I think that Sandesh Gulhane is right to point to the importance of autonomy, but does he also agree that the safeguards in the bill would require discussions to take place around the prognosis and the alternative treatment and care options that may be available in order to understand the rationale and the reason why an individual has come to the decision to make such a request?

Suicide rates among the terminally ill are running at twice the national average and more, so we have to question whether having the safeguards in the bill will provide protections that are not there at the moment. I do not see any proposals coming forward that would see them applied more routinely, but having those open discussions is far more supportive of those who may be vulnerable and need assistance in whatever form.

Good morning, convener. I thank all members who have lodged amendments to the bill at stage 2. The breadth of the amendments will allow most of the substantive issues that the committee wrestled with at stage 1 to be debated at stage 2, which is the purpose of the process.

I thank Jeremy Balfour and Daniel Johnson for setting out the rationale for their amendments and I agree with much of what they have said. In other jurisdictions, we see that people are accessing the choice that the bill would enable at the end of their life, but I understand why we are having the debate.

Before I touch on the amendments that have been spoken to, I will first address my amendments. My amendment 24 clarifies that,

“For the avoidance of any doubt, a person is not”

to be considered as meeting the definition of terminal illness as set out in section 2

“only because they have a disability or a mental disorder (or both).”

That does not, however, prevent a person from meeting the requirements as set out in section 2 from being regarded as a terminally ill person.

Amendment 26 is consequential and tidies up drafting.

I noted the concerns that were raised at stage 1 about the potential risk of a person with a disability or a mental disorder being assessed as meeting the definition of terminal illness as set out in section 2. I am clear that the bill, supported by its accompanying documents, does not permit a person to be assessed as being terminally ill for the purposes of the bill only because they have a disability, a mental disorder or both.

However, in order to provide further reassurance of policy intent and on the meaning of section 2, and to further inform any future guidance on and the practical operation of the act, I have lodged amendment 24. It is not a change of policy but it will remove any doubt. I remain of the view that, if it is their wish, a person must not be prevented from requesting assistance to end their own life because of a disability or a mental disorder, if they meet the requirements as set out in the bill and are assessed as being eligible.

Jackie Baillie’s amendment 73 relates to the amendments that I have lodged in this grouping. Amendment 73 and consequential amendment 84 duplicate the part of my amendment 24 that relates to mental disorder but do not include the part about disability. I am therefore supportive of the principle of Jackie Baillie’s amendments, but I ask her not to move them, and I ask that the committee supports amendment 24, given its application to mental disorder and disability.

I turn to Jeremy Balfour’s amendment 143, which, as the convener said, pre-empts amendments 144 and 4. The first two parts of the amendment, which relate to the diagnosis of an

“irreversible and actively progressive disease, illness or condition”

for which

“no treatment is available that could reasonably be expected to prevent death or lead to recovery”,

are already provided for in section 2. On the proposal that terminal illness should be defined as a person being considered to have three months or less to live, as the committee heard during stage 1, there are risks in including a timeframe for a prognosis of death.

Yes—briefly.

I would respond to that by saying that there is nothing wrong with that guidance. It is consistent with the approach that is taken in the bill. The discussions that my team and I have had with the Scottish Partnership for Palliative Care on that have yet to determine where that difference is. I will continue those discussions with the SPPC and, indeed, with Bob Doris to establish whether more can be done. However, as yet, I have not seen the evidence that shows the disconnect between the definition in the bill and the GMC guidance. As Mr Doris acknowledges, the policy memorandum refers to that guidance.

I turn to Emma Harper’s amendment 12. I support the assessing medical practitioner being required to make inquiries of those who are providing or have provided health or social care to the person. I consider that that should include social work services as well, if they think that that would be helpful, and their having the option to make inquiries of health, social care and social work professionals on any matter that is relevant to an assessment that they are making. That includes input that might be helpful from people who are providing or have provided care to the person and will know them to an extent and might have seen them interact with family and friends on matters where coercion might be relevant.

I note that amendment 12 is pre-empted by amendment 88 in group 10, on assessments of the terminally ill adult. I consider that that potential input should include social work services, which amendment 12 does not. I also consider that it should extend beyond being limited to matters of coercion.

My amendment 69 seeks to require assessing registered medical practitioners to make inquiries of health, social care and social work professionals who have provided care to the person, if they consider that appropriate. It would also allow those assessing practitioners to seek input from those professionals on any relevant matter at the assessing stage. That would include seeking input on potential or suspected coercion.

Those same points apply to Emma Harper’s amendment 13. Although I am grateful to her for lodging her amendments and enabling this debate to take place, I ask her not to move them and for the committee to support my amendment 69. If further work needs to be done ahead of stage 3, I am happy to work with Emma Harper on that.

With regard to Brian Whittle’s amendments 161, 162, 172 and 210, and amendments 164, 169 and 174, it is fundamental that a terminally ill adult makes the choice about requesting assistance themselves without coercion or pressure being put on them by another person. The bill is clear on that, provides for it and makes it an offence to coerce or pressure a person into requesting assistance.

Given that the co-ordinating registered medical practitioner and independent registered medical practitioner will already be assessing for signs of coercion, I question whether a further assessment by an independent assessor is necessary.

I echo Brian Whittle’s comments on the Scottish Government’s engagement in the process. My conversations with the Scottish Government have been constructive throughout but, for the reasons that Brian Whittle indicates, notwithstanding its neutrality, there are issues about the operability of the legislation on which members across the Parliament would welcome the Scottish Government’s views—now, and certainly ahead of and during stage 3. That is important.

I will start by addressing my amendments, before I address the amendments that colleagues have lodged. My amendment 42 extends the section 21 offence to cover the day of death when the co-ordinating registered medical practitioner or authorised health professional provides the substance to the person. There is no change to the penalty that is set out in section 21(2). Amendment 43 is a drafting consequential.

Section 21 makes it an offence to coerce or pressure a terminally ill adult into making a first or second declaration. Amendment 42 adds a new offence of coercing or pressuring a terminally ill adult into the act of using an approved substance. The bill as introduced requires the co-ordinating registered medical practitioner or authorised health professional who is providing the substance to the person on the day of the intended assisted death to be satisfied that the person is not being coerced before providing the substance; however, coercion at that point is not covered by the offence in section 21. Therefore, the amendment ensures, in a situation in which a person has not been coerced or pressured into making a first or second declaration but is subsequently coerced into self-administering the substance, or if coercion is suspected on the day, that that is made an offence. If coercion is discovered after the terminally ill adult has died and it can be shown that the person was coerced into using the substance, the offence will remain prosecutable. That may also trigger a homicide investigation. The amendment will further strengthen the safeguards in the bill and bring it more closely in line with the Westminster bill as it stands.

Turning to the other amendments in the group, on Pam Duncan-Glancy’s amendments 220 and 223, I am content that my bill has safeguards in place to ensure that a person who is seeking an assisted death has not been unduly influenced. I am also concerned that her amendments may make doctors hesitant about discussing assisted dying with their patients, thereby limiting the information that is available. I note that the British Medical Association has been unequivocal on that, stating:

“Doctors should be able to talk to patients about all reasonable and legally available options; a provision that limits or hinders open discussion about any aspect of death and dying is likely to be detrimental to patient care.”

On amendments 237 and 238, my bill provides that the co-ordinating registered medical professional’s statement must set out that the person made the declaration voluntarily and is not being coerced or pressured by any other person into making those decisions. I am not convinced that there would be value in adding another similar statement.

I agree with Fulton MacGregor’s final sentiment about the way in which we must embed the service. That is crucial. I thank other colleagues for setting out the rationale for their amendments.

Turning to Murdo Fraser’s amendment 148 and the issue of the administration and regulation of assisted dying services, the bill does not expressly establish a system within the NHS. It provides for a process with roles for health, social care and social work professionals; Public Health Scotland also has a role in data gathering and reporting.

My view throughout the process has been that assisted dying services under the bill should be provided predominantly through the NHS, although I can envisage that there might be scope for them to be provided in some private settings as well. I am concerned that the implications of the approach proposed by Mr Fraser would potentially exacerbate inequalities in access and disrupt existing pathways for treatment and care at a point when the individual is least able to cope with that.

In relation to that point on amendment 148 and its consequential amendment 208, I note the Scottish Government’s concerns about competence and about the possible duplication of the roles of Public Health Scotland and the Scottish ministers.

To some extent, that concern also applies to Jackie Baillie’s amendment 62 on the provision of assistance outwith the NHS. Amendment 63, which is consequential to that, proposes that the related regulations be subject to the affirmative procedure. I listened to the comments that Jackie Baillie made and her response to the interventions. I am reassured that she does not seek to set up a service outwith the NHS. The points that she makes about regulation are fair and reasonable. They lead me back to the point that Brian Whittle made earlier: this is one of those areas where engagement with the Scottish Government on the operability of the system would be welcome, especially ahead of and during stage 3. I am committed to such engagement and am happy to work with Jackie Baillie on those provisions and others that may relate to similar issues.

I am saying that there is plenty of scope in the bill for instructing or requiring ministers to introduce secondary legislation, and for them to work with healthcare and other relevant stakeholders in doing so, and for requiring professional bodies and others to introduce guidance. I think that the public and we as parliamentarians would expect that to take place in a timely fashion and allow the bill to proceed. I would be reluctant to link the provisions, as set out in amendment 128, to commencement of the bill.

I will give way—very briefly—to Bob Doris.

That is correct.

I do not know whether Daniel Johnson wants to make a similar intervention on the back of that point. If so, I can try to address both interventions.