Chamber and committees

I think that that is difficult to predict or anticipate.

I know, but there is not a residence requirement in relation to Switzerland. The point that you are making is that, at the moment, we are kind of outsourcing that service for people who can afford it.

The figure was drawn from international comparators. I read the submission with interest. There are mechanisms at the moment for procurement and disposal, so, in a sense, we would be operating in a system that currently exists. Hiving that off from other aspects of what is done within pharmacy was tricky. It would be helpful to have more understanding of how the Royal Pharmaceutical Society sees that breakdown and how it is an additional cost over and above what could be absorbed in existing structures. I am very happy to engage with it on that point, but it is difficult to comment without having an alternative set of figures and the basis for them.

That 33 per cent is not unique to Oregon. It is made up of those who made the initial request but did not ultimately follow through with it, and some of those people will have had the medication sent to them. However, as I have said, that is not a figure that is unique to Oregon. Indeed, it seems to be pretty consistent; when we were in California in February, people indicated that the figure there was broadly similar. When the witnesses from Victoria and more widely in Australia gave evidence to the Health, Social Care and Sport Committee, they, too, recognised that figure—that is, that a third of those who make an application do not proceed with it. I am not quite sure that I understand the differentiation that the bioethics witnesses are suggesting in the figure that they are talking about.

As my proposals require a medical professional to deliver the medication, there would be no such instance. If somebody had changed their mind or had lost capacity—indeed, the medical professional would need to determine both capacity and intent at the final stage—the medication would be taken away. I cannot, for no other reason than that, see the situation that has been referred to arising.

Over what period?

The individual circumstances will drive what those savings might be to such a large extent. We do not look at it that way just now in relation to people moving between curative and palliative pathways. The bill is looking to build in something that will become part of the end-of-life options. As I said, it was felt impossible to come up with a figure that would be in any way meaningful. There is not a precedent or a model to draw on.

Even in those jurisdictions where this option has been in place over a lengthy period, there will be differences in terms of pension arrangements, healthcare costs and all the rest of it. However, I am not aware of statistics that show what those savings were. I suspect that it is because they have been redirected into the provision of other care within hospitals or within hospices.

Yes, and that is the point: there is a gearing up. To some extent, it is a question of the time period for implementation. As I have said, there seems to be a wide variety in that respect, with the implementation period ranging from six months to 18 months, two years or more. It will not surprise you to hear that the chief medical officer is keen for it to be at the longer rather than the shorter end, which I absolutely understand.

I am conscious that, if the Parliament were to pass the bill, we would not want to delay it unduly, because I routinely hear stories from people who are desperate for the process to be introduced as quickly as possible. However, I do not think that we do the public or the medical profession any favours by not ensuring that the systems and training and so on are in place as robustly as possible at the point of introduction. Over time—again, this is what has been seen elsewhere—confidence grows among medical professionals to get involved, so the numbers go up. Even if they are not necessarily actively involved year to year, the number of people who are involved in the system as a whole continues to rise, as does confidence among the wider public. However, as much as there is public support for the option and as many terminally ill patients are desperate for it to be available, it is not surprising that some will want to see how it beds in and works in practice before deciding whether it is for them.

Again, those are interesting and legitimate questions to raise. I would probably question whether it is the antithesis of the Hippocratic oath. I am not a medical professional, but I have spoken to many who do not see it in those terms. To be involved in helping to manage and end a patient’s suffering, whether it is pain or existential suffering, is something that they feel is consistent with the oath that they have taken.

This might be a small step in terms of the cohort and the numbers that might be involved, but I do not underestimate the extent to which it is a significant step for the medical professional and society. It has always struck me that public support for the choice has been consistently and overwhelmingly strong for many years now, but there is a difference when you are making a decision as legislators to change the law. You weigh up a series of different factors, and it is not as simple as saying whether you are in favour of or against something. Those who are making the arguments on both sides of the debate come from similar places in terms of what they want to see and their compassion and care for the best interests of patients and the vulnerable, but they come to different conclusions about how that is to be achieved.

Those discussions are already happening, and not just because of my bill, although I think that it has acted as a bit of an accelerant. They are taking place in the palliative sector and the hospice sector. I spoke at the Hospice UK conference at the end of last month and it was clear that, in the staff rooms in hospice communities, discussions are taking place not just among the medical staff but among the wider hospice community about what it is to be patient centred and to give patients as much control and autonomy as possible to recognise their needs.

I think that I have exhausted any and all speaking notes that I might have had, convener. Thank you very much.