Chamber and committees

I want to start by saying how deeply concerned I am about Jeremy Balfour’s amendment 146 and the idea of an individual being presumed not to have capacity. If someone is diagnosed with a terminal—or very serious—medical condition, am I to say, “You can’t make any decisions about your treatment going forward, because you have been diagnosed with cancer and therefore do not have capacity. I need to prove that you have capacity first”? If so, I think that that is wrong. We cannot have a presumption that somebody cannot have capacity—the presumption needs to be that people do have capacity.

The convention is that doctors will look at a person’s capacity when they speak to them and bring to bear their judgment as to whether or not they have it. If necessary, they will then take that further and say, “I am concerned about the capacity this person has—or hasn’t—got.” Putting that the other way round is deeply concerning. I do not want to go into the other amendments in the group; that is the one that I really wanted to speak to, because it is of great concern to me.

My amendment 2 is very simple. I just think that 16 is a bit too young. We have a problem in Scotland with defining what an adult is; I know that there is another amendment that seeks to change the age to 25. I believe that an adult is somebody who is 18 years old, and I believe that, at that point, they have the right to decide on their medical treatment and whether to accept or refuse treatment. They have the right to go to a pub and drink legally; they have the right to smoke; they have the right to do a lot of things. In the majority of cases, they are no longer at school.

On balance, I think that that is the right age to—

How many notaries public do we have in Scotland who are readily available?

I feel that an individual has a right to say no. At the moment, I would love for every patient of mine who has a terminal illness or pain or a problem and who needs palliative care to be able to access it. I love the people who do palliative care—they do great work. However, a lot of patients say, “No, I don’t want that,” and it should be up to the individual to make that choice.

I am very sympathetic to your amendment, and I wonder whether you could perhaps change the wording to say that a palliative care support plan should be discussed with the individual. If they would like a plan, they absolutely should have one, but if they say no, despite best practice, it is their right to do so.

On good judgment, peer pressure and taking more risks, I was a doctor at the age of 24. Does that mean that it would have been okay for me to make a decision about other people’s lives, but not mine?

Will the member take an intervention?

How do you envisage the NHS working and functioning to provide an assisted dying service without amendment 257? Does that need to be in the bill? Would it not happen anyway?

Capacity is an individual matter. When it comes to medical interventions, there are 13-year-olds who can make a decision based on their particular ability to do so. It is different for everyone, and every person will be a case in point. I just think that the vast majority of people at 18 do have that full capacity and are able to make their own decisions.

I do not know whether members agree, but I said earlier that we need to start to think about, in the majority of cases, the question of what an adult is. Yes, development does go on in a person’s brain until the age of 25, but I do not believe that 25 is the right age, because plenty of 18-year-olds have the ability to make informed decisions. I think that that is the most important thing.

I declare an interest as a practising national health service general practitioner and chair of the medical advisory group on the bill.

I would like to say a number of things regarding the amendments in this group. On Jeremy Balfour’s comments, I think that we in Parliament should be cognisant that it is not up to us to tell people what meaningful life is or to tell people who are living their life what quality of life means, because it is different for everyone. One person’s quality of life is not the same as another’s. If somebody feels that their quality of life is bad, that they are not getting what they need and that they would like to go through the assisted dying process, we should not be saying, “No, that is not right—you could still live a bit longer, even though you are very unhappy with your quality of life.”

Will you clarify that point? Are you proposing that the assisted dying not be part of the NHS and thus, as Murdo Fraser has suggested, that we have a regulatory body for that?

I start by saying that this is not assisted suicide. This is assisted dying, as the bill puts it, but Mr Balfour has called it assisted suicide multiple times. That is a way of being very emotive, but I do not think that it is correct.

If somebody is diagnosed with motor neurone disease, we do not know what stage they are diagnosed at. They could be diagnosed at a critically horrible stage where they are struggling to breathe and it is a late diagnosis. Day 2 of that diagnosis is very different from day 2 of a diagnosis that is made when they are right at the start of the journey.

It is important that we, as parliamentarians, do not tell the people what meaningful life is.