be recorded. I welcome this amendment, which would increase accountability. We know that, shockingly, there have been successful efforts in some jurisdictions to broaden access to assisted dying to that age group. In Canada, a 2023 parliamentary committee review of Canada’s assisted dying legislation recommended the expansion of assisted dying to children, although I note that the recommendation has not yet been advanced. We know that public support in Scotland falls quite significantly when people consider the fact that, in the Netherlands and Belgium, children of any age may, in certain circumstances, be eligible for assisted dying. That tells me that the public view the risk of that becoming a provision in Scotland as being just too high.

I note Liam McArthur’s clarification on amendment 57. Although the amendment seems innocuous, I am worried about the unintended ramifications, given that it would replicate the type of recording that is used in Australia, which has subsequently been used by review boards and campaigners to argue for widening access.

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I very much note and accept the member’s point about different models. To draw on his comments, perhaps it is the case that different models have different strengths and weaknesses.

My amendments 275 to 277 and the amendments in the names of Bob Doris, Emma Roddick, Miles Briggs, Sue Webber and Murdo Fraser all attempt to bolster reporting and increase accountability. I consider that they are proportionate and that they will strengthen and complement reporting. However, I am also mindful of the comments that have been made about overlap and duplication.

That brings me on to issues that have been flagged in Oregon, where more than two thirds of the data have been found to be missing in reports on matters such as complications. Annual reporting has shown that, in practice, the application of the terminal illness threshold has expanded well beyond a normal understanding. Despite that being clear in annual reporting, issues have not been rectified. I doubt that that was the original intent of lawmakers. In fact, last year, in Washington state, they decided that, due to budget restrictions, they would drop annual reporting on their operation of assisted dying altogether. The evidence from abroad flags for us the issue that, even with the best reporting, incrementalist expansion and a lack of corrective action remain a risk. I draw members’ attention to amendments 289, 296 and 116, in the names of Stuart McMillan, Stephen Kerr and Sue Webber, which attempt to address the issue.

I, too, commend the Scottish Government’s suicide prevention strategy, which is world leading, as Kevin Stewart highlighted earlier. I had the privilege of supporting the development of that strategy in its fairly early format—and that was certainly not yesterday. The strategy is essential when it comes to issues such as the vulnerability of terminally ill people who are considering ending their own lives. We know that, with proper support, the desire to die diminishes.

I seek clarification of the member’s earlier response to the Deputy First Minister on the question whether assisted dying is understood to be a “reasonable” treatment option under the Montgomery ruling, which says that, by law, a doctor must offer all reasonable treatment options.

I am concerned about the member’s response to that query. Some of that concern is driven by a conversation that I had with a consultant in my constituency, who is very anxious about this proposal in the context of the impact that it would have on the doctor-patient relationship.

During the consideration of stage 3 amendments, there has been on-going interest in how the bill might impact our palliative care provision, and not least our hugely valued hospices. As colleagues who represent constituencies that contain a hospice will know, they are very dependent on charitable giving; they rely on it for approximately two thirds of their income.

Therefore, we must tread carefully in crafting the bill to ensure that the already delicate funding situation for our hospices is in no way weakened. Amendments 251, 253 and 254 would alter section 22A to require formal assessment of the act’s impact on hospices and palliative care every three years after it comes into operation. The amendments would ensure on-going monitoring rather than a single discretionary review and would require publication within six months, which would enhance transparency.

I would not argue with those findings, and I am sure that that evidence is robust, but there is evidence elsewhere that reflects a very different picture. The thrust of my amendments is to ensure that we can monitor, using an on-going method, the impact of an assisted dying provision on palliative care.

By linking to section 22A(2), the assessments would cover staffing, operations, funding streams and regulation. That would provide clear evidence of how the act affects end-of-life care services over time, and would enable policy makers and the public to identify and address any emerging pressures or issues. Given the heavy reliance of hospices and palliative care on charitable donations, which can fluctuate depending on factors such as cost of living and sustainability of Government funding, that is significant.

As the anticipated costs of assisted dying have not yet been settled, we must take every precaution to ensure that there are no unintended consequences as a result of passing the bill, if it does pass. I trust that colleagues will feel able to support amendments 251, 253 and 254 as important additions to the bill.

I am keen to remind members that the provision of palliative care is not just the provision of that care itself; it includes workforce planning and staff training, often in specialist roles, and there are potentially significant additional costs for colleges, universities and other teaching environments.

I agree with the points that the member made, and the concerns about the impact of introducing assisted dying legislation on palliative care provision. I am aware that research in Europe shows that there has been a clear trend in palliative care funding being devalued. Where care funding has increased, it has not been anywhere near in line with funding in countries that do not have assisted dying. That has increased significantly. I take the point that the member made, and I agree with it.

I am interested in the issue around the word “independent”. I understand the rationale for the member’s amendments, but I am interested in what reassurance can be provided that an independent advocacy service is truly independent. That circles back to the issue of coercion, which has cropped up regularly over the past few days.