Chamber and committees

To be clear, as Miles Briggs helpfully indicated, this is a feature of the legislation that is being taken forward at Westminster and in Jersey and the Isle of Man and it is my intention and expectation that it will also apply to this bill.

I have some concerns about passing amendments at this stage while there are on-going discussions between the UK and Scottish Governments in relation to areas of legislative competence. This will have to be a feature of any legislation that is finally passed by Parliament but, at this stage, I urge the members who lodged the amendments not to press them but to be reassured that we can return to the issue at stage 3.

This group also contains amendments that seek to allow organisations to opt out of the process. Daniel Johnson’s amendment 16 would extend the conscientious objection provision to care homes and hospices, therefore introducing an organisational conscientious objection, rather than having the conscientious objection provision limited to individuals, as it is in the bill at present. Amendment 20 would add a no-detriment clause to the effect that a care home or hospice that opts out as per amendment 16—and in line with the general no-detriment provision for individuals and organisations in amendment 11—

“must not be subject to any detriment by a public authority as a result”

and would provide that no funding of a care home or hospice can be dependent on it providing or permitting assisted dying.

With regard to amendment 16, I refer to my amendments to remove the conscientious objection element and replace it with a broader no-duty-to-participate provision. My amendments to section 18 would mean that no individual was under any duty to participate directly in anything that was authorised by the act. There would be no obligation to claim or demonstrate a conscientious objection; not wishing to participate for any reason would be sufficient.

As I have stated, I have significant concerns about establishing an organisational opt-out. As I told the committee at stage 1, with such an opt-out, although an organisation might well include individuals who are willing to participate in the process, it ceases to be about individual choice. The risk, too, is that barriers are put in place to individuals who, despite meeting all the eligibility criteria and being protected by the safeguards that are in place, find that they are not able to access that choice as a result of an institutional opt-out. We have seen that happen in other jurisdictions, and it has proved extremely problematic. I must say that it also cuts across the patient-centred principles and ethos at the heart of palliative and hospice care.

Likewise, for Jackie Baillie’s amendments 52 and 60, I support the principle of a no-duty-to-participate provision for individuals, but I am not supportive of extending that to permit organisations to decide whether to participate. Establishing such an organisational choice could act as a significant barrier to a person being able to access assistance under the act. The potential effect of the amendments would be that a person in a particular care home or hospice would need to be moved to other premises in order to access the assistance that they wish, at the most inappropriate of times. Some of the testimonies that are set out in the Dignity in Dying briefing for today’s proceedings are certainly worth reading in that context.

It is not to say, however, that hospices should not be given flexibility in the way that they engage with the provisions of the legislation, as we see in other jurisdictions. However, my position remains that an individual can decide not to take part for any reason, but if a registered medical practitioner and other relevant health and social care staff are willing and able to participate, the fact that the terminally ill adult resides in a particular setting should not prevent them from accessing assistance, if eligible.

I note that amendment 190 pre-empts amendment 40 and amendment 41 pre-empts amendment 191. I turn to Jeremy Balfour’s amendments 190 to 193 and 211. Regarding amendment 190, my amendments to section 18 reframe the section by replacing the reliance on a CO with a wider no-duty provision, so that no person is under any duty to participate directly in anything authorised by the act. Amendment 190 would amend the existing CO provision too broadly, in my view, by referring to a person facilitating

“in any way, anything authorised”

by the act. I note that the British Medical Association, when addressing similar amendments in the Westminster bill, reinforced the need to

“ensure that the doctor’s views are respected, whilst also ... ensuring that patients can easily access the information and support they need.”

Amendment 190 could exclude patients from accessing their crucial right to information, which I note that Mr Balfour would not wish to see.

Amendment 191 would move the burden of proof away from existing legal precedent. It is also not necessary, as, if a decision is made to move to a wider no-duty provision, such a provision will not be required in any event. I have lodged an amendment to remove that subsection from the bill, subject to further discussion and considerations, including with the cabinet secretary, ahead of stage 3.

Amendment 192 is another no-detriment amendment. As I have said, I am sympathetic but, given the amendments that I have lodged to section 18 and the further considerations that might be required ahead of stage 3, I ask the member not to press it.

Amendment 193 and consequential amendment 211 also seek to establish a form of institutional objection, as does Stuart McMillan’s amendment 249. I have made it clear why I do not support such an approach. I urge members not to press those amendments and the committee not to support them.

Taking a blanket approach has superficial attractions, but I am not sure that it would necessarily be as effective. I will go on to explain the intent behind the amendments that I have lodged, which I hope will significantly bridge some of the gaps—if not all of them—between where I am and where Mr Doris is at the moment. I am happy to continue working with him ahead of stage 3, to see whether we can bridge the final short spans.

The convener intimated that the Scottish Government has raised concerns in relation to the burden that Mr MacGregor’s amendments would place on local authorities—that seemed to be the implication in the questions that she was asking—and I do not think that that burden would necessarily improve or strengthen the safeguards that are already in the bill. The assessment process allows assessing registered medical practitioners to refer any doubts on matters of capacity to psychiatry specialists or those who otherwise hold qualifications or have experience in the assessment.

Thank you, convener. I start with an apology that my remarks are, again, going to be on the lengthy side. Again, it is a reflection of the fact that I want to do justice to the amendments in the group. I thank Miles Briggs for helpfully setting out the rationale for his amendments and the case for an opt-in model; that has always been my intention and I think that my amendments in the group reinforce that.

Amendments 39 to 41 amend the current conscientious objection provision in the bill to broaden it out and ensure that no person is under any duty to directly participate in anything that is authorised by the bill. That provision is broader than the conscientious objection provision, as a person no longer needs to claim a conscientious objection to participating but can decide not to directly participate for any reason.

My original policy intention was to include a conscientious objection provision similar to that provided in abortion law, so that health professionals would not be under a duty to participate in the provision of assisted dying if they had a conscientious objection to doing so. It has always been my intention that no health professional would be expected to participate if they did not wish to, and this approach should cover anyone who is directly and actively involved in the process—by which I mean anyone carrying out functions in the process as set out in the bill’s provisions.

Following stage 1, I have reflected carefully on how best to ensure that the bill fully reflects my intended policy, and I have concluded that, to simplify the matter further, the bill, instead of relying on a CO provision, should allow anyone carrying out such functions to not participate directly for any reason, thus ensuring that only those who are content to participate directly do so. That will have implications for overall training need, thereby reducing some of the cost issues that have been raised by the Scottish Government.

Amendment 39, which adds the word “directly” after “participate”, is in line with my view that there should be no blanket provision that would allow any person, however peripherally involved in some aspect of the wider process, to be able to not perform their role. Instead, it is intended to ensure that the provision is focused on those people who are directly involved—for example, the independent registered medical practitioner or the authorised health professional, who might be approached by the co-ordinating registered medical practitioner to undertake the duties under sections 6 and 15. Amendments 39, 40 and 41 enable a debate to be had on the pros, cons and potential consequences of a change from CO to only those directly participating who are willing to do so.

On amendment 27, it has always been my policy that a person first seeking assistance should be directed to another medical professional if the medical professional whom they first approach does not wish or is unable to perform the role of co-ordinating registered medical practitioner. My understanding is that such signposting already takes place in healthcare settings and, therefore, it was not specifically provided for in the bill as introduced. On reflection, however, I have decided to lodge amendment 27 to ensure that someone seeking an assisted death is either directed towards a registered medical practitioner who is willing and able to participate, or given further information on how to proceed.

That will not require formal referral of the person to a specific registered medical practitioner, but it will require a registered medical practitioner who is approached by a terminally ill adult looking to make a first declaration and who is unwilling or unable to participate to signpost the person to where they can receive information on how to proceed and/or where they can make a first declaration. That might involve, for example, a GP at a medical practice directing a person to another GP at the practice who is willing to participate in assisted dying provision. In later groupings, we will have a chance to consider amendments on the provision of information.

As for other amendments in this group, amendments 151, 154, 186, 198 and 213, in the name of Miles Briggs, form part of the debate on how best to provide for health professionals in deciding whether they wish to participate directly in the provision of assistance. Indeed, we have heard as much from Mr Briggs himself. At the heart of the amendments is a requirement for

“Scottish ministers, by regulations,”

to

“establish and to maintain a register of persons willing to carry out functions under this Act of ... a co-ordinating registered medical practitioner ... an independent registered medical practitioner ... an authorised health professional”

and

“a registered pharmacist ... supplying”

the

“substance.”

I considered such an approach when I was originally looking at how best to proceed on the issue and came to the view that the establishment of such a register was not necessary. In practice, it is, as has been seen in other jurisdictions, likely that such registers will form part of the information that is held in each health board, and nothing in the bill at the present time will prevent that from happening. However, I am not persuaded that mandating the establishment and maintenance of a central register and requiring individuals to notify Scottish ministers of their willingness to participate is appropriate or proportionate.

That said, I again pay tribute to Miles Briggs for the way in which he has engaged with me on these and, indeed, other issues, particularly around palliative care. I am keen to continue working with him to see how the bill might be further strengthened, and I thank him for the constructive approach that he has taken throughout, not just with me but with other colleagues.

On related amendments that were lodged by the equally constructive Jackie Baillie, and which are being spoken to by the ever-constructive Daniel Johnson, amendments 74 and 80 to 82 relate to the establishment of a register of psychiatrists who can undertake assessments, as set out in the bill. The amendments provide that psychiatrists may apply to be on the register and, to do so, must be approved medical practitioners or must

“meet criteria specified by the Scottish Ministers in regulations”.

I recognise Ms Baillie’s work with the Royal College of Psychiatrists on those provisions.

It is important that the assessing registered medical practitioners are able to seek input from specialists when assessing capacity, which is why the bill provides for that in section 7(2)(b). That provision allows for such referrals to be made by either assessing doctor to

“a registered medical practitioner who is registered in the specialism of psychiatry”

or who

“holds qualifications or has experience in the assessment of capacity”.

Section 7(2)(c) provides that the views of such specialists must be taken into account by the assessing doctors. I firmly believe that such specialists will be capable of assessing the capacity of an individual for the purposes of the bill without any need for the creation of a new register, just as currently takes place in other matters of determining capacity.

Section 3(2) sets out the capacity requirements for a person to be judged as eligible to request assistance. I note that the Scottish Government has highlighted legal and technical concerns, and deliverability challenges, with the amendments, which, on balance, I do not believe to be necessary.

Amendment 74 would be pre-empted by amendment 159 in the group dealing with the assessment of terminally ill adults. Several amendments in that group are concerned with the issue of providing for variations of a no-detriment provision to ensure that no person suffers any detriment as a result of a decision on whether to participate, as Miles Briggs explained. Those amendments include Daniel Johnson’s amendment 11, Jeremy Balfour’s amendment 192, Paul Sweeney’s amendment 248 and Miles Briggs’s amendment 194, which establishes

“Employment and partnership protection (for involvement or non-participation)”.

Employers

“must ensure that there is no employment detriment to their employee”

for actually, or potentially, participating, or not participating, in the act. As I have stated, it is important that those who do not wish to participate directly in the process are protected and I support the principle of individuals suffering no detriment.

I note that the Scottish Government has indicated that such amendments may relate to the reserved matter of employment rights and duties and industrial relations. As I have previously said, I am aware that the Scottish Government is working with the UK Government to ensure the full operation of the bill, should it be passed. The Scottish Government will consider the effect that this amendment and others might have on current engagement with its UK Government counterparts and I hope that the cabinet secretary will continue keeping the committee informed about those discussions. In the meantime, Parliament might wish to return to and address the issue when further amendments are addressed at stage 3.

There is an issue with the amendment not referring to both roles. However, my principal concern is about how appropriate it would be to put that level of detail in the bill, as opposed to requiring through guidance that those aspects be incorporated into training to ensure that those who participate in the process are aware of the issues that Pam Duncan-Glancy has quite rightly raised.

I welcome that point from Brian Whittle. It goes to the heart of a lot of this. It is why so much discussion around palliative and hospice care has happened alongside the consideration of the bill. Although I have always taken the view that that issue cannot be resolved through the provisions of the bill, the bill has opened up a debate about the current situation. The quality of palliative care generally is seen to be very good across most specialisms, but I think that we would all acknowledge that access can be patchy, particularly in certain parts of the country.

Nevertheless, the process opens up a discussion that is not happening at the moment. It is about providing protections for those who are not necessarily protected as well as we might wish them to be or think that they are. Therefore, when the medical professional has concerns that the option that the individual would prefer is not available, there is an opportunity to take steps to try to address that, which is what the process seeks to achieve.

I now turn to Mr Doris’s amendments 117, 121, 122, 123 and 135. The bill requires the assessing doctors to make a statement recording that the person assessed is terminally ill, eligible for assistance to be provided and making the decision voluntarily. The forms are set out in schedule 3 and must be signed and dated by the assessing RMP and recorded in the person’s medical records. The form captures the required information resulting from the assessment process and allows a person to make a second declaration for assistance to be provided if they wish. If either registered medical professional is not satisfied and does not complete the assessment form, the process stops. I therefore believe that the reports provided for in the amendments are unnecessary, as all required and relevant information will already have been captured. I am happy to work with Mr Doris to see whether any additional information might usefully be captured.

I am grateful to Mr Balfour for taking an intervention. I draw a parallel with established practice in the way that conscientious objection works in the area of abortion, where there is no requirement for a practitioner to participate but there is an expectation of a referral or a signpost on, so that a patient is not left with no option whatsoever. There is a duty on medical practitioners, whatever their views, to ensure that their patients get the support that they need. The no-duty provision makes it far clearer that there is no expectation on a practitioner to participate. The BMA has raised issues in relation to the specific understanding of “referral”, which is why amendments refer to signposting. However, whether it is referral or signposting, is that not a reasonable way of respecting the rights and choices of medical practitioners, while ensuring that patients do not come up against a brick wall when they are looking for choice, often at a very vulnerable point in their lives?

I appreciate Mr Doris’s point. If additional information could usefully be added to the process, I am happy to consider it. In relation to schedule 2, a practitioner would already need to be satisfied that quite a lot of details had been met before those forms were signed.

Stuart McMillan’s amendment 117A amends Bob Doris’s amendment 117 and states that, if a report under Mr Doris’s amendment sets out why a statement has not been made,

“no registered medical practitioner may carry out an assessment in relation to the same request before the end of the period of six months beginning with the day the report is recorded in the patient’s medical records.”

I cannot support the amendment, which appears to be arbitrary and disproportionate and does not appear to take account of the potential for circumstances to change.

I now turn to Jackie Baillie’s amendments 50, 51, 58 and 59. Amendment 51 would require both assessing doctors, if the person being assessed was under 25, to refer the person to a social worker and a psychiatrist and to take account of their specialist opinions. The amendment would also allow Scottish ministers to make regulations on any qualifications that the social worker or psychiatrist must have, and it would provide that the regulations must be consulted on. Amendment 59 would requires the first regulations made to be subject to the affirmative procedure, and amendment 58 would require subsequent regulations to be made under the negative procedure. Amendment 50 would add to section 6 the requirement that the assessing doctors carry out the steps that are set out in amendment 51.

I note the Scottish Government’s concerns regarding the potential time commitment for practitioners and the risk of creating barriers to access for individuals in the affected groups, which could potentially result in delays or inequitable access. Daniel Johnson sought to address that in his remarks, but I think that it would still be a matter of concern. As I have said, the way in which the process will work for younger adults, who are likely to be living with, or who have been living with, complex conditions for some time—this was set out very well by Mr Johnson—will reflect that complexity and will invariably involve a wider range of medical and other professionals, who, in turn, will require the appropriate training. A separately established and distinct process might be seen as arbitrary and open to challenge, so it might be better to set out in the relevant guidance what Jackie Baillie seeks to achieve, including in relation to training. I remain willing to work with Jackie Baillie and Daniel Johnson on those issues ahead of stage 3.

In the meantime, I have no objection to Jackie Baillie’s amendment 93, which would require the assessing doctors to inform the terminally ill adult that they could be referred for a palliative care assessment. The bill already requires assessing doctors to explain and discuss with the person their diagnosis, prognosis, available treatment, palliative care and other care that is available. My amendment 29 would require them also to discuss psychological support and symptom management. Although amendment 93 appears to replicate part of that, I have no objection to it.

Jackie Baillie’s amendment 75 would enable assessing RMPs to refer a person who is being assessed for an additional second opinion in a psychiatric assessment on capacity. The amendment would also allow the person being assessed to request a second opinion in relation to their capacity. In either circumstance, the referral would have to be to someone on the register of psychiatrists, which would be established by amendment 80, which we have already debated, and the assessment would have to be taken into account by medical professionals. I refer members to the comments that I made earlier on that issue. I also note that the Government has stated that, should amendment 75 be passed, it could raise concerns around consistency and increase the risk of “doctor shopping”. The Government also suggests that

“This may also place significant strain on staff resources, as additional referrals and second opinions would require more specialist availability and coordination.”

Let me turn to Pam Duncan-Glancy’s amendments 231, 234, 235 and 236. Amendment 231 might be a helpful addition to the list of things that assessing doctors should explain to and discuss with the person being assessed. However, assessing doctors would benefit from having discretion in such matters. For example, the inquiries and discussion provided for by amendment 231 would not be appropriate in every case being assessed, as I am sure Ms Duncan-Glancy would accept.

I appreciate the intention behind amendment 234 in seeking to ensure that any terminally ill adult who requests assistance and who has a disability has access to the support that they need. I also appreciate that the amendment frames any referral as being discretionary for the assessing doctors. There might be issues to consider in relation to which disability organisations could be involved in something of that nature, how reasonable it is to expect them to be involved in the way that is envisaged and how well placed they would be to provide support.

That brings us to amendment 236, which would require ministers to ensure that disability organisations are adequately resourced to provide that support function. It is obviously for the cabinet secretary and the Scottish Government to comment on duties that amendments would place on the Government to deliver funding. However, that consideration might add to concerns about whether such an amendment would make a proportionate difference to the bill and to the robust safeguarding measures that are already in place and that can be delivered.

With regard to amendments 234 and 236, the Scottish Government has stated:

“... this would require discussion with disability organisations to understand in what form this support would take; how it would be funded; and how it could be delivered consistently”.

The Government further notes that amendment 236

“would place an open-ended, and potentially significant, resourcing ask on Government.”

Amendment 235 also aims to provide support to any terminally ill adult with a disability and, again, allows discretion, so the provision can be used if deemed necessary or helpful. However, I again have concerns about how that would fit within the overall assisted dying process provided for by the bill, and I am also unsure how well positioned local authorities are to meaningfully provide the kind of assessment that is provided for and envisaged by the amendment.

Stuart McMillan’s amendment 232 appears to duplicate the policy intent of the provision in section 7(2) of the bill, which allows the assessing doctors, if they have any doubts about whether an illness is terminal, to refer to an expert in the particular illness in question.

On Mr Balfour’s amendment 157, I note that section 7 sets out further provision for assessments to be carried out by registered medical practitioners. Amendment 157 would add a requirement that the registered medical practitioner must refer the person seeking an assisted death to a registered social worker and a registered medical practitioner who is registered in the specialism of psychiatry for an assessment and must take account of any view provided following that assessment.

In terms of amendments that relate to a required social work assessment, I have lodged amendments that, if agreed to, would see assessing doctors being able to make inquiries and seek the views of health, social care and social work professionals and those who have provided or are providing care to the person. I further note that the bill does not limit assessing doctors to seeking the views of only one specialist on either illness or capacity, so there is nothing to prevent other opinions being sought if that is considered necessary. I therefore do not believe that amendment 157 is required, and nor are the consequential amendments 159 and 160.

Sue Webber’s amendment 158 would add a requirement that the medical practitioner must inform the person of any potential side effects of using approved substances that may be provided to assist them to end their own life and of any potential risks or complications, including pain. I would expect such information to be shared by the RMPs as part of the requirement under section 1 of the bill, which requires assessing doctors to explain to and discuss with the person seeking assistance

“the nature of the substance that might be provided to assist the person to end their own life (including how it will bring about death).”

I therefore consider that the amendment may not be essential, but I certainly do not oppose it.

I note Daniel Johnson’s comments about his amendments 5 and 6 being generally probing amendments. Amendment 5 would require the assessing doctors’ statements to record how long they have known the person, and amendment 6 is consequential. I am not necessarily clear as to what extent that would strengthen the bill, as it would simply record, and only for the co-ordinating registered medical practitioner statement, how long they had known the terminally ill adult. I have always acknowledged that there may be a value in the co-ordinating practitioner having a pre-existing relationship with the terminally ill adult, particularly when assessing for coercion. Indeed, the explanatory notes accompanying the bill state:

“It is expected that this will usually be the terminally ill adult’s GP or primary care doctor.”

However, I understand the rationale behind the amendments and there is probably scope for further discussion ahead of stage 3.

Finally, I will address Paul Sweeney’s amendments 239, 240, 241 and 273, regarding the establishment of an assisted dying panel to determine eligibility once the assessing doctors have both made statements of eligibility, as is set out in the bill. I note that the amendments would prevent a terminally ill adult from making a second declaration until the panel had granted a certificate of eligibility and would require the panel to hear from one or more of the assessing doctors and the terminally ill adult and others. In my view, the amendments would add a burdensome and unnecessary step to the assessment process, which is already robustly and proportionately safeguarded. Two doctors must assess eligibility with input from others, if and as required, before a person is allowed to be provided with assistance. Having to then pass to a further panel would inevitably delay the process and potentially deny assistance to many who met the eligibility criteria. As such, I cannot support the establishment of an additional review panel, which I believe would not strengthen safeguards but would rather act as a potential barrier to those accessing the choice that they wish, having met the stringent eligibility criteria set out in the bill.

Apologies for the length of time that I have taken to speak to the group, but I hope that that is helpful to the committee.

You might not know which physician operated on you, Daniel, but I am glad that they were clearly up to the task.

I thank Daniel Johnson, Bob Doris and Pam Duncan-Glancy for setting out the detail that lies behind their amendments and for providing justification for my taking some time to go through them, for which I apologise.

I will start with my amendments. Amendment 69 would require an assessing registered medical practitioner to make inquiries—for example by seeking input, if they consider it appropriate—from any

“professionals who are providing or have recently provided health or social care or social work services”

to that person. Beyond that, it would require assessing registered medical practitioners to consider seeking input from health, social care or social work professionals on any “matter relevant” to the assessment carried out.

Following stage 1 evidence and further engagement with social work, health and social care representatives, I lodged amendment 69 to ensure that there is provision that requires assessing doctors to seek the input of social work and social care professionals and other health professionals—in addition to those whom the process already provides for—who know the person because they have treated them or provided care to them or because they might have a relevant contribution to make to the assessment process.

The formal parts of the process would be well supported by ensuring that the assessment process is able to take a multidisciplinary approach, particularly because those who have provided social care to a person might have knowledge, insights and expertise from which the assessing doctors and the safeguards in the process would benefit.

I note the points that were raised by social work professionals and organisations at stage 1, suggesting that there is potentially a need for additional specialist expertise in assessing capacity. Such input might also be helpful on matters relating to the person’s illness, in assessing coercion and, as I said earlier, in understanding the fullest range of options available to the terminally ill adult.

Therefore, amendment 69 would further strengthen what I believe is an already robustly safeguarded assessment process and would provide further reassurances that any issues of coercion will be picked up. The amendment continues to respect the role of both assessing registered medical practitioners and therefore allows for their professional judgment, as referred to by Daniel Johnson, as to whether they should make inquiries or seek input and, if so, from whom. Further details around that multidisciplinary input, as well as other aspects of the assessment process, will be addressed in guidance that is provided for under section 23.

Following reflection on the stage 1 evidence, I lodged amendment 29, which would amend the provision in the bill that requires the assessing registered medical practitioner to explain to, and discuss with, the person being assessed any palliative and other care that is available and appropriate. That includes hospice care, symptom management and psychological support. As has previously been discussed, my policy has always been that the assessment process for any terminally ill adult who decides that they wish assistance to end their own life must include the person being given as much information as possible about care options, so that they can make an informed choice at the second declaration stage and on the day that they intend to use the substance.

I thank Sandesh Gulhane for making that point and I agree with him.

I welcome Bob Doris’s intervention, because he shone a light on the interplay between the requirements for training and the necessary option that is available to those who are involved, whether they are the co-ordinating registered medical professional or the independent registered medical professional, to make referrals to specialists that are in palliative care or social work and social care. It is perhaps unreasonable to expect everybody to be an expert in everything, so referrals to those who have the relevant expertise will be important. The training needs to pick up much of what we have discussed but, alongside that, there is the absolute expectation that specialist referrals will be made when required and that the advice that is provided thereafter will be taken on board by the co-ordinating medical professional.

I do not want to cut across Mr Balfour, but I understand the point that has been made. The concern in relation to an organisational opt-out is that, in a sense, any nuance in the debate about how an individual hospice might participate—the extent to which it might participate in the delivery of what is proposed in the bill on behalf of the patients who meet the eligibility criteria and wish to pursue that choice—would be lost. The organisational veto of any choice exercised by individuals within that hospice community is not a place that the Parliament wishes to go. There will be nuances around how each hospice engages with the legislation—we have seen that in other jurisdictions—and it is safeguarded in the provisions in the bill.