Chamber and committees

I do not think that it is likely that anybody would raise it as a recommendation—I do not think that that would be intended.

I am curious about the fact that amendment 53 says that this cannot happen

“where the subject has not first been raised by the person with the registered medical practitioner”.

Surely in a situation where a child or young person has raised the issue with somebody else—for example, a family member or a professional in a non-medical capacity who is supporting them—by saying, “I have heard that this is an option. Will you ask the doctor to tell me about it?”, the amendment as written would prevent the doctor or the registered medical professional from doing so.

First, I want to make a minor point for clarity: the previous bill that the member referred to was introduced by Margo MacDonald. As the second member in charge, I took it through the committee process at stage 1.

Clearly, Stuart McMillan is quite correct to say that there is a wide range of strongly held views on this contested and difficult issue. However, it is not the only such contested and difficult issue. In the past, we have had campaigns calling for issues affecting my human rights, and my community’s human rights, to be subject to a referendum, including an attempt to stage a mock referendum that was funded by a private individual. I have no doubt that if the next Parliament were to legislate on, for example, recommendations on the reform of abortion care, there might be those who would call for that to be subject to a referendum, and for similar reasons to those that Stuart McMillan has just set out.

I am not convinced of the case that the member is making, but if he were successful at persuading the Parliament to authorise a referendum in this case, how would he say no to the many other potential campaigns that would arise to put the rights and freedoms of marginalised minorities, which are contested in society, to a referendum? How would he resist those much more provocative attempts to marshal the same argument?

Will the member give way?

Murdo Fraser seems to be coming to the end of his remarks, and I was wondering whether he was going to address why he chose to make specific reference to family members in his amendment. As the convener pointed out, we have criminal law and regulation of the medical professions. If an assisted death was provided today, in the absence of such legislation, it would be dealt with by those mechanisms. Those mechanisms will still be available if anybody had a concern that the law had been broken. I am wondering why Mr Fraser thinks that a different mechanism ought to be available if, and only if, a family member has such a concern.

I am grateful to Pam Duncan-Glancy for giving way. I was wondering about the use of the term “advertising” in amendment 252. That is clearly the subject of the amendment, but the amendment also covers “social media posts”. Is it Pam Duncan-Glancy’s view that a social media post by an individual expressing a view that might be found offensive would be regarded as advertising under the terms of the amendment? What in the amendment would prevent that from being captured by what is proposed?

I am grateful to the member for taking an intervention on amendment 253 before she moves on. I see entirely that there are circumstances in which information of the kinds to which Sue Webber is referring would be inappropriate or would be made available in an inappropriate place or with inappropriate framing. However, from my reading of the amendment, it seems as though it would prohibit, for example, academic research from being disseminated, unless it had specific approval by Scottish ministers. Can Sue Webber explain in what way legitimate sharing of information for such purposes would not fall within the terms of her amendment?

I thank the convener for her flexibility in allowing me to speak on behalf of Ross Greer, who has lost his voice. It is very tempting to abuse the privilege. However, to be clear, I will simply read the statement that Ross has given me, so references in the first person should be taken as referring to him.

As I mentioned at stage 1, I have two primary concerns about the bill. The first is in regard to the proposal for a dispersed rather than a specialist service. My amendments on training, in a later group, are intended to address that concern.

This group of amendments is intended to address, in part, my other concern, which is about the risk of coercion of and undue influence on someone considering making the choice to end their own life.

To summarise my amendments in the group: amendment 242 would create a right to access independent advocacy for those who were considering making a request for assistance under the act; amendment 243 would require the provider of independent advocacy services to comply with minimum standards that would be set by ministers in regulations; amendment 274 sets out that those regulations should be subject to the affirmative procedure; amendment 279 sets out that provisions on the right to advocacy and advocacy service standards would commence on the day after royal assent; and amendment 283 sets out that substantive provisions on assisted dying services could not commence before the minimum advocacy standards were set.

The key amendment is 242, which would create for those who engage with the assisted dying system the right to high-quality, independent and rights-focused advocacy. A neutral third party would be able to support a person through what is a potentially complex system and put their interests first.

That right mirrors other statutory provisions for independent advocacy—for example, in the Social Security (Scotland) Act 2018. As is the case with the 2018 act, which I drew on for drafting purposes, advocacy would be optional and would be intended for those who would benefit from an advocate’s support to ensure that they could make their choice with all the relevant information available to them and with the safeguard of someone whose only role in the process would be to represent their interests and help them navigate the system.

I envisage that the advocate would not already be known to the person and that they would otherwise not be involved in the person’s care. They would be able to advocate for a person from the point at which that person first contemplated assisted dying until the point of their death, should that be the choice that they ultimately make. Among other services, the advocate would support the person in navigating the system, ensure that the person’s rights were respected, and act as a safeguard against coercion or other forms of undue influence.

The intention of amendment 242 is to embed a patient’s rights throughout their interaction with the assisted dying process. In particular, in recognition of the potential increased risk to a patient’s rights from a dispersed rather than a centralised service delivery model, the advocate is intended to protect against potential infringements of those rights and to identify and intervene in cases of potential coercion, pressure or undue influence.

I thank Dr Sandra Lucas and Dr Rhona Winnington from the school of health and life sciences at the University of the West of Scotland for their support with these amendments. Their briefing helped to shape my thinking ahead of the stage 1 debate, and the amendments stem from that briefing and my subsequent discussions with them. They both have invaluable experience of assisted dying systems in Australia and New Zealand.

My advocacy amendments reflect the voluntary assisted dying statewide care navigator service system that is operated in Victoria, Australia. Research, including the Ben White report in the Medical Journal of Australia, which was a qualitative study of the Victoria scheme, has called the advocate—the navigator—the “jewel in the crown” of that scheme, facilitating crucial discussions with compassion and giving people the confidence and knowledge to assert their rights. If the Parliament passes the bill, I want people in Scotland who will access or will consider accessing the system to have that same confidence and knowledge of their rights.

Other jurisdictions that have adopted assisted dying have included navigator or advocacy schemes, such as the Queensland voluntary assisted dying support service. The Victoria model is staffed by trained allied health professionals, but the Queensland scheme is open to social workers, psychologists and lawyers as well. I can see the advantage of the role’s being fulfilled either by medical professionals or by those with a degree of separation from the health service entirely; my amendments therefore do not specify either way. It could reasonably be up to ministers to set that out via regulations, although I would be happy to look at revisions ahead of stage 3 to clarify some details about the advocacy scheme, if colleagues felt that further detail was required in the bill.

I am grateful to various stakeholders for supporting the amendments. The Equality and Human Rights Commission’s briefing for stage 2 supports including a statutory right to access independent advocacy, and I am aware that the British Medical Association has welcomed debate on the issue of advocacy at stage 2.

I clarify that the intention is that everyone who was contemplating or undergoing assisted dying would be entitled to advocacy akin to the care navigator in other jurisdictions. Amendment 242’s proposed subsection (3)(b) is intended to capture that anyone who would benefit from advocacy would be entitled to it.

The intention is not to replace the role of assessing doctors in spotting coercion. The advocates would complement that, providing an additional safeguard. That goes to the heart of my concern about putting on to the doctor, under a dispersed model, the burden of spotting something as complex and contestable as coercion. To me, that feels too much like risking a single point of failure in the system. Part of the training that I envisage for the mandatory service standards would be in identifying coercion and spotting warning signs of undue influence.

I am nearly finished, convener. On interaction between advocacy and a potential information service, my intention is for advocates to take on the role similar to that of the Victoria and Queensland navigators, who are more than just a source of information and signposting; they are a source of fuller support and safeguarding, particularly emotional support for patients and, importantly, their families.

I would be happy to work with the British Medical Association and other interested stakeholders and members ahead of stage 3 to add further details if they believe that that is necessary. I certainly do not oppose provisions for an information service as proposed by others, but I do not think that that would be enough. If we are providing independent advocacy for those accessing social security, for care-experienced young people and others, we should provide it for those who are considering making a decision as significant as this.

I move amendment 242.

I will speak to my amendments 127 and 137. As Liam McArthur anticipated when he commented on them, I lodged them largely as probing amendments for discussion. I was curious about how Liam McArthur and the committee would respond to the issue. As members will be aware, just last year, the Parliament, by an overwhelming majority, passed legislation to allow safe access zones for abortion services.

Abortion services can, of course, be a contentious and divisive issue within society, and they are, like the issues covered in this bill, generally regarded as a conscience matter by most political parties. In places around Scotland, we have seen a significant number of protests targeting the sites where abortion services are provided and impacting in a negative way on those accessing them, as well as on professionals working in those locations.

As Liam McArthur said, there have been protests in some jurisdictions where assisted dying takes place, but they have not necessarily been targeted at specific sites. The one instance where end-of-life issues have given rise to protests in this country relates to different circumstances, and not to assisted dying as such, and I think that it is probably fair to say that it was generated as much by online activity and information that was not necessarily accurate as by the issue itself.

I was mostly concerned that we were going to have this discussion in the context of the possibility that the Parliament might have agreed to organisational opt-outs, if our discussion last week had gone a different way. I was concerned that, if organisations—for example, providers of hospice or care home facilities—were under pressure to make an organisational decision whether they supported their residents in being able to access the assistance provided under the bill, they could become targets of the kind of protests that we have seen in relation to abortion services. Given that the committee, so far, does not seem to have gone down that route, I am minded at the moment not to move these amendments when we come to them. Obviously, though, I will want to see how the debate goes on other amendments and might revisit at least this discussion at stage 3, even if only for the purposes of debate.

Will the member give way?

I thank Liam McArthur for his broadly constructive and positive comments. I am aware that Ross Greer is keen to press amendment 242, so I will do that. I note that, if the committee is not minded to support amendment 242, there is an intention to work constructively before stage 3. For the time being, I will press amendment 242.

Amendment 242 agreed to.

Amendment 243 moved—[Patrick Harvie]—and agreed to.

Section 15—Provision of assistance