I will speak briefly in support of Liz Smith’s amendments in the group. At stage 2, I proposed amendments that would have created a commission—a cross-party body—to oversee the guidance. My reason for doing that is that I believe strongly that much of what we are talking about, including the fundamental issues, will boil down to matters of practice, professional procedure and the culture that will develop surrounding the legislation. Therefore, it is absolutely vital that the guidance that is developed is not treated like guidance in other areas on which we legislate. It should continue to have on-going parliamentary oversight so that Parliament can continue to monitor it and input into its development. Liz Smith’s proposals are very sensible; indeed, I would say that they are the bare minimum that we require for Parliament to maintain oversight over what will be incredibly sensitive guidance.

Jamie Greene made the relevant point that we cannot bind our successors, and we do not know what they will do. However, equally, no legislation is immutable. There is no telling what future Parliaments might do to the legislation. All that they need to do to undo any of the elements that we have considered is to find a simple majority. Notwithstanding that, we have to legislate in good faith and assume that our successors will make the right judgments, just as we are attempting to make the right judgments today.

I urge members to support Liz Smith’s sensible and necessary amendments.

I thank Jamie Hepburn for his comments. Fundamentally, it is important that we recognise that the medical practitioner will not be the only source of possible information, but that they have a unique and distinct relationship with the patient in this context, and that is what we are discussing. To assume that the medical practitioner is the only possible source of information would be to misunderstand what we are considering right now.

This is quite a group of amendments to attempt to sum up, but I do not think we should be surprised by that because we are all aware of the delicate and sensitive nature of the doctor-patient relationship and we know that we are contemplating legislation that will enable something that is quite different from what is ordinarily discussed and considered within that relationship. We must acknowledge that. Although we can talk about technicalities, as we have done with other groups of amendments, this group puts us in the consulting room.

I pay tribute to Edward Mountain. He did well in making the point that this is about when the right moment to have a discussion is, and his sharing of his insight and story was helpful. I have never been in that situation. The closest I have come to it was when my daughter was born and we were in hospital. I do not want to go into all the details, although I have shared some of them with Mr Mountain. I always thought that it was a euphemism when people said that the room was spinning when they were being told information and had to make decisions, but it is not a euphemism, because that is literally how it feels when you are faced with doctors telling you things in some detail, in 30 or 45 minutes, and you have to make decisions. The room spins and you do not take it all in. That is what happens when you contemplate life, and it would be more profound if you were contemplating death. I can only imagine what that is like, but it is important that we realise that, therefore, the introduction of information about the options is incredibly delicate. There is a question as to whether that is a matter for the bill itself or for guidance, but any guidance is out of our hands whereas the detail of the legislation is in our hands.

There has been much discussion about presenting all treatment options. I speak as someone who voted for the bill at stage 1, but who does not consider assisted dying to be a treatment option. It is an option, but it is not a treatment option. Treatment alters the course of a disease, improves a condition or alters a state of life. We are considering something quite different—the ending of life. That is in a different category from other things that a doctor might advise, such as analgesics or things that might alter an underlying disease.

I understand that those things are happening, but we are talking about an option where the express objective is to end life and bring about death.

I am happy to do so after I finish my point.

I recognise that none of those conversations is easy—that they are all quite difficult. The amendments are not about prohibiting those conversations; they are simply about the point at which they should be initiated.

18:45

The intent of amendment 292 is to provide direct accountability through oversight of data. My concern is that, across the bill, we would be creating general or corporate responsibilities, but some of those areas need the direct accountability of an office-holder. Unfortunately, the drafting of the amendment is not good enough, so, when Jackie Baillie suggested that some of the other members speaking to this grouping might be being silly, in my case, she was being quite accurate. [Laughter.] I will not move the amendment.

I take the member’s point. I do not mean to use the term “death” in a way that would take away from the points that have been made. I note, however, that the chamber elected not to make suffering a condition for consideration of the issue.

I accept that there is a point around information. I am asking the chamber to think about the impact that that information has when it comes from the doctor who is in consultation with the patient at that time. To reflect Jeremy Balfour’s point, we need to think carefully about the authority that a doctor has in that relationship and the impact of their words.

I respect doctors’ professional judgment but, unfortunately, they do not always get it right—I have experience of that. However, we need to understand that, given that we are talking about the point at which people are dealing with the most difficult healthcare considerations, if a doctor presents assisted dying as an option at the end of the list of options, that will have an impact. As Bob Doris put it, that is not a neutral option.

I do not believe that doctors are the only information source. Ross Greer’s information was helpful in that regard. Members may decide that what I am proposing is not right, but it would be false to say that it would deprive people of information. If my proposal were accepted, we would need to think carefully about how that information could be provided. I am saying that we also need to think carefully about the impact of the information being provided by the self-same person who is presenting difficult news to a person.

My amendments do not prevent communication. They seek to strike a balance. One of the things that my amendments make clear is that, once the conversation has been initiated, nothing prevents it from taking place. There is a danger that, if we frame the proposal in other ways, some ambiguity might be caused, but I think that the position in my amendments is clear.

Ultimately, I have some concerns about the fact that a great deal of what happens will end up being dealt with in guidance. The conversations will involve nuanced interactions, and we cannot legislate for that. I think that that is unfortunate, in a sense. That is why, at stage 2, I lodged amendments that sought to provide an unusual level of parliamentary oversight with regard to the development of the guidance. Unlike any other form of guidance, that guidance will be incredibly sensitive. If the bill passes, the guidance that will be required will have things in it that will have a huge impact.

Other people have mentioned other jurisdictions where certain provisions have been put in place. All that I would say is that I do not think that the Parliament should be trying to short-circuit the process. Furthermore, it will be open to us to legislate further in the future. Simply saying that other places have looked at the issue and taken other options is not an argument against the amendments. Perhaps that is a journey that we need to go on.

Although I have a great deal of sympathy for what Jeremy Balfour has set out in amendment 243, I have problems with requiring a conversation to be ended immediately. I understand that such a situation would need to be treated very carefully, but phrasing the provision so tightly that the conversation would have to be ended is problematic.

At the start of stage 3 proceedings, I set out that the Parliament has a choice about whether it wants an expansive bill that permits certain acts, or a restrictive bill that puts in place safeguards and allows those acts to be taken only by exception. My amendments in this group are critical to that and follow on from similar amendments that were lodged at stage 2.

Whether the matter of assisted dying is raised as a matter of course in dialogue with one’s doctor, or raised only when an individual brings it up first, is a critical issue. I note that the amendments in the names of Brian Whittle and Jeremy Balfour have similar intent and effect.

Amendments 18 and 19 would make two simple, straightforward changes to section 18A. Section 18A(1) would be amended to say that

“No registered medical practitioner may raise the subject of the provision of assistance in accordance with this Act with a person”

and section 18A(2) would go on to say that

“nothing in subsection (1) would prevent a registered medical practitioner from discussing the matter with a person when the matter is raised by that person.”

That would make it clear that this is about ensuring that the matter is discussed only when an individual chooses to raise it, that it is not proactively offered and that it does not become the norm or part of medical practice—it is by exception and requires clear intent from the patient.

I move amendment 18.

I thank Mr Balfour for his intervention. That is helpful.

In a sense, I think that Parliament has accepted the principle. If we accept that it would not be right to raise the topic of assisted dying with an under-18-year-old, have we not already accepted that it is a sensitive matter that must be discussed only once that is instigated by the individual? I suggest that, if the under-18-year-old would be in a vulnerable state, anyone who was facing terminal illness would be in a vulnerable state, and they need to be treated equally sensitively.

I press amendment 18.

Alasdair Allan makes an excellent point about the subtle cues in detecting coercion. Does he agree that the point about communication goes in the other direction, too, regarding the information that a patient might seek when communicating with the doctor before making a very difficult decision? There is an issue in relation to detecting coercion and another in relation to the patient themselves. Nobody makes a decision by themselves—we are social beings—so it would be vital for the patient as well as for the doctor that there was good-quality interaction.