Chamber and committees

For absolute clarity, up to the point of a declaration that the patient wished to seek assisted dying, all the notes would be readily available. Once the assessment was to be made after the declaration, however, I think that it would be absolutely crucial that both medical practitioners were independent, because they both have to come to the same conclusion for assisted dying to be granted. To make that absolutely independent is crucial.

That is entirely within amendment 153—the patient has the ability to say, “I don’t need to fill anything in,” and that, in itself, is an advance care directive. There is no need to write screeds of text. If the patient does not want to participate in an advance care directive, that, in itself, is completing an advance care directive.

I seek the convener’s clarification. I am pretty sure that questions about what can happen when medication does not work were asked when we heard evidence from other parts of the world. I am pretty sure that the answer was that those instances were very rare but that it has happened. I disagree with Ms Harper, because I am sure that we heard about that during evidence.

It is exactly that point that started me down this route. On the very rare occasions—and it is rare—that the system does not work and it leaves the patient either incapacitated in a vegetative state or incapacitated in pain, an advance care directive clarifies the patient’s wishes.

My overriding concern is that, if we are asking two independent medical practitioners to make a consideration, they must be able to come to the same conclusion independently of each other. One cannot influence the other. That is absolutely crucial to the bill.

I welcome Liam McArthur’s offer to engage in developing amendments. I restate that I am undecided about my position at stage 3. In considering all amendments, I will be seeking to make the bill the best piece of legislation that it can be.

I will speak to amendments 155 and 196. In relation to amendment 196, the concern is that the care of patients who seek assisted dying will extend beyond the authorised health professional roles that the bill specifies. All healthcare professionals who provide care to a patient who seeks assisted dying should have adequate training. Amendment 196 recognises that the relationship with healthcare professionals who look after patients may alter when a patient decides that they will take the route of assisted dying. We have not considered that, which is why I lodged the amendment. It provides for the Scottish Government to bring forward training on the legislation for healthcare professionals. As I said, it is key that those who care for people towards the end of their life are able to understand the decision that is made by a patient and maintain that relationship.

The concern behind amendment 155 is that medical professionals’ opinions must be truly independent of each other. Amendment 155 would limit access to notes by the independent practitioner. Except for seeing the referral, the independent practitioner would not be able to consult the co-ordinating medical practitioner on the case, and, from the point at which the first declaration was made, they would not have access to the notes by the co-ordinating medical practitioner, including that practitioner’s assessment.

I listened to what Liam McArthur had to say, but my concern is that the position needs to be absolutely clear and has to be in the bill. Once a patient has declared their intention to seek assisted dying, there must be no co-ordination between the two assessing practitioners. That is why I lodged amendment 155. It is important that both medical professionals are truly independent of each other.

I welcome Pam Duncan-Glancy’s amendment 220, which she spoke to very powerfully. I also commend the work that Tanni Grey-Thompson has done—having sought her advice, I know that she is a powerful advocate on this issue.

I would welcome engagement across parties and, more importantly, from the Scottish Government at stage 3. I recognise that the Government is neutral but that does not mean that it cannot advise on operational challenges that the amendments could cause. Arguably, by failing to engage, the Government would in effect be acting against the bill. If the bill is going to be the best that it can be, it must be deliverable, and the Government needs to advise on whether it would not be deliverable.

I declare my position: I have not decided what my position will be at stage 3. In considering all the amendments, I am seeking to make the bill the best piece of legislation that it can possibly be.

I have lodged my amendments in this group because of my concern that an individual who may have a moral or personal reason to oppose the decision of the person who has made an assisted dying declaration could use the police or court system to delay the process through a protracted investigation resulting from an allegation of coercion. Amendments 161, 164, 169, 172 and 174 create a mechanism for review that is independent of the medical profession, for use in cases where people who are close to the patient—that would be family, named friends or carers—suspect or allege coercion.

I have tried to model my approach on a similar independent assessment model for organ donation, which has a 10-day reporting time. Amendment 162 says that reports should be referred to the medical professional or police where appropriate; amendment 210 gives the Scottish ministers flexible powers to create the model. The mechanism is triggered only when those close to the patient express that concern. The 10-day reporting time is also included in an effort to not prolong the suffering of the person who wishes to access assisted dying.

The driving force behind the amendments was the realisation that, as the bill stands, if somebody tries to access assisted dying and there is an objection from a relative or close friend, they could be wrapped up in a legal court case because the police would be duty bound to investigate any such allegations. We all recognise the length of time that that can take—by which time, the person who has tried to access assisted dying may be unable to comply with the rules and regulations or may have passed away. The amendments are about trying to protect the person who wishes to access assisted dying and make sure that they do not suffer excessively.

Will the member give way?

Rhoda Grant and I have made the point—quite strongly, I think—that we are not forcing people into palliative care or into social care. However, the important point—the key element—is that, in order to make an informed choice and to provide an even choice, palliative care must be available.

I am very grateful to you for taking my intervention. Surely you would accept that, in order to make the choice not to accept palliative care, an individual has to be given the option of palliative care in the first place. You and every other member here are aware of the inequality of access to palliative care. We have talked about how quality of life can be greatly enhanced by palliative care. Not having access to palliative care much reduces quality of life. The decision to access assisted dying has to be a decision of equality. Not having access to palliative care creates a real problem with the bill.