Chamber and committees

I wonder what your thoughts are on section 7, which places a duty on registered medical practitioners, during the first declaration, to discuss palliative care and any other care that might be available to that individual. That would allow the individual to make an informed decision about any palliative care plans or future care planning that could be made. That is a safeguard; that will be discussed at that point. However, if you were to tie that to eligibility criteria, that person would not have the autonomy to say, for example, that they did not want those plans to be made. Indeed, when timeframes are really short, that might preclude somebody from accessing the supports that are available under the bill.

From the outset, my position is that I support Liam McArthur’s amendment 24, because it will allow us to put in place some more safeguards around the definition of terminal illness. In countries where such a definition is applied, we see, as Patrick Harvie just set out, that those who seek an assisted death do so at the later stages of a terminal illness.

I turn to amendment 143, which Mr Balfour has said is more of a probing amendment. If we use three months as the timeline, such a short prognosis will put people who are terminally ill in the difficult position of making a hurried decision, instead of being able to take time to consider all their circumstances.

On Daniel Johnson’s amendment on a six-month prognosis, I would defer to the committee’s stage 1 report, which set out our understanding of why a prognostic timeframe can be particularly difficult. I understand members’ desire to explore the issue but, at this stage, I would not be supportive of that. That is not to say that I will not change my position as we go forward, but clinicians who make decisions that affect access to benefits sometimes feel under undue pressure to make an assessment of a prognostic timeframe. That can also lead to a situation in which, although there is no clear prognosis, people are given a time limit that might not be realistic. We are starting to funnel people down a path.

We have heard from Liam McArthur about the differences. I agree that people who are terminally ill will, by definition, probably be considered to be disabled, too. However, Liam McArthur’s amendment 24, which excludes people who have only a disability or a mental health condition, would put in further safeguards.

At stage 1, clinicians and practitioners from Australia warned us about the limitations and difficulties of the six-month prognostic timeframe, which, as set out by Liam McArthur, specifically excluded some people who had neurological conditions.

That is helpful. Perhaps Adam Milne would like to comment from a Carnegie perspective.

I want to spend a little time looking at the definitions. We have touched on that aspect quite a few times this morning, but it would be helpful if we had an understanding of where each witness sits on them. I will start with the definition of “sustainable development”. Section 2 of the bill gives a definition that was inspired by the 1987 report “Our Common Future”. It states:

“‘Sustainable development’ is development that improves wellbeing in the present without compromising the wellbeing of future generations.”

Kristers Lukins touched on the Scottish Youth Parliament’s work to look at what sustainable development means to young people, and I will give him an opportunity to come back in. First, however, I want to hear from the other witnesses about what they feel about the definition of “sustainable development” as set out in the bill. Perhaps Frances Guy can start.

Lloyd, do you want to comment from a Scottish Environment LINK perspective?

That is very helpful. I had a question about how we could make the bill stronger to show that we have to pay due regard to planetary boundaries and environmental limits and to make that explicit link. Kristers and Skye, from the perspective of the Scottish Youth Parliament, is that something that you thought about when you worked through this with MSYPs? Did you consider how we could make the links between wellbeing and sustainable development and the planet?

Thanks for that.

Frances, you started the evidence session by speaking about the need for human rights in this regard and about the UN sustainable development goals. Does the bill present an opportunity to weave a thread through all those things to achieve real coherence with regard to how we conduct ourselves, before future generations have to deal with what we have perhaps not dealt with?

I would like to spend a wee bit of time thinking about data. This morning, we have heard a lot about data gaps and the work that is being done to understand those in every local area. I understand the robustness of the child and adolescent mental health services waiting times data and how that is assessed and presented by Public Health Scotland. I am interested in understanding—and I think that the committee would benefit from understanding—the impact that the national specification implementation and the focus on CAMHS waiting times has on neurodevelopmental waiting lists and what that looks like at the local level. That is very different from the CAMHS waiting lists as we understand them. It would be helpful if you could set out for us, as you understand it, what impact that has had on CAMHS neuro waiting lists.

Where it becomes tricky for individuals at a local level is the fact that, for some people, it will be CAMHS that does the assessments once they get there. That feels a bit confusing. It will be confusing for someone whose child has come off the list that it is perhaps still CAMHS that eventually delivers that service.