Chamber and committees

I have nothing further to add.

Amendment 7, by agreement, withdrawn.

Amendment 112 not moved.

Although I very much appreciate having a group entirely to myself, I think that, in some ways, these amendments should be considered with the amendments in the previous group.

To my mind, there are two hugely important elements to the bill. The first is the judgment that will be made by medical practitioners as to whether an individual meets the criteria set out in the bill: that they are terminally ill and unable to recover. In those circumstances, they would meet the criteria for assisted dying.

The other really important element is that individuals will have to fully consider all the options that are available to them. To that end, the 14-day period is doing an awful lot of work, and I am not sure whether it provides a sufficient safeguard. It is an arbitrary time period. It is neither short enough, if death is imminent, nor is it long enough to provide a genuine period of reflection if an individual’s death is not imminent and they are planning ahead of time.

I will not move the amendments, which are probing. I wanted to draw to the committee’s attention the fact that the 14-day period is doing an awful lot of work. There need to be more safeguards to ensure that the individual makes a clear decision. Facing the end of life is clearly going to be difficult and, as human beings, we often find it difficult to make fully rational judgments.

I note that the committee has rejected a large number of amendments that seek the provision of additional information. This is an area that needs to be considered at stage 3 to ensure that people have full information, can reflect and can make a careful and considered decision.

I will not move the amendments at this time.

I support the amendments that have been lodged by Jackie Baillie, which have the support of the Royal College of Nursing. We must have clarity on roles. The final provision of the substance is particularly sensitive. It is also important that we have clarity about not only the role of the registered medical practitioner but those of other medical professionals and in what combination those roles take place. The role of nurses and the points about accompaniment and supervision are very important.

I voted for the bill at stage 1 on the basis of the principle that people should have bodily autonomy, and because the bill is very much about people whose death is imminent and enabling them to make the final decision and to carry out the final act.

That last point is very important to me, which is why I have lodged amendment 10. Although I note the intent of the legislation and what is set out in the policy memorandum, I am concerned that there is not sufficient clarity that the final act will be that of the individual. My amendment seeks to specify that, for similar reasons to those that Marie McNair pointed out.

Throughout the discussion, great care has been taken about the language—whether this is assisted dying or suicide—and the bill very much rejects any notion that this could be viewed as euthanasia. I understand that. Those are important distinctions. It is important that this is about enabling someone to act for themselves and do this to themselves. It cannot be about enabling an act in which one person is administering a substance to another.

There is a big difference between enabling someone to end their life and enabling others to end others’ lives. One is about enabling one’s own death. The other is, quite simply—as a matter of moral distinction—killing another person. I use that word advisedly because there is an important moral distinction. It is easy in these settings to highlight the complexity and say that, in practical terms, there are not necessarily those distinctions, but the moral differences are important.

I also think that, practically, it is essential that an individual has the ability to withdraw their consent to ending their own life up until the very final moment, which is why self-administration is so important. My amendment seeks to clarify that, because there are also sensitivities about a person’s physical capacity to undertake that.

The amendment specifies that the act would be for the individual to carry out, and specifies that the co-ordinating registered medical practitioner may

“prepare that substance for use by the adult ... prepare a medical device which will enable the adult to use the substance”

and assist the adult for the final ingestion of the substance.

My amendment further clarifies that, those points notwithstanding, the final decision must be made by the individual themselves and, further, that the co-ordinating registered medical practitioner may not administer the approved substance to the individual directly.

Those are important clarifications that state clearly and specifically what the bill would authorise. As I have stated, I think that it is important that we have that moral clarity and that moral distinction, but, ultimately, it is vital that it is the individual’s choice and that they can withdraw their consent right up until the final moment. That is the reason for my amendment 10.

I wonder whether Brian Whittle would agree with me that there are two fundamental points here. First, it is important that safeguards are put in place, especially where those issues have been raised by the people who would be delivering the bill. Secondly, as we proceed, given the sensitivity of the issues, we have to be seen to be providing those safeguards. Those are two very important purposes. The second point is about providing strong signals and clarifying principles that we want to see if the bill is to be enacted safely with the confidence of the people who we are going to ask to deliver it. I wonder whether Mr Whittle would agree with those two distinct points.

I thank the committee for its forbearance in allowing me to speak remotely. I have had to do a bit of juggling this afternoon.

With regard to the amendments, I say up front that I think that Jackie Baillie’s amendment 53 is very important. Having previously spent some time around the sick kids hospital in Edinburgh, I realise that, for many families, healthcare settings are home. They are part of everyday life and the medical teams are part of the extended family, and discussing matters with them seamlessly and on an on-going basis is very much part of the day-to-day norm. The prospect of assisted dying being discussed with a young person in that context is hugely problematic, which is why amendment 53 is so important.

My amendments seek to extend the age limit in amendment 53 a little further. Under previous groups of amendments, we discussed the differences for those who are facing terminal illness earlier in life. There are different considerations for them and there are questions regarding the capacity of people up to the age of 25, when brains are still forming.

My amendment would not withhold treatment for those aged under 25; it is just about recognising that such treatment needs to be dealt with differently.

In that regard, I am careful to state that Jackie Baillie’s amendment is important in its own right. My amendments are simply about exploring whether there is a lighter-touch way to address the point about those aged under 25. They are not about preventing treatment or providing that people aged between 18 and 25 would be precluded from having an assisted death; they would merely provide that the options could not be proactively raised with them. Amendments 53A and 53B would give effect to that.

I note what Liam McArthur is saying, and in a sense, he is right, but would he also observe that those amendments were lodged following the RCN requesting them, so the profession itself is asking for those restrictions? Why does he think that those observations—and, indeed, requests—should be rejected?

That is why training does not exist on its own. It would be for the guidance to set out good practice and the point at which someone would need to use the training from training providers. That is not to say that it would be the only training available to help people who were dealing with such situations.

In broad terms, yes. I have thought for a long time that initial teacher education should focus far more explicitly on additional support needs. Within that, there should be real clarity about elements of cognition and executive function and, by extension, de-escalation. It should be a core topic for anyone embarking on a teaching career.

I can respond in a number of ways. In essence, my bill does not alter that situation. If those things are occurring, we want to know about them. If people are making interventions, we want them to happen when the people concerned have already been properly informed and appropriately trained.

In a sense, there is a tension here for me, in that I almost do not know who to believe. On one hand, I am being told that everyone is already complying with the guidance. If that is the case, I would say, “Great, so what is the issue with putting it on a statutory basis?” On the other hand, people tell me that the bill will have massive resource implications. In that case, I would say, “I thought you said that everyone was already complying with the guidance.” You cannot have both going on.

Most fundamentally, let us be clear that there are different cohorts and different dynamics. Overall, when looking at education policy, you have to consider everything all at once. What I am looking at is the situation for children with additional support needs, who are often of primary-school age and often have quite profound needs. The wider issues of behaviour and violence in schools are a much bigger topic, which extends through the age range, and that is reflected in the evidence that we have had from people working in education. That was also quite clear from Lynne Binnie’s contributions.

The fact that there are other issues and problems—and even ones that are connected—does not mean that we should do nothing. The bill can provide clarity and will provide support and training to practitioners who really need them. Ultimately, it is also about providing clarity for parents.

My other response, especially on the point about violence in schools, is that that is a different situation, but that, as a parent, if my child is involved in an altercation in school, I would want to know. I would want to know if they were on the receiving end of that; I would want to know if they were the instigator. If that situation involved a teacher, I would want to know, and I would also want schools to have a clear understanding of such situations and what they are doing about them and to have a clear plan to deal with that. My bill does not detract from that; in fact, it might even help.

Let us again be clear about what the bill would and would not do, and what the definitions would and would not do. The definitions are simply about providing the scope of practice around which there needs to be guidance from the Government. The bill does not state that anything would be prohibited, nor does it provide for any penalties. The bill literally states that the Government must provide guidance for actions that fall within that scope of practice. It is then for the guidance to provide the sort of clarity that the member quite rightly seeks.

That is a normal way for the Parliament to proceed. Jackie Dunbar is here—we had a similar discussion yesterday about the Assisted Dying for Terminally Ill Adults (Scotland) Bill. There is a balance between the boundaries that we create in legislation and the things that we leave as a matter for guidance. What I am saying is that there is a scope of activities that need to be regulated by guidance. It is then for the guidance to specify precisely what those activities look like.