Chamber and committees

:In fairness, he was not assisted entirely by me. The petitioner has moved, with great judgment, from Dundee to Dumbarton, so he is now my constituent. Other people have been involved, and the assistance has been cross-party.

I will add just a couple of things. I, too, note that members of Isla’s family have joined us in the public gallery. You are correct to say that they met the Cabinet Secretary for Health and Social Care. It is fair to say that considerable progress has been made, and I pay tribute to Isla’s family for pursuing the matter, but the work is not quite yet complete.

I know that the committee is keen to close petitions, but I feel the need to put on the record that we are talking about a number of on-going reviews and that we do not yet have final changes to practice across Scotland in relation to the diagnosis of cancer among children and young people.

It may well be that the family choose to bring back their petition in the new session of Parliament, depending on what happens on 7 May, to make sure that this is finally concluded, but I acknowledge the progress that has been made because of their campaigning and their interest in this issue. Thank you, convener.

:Thank you for giving me permission to speak, convener. I would like to add a couple of things.

You will know that the issue has been raised not only in the Scottish Parliament but in the United Kingdom Parliament, by Dave Doogan MP and now Douglas McAllister MP. There has truly been a cross-party effort on the petition, and Mr Cornock has met the Lord Advocate, as you said, and the First Minister.

Although you are right to say that the process has been helpful and has led to changes, including the minute and guidance that you mentioned, the solution requires more than guidance. If the solution does not involve legislative change, I am yet to hear from the Government what change will consistently deliver the result that people want.

As you acknowledged, the reality is that, since 2007, there have been no FAIs in Scotland for unexplained deaths abroad, while, in England, there have been 1,700. That is not right. There is a gap in the law.

I would argue, given the thousands of Scots who work abroad, that this process is not over and that the petition needs to carry on. It is a matter for the committee whether you continue it, but I would urge you to do so, because the reality is that loved ones need clarity, truth and justice in the event of an unexplained death abroad.

The committee has taken the trouble to make sure that the petition is heard. I hope that you will continue to keep it open but, if you decide not to, please take this as notice that the petitioners will bring the issue back to Parliament, because it is unfinished business.

Will Mr McArthur give way?

I have lodged amendments 76 to 79 on behalf of the Royal College of Nursing Scotland. As you know, RCN Scotland maintains a neutral stance on assisted dying, but it has serious concerns about section 15, specifically the expectation that registered nurses acting as authorised health professionals will carry out complex assessments of capacity and coercion, and the possibility of nurses providing assistance while working alone.

Amendment 77 proposes that final assessments of capacity and coercion be carried out by a doctor. Such clinical judgments are complex, especially when time has passed—there might have been earlier assessments, and factors such as pain or medication might affect cognition. It might have been months since the co-ordinating and independent doctors undertook the assessments to determine eligibility, and capacity can fluctuate in a person who is terminally ill. Similarly, identifying coercion is inherently difficult, particularly without a structured framework.

Although some nurses in advanced practice roles have the relevant expertise, the bill is structured in such a way that those specialists are unlikely to be asked to act as authorised health professionals. Instead, nurses in more general settings, such as community care, general practices or hospital wards, might be expected to take on the role infrequently. RCN Scotland believes that assessing capacity in this context requires a depth of knowledge and experience that goes beyond the scope of practice of most registered nurses, and the amendment seeks to ensure that the final assessments are undertaken by either the co-ordinating doctor or another authorised doctor. The RCN believes that that is a safer and more appropriate approach.

Amendments 76, 78 and 79 address RCN Scotland’s serious concerns about lone working. The bill, as it currently stands, allows nurses to provide the approved substance alone, which RCN Scotland considers unsafe. The provision of assistance will take place in a highly sensitive and emotionally charged environment, where complex family dynamics might arise. Nurses might then face distressed families; individuals who are unable to self-administer and therefore cannot receive assistance; or unexpected reactions to the substance. Current practice for controlled drugs typically requires that two registered nurses prepare and administer them, and that safeguard should apply here, too.

These amendments would require a nurse acting as authorised health professional to be accompanied by another health professional. In practical terms, that would mean that a doctor would carry out the final assessments on capacity and coercion, and either they or a nurse accompanied by that doctor would then provide the substance. Where a nurse provides the substance, either the accompanying doctor remains present, or the doctor leaves and another health professional arrives to accompany the nurse while the person decides whether to use the substance, and if they have done so, has subsequently died.

Although the bill allows a nurse to be accompanied, it does not require it; instead, it leaves it up to individual nurses to advocate for themselves when they are asked to attend alone, and we do not regard that as acceptable. RCN Scotland believes that these amendments would introduce essential safeguards and must be incorporated into the bill.

We are not talking about an everyday occurrence; this is something very unusual and highly sensitive. Furthermore, as you have acknowledged, significant numbers of people will not be impacted by your bill. Consequently, issues of access being limited for some terminally ill adults are not valid in this instance.

It is very difficult for a nurse who is placed alone to advocate for themselves and say that they do not want to carry out that role on their own, thereby causing unnecessary delay. What I am seeking should be built in from the start—it must be the expectation. If we want effective implementation of your bill, we need to assure those who are likely to be significant participants in it—that is, nurses—that we have their interests at heart.

I urge you to accept the amendments, because they do add to the bill.

Amendments 73 and 84—amendment 84 is consequential—are to make it clear that a person is not considered terminally ill solely because they have a mental disorder.

Amendment 73 reflects the position of the Royal College of Psychiatrists in Scotland that mental disorders such as anorexia nervosa should not be classified as terminal conditions under the bill. It provides clarity and reassurance that the bill does not open the door to assisted dying for individuals whose suffering arises from mental illness alone. I believe that that safeguard is vital to prevent misinterpretation and to uphold the integrity of the bill’s intent, which is focused on those with a qualifying terminal physical illness.

I heard Liam McArthur’s earlier comments and, as amendment 24 captures the intent of my amendment, I will not move amendment 73.

No, I am not proposing a separate regulatory body; I am leaning into the current arrangements, and I am allowing for the circumstance that assisted dying might not be entirely delivered by the NHS, which is the case in other countries. It is a belt-and-braces approach that aims to make sure that we have the right regime in place, so that we are satisfied with the levels of scrutiny and regulation. I hope that that is clear.

Amendment 62 would allow the Scottish Government to bring forward regulations to prevent an assisted death from taking place in certain settings—for example, in care accommodation for people aged under 18, in a care service that is used primarily by children, in a drug and alcohol rehabilitation centre, in supported accommodation for people with mental health illnesses or in a women’s aid refuge. Those are all registered care settings, but providing assisted dying in them would clearly not be appropriate.

I also anticipate that the regulatory framework could make situations in which a person is asked to undertake an assisted death in a public place or outdoors a sensitive issue. The Scottish Government should bring forward the details in due course through secondary legislation. I also anticipate that secondary legislation will clarify whether the service can be provided privately on a for-profit basis. There are already legislative prohibitions on other types of care providers—for example, adoption agencies—operating for profit in Scotland.

In summary, the amendments are about ensuring that we have the right safeguards in place, that we allow only reputable and regulated organisations to be involved, and that a standard is set, that there is oversight of it and that we align that standard to existing bodies such as Healthcare Improvement Scotland and the Care Inspectorate, with which we are all familiar. I hope that members can support amendments 62 and 63, which provide for affirmative regulations.

Amendments 62 and 63 were lodged after discussion with CHAS—Children’s Hospices Across Scotland—which runs Robin house children’s hospice, in my constituency. The bill does not contain any details of the regulation, scrutiny or inspection of organisations that would provide an assisted dying service, nor of the reporting on the processes that they would operate. All of that happens in other types of care, so this would represent an unprecedented lack of regulation and scrutiny.

The requirement for regulatory arrangements needs to be made explicit in the bill, because we all want to ensure patient safety, and the quality of the service is a paramount consideration. Healthcare Improvement Scotland and the Care Inspectorate already ensure that non-NHS services are run by fit and proper people. They already have statutory powers to secure patient safety and significant experience of regulating the provision of social care and healthcare outwith the NHS. They are also accountable. To be clear, the amendments would not in any way prevent an assisted death in a person’s home; they would simply ensure that the organisation supporting that, if it was not an NHS service or a GP practice, met all the standards and was safe.

Absolutely. Not you, convener—the Government.