Chamber and committees

The minister and many colleagues have mentioned the UK Government’s employer national insurance contribution hike. That hike could cost the social care sector in Scotland £84 million a year. I think that the minister mentioned that the cost could even be £300 million. That is a huge cost for the sector, including in Dumfries and Galloway.

Can the minister reiterate how the Scottish Government is engaging with the UK Government on the issue and provide reassurance that the Scottish Government will continue to press it on the costs?

My question relates to the first question and not the anti-trans supplementary. Can the cabinet secretary say any more about how revising the framework document to permit more financial freedom will benefit Historic Environment Scotland?

Good morning, and thank you for being here.

The bill requires a relevant healthcare professional to diagnose individuals with a drug or alcohol-related problem and then to provide a treatment determination. What are your thoughts regarding the requirement for somebody to receive a diagnosis before they can enter into treatment?

I asked the previous witnesses about the requirement for a diagnosis of an addiction. I am interested to hear your thoughts on the advantages or disadvantages of the bill’s approach to requiring a diagnosis ahead of entering into all the different types of treatment that could be offered.

Some people might not want to seek that diagnosis, then, or the stigma might prevent them from coming forward to access care or treatment because, although they know in themselves that they have a problem with alcohol or drugs, they do not want to hear it. Do we need to find some way of getting people into treatment without a diagnosis?

Thank you.

To be clear, the protection of somebody’s anonymity is one thing that we need to be careful about with regard to the language around addiction. That is something that could be amended in the bill as it progresses.

Before Lee Ball comes in, I need to remind everyone that I am a nurse and I have worked in recovery rooms and operating theatres with people who were harmed by drugs and alcohol.

While you are responding, Lee, can you say whether the language in the bill needs to change? What language would you suggest?

I know that this is a difficult debate for many—we have witnessed that already this afternoon. It is a complex and challenging subject for all of us.

Before I pursue the detail of my concerns, I thank my Health, Social Care and Sport Committee colleagues, including the convener and the clerks, and everyone who provided evidence to us. I remind members that I am a registered nurse—I have been a nurse since 1988. I also thank Liam McArthur for his diligence, his ability to listen and his professionalism in presenting the bill.

I started out with a typed speech, but it has been altered somewhat over the course of the afternoon.

The purpose of assisted dying legislation is to promote choice and dignity. Any process must therefore consider whether the decision is genuinely free of coercion and whether it reflects the person’s authentic wishes, recognising society’s responsibility to honour individual autonomy. Has all possible community and hospital support been made accessible, with adequate consideration of social factors that might influence decision making?

How do we protect those who may be at risk of coercion? I note that Edward Mountain described active, passive and state coercion. We need to make sure that the medical practitioners are educated well enough to assess for any coercion of vulnerable persons. The protections that are contained in the Human Tissue Act 2004 in relation to living donor organ donation are robust and could be a model for comparison.

I note what Rona Mackay said about evidence showing that coercion has not occurred elsewhere. However, we in Scotland would need to support the medical professionals assessing persons who have indicated that they seek to pursue assisted dying. We would need to make sure that those medical professionals could confidently assess whether a person who chooses to pursue assisted dying had been influenced and coerced.

On the issue of opposing assisted dying in favour of supporting palliative care, I note that assisted dying should not be seen as opposite to palliative care. Assisted dying should be seen as one choice that people have to face the end of their lives with compassion, dignity and autonomy.

On conscientious objection, I would want to make sure that healthcare providers who objected on the grounds of their personal preference, including carers in the community, as a minimum referred persons to a health professional who would engage to address what they wished to pursue in terms of assisted dying. Allowing health practitioners to not only exercise conscientious objection but extend that to refusing to pass on a patient’s wishes to another practitioner would risk creating a kind of postcode lottery.

Evidence to the committee also highlighted the particular challenges in more rural areas, where there are fewer GPs and other medical professionals in comparison with urban Scotland. People living in Glasgow or Edinburgh whose GP exercised their absolute right to conscientious objection would have options and other professionals to be referred to in their area. That is not always the case elsewhere, where alternative GP practices or hospitals may be an hour, or 100 miles, away. We do not want a situation in which, if the bill passes, those in more rural areas face higher practical barriers than those in cities to their exercise of their right to assisted dying. I hope that that will be addressed if the bill passes stage 1.

We also heard concerns about those who might exercise conscientious objection and how that might impact their careers. Professional representatives such as the Royal College of General Practitioners Scotland and the Royal College of Nursing were clear that staff should not face discrimination of any kind if they chose to exercise their rights under the bill.

Lastly, I thank every constituent who has contacted me about the bill. Many personal experiences have been conveyed, including those of healthcare professionals who have contacted me, either in support of or opposition to assisted dying, citing the fact that I am still a nurse.

Medical science has improved immeasurably over time, including in my 40 years as a nurse. First-rate, world-class medical professionals apply care to their patients, and I thank them all.

I am content to support the general principles of the bill at stage 1, so that we can continue to probe, debate and engage with one another, and so that the concerns that have been raised by members across the parties continue to be addressed as we go down the road.

On the back of that, I am thinking about the convener’s example of a pylon replacement project and the wider stakeholder engagement provisions in the bill. I will go back to my earlier questions about parliamentary scrutiny in part 1 of the bill. I know that the stakeholder engagement aims to ensure a collaborative approach to achieving nature recovery targets by consulting with a wide range of groups, including land managers, estates, NGOs and various partners, as well as the local authority, which might already have local place plans in development or even being delivered. Does the bill make provision to include the requirement for stakeholder consultation and agreement? I suppose that that goes back to what the convener was asking about. Does the bill mean that the Government can decide to overrule?