Chamber and committees

I am sorry to prolong the debate on this issue, but I am struggling with the fact that one of your amendments would have the bill say that what is recorded as the “direct cause of death” is the terminal illness, because that will not be the case. Those individuals will have accessed assisted dying because of an illness that would have ultimately led to their death, but it will not be the direct cause of death. I am struggling between your amendment 37 and Pam Duncan-Glancy’s amendment 247, and I do not know where to go on the issue. I think that the answer somehow lies between both amendments.

I raised a similar issue in a previous amendment, although I did not mention the procurator fiscal. The issue would be malicious intervention by other members of the family, and the moral grounds for trying to prevent someone from accessing assisted dying. I was asking for a 10-day window and an independent adjudicator, but my amendment was not passed.

If the procurator fiscal was brought into the process, would that not mean that the length of time that it took for the case to be processed would be such that the person who was trying to access assisted dying might have already died?

Thank you for that intervention on my intervention. In that circumstance, it would be the patient, not the GP, who had raised the matter of assisted dying—that is the key. I cannot envisage any situation in a patient-GP relationship in which it would be appropriate for the GP to raise the issue of assisted dying.

Amendments 178 and 180 seek to deal with concerns, in the event that something does not go to plan, about the liability of medical professionals who are not in the room and are not immediately aware of any adverse reaction, should it occur. In essence, the amendments would ensure that the medical professional providing the substance must remain in the same room as the patient.

I turn to amendments 185, 177, 173 and 175. It has been my approach, as a committee member, to take a neutral stance on the ethical and moral issues surrounding assisted dying and to focus instead on ensuring that the legislation is as good as it can be. In line with that, I have evaluated the approaches that were put to me by organisations looking for someone to lodge amendments on their behalf in order to identify where I believe such amendments would improve the legislation.

There are clearly gaps for the pharmacy profession, which I hope we can address—if not at stage 2, then at stage 3. The concern is that the bill is not clear on the role of pharmacists in the process of assisted dying with respect to their scope of practice. That could also risk devaluing the skills of the pharmacist. Amendment 185 seeks to make provision for registered pharmacists to undertake the role of the authorised health professional, clarifying the role of the pharmacist in the process and allowing them the clear option to use the conscientious objection clause.

Amendment 177 seeks to limit the role of the pharmacist within their scope of practice but does not expect them to make decisions on the competency of the individual.

Amendment 173 seeks to clarify that a pharmacist should supply the substance to the registered medical practitioner or authorised healthcare professional and would also allow the option to use the conscientious objection clause.

Amendment 175 seeks to limit the role of the pharmacist within their scope of practice when acting as an authorised health professional to providing a terminally ill adult with the approved substance and to removing it from the premises at which it was provided.

I move amendment 173.

I am really struggling with this—not with your amendment as such, but with the thought that doctors would actually raise the issue of assisted dying. I cannot, for the life of me, think of a situation where a GP would say to a patient, “We’ve tried everything else; have you considered assisted dying?” I just cannot get my head round the fact that we would be giving GPs the opportunity to have that conversation and I do not even know how they could start it. Would we not be taking healthcare into a completely different sphere if we gave GPs licence to raise assisted dying?

Yes, I will in two seconds. It will be an intervention on an intervention—I like that. I cannot imagine those circumstances because, as Jackie Baillie highlighted, there is a unique relationship between a patient and a doctor, and I suggest that, in and of itself, a GP raising the option of assisted dying is a form of coercion. I cannot imagine a single situation in which a GP could be the person to raise the option of assisted dying.

Amendment 202 is a simple amendment that asks that, as part of the annual report, a review be undertaken to ensure that the independence of registered medical practitioners is being maintained in practice. That would require data to be anonymised to adhere with the general data protection regulation, and the review itself should be independent, too.

Turning briefly to the amendments in the name of Jackie Baillie and Pam Duncan-Glancy, I feel that it is absolutely fundamental that the services and the system are able to cope and have the capacity required to deliver the bill, and that will include carrying out a review of palliative and social care services. Once again, I have been struck by Pam Duncan-Glancy’s remarks on the quality of life, and I would just like to highlight a simple example in that respect.

Members knew that I would get sport into this somewhere, but in relation to powerchair football, I have been struck by the value of interaction. I want to mention powerchair football for two reasons, the first of which relates to the Ayrshire Tigers. It is evident to me that social interaction and the ability to be social are fundamental to the players’ quality of life, having seen a couple of them unable to participate, because they were unable to get transport. We take that sort of social interaction for granted.

The other reason that I want to highlight the sport is that I never tire of mentioning the trauma that Alexander Stewart had when he played powerchair football against the Scottish national team. He thought that sitting-down motorised sport would be his way of getting involved in sport, and the trauma that he received has given me no end of joy since.

I could not agree more with Daniel Johnson—the signal that comes out of the Parliament is incredibly important. As we have already held a session on the bill at stage 2, many of us will have already had responses by email and discussions with members of the general public and the medical profession who have raised concerns.

Liam McArthur talked about precedents for the way in which medication is delivered, but what the bill seeks to do is unprecedented. We are asking medical professionals, who operate on the “Do no harm” principle, to do something that they have never done before, so we have to take their views into consideration and ensure that the likelihood of there being any liability on a medical professional is minimised. That is why, at stage 3, I will bring back advance care directives, and should the committee push back against some of the amendments before us, they will be brought back again.

I have a follow-up to the convener’s questions. There is assisted dying legislation in other jurisdictions. Do you feel that elements of the bill differ from other things and therefore require more scrutiny?

As an addendum to Douglas Ross’s point, I am concerned that you have not considered the liability of the medical professional if he leaves the room. We talk about other jurisdictions, but our laws and legal processes are different. Has the protection of our medical professionals, and their liability if something goes wrong, been considered?