Chamber and committees

I take that point entirely. Those representations have facilitated the debate around the issues that need to be picked up in training. However, I question whether we should take a different approach to where the detail sits in relation to this bill compared to where it sits in relation to other pieces of legislation that we pass. I get that this bill is perhaps seen as more significant than some other pieces of legislation, but I would caution against taking a different approach in relation to this from the approach that we take to other clinical practice. That would only open up scope for confusion and misunderstanding—indeed, it would undermine the safeguards. I think that, irrespective of where we stand on the bill, we are all determined to ensure that the safeguards are as robust as possible.

I thank Brian Whittle for setting out the rationale for his amendments, which I think allow us a bit of a reprise of our earlier debate in relation to the amendments on future care plans. I think that the points about how desirable it would be, for a whole host of reasons, for more people to undertake to make future care plans and advance care directives have been firmly put on the record.

With regard to Brian Whittle’s amendment 153, I note that there is nothing in the bill as it is introduced that would prevent someone from having an advance care directive should they wish to have one. Although I can see the value of advance care directives, I am cautious about anything that would cause undue delay and prolong the suffering of someone who was seeking an assisted death. I would also raise the question whether people may not wish to have such a directive.

I thank Brian Whittle for that clarification, which is helpful in addressing an issue that came up in relation to future care plans: the fact that, however desirable they are and whatever benefits may derive from them in terms of understanding the individual’s wishes at the end of life, the process still needs to be voluntary.

The Scottish Government has confirmed that

“advanced directives are not legally binding”

in Scotland and that

“Mandating their use in this context could create uncertainty for practitioners and patients.”

Should amendment 153 be agreed to, I would not oppose amendment 156, which would require the assessing registered medical practitioner to explain and discuss advance care directives with the person who was seeking an assisted death—something that Mr Whittle has further clarified.

After extensive discussions with stakeholders, including medical organisations and practitioners, I have been cautious about imposing measures that might unduly interfere with patient autonomy, the doctor-patient relationship or existing clinical practice. Although assisted dying must be carefully regulated, the bill should establish a clear regulatory framework, with the detailed guidance and best practice procedures developed in consultation with those who work directly with patients and in healthcare.

Amendments 163 and 209 are consequential to the aforementioned amendments.

Apologies, convener. I had my head down.

Good morning. I start with a declaration of interests and remind the committee that I receive support from three separate campaign organisations—Dignity in Dying, Friends at the End and the Humanist Society Scotland—that have helped in supporting the costs of a website during the consultation on my bill and of a staff member who works on the bill.

As I did last week, I will start with my amendments before moving on to the considerable number of other amendments in the group.

My amendment 65 seeks to allow the Scottish ministers to regulate any training that the co-ordinating registered medical practitioner, the independent registered medical practitioner and the authorised health professional must have completed in order to carry out their roles under the bill. I made clear throughout stage 1 that training will be required for those health professionals who are directly involved in the assisted dying process. A specific requirement for training was not included in the bill because I believe that the profession is best placed to devise, develop and roll out the training that it considers most appropriate and that training does not require to be mandated in the bill. Further, the bill already sets out qualifications and experience requirements for medical professionals, which I am seeking to extend to authorised health professionals. It is also worth acknowledging that the Health and Care (Staffing) (Scotland) Act 2019 already places a duty on health boards and the Scottish health service to ensure that staff are suitably trained.

However, after further reflection ahead of stage 2, I have lodged amendments 65, 67, 34A, 35A, 35B, 46A and 47A to add the provision of training to the existing regulating powers that the bill confers on the Scottish ministers with regard to the qualifications and experience that the co-ordinating registered medical practitioner, the independent registered medical practitioner and, if my amendments 34 and 35 are agreed to, authorised health professionals should have. That would allow the Scottish ministers, after consultation with relevant partners, to regulate the training, qualifications and experience that those health professionals must have in order to participate in any assisted dying scheme.

Amendment 65 therefore seeks to add training to the matters that the Scottish ministers may make regulations on, in addition to the qualifications and experience that are required to take on the role of co-ordinating registered medical practitioner. Amendment 67 seeks to do likewise for the role of independent registered medical practitioner, and amendment 34A seeks to do the same for the role of authorised health professional by adding the word “training” to my amendment 34, which seeks to allow the Scottish ministers to make regulations setting out the qualifications and experience that a registered medical practitioner or a registered nurse should have in order to take on the role of authorised health professional.

Amendments 35A and 35B are consequential. They seek to add the word “training” to amendment 35, which requires regulations that are made under amendment 34 regarding the authorised health professional to be consulted on before they are laid or made.

Amendments 46A and 47A are consequential. They seek to add the word “training” to amendments 46 and 47, which require first sets of regulations to be subject to the affirmative procedure and subsequent regulations to be subject to the negative procedure.

Amendment 48, which is also consequential, clarifies which regulations under section 15(8) are which, as there are two regulation-making powers in that subsection.

I note that amendment 47 would be pre-empted by amendment 59, which we will come to in a later group.

Paul Sweeney’s amendment 34B seeks to amend my amendment 34 to change the word “may” to “must” and require the Scottish ministers to make regulations. That links to certain other amendments in the group, which I now turn to. Although I have always considered those who work in healthcare to be best placed to determine training factors and I therefore want to allow some flexibility as to whether that is determined by Government regulation, I am open to amendments 34B, 224 and 230, which would make it a requirement for such regulations to be introduced.

I note that the Government suggests that amendment 34 might be defective, so Mr Sweeney might wish not to move it at this point, pending further discussions with the Government ahead of stage 3.

Ms Duncan-Glancy’s amendment 225, in relation to the co-ordinating registered medical practitioner, sets out that Scottish ministers

“must, in particular, specify training or qualifications related to”

a range of matters, namely:

“knowledge of palliative care and alternative care options to providing terminally ill adults assistance to end their own lives ... understanding of independent living, in accordance with article 19 of the UN Convention on the Rights of Persons with Disabilities ... awareness and identification of coercion, pressure or undue influence”

and

“equality and non-discrimination principles, with specific reference to the rights and experiences of persons with ... disabilities ... terminal illness, or ... socio-economic disadvantage.”

I note that that provision would extend only to the co-ordinating registered medical practitioner and not to the independent registered practitioner.

Again, I am of the view that those who work in healthcare are best placed to determine what training would be required and most useful. I agree with Ms Duncan-Glancy on the importance of doctors being appropriately trained on all relevant issues, including in areas such as palliative care and the rights of disabled people, but I do not consider that that sort of detail would be appropriate in the bill.

With regard to a request for an assisted death, if it was evidenced that someone was experiencing financial difficulties, issues around housing or whatever else, there would be an opportunity during those discussions to make interventions that would allow those issues to be addressed. However, I think that it would be problematic to introduce subjective judgments to that assessment process, which would cut across the relationship between doctor and patient. Doing so might even make the individual reluctant to declare that they have concerns, whether about their financial situation, their housing situation or otherwise. That would not be in the interests of protecting those who are vulnerable. As I said, I understand the intention behind the suggestion, but medical judgment would need to be applied in such a case, with the practitioner deciding whether they were comfortable with proceeding with the process in such circumstances, as opposed to seeking to engage with other professionals who may be able to provide support—which, as Pam Duncan-Glancy suggests, would not necessarily always be medical.

As I said to Mr Doris, I am happy to have those discussions. It would probably be helpful to see where the bill is at the end of stage 2 and what further refinements are necessary. I would be happy to work with Mr MacGregor and the Scottish Association of Social Work, which I have, as he suggested, had the benefit of speaking to on a couple of occasions.

In relation to the 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, as well as those who have provided, or are providing, care to the person. I believe that those are appropriate safeguards that will ensure that only those with the capacity to make the decision are deemed eligible to receive assistance.

I would urge caution against adding processes that duplicate what is already in the bill and risk adding burdensome processes that could delay those seeking assistance from accessing it while not necessarily offering meaningful additional protection. I appreciate the attempt in subsection (5) in amendment 226 to set out reasonable timescales, but I again caution against mandating additional processes that could potentially add undue delays to the process.

I also consider that, in line with existing clinical practice, health professionals can—and do—undertake such approaches to the local authority where that is warranted. Nothing in the bill would prevent that practice from continuing should it be felt necessary in relation to particular patients.

Should amendment 226 be agreed to, it would be sensible that the registered medical practitioner must take account of any assessment made by the local authority, as is set out in amendment 233. I also note that aspects of the amendments in this group overlap with processes and requirements that are already considered and provided for in the bill.

As I said, I am happy to continue to work with Bob Doris and Fulton MacGregor, at the end of stage 2 and ahead of stage 3, to see whether we can make further refinements and improvements. I thank them for lodging and speaking to their amendments.

Some of that will have to be captured in training, but, as I said earlier, it is unreasonable to expect all GPs or consultants to be specialists in the areas that have been referred to. That is why the option to refer on is available under the bill, the need for which would emerge from discussions with the individual. To an extent, there is a balance to be struck between what a medical professional believes that an individual should take forward, in their own best interests, and the right of the individual to say, “I understand that, but that might not be for me,” for a variety of reasons. It is about getting the balance right, and it is an uncomfortable balance for legislators, because it leaves the option open. However, patient-centred care is at the heart of the principles and ethos of the bill.

On the other amendments in the group, although, for the most part, I understand the reasoning behind them, many appear to duplicate each other or ask for very similar information to be included, as both Daniel Johnson and Bob Doris acknowledged.

Pam Duncan-Glancy’s amendment 229 would require that, in carrying out their assessment, the co-ordinating registered medical practitioner must ask the person who they are assessing what their primary reason is for seeking an assisted death. If it is determined that the reason is not related to the person’s terminal illness or otherwise falls outwith the bill’s provisions, the assessment must cease immediately and not proceed. I understand the reasoning behind the amendment, and I again remind the committee that section 7 of the bill requires discussions to take place with those requesting assistance about their illness and available care and support, so that they can make an informed choice.

Amendment 69, in my name, would further strengthen the safeguards in that regard, and section 24 already addresses the reasons for choosing an assisted death or, indeed, the reasons for withdrawing that request. I am concerned that amendment 229 might go further than is desirable in placing subjective eligibility judgments in the assessment process; therefore, I do not support that amendment.

That is a helpful issue to raise, and that is why we need the training requirement to be developed by those who are operating in the area. There will be areas where face-to-face engagement is crucial and areas where it will not be felt to be essential. Ultimately, we need to ensure that the professionals who have the relevant expertise inform the way in which guidance will be taken forward.

The amendments in this group, which have a great deal of overlap for wholly understandable reasons, have facilitated a useful debate, if not about what will be in the bill then, certainly, about what the Parliament should expect in subsequent elements of the process. I press amendment 65.

Amendment 65 agreed to.

Amendment 224 moved—[Paul Sweeney]—and agreed to.

Amendment 66 moved—[Daniel Johnson].

I thank Daniel Johnson for taking the intervention and for setting out a reflection on the hospice sector that I fully recognise. I understand the concerns that have been expressed, but would he accept that the hospice sector is made up of hospice communities that do not simply include those who are directly employed in those hospices but stretch rather wider? Within those communities, there will invariably be those who are very concerned about what is proposed in the bill and would not want to participate at all; there will be others who are very comfortable with it and see it as an extension of the sorts of patient-centred support that they already provide; and there will be others who are uncertain, as I know many colleagues are, and who will want to see the detail of the bill and how it might impact on them before they make a decision one way or the other.

The risk in introducing an institutional or organisational conscientious objection is that we would remove from individuals in the hospice community the choice to participate, if they wish to, with the strict safeguards that are in place, and we would allow, essentially, a veto on that choice by those who are opposed to it, for reasons that I fully respect, who would be under no duty to provide anything that is set out in the bill. Does the member accept that that cutting across individual choice is something that we should steer clear of if at all possible?