Chamber and committees

As we have heard, the issue in this group of amendments goes to heart of both the legal framework surrounding the bill and, frankly, the fundamental principles that underpin our criminal law.

In any other circumstance, taking a person’s life is a crime. Enabling or assisting a suicide is also a crime. Right now, our laws rightly contain strong protections to prevent anyone from encouraging, facilitating or enabling another person’s death. Those safeguards exist to protect the vulnerable and to ensure that the law remains firmly on the side of preserving life.

Stephen Kerr’s amendments have sought to reinforce the importance of those legal boundaries. Fergus Ewing’s amendments on lawful assistance would ensure a clear understanding of what lawful behaviour was and of the practical expectations in law. We have challenged Mr McArthur on his statement that the clinician would provide care and take steps to make the patient comfortable and on what would happen when the substance did not work, but I do not think that we have had that clarity from him today.

That is where my amendment and the other amendments in the group—

Frankly, yes, I agree, and law-abiding Scots across the country would also agree, and they would agree that free bus passes must be stripped from those who have used them as any excuse to act violently, whether they do so on a bus or whether they use their pass to travel to a location where they carry out antisocial behaviour and criminality at stations—bus or rail—retail venues or leisure facilities.

The Scottish Conservatives are on Scotland’s side and believe that any passenger who commits criminal or antisocial behaviour should automatically have their bus pass stripped from them. That is the least that passengers and bus drivers deserve. The SSI gets the ball rolling, but far more needs to be done to deliver safer buses for Scotland.

22:22

The bill is full of ambiguity, and there is not a lot of clarity in much of it. We need to ensure that patients who are perhaps considering an assisted death—which is not something that I would consider—are given the stark reality of what the process entails. I am sure that we will hear about some dignified deaths but not about the unpredictable reality of what administering those life-ending drugs might mean.

My amendments 213 and 215 to 217 address the ambiguity around self-administration. They would make it clear that no physical assistance may be provided at the point at which the substance is taken. Without clarity about that, there is a risk that what is described as assisted dying could in practice move close to clinician-administered euthanasia. The amendments attempt to protect the central claim made by the bill’s sponsor that the final act would be undertaken solely by the individual.

Amendments 99 and 100 deal with what would happen if the approved substance is not used. They would require the immediate securing, return or destruction of the drug, alongside written documentation. Given the potency of the substances, the bill should clearly address the risk of diversion, misuse or unsafe storage. On that point, I was pleased that one of Mr McArthur’s amendments in the previous group was not agreed to.

Amendments 106, 122 and 124 relate to reporting complications, because there will be complications. Provision of lethal medication in the NHS will place us in entirely new territory. If complications occur, particularly where distress or prolonged death is involved, it is vital that that information is recorded, analysed and reported to Parliament so that meaningful oversight is possible. We have to understand that people are individuals and that they all interact with and respond to drugs in unique ways.

Taken together, my amendments in the group highlight the number of practical and clinical questions that remain unresolved in the bill before us.

I am quite glad that we are not all clinicians, because I would be upset if we were not out there actually seeing patients, perhaps in a GP surgery or an out-patient clinic, which might make more of an impact on waiting lists. I know that that is perhaps a slight on your remarks, Mr Cole-Hamilton, but we are not all clinicians.

I am sorry. I would have taken an intervention if the member had jumped in a wee bit earlier.

I move amendment 90.

As members know, buses are central to Scotland’s transport network. Although most passengers just want to get on with their journey, it is clear to bus operators and other passengers that antisocial behaviour on our buses has been a growing problem for the past number of years. A small minority of disruptive passengers, whether they are aged under 22 or older, disrupt buses, commit verbal and physical assaults and put the safety of passengers and drivers at risk.

We all remember the tragic death of Keith Rollinson in February 2024. However, only a few weeks ago, the First Minister was unable to answer whether Rollinson’s killer would have had his bus pass removed under the Scottish statutory instrument that we are voting on tonight.

The Scottish Conservatives will support the SSI. However, although it is a step in the right direction, we believe that it does not go far enough. The fact that the minister, Jim Fairlie, had to appear before the Net Zero, Energy and Transport Committee twice to get the SSI passed demonstrates that.

Furthermore, the SNP’s plan to remove free bus travel from passengers who commit antisocial behaviour on buses is soft touch and full of loopholes, and it does not guarantee that criminals will have their bus passes removed.

I thank Ruth Maguire for that intervention, because these are not theoretical concerns, as we have heard time and again. There are fundamental questions about responsibility, legality and patient safety.

The fact that so many questions remain unsolved at this late stage should give every member pause for thought. I would like to know whether Mr McArthur agrees with the statement in the medical advisory group’s report that the doctor should be present to ensure that the patient dies peacefully, because we have heard about some rather unpeaceful deaths.

There are still too many what-ifs surrounding the bill. If Mr McArthur believes that raising such concerns amounts to hunting for reasons to oppose the bill, he is mistaken. These are legitimate and necessary questions that must be answered, given that we are dealing with a bill that would fundamentally change the role of the state, the medical profession and our approach to end of life.

For me, the uncertainties remain far too great, the safeguards remain far too unclear and the consequences remain far too profound. I urge colleagues across the chamber to think carefully as they vote on the amendments in this group.

I press amendment 90.

I am looking back at some evidence that I have seen from elsewhere. A report called “Assisted Dying/Assisted Suicide” by the Health and Social Care Committee at Westminster notes:

“The Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation at King’s College pointed to examples of findings from Canada that ‘palliative care resources were disproportionately consumed by MaiD requests, while non-MaiD patients had reduced access to palliative care’.”

Does that sound fair to Mr Kerr?

First, I thank my colleague Stephen Kerr, who spoke to my amendments in group 2 yesterday.

My amendments 91 and 92 seek to reinforce the safeguards that exist earlier in the bill. They are not there to serve as any form of obstacle. I note that the Parliament has agreed to redefine terminal illness—or to refine the definition—to include only those who are expected to die within six months. That amendment has consequences that should be reflected elsewhere in the bill.

It is imperative that, at the second declaration, the doctor once again considers that prognosis. We have heard from colleagues just how arbitrary the six-month timescale can be, and we all have friends and family members who have outlived the timeframe that doctors have given them. Indeed, Esther Rantzen, who has campaigned vigorously for the similar bill to pass in England, has had a much longer life due to new treatments becoming available.

Scott Murray, emeritus professor of palliative care at the University of Edinburgh, in correspondence with members of the Scottish Parliament, pointed out that accuracy rates in prognosis were as low as 23 per cent. Writing in The Times, he said:

“While those facing death cannot access the high-quality palliative care they need, such legislation risks becoming a simple and dangerous cost-saving measure.”

Those are chilling words from those who are working on the front lines of our health service.

Given that, as we heard earlier, prognosis is so flawed and inaccurate, it is vital that a further assessment is made at the second declaration. If it is found that the individual is doing better, that treatment is working or that palliative care is giving a better quality of life, the process should be halted and referred to a panel. If the prognosis has changed, there must be a mechanism to deal with it. As we have just heard, we must ensure that people are not able to doctor shop and that they can be given a decision quickly and clearly.

Colleagues, you can see how complicated all this is. The member in charge is keen for you to believe that it is the simplest thing in the world, that other countries have done it easily and that there is nothing controversial in the bill. That is simply not the case. Every time we scratch the surface of this bill, we open up another load of questions and issues. What happens if the prognosis at the second declaration is different from that at the first? What are the options for the doctor and the patient? There is no panel to adjudicate on decisions, such as the one under the Westminster bill.

This is a flawed bill. We can tighten one bit, but that just exposes issues elsewhere.

I will speak to amendments 90, 96, 134, 135, 213, 215 to 217, 99, 100, 106, 122 and 124. As members can see, I have quite a few amendments in the group. Together, they are an attempt to clarify several areas of the bill where significant uncertainty remains.

Amendments 90, 96, 134 and 135 are concerned with informed consent, which we have heard a lot about. The amendments would require that a registered medical practitioner clearly explains the risks, side effects and uncertainties that are associated with the substances that are used to end life, including the possibility of complications or of the substance failing to cause death.

Evidence from jurisdictions where assisted dying is in operation shows that those substances can involve large quantities of medication and unpleasant side effects and that anti-nausea drugs are sometimes required simply to keep them down. In a small but significant number of cases, the drugs do not work as intended—in other words, they do not cause death. If the bill is to proceed, it is surely essential that patients are fully informed of those realities.

My amendments 213 and 215 to 217 address the ambiguity around—