Chamber and committees

I want to set this in context, on the basis of having spoken to medical practitioners, who want this legal clarity. Say that you were a GP, and I came to you and said, “I have a terminal condition. I want to go to Switzerland—I want to go to Dignitas.” How would you provide information to me about what would be legally available in Scotland—if the bill passes? That issue being raised with professionals is a real-world experience.

Do you see that proactively taking place? We know that many schools have not been inspected for a long time. In relation to the bill, if incidents are reported on—you have suggested that that reporting would be council-wide, not school-specific—that involves a piece of work proactively taking place. I am not sure that leaving it to be part of a wider school inspection would provide the live support to address incidents and potential training needs.

I have raised this next point several times when we have taken evidence. The committee has been interested to hear about the Care Inspectorate and the reduction that there has been in the use of restraint. That might be around the conversation that your bill has taken forward. The Care Inspectorate can provide support and challenge to care settings shortly after a report of restraint is made. When you were drafting the bill, did you consider a similar role for His Majesty’s Inspectorate of Education in providing support? Do you see it having that proactive role?

Thanks for that. You see the guidance aspect as the main route, then.

Good morning. Congratulations on the bill, Mr Johnson. As Edinburgh MSPs, we will have dealt with the same constituents highlighting their concerns. It is very important that the bill makes progress, so I congratulate you on that.

I have two specific questions, which return to an earlier point on informing parents and carers. In regard to the bill’s approach to schools providing information, what should the timescales be, particularly if the parents or carers have welfare concerns? What consideration have you given to that?

If the bill passes, it will be acknowledged by all healthcare professionals. The important choice for people whether to take part is what I am trying to introduce with this opt-in. I am sure that, as Sandesh Gulhane outlined, this will become part of a training conversation. However, on whether staff want to be part of delivering assisted dying in our NHS, the point at which someone starts their career is where the opt-in model would be best placed. That would answer a lot of questions that medical professionals are raising with all of us in relation to whether, in the course of their careers, they will have a patient who requests assisted dying of them and how they will be able to deliver on that patient’s wishes. I therefore urge the committee to vote for the establishment of an opt-in system in the bill to provide that assurance.

I will come to amendment 194 in a second, but, with regard to how we would ensure the provision and updating of training, a single opt-in register makes sense. I am open with regard to where the register would sit. Given the professionals with different responsibilities in this area, it would be sensible, at stage 3, to look at how the register could best be taken forward by the professional bodies.

There are two aspects to that. People will register their wishes to opt in at the point that they are coming out of training and starting their careers, but I take on board your general point. There must be flexibility for people who opt into the system and then decide that they want to change that. The opt-out model does not create the capacity that we need with regard to professionals—to know where they are, to provide on-going training and updating of training, and to ensure that we have actively asked healthcare professionals, “Are you intent on doing this work and have you opted in to do it?” That is what will create the specialist team to deliver across the country for everyone. Otherwise—this is one of my concerns—some people might only ever have one patient request assisted dying of them over the course of their career. To put an individual in that situation is not fair and does not necessarily provide all the safeguards that the bill has been pointing towards. That is why I see the opt-in model as providing exactly what we want to achieve.

Amendment 194, which also touches on some of the issues that Jackie Dunbar was perhaps pointing to, is from the BMA, which represents all branches of practice by doctors who will be associated with carrying out the functions in the bill. The BMA is neutral on the principle of introducing legislation on assisted dying but wants to ensure that any legislation that is introduced protects the needs of doctors, whether they choose to or choose not to provide assisted dying to their patients. BMA Scotland members are concerned that choosing to or choosing not to provide assisted dying might impact on them professionally and that they might be subject to discrimination or detrimental treatment in their current job or with regard to any future job that they might apply for. Concerns include jeopardising career prospects and being ostracised.

All other jurisdictions where assisted dying is being introduced and debated have included statutory protection for doctors from detriment on the basis of their views and/or intentions with regard to assisted dying. Amendment 194 includes protection for the employee-employer relationship and for potential employees and GP partners who are independent contractors to the NHS. It would protect those who might wish to participate and those who choose not to participate in assisted dying for any reason.

During the stage 1 evidence, other professional bodies representing healthcare staff took a similar position to BMA Scotland on the need for the inclusion of additional protections in the bill. The committee also recognised the issue and requested further consideration at stage 2. I urge committee members to vote for this and other amendments that provide protection for health professionals against discrimination or detriment based on their views and intentions in relation to assisted dying.

I move amendment 151.

Listening to the debate, I think that the delivery of an opt-in system will address a lot of the concerns, and I am therefore keen to see it in the bill. Real-world experience is what we will all be looking towards if the bill is passed. This is very much about hospices, care homes and hospitals, but the wish of the vast majority of people is to be able to die at home, and the question is how that will be fulfilled by professionals with the experience and the training. As the best way of doing that will be through an opt-in system, I will press amendment 151.

Good morning, colleagues. Amendments 151, 154, 186, 198 and 213 would establish an opt-in model of participation for healthcare staff. The proposal for those amendments comes from a number of organisations that represent healthcare professionals who are associated with carrying out the functions in the bill. All those organisations are neutral, in principle, on introducing legislation on assisted dying, but they want to ensure that any legislation that is introduced protects the needs of healthcare professionals who choose or choose not to provide assisted dying to their patients. If assisted dying were to be introduced by the bill, that would be a significant change for healthcare professionals. Therefore, it is vital that they are given a genuine choice as to whether to participate and to what extent.

The amendments would allow only those individuals who have registered that they are willing to carry out functions under the legislation to take on the roles of co-ordinating doctor, independent doctor, authorised health professional or pharmacist responsible for supplying an approved substance for use under section 15 of the bill. Amendment 198 would establish a register of willing individuals for that purpose.

In its stage 1 report, the committee called for further exploration of an opt-in system at stage 2 and recognised that a number of stakeholders were in favour of such a system. The BMA firmly believes that only those individuals who positively choose to provide the service should be able to do so, and has long called for an opt-in system for healthcare professionals, should the law change. That has been accepted in other parts of the United Kingdom and Crown dependencies in all current legislation making its way through those jurisdictions. In Jersey and the Isle of Man, doctors and nurses register their intent to provide the service. Under the Westminster bill, doctors and nurses opt into the required training.

The preferred model would be a register, as it would have the added advantage of making it easier for health professionals to direct a patient to a doctor who would fulfil the role of co-ordinating registered medical practitioner. It would also make it easier for the co-ordinating medical practitioner to identify someone to fulfil the role of independent registered medical practitioner and, if required, an authorised health professional. A register would also allow health boards to accurately map the staff who are available locally and nationally to provide assisted dying.

I welcome the fact that Liam McArthur recently agreed that the bill should be based on an opt-in system. However, I believe that that must be made explicit in the bill in order to give health professionals across our country the reassurance that they need.

It is important that we recognise the psychological difference between assisted dying being something that all health professionals could be expected to participate in versus it being expected only of those who have positively chosen to opt in. Some of the benefits of establishing an opt-in model are that it would give a greater degree of choice about participation, protect against any expectation or pressure to do training and participate, and ensure that staff who participate receive the appropriate training and are deemed competent to carry out all roles.