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Ms Duncan-Glancy is making a powerful case. Better training for the practitioner who takes someone who is seeking assisted dying through the process is, of course, to be welcomed, but that would not be in place of, say, a social work referral or a palliative care referral, when that is deemed to be required. I ask for clarity on that. Would both be required, or just the provisions that you are setting out?

Before I get into the meat of the four main areas that I seek to amend, I will identify some amendments in this group that are consequential to amendments that we have previously debated. As the convener mentioned, amendments 88 and 89 are part of the group on assessment, but they are consequential to my section 7 amendments 100 and 101 on vulnerable adults. Likewise, my amendment 92 is a consequential amendment to the same section to afford a proxy the right to request a social work assessment. I wanted to put that on the record.

I turn to my amendments in this group, which cover new themes to be explored. They aim to strengthen the assessment process and they are proportionate and sensible safeguards. Together, the intent and effect of the amendments is to make the assessment process more robust, transparent and consistent. I have worked closely with the Scottish Partnership on Palliative Care on the amendments. It believes—and I agree—that significant amendment is required in those areas.

I will try to put my amendments together in such a way as to allow proper scrutiny while being as concise as I can, despite the fact that I need to explore four chief areas. The first is that amendment 90 would require assessing practitioners to inquire about and discuss the person’s reasons for wishing to be lawfully provided with assistance to end their own life. Understanding people’s reasons and motivation for seeking an assisted death is vital and central to assessing whether the process can safely and legally proceed. It is also central to understanding how the bill operates in practice, and I will return to that. However, the assessment process set out in the bill says absolutely nothing about eliciting and documenting the reasons why a person is seeking an assisted death. Amendment 90 would simply require that there is a discussion around that reason.

Amendment 106 would add to the bill a requirement that the statement made after assessments by medical practitioners

“must specify the reasons given by the person for wishing to be lawfully provided with assistance to end their own life.”

We assume that that would happen anyway, but there is nothing in the bill to say that it should, and amendment 106 addresses that.

Amendments 110, 111 and 113 to 115 would amend schedule 2, which sets out the form of the statements by the co-ordinating and the independent medical practitioners, so that both statements would document appropriately the reasons for requesting assisted dying.

Importantly—this is the bit that I wanted to return to—section 24 of the bill sets out what information Public Health Scotland must report, which includes

“the reasons given by persons wishing to be lawfully provided with assistance to end their own lives.”

However, it will not be possible for Public Health Scotland to do so unless the reasons have been identified and documented during the assessment process. Those amendments would address that particular gap.

I move to the second area that I wish to see amended, which is around the discretion that is afforded to the assessing medical practitioners. As drafted, the bill provides sweeping discretion and there is not a clear baseline for clinicians to start from when seeking to make assessments. As things stand, assessing practitioners do not have to discuss any of the following at all with the patient:

“diagnosis and prognosis ... treatments available, palliative ... care”,

or

“the nature of the substance that might be provided to ... end their ... life.”

Amendment 91 would rectify that and ensure that such matters were discussed with the person being assessed. I point out to members that, of course, that is not to say that the person who applies for assisted dying would engage with that discussion. However, at the very least, a practitioner should ask about those matters.

I am conscious that the Scottish Government said that there are deliverability challenges, but it did not take a view on whether the amendments should be supported or otherwise. Of course, the bill process is a three-stage process, and, notwithstanding that I intend to press my amendments, will Mr McArthur work with me either to lodge fresh amendments at stage 3 or to refine these amendments, if they are passed at stage 2, to deal with some of those challenges? Does Mr McArthur agree with the principle of what the amendments are trying to achieve?

Will the member give way?

I appreciate that intervention, which allows me to make a distinction: you just referred to what is implicit in the bill, Mr McArthur, but my amendments would make it explicit. The important thing from that intervention is that you appear to agree with the amendments, irrespective of whether they are required.

If the Scottish Partnership for Palliative Care, which has a huge range of practitioners around the country who do excellent jobs, believes that that addition would be beneficial and if the member agrees with it—even if he feels that it might be a bitty duplication—it would be helpful if he could give a steer that he would be willing to accept those amendments, notwithstanding the points that have been made.

In a similar vein, amendment 94 would introduce a requirement that the registered medical practitioner must advise the person seeking assisted dying to inform a doctor at their GP practice and to discuss their request with those close to them. Currently, there is no requirement for the practitioner to do so.

Amendment 95, along with amendments 96 and 98, respectively, is particularly crucial: it would require that the registered medical practitioner must refer the person who requested assisted dying to a specialist in the particular terminal illness if the practitioner had any doubt as to whether the person was indeed terminally ill and, if they had any doubt as to the capacity of the person being assessed to request lawfully provided assistance to end their own life, refer the person for assessment by a registered medical practitioner with the relevant specialism in psychiatry. As the bill stands, there appears to be no requirement to do so in those circumstances, and I very much hope that we can agree with that amendment. Irrespective of individual members’ views of the legislation more generally, it must surely be an obligation in the bill.

Amendment 99 is consequential to amendment 95. An individual clinical judgment is important, but it should operate in a clear framework that ensures minimum standards. We would expect that in any other field but, in my view, the bill does not take that approach. My amendments in that area seek to address that issue.

The third area that I wish to address is that of palliative care. Amendment 116 would require that

“The coordinating ... medical practitioner must, as soon as reasonably practicable after the first declaration is made, refer the person for assessment of their palliative care needs by a registered medical practitioner who is registered in the specialism of palliative medicine in the Specialist Register kept by the General Medical Council.”

The amendment also clarifies that palliative care needs include social care needs. In current medical practice, if a person with a terminal illness presents to a healthcare professional with thoughts of ending their life, it is good practice for the professional to refer the person for a specialist palliative care assessment. If that happens at the moment without assisted dying being in law, surely, it will become more important than ever if we institutionalise assisted dying.

In the experience of palliative care specialists, with exploration of a person’s fears and concerns, improved management of their symptoms and by addressing practical issues, often, that person will not continue to wish to end their life. Indeed, they often say later that they are glad that they did not end their life. I acknowledge that many people who seek an assisted death may have already been in receipt of palliative care. However, a new referral should be made because their circumstances may have changed between the time that the palliative support was initially put in place and when a request is made for an assisted death.

Furthermore, receipt of palliative care is vague and imprecise, as people often receive palliative care that is not of the required specialist expertise. Indeed, some people will not have been in receipt of palliative care at all, particularly not specialist palliative care. Accordingly, the medical practitioner would simply be acting in accordance with existing good practice by making a referral for a specialist palliative assessment—that is what would happen now, and the bill is not passed into law.

Of course, some people may still have a settled wish to seek to have an assisted death. My amendments would not remove any of the rights that Mr McArthur is seeking to legislate for within the bill. It is also crucial to put that on record.

The convener will be relieved to hear that my final area of consideration in the group makes provision for a medical practitioner’s report to be part of the decision making and recording process on assisted dying, as opposed to the current provisions, which are that medical practitioners should simply make what I feel is a standard pro forma statement as provided for in schedule 2 to the bill. Amendment 117 and related consequential amendments 121 to 123 and 135 would require the assessing medical practitioners to produce a report detailing the information that is

“gathered as part of the assessment”

and their reasons for approving, or not approving, the assisted dying request. Amendment 117 also states that the Scottish Government must make regulations under the affirmative procedure on the form of the report and that the report should be put into the person’s medical records.

As the bill stands, it contains what feels as though it is a tick-box exercise to record the outcome of assessments, although I do not think that that is the intention. However, there should also be a requirement for the co-ordinating medical practitioner to compile a meaningful report that documents the outcome and sets out how it has been arrived at. It should document the person’s reasons for wanting an assisted death, the evidence that was gathered and used to inform the decision, and the practitioner’s reasons for reaching their judgment. Such a report would protect the practitioner in case of complaints and would be in their interests. It would also inform the understanding of the bill, if passed, in operation, as it would be reviewed.

The evidence behind each assisted dying decision should be clear. That would aid transparency and protect all who were involved in the process.

Mr McArthur wants a more targeted approach to the situation. However, how could a practitioner know, in advance of asking local authorities to search their records for those who are at risk, that the person may be at risk? Surely you cannot target that; you have to ask in every instance, or we would never know.

I feel Mr McArthur’s pain in debating such a massive group. These discussions are substantial and substantive in relation to whether the legislation passes. In relation to schedule 2, it would appear that, at the moment, simply stating that the medical professionals are content, that criteria have been met and that there is no coercion, and signing off on that, is effectively it. From what I can see, there is no rationale requirement whatsoever. The report would give a rationale argument and show the working, if you like, Mr McArthur, which would protect the medical practitioners as well as supporting any post-legislative scrutiny work to consider how robust the process is.

The proposed safeguard, which I and the Scottish Partnership for Palliative Care are trying to put into the bill, is a key tool. I also note that there are a variety of amendments in relation to coercion, not all of which have been disposed of yet, including some in my name, which I hope that the committee will be persuaded to vote for later today or at another time.

My amendment 101 would ensure that, where a person is at risk, a social work assessment would be mandated. The same would be required if a qualified medical practitioner had any doubt at all. To do otherwise would allow the assisted dying process to operate outwith the existing frameworks and without drawing on well-developed expertise. Irrespective of our views on assisted dying, I do not believe that that is something that any of us wishes to see, and I hope that committee members will be persuaded by my amendments.

That query is really helpful, because that is not how the amendment is drafted and it is not the policy intent. Having a terminal illness in itself does not debar someone from seeking assisted dying. That would be counter to the policy intention of the bill, so that is not the intent.

However, you could imagine a whole range of situations such as when someone loses their job, there is a marital breakdown, there is estrangement from family members, or there are significant care costs—you could imagine a series of factors that could then be pieced together to create additional vulnerabilities and, if the adult is at risk under current legislative frameworks, that should be identified. That is the policy intent that we are trying to get at here. A narrow, purely medical-based process is not the strongest safeguard—that is the point that I am trying to make.

That is backed up quite strongly—I will not quote all these organisations because of time constraints—by the Royal College of Physicians, the Royal College of General Practitioners and the British Geriatrics Society in its position statement on assisted dying. The Royal College of Psychiatrists in Scotland has stated:

“Assessing coercion is not a medical skill, though evidence of it may emerge during medical assessments.”

If assessing coercion is not a medical skill, we have to look at other ways of assessing it, and the risk register is surely one key way of doing that. It is surely reasonable that all requests for assisted dying should trigger a search of local authority data to identify any grounds for considering the person to be vulnerable or at risk.

Amendment 100 seeks to ensure that any co-ordinating medical practitioner carrying out an assessment must request a statement from the local authority where the applicant resides about whether it knows or believes that the person is an adult at risk, within the meaning of section 3 of the Adult Support and Protection (Scotland) Act 2007.

For clarity, section 3(1) of the 2007 act defines adults at risk as adults who are

“unable to safeguard their own well-being, property, rights or other interests”,

are

“at risk of harm,”

and

“because they are affected by disability, mental disorder, illness or physical or mental infirmity, are more vulnerable to being harmed than adults who are not so affected.”

Crucially, all three of those criteria must apply. I believe that that is a reasonable prerequisite before any co-ordinating medical professional can consider taking an informed position on whether to progress further any application under the assisted dying legislation that we are considering.

Amendment 101 seeks to ensure that a co-ordinating medical practitioner carrying out an assessment must refer the person for a social work assessment if the person says that they want one, if a statement from the local authority raises a concern or if the co-ordinating medical practitioner has any doubt as to whether the person is being coerced.

That last point is crucial, because balance comes into play right across this legislation. The co-ordinating medical practitioner would not take an on-balance position on whether there was coercion. Rather, if there was any doubt, a social work referral would have to be made.

Amendments 102 and 103 would give powers to the Scottish Government to specify timelines for local authorities to produce a statement and to conduct any assessment. I have heard the interaction between Fulton MacGregor and other ���˿��� on the committee and I think that that is a very reasonable way to do it—with no timescale specified and using the affirmative procedure to introduce more details. That would allow discussions to take place with COSLA, the Scottish Association of Social Work and others, as you would expect. I think that the convener has made that point during her observations.

More generally, however, Scotland has a well-established legal and procedural framework for protecting adults who might be vulnerable, including the maintenance of records of such individuals. My amendments and the substantial amendment by my colleague Fulton MacGregor—to which I am sympathetic, as I can see what Mr MacGregor is trying to do—should be viewed in that context.

The Scottish Partnership for Palliative Care and its membership are clear that such protections should be put in place as a key safeguard in the legislation. The partnership takes no view on whether the bill should pass or otherwise—this is about putting in place a robust series of protections. The SPPC has noted that, in addition to pre-existing vulnerabilities, a terminal diagnosis can often create new vulnerabilities, which might be due to physical, psychological or circumstantial changes. Elder abuse, for instance, is distressingly common, and care costs might provide a motivation for implicit or explicit pressure towards assisted dying. I will not list other factors that can be taken into account, because of time constraints, but you can see the importance of ensuring that there is not a vulnerability.

As drafted, the bill leaves the potentially difficult assessment and judgment as to whether any individual seeking assisted dying is being coerced to the co-ordinating medical practitioner and the second medical practitioner.