Chamber and committees

If I may, I will finish my sentence, at the very least.

The concern is that, because of the intimate nature of hospices, practice with regard to one person may well interact with practice for others in the same context. We are talking about small settings where the small numbers mean that there are not sufficient staff to undertake the proposed duties, particularly if there are staff who wish to opt out, which there may well be. There is a great deal of concern among those who work in hospices. I have spoken to such people—just outside my constituency, actually, rather than inside it—and there is concern that there may not be sufficient capacity or the necessary physical layout to provide what is proposed in the bill in a delicate and understanding way, because there will be implications for other people.

With that, I have finished my sentence, so I will first take Mr McArthur’s intervention and then listen to Mr Balfour.

I will be speaking to a number of Jackie Baillie’s amendments today, and I ask members to bear with me as they hear more than they might have expected to hear from me.

At last week’s meeting, we heard the concern that, although we can examine what is in the bill, what will be enacted and put into effect will be a matter of practice and of professional conduct. That is why training is so important both to how the bill operates at the start, should it be passed by Parliament, and to how it continues to operate as it evolves over time. It is important to ensure that the bill makes adequate provision both for the training that will be required by the professionals we will ask to make the most sensitive of judgments, and, critically, for the oversight of that training.

I am grateful for your reflections on those points. Do you acknowledge that the amendments that have come from the professional bodies themselves reflect a need or desire from the professions that we strike a slightly different balance as to where not just training but qualifications sit and how they are reviewed?

I understand Liam McArthur’s reluctance in relation to a full referral, but does he acknowledge that simply discussing options can sometimes be a little narrow? There needs to be the practical ability to act on those options. Does he agree that there is scope for looking at positively signposting options rather than simply discussing them or having a default referral? In a medical context, discussing options can sometimes be very narrow and about mere possibilities rather than actual things that a person can avail themselves of.

Yes. It is certainly not nonsense to raise concerns about patient pathways. In any clinical circumstances, a patient journey and the degree to which it is patient-centred is of critical salience. We live in a world in which healthcare settings are very complex, terminology is used that people do not necessarily understand or are not familiar with, and there are considerations and circumstances that people are not used to. Healthcare is often disempowering to the patient. Therefore, making sure that those settings are such that people are comfortable is important.

Another thing that very often happens in a healthcare setting is that people’s decisions are, naturally, influenced by the broader assumptions within such settings. I do not dismiss that for a moment. If the member is asking me whether there is speculation, my answer is, yes, there is. That is absolutely what stage 2 is about. It is about exploring such speculations.

I recognise the complexity of allowing opt-outs and that patients might need to move. I see that Sandesh Gulhane is forming words, but I would like to make a little progress. I did not intend to speak for so long on this group. I am just asking us to contemplate. It is not that I dismiss those things, but I ask those people who are asking about movement causing disruption or distress whether the reverse is also possibly true. Given the very intimate setting of a hospice, introducing someone into that environment with a set of assumptions in favour of assisted dying may well cause disruption or distress for the other cohort of people. I do not think that the issue is binary, but I ask the committee to consider that.

Amendments 74, 80, 81 and 82 were also drafted in conjunction with the Royal College of Psychiatrists. I promise that I will not speak to those at such great length as I have spoken to the previous amendments.

Amendment 80 would create a register of psychiatrists to undertake capacity assessments. The key point of amendment 74, if it is not pre-empted by amendment 159, is that such assessments should be drawn by practitioners from a central register. Amendment 81 would ensure that the register of psychiatrists was not just a list but would be used to improve learning and general clinical practice. It would enable data collection on assessments that were carried out under the bill to be used for oversight. Amendment 82 is a consequential amendment.

Throughout our deliberations, there has been a concern about making assessments of capacity. The psychiatric profession in particular is taking a keen interest in that. When it comes to people with associated mental health conditions—particularly. in later life, dementia—getting input and a detailed understanding from the psychiatric profession is very important.

Those points are well made, but we must be clear about what amendment 66 would do and, critically, where it comes from. Jackie Baillie’s amendments were drafted in conjunction with the British Medical Association and other professional bodies, so it is not MSPs who are asking for this but the profession itself, because doctors are concerned about the very points that I am setting out. Furthermore, amendment 71 states plainly that the regulations “must” be made in consultation

“with trade unions and professional bodies”.

Such matters are always about balance, but the medical profession and medical practice are highly regulated. It is not true that the law has nothing to say about medical practice or that it does not set out standards, review periods and expectations about training, because it does. Amendment 71 would require ministers to put in place regulations that set out training requirements and professional standards, which would be kept under review.

Amendments 66, 68, 70 and 72 are largely consequential. In addition to the medical and clinical considerations, amendment 71A sets out the need to consider domestic abuse. There has been a great deal of concern about the possibility of individuals facing undue pressure or coercion by third parties. Amendment 71A was drafted in consultation with Dr Anni Donaldson, an academic who is an expert on domestic abuse. It is important that any such training takes account of the dynamics of how domestic abuse can take place, how to respond effectively when that may be in play, and how treatment can be offered in such circumstances.

Amendment 49 was drafted in consultation with CHAS, which Liam McArthur referred to. Although CHAS operates in Jackie Baillie’s constituency, its office is in my constituency. I do not know whether that is a declaration of interest, but there is certainly an overlap.

It is true to say that the way in which terminal illnesses manifest in young people can be substantially different in how patients are treated and the nature of those illnesses. Understanding the prognoses requires a great deal of attention.

It is right that we think about how the provisions in the bill might extend to younger people—they will find themselves in a very different set of circumstances from the bulk of the people who we think of as being in this cohort, who will be substantially older. Amendment 49 therefore seeks to add specific training requirements for those who will consult young adults and younger people and assess the degree to which the illness is terminal, advanced and progressive. The amendment would require additional qualifications and understandings on that.

Yes. It is certainly not nonsense to raise concerns about patient pathways. In any clinical circumstances, a patient journey and the degree to which it is patient-centred is of critical salience. We live in a world in which healthcare settings are very complex, terminology is used that people do not necessarily understand or are not familiar with, and there are considerations and circumstances that people are not used to. Healthcare is often disempowering to the patient. Therefore, making sure that those settings are such that people are comfortable is important.

Another thing that very often happens in a healthcare setting is that people’s decisions are, naturally, influenced by the broader assumptions within such settings. I do not dismiss that for a moment. If the member is asking me whether there is speculation, my answer is, yes, there is. That is absolutely what stage 2 is about. It is about exploring such speculations.

I recognise the complexity of allowing opt-outs and that patients might need to move. I see that Sandesh Gulhane is forming words, but I would like to make a little progress. I did not intend to speak for so long on this group. I am just asking us to contemplate. It is not that I dismiss those things, but I ask those people who are asking about movement causing disruption or distress whether the reverse is also possibly true. Given the very intimate setting of a hospice, introducing someone into that environment with a set of assumptions in favour of assisted dying may well cause disruption or distress for the other cohort of people. I do not think that the issue is binary, but I ask the committee to consider that.

Amendments 74, 80, 81 and 82 were also drafted in conjunction with the Royal College of Psychiatrists. I promise that I will not speak to those at such great length as I have spoken to the previous amendments.

Amendment 80 would create a register of psychiatrists to undertake capacity assessments. The key point of amendment 74, if it is not pre-empted by amendment 159, is that such assessments should be drawn by practitioners from a central register. Amendment 81 would ensure that the register of psychiatrists was not just a list but would be used to improve learning and general clinical practice. It would enable data collection on assessments that were carried out under the bill to be used for oversight. Amendment 82 is a consequential amendment.

Throughout our deliberations, there has been a concern about making assessments of capacity. The psychiatric profession in particular is taking a keen interest in that. When it comes to people with associated mental health conditions—particularly. in later life, dementia—getting input and a detailed understanding from the psychiatric profession is very important.

I think that Sarah Boyack will come in on exactly those issues.

Thank you very much for those introductory answers. I will now bring in some of my colleagues, starting with the deputy convener, Michelle Thomson.

Is it all hype or are we seeing acceleration?