Chamber and committees

The strategic importance of the aerospace, defence and space industries to Scotland cannot be overstated, as they add £3.7 billion to the economy and currently employ just under 37,000 people. I welcome the fact that many Scottish colleges and universities are developing active partnerships with the sectors, a great example of which is the National Manufacturing Institute Scotland, which is hosted by the University of Strathclyde. I also note today’s announcement of the Scottish defence growth deal and the skills aspect within that.

However, a significant roadblock that is impeding future growth and prospects is the chronic skills shortage, particularly in science, technology, engineering and mathematics. Does the minister agree that, in order to address that challenge, we must see in the next parliamentary session an expansion in the scale of engineering skills provision, stronger industry collaboration and the expansion of models such as the National Manufacturing Institute Scotland to secure our future skills needs in such vital sectors?

To ask the Scottish Government what support it is providing to colleges and universities to address skills shortages in the defence, aerospace and space sectors. (S6O-05637)

To answer Ruth Maguire’s first point, yes, I share her concerns. There is perhaps an issue about public awareness, but there is also an issue about the lack of research that has been undertaken into the reliability of drugs that are used in assisted dying. For example, a recent article in the Journal of Law and the Biosciences set out that point very clearly. I share the member’s concerns.

Although amendment 224 would not address all issues relating to complications, it would make the identification of trends in complications more possible. The recording of basic information on what drugs are used is a necessary step in firming up accountability and prioritising patient safety. I therefore urge members to support amendment 224.

Before I speak to my amendment 173, I say that I fully support Fulton MacGregor’s amendment 171. It is a practical provision that shows the intersection between issues such as adult support and protection and observing the rights of adults with incapacity, on the one hand, and the legislation that will be enacted should the bill be passed, on the other.

Amendment 173 is designed to improve transparency and accountability and to promote robust record keeping. It would introduce a mandatory requirement for registered medical practitioners who carry out assessments under section 6 to prepare and retain a comprehensive written record of the assessment process. That would cover all inquiries made of other professionals; discussions with the person being assessed; explanations that have been provided regarding diagnosis, prognosis, treatment options, palliative care and the nature of any substance that might be provided; and advice given, referrals made and the clinical reasoning for decisions, including any instances in which inquiries or referrals were not completed.

There is a high prevalence of people choosing to die because they feel that they are a burden on others. For example, in Oregon and Canada, close to 50 per cent of people cite that as one of their main reasons for wanting to take their life early under assisted dying provisions. That raises serious questions about the prevalence of coercion. There are also issues such as the postcode lottery that exists in the provision of palliative care. Some people have excellent care at the point of need, but others receive too little, too late. Given such factors, it is incumbent on us to ensure that robust information is recorded so that the potential reasons driving the choice of an assisted death have been discussed fully; so that all possible help is provided to ensure that someone is not driven to take their life when they otherwise would not consider it; and so that the process does not become a tick-box exercise.

We have heard evidence from abroad of what is called “doctor shopping”. That is where patients are turned down for assisted dying because doctors who know them and their conditions well deem that they do not qualify, but those patients keep applying to different doctors until they find one who applies the eligibility criteria liberally—for example, by approving a disabled person who has many comorbidities.

That might explain why, in places where the law has not technically expanded beyond the terminal illness eligibility criteria, people with non-terminal conditions have nonetheless been approved for assisted dying. In Oregon, Government data shows that people with conditions such as arthritis and anorexia have been approved. An anorexia charity has found from whistleblowing doctors across the US at least 60 confirmed cases of people struggling with anorexia—mainly young women—being given drugs to end their lives under assisted dying laws.

17:00

My amendment 224 is a straightforward amendment that seeks to ensure that, after a patient dies from the lethal drugs injected, the doctor’s final statement contains sufficient information on those drugs for insurance claims, regulatory review and investigations. That will improve transparency, traceability and accountability. From the evidence that was provided at the committee stage on assisted dying abroad, we know that, unfortunately, there are cases of malpractice. In those situations, it is important that police forces and others have that basic information available.

Dr Ramona Coelho serves on the Medical Assistance in Dying Death Review Committee, which works with the province of Ontario’s Office of the Chief Coroner to identify and address public safety concerns. She was asked to give evidence to the Scottish Parliament and to reflect on her experience of reviewing the practice of MAID. She advised MSPs that, in Ontario alone, more than 400 violations of MAID have been identified since 2018, and that doctors with many complaints to their names have been allowed to continue in their practice. No matter what members’ position is on the workability of the bill, we will all be keen to use all the means at our disposal to make it harder for the same issues to be replicated in Scotland.

The recording of information would also be relevant for identifying trends in complications that are experienced by patients during the process of dying from lethal drugs. Although, unfortunately, there are no studies into the physical experience of patients as they go through assisted dying, we know that there can be a crossover with drugs that are used on death row, which have undergone research. It is suggested that, due to the combination of the drugs that are used and their side effects, prisoners are conscious and possibly aware of pain but unable to communicate. Palliative care experts warn that questions remain unanswered as to whether patients who are dying with the same or similar combinations of drugs under assisted dying in fact feel any painful sensations.

I completely agree with Carol Mochan’s comments. It is important that we strike a balance in recognising the role of medical professionals and the role of a patient in that space. That makes it all the more imperative that detailed reporting should take place to support the decision-making process.

The purposes of amendment 173 are to promote transparency, consistency and accountability in the assessment process and to ensure that a clear audit trail is available for regulatory review or professional oversight. Given the instances in which a lack of scrutiny can allow abuse of legislation and significant failures for very vulnerable individuals, I hope that members can see why amendment 173 is necessary and will support it today.

Clare Haughey has raised a valid point, which I absolutely recognise. It is important to set the context of the discussion, given the differences in healthcare provision.

Nobody in the Parliament wants people with eating disorders or similarly vulnerable people to be given drugs on the NHS to take their lives in Scotland, so I am certain that amendments that seek to promote strong data collection to improve the accountability of doctors will be welcomed. This afternoon, the point has been made several times that a huge responsibility rests on the shoulders of two medical practitioners. In my view, detailed and comprehensive recording is extremely desirable and important, not only to support those professionals to fulfil their role but for reasons of accountability and transparency.

The simple answer is yes. Case study review is a critical part of the overall function that we need to undertake with regard to the operation of any legislation, particularly in the context of public protection. I fully endorse and agree with Bob Doris’s points. I ask members to support amendment 173.

I will finish with questions that arise from the unfortunate news of the death this weekend of a 19-year-old boy at HM Young Offenders Institution Polmont. When was Polmont last inspected? What is your role in the aftermath of such incidents in, if nothing else, providing reassurance that Polmont is not an unsafe environment?

We have run over time, so apologies for that, but it has been a really helpful session. Thank you all. I extend the committee’s best wishes to Stephen Sandham and Calum McCarthy on their impending retirements.

We will have a short suspension to allow for a changeover of witnesses.

10:49

Meeting suspended.

10:55

On resuming—