Murdo Fraser
Scottish Conservative and Unionist Party · Scotland
“This has been quite a lively debate so far. I might take a slightly more sympathetic approach to Reform than other colleagues who have spoken. To be fair to Reform members, they have been on a steep learning curve in relation to how they approach debates in the Parliament.”
“After all the promises that were made about Reform members coming in to shake this place up, they cannot even get the basics right. If these are the foxes in the hen house, the chickens will be sleeping pretty safely tonight. That seems reflected in Reform’s most recent electoral performances.”
“I will make what I hope is a constructive suggestion, which is that it would be more helpful to have a debate on any one of those topics to allow us time to discuss the issues in detail. We will all be here for another five years, so Angela Ross should not fire all her bullets at once.”
“Murdo Fraser: I will give way in a second. The only things that have been left out are the NHS and justice. Virtually every topic in the remit of the Parliament is covered in the motion, as are some topics that are not in the remit of the Parliament.”
“Most significantly of all, we had a superb Conservative victory in the Aberdeen South constituency, with my good friend Douglas Lumsden winning just shy of 50 per cent of the vote—a massive swing from the SNP. Reform received just 2,478 votes, or 8.6 per cent of the total.”
“He will know that there is a necessity in the case of individual judgments for those involved to consider whether there is any basis on which an appeal should be mounted in a particular case.”
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“In the debate on the previous group, in the wider debate that we had on coercion and coercive control and in the debate on this group, we have identified that medical practitioners do not always have the specialist training that is required to recognise the complex and often conflicting issues that arise in cases of abuse and in the patterns of behaviour that are associated with coercive control. Such patterns have to be monitored over a longer time. Colleagues have highlighted the challenges that arise from the fact that a patient’s relationship with their general practitioner is not what it was many years ago, when patients were more likely to see the same practitioner consistently. That issue has to be looked at more broadly.”
“Paul O’Kane: I do not intend to say too much about my amendment 156, because my points have been largely covered in colleagues’ amendments. A number of amendments in the group seek to do the same thing: mandate that regulations are laid on the training to be offered to medical professionals to identify “coercion, undue influence and coercive control” and “situations of dependency arising from illness, disability, age, social care needs or caring arrangements.” Those are the words of my amendment.”
“Jackie Baillie touched on why that matters. Young adults’ illnesses and trajectories are often unpredictable and do not match adult timeframes. Many experience fluctuating capacity, communication differences or different periods of stabilisation in their conditions. That makes eligibility assessments particularly difficult and increases risks of misinterpretation and safeguarding issues. Amendment 147 would ensure that training standards are developed through expert consultation that is led by the chief medical officer. They would be reviewed every three years to reflect new clinical evidence and supported by guidance to be published when regulations commence. If the Parliament legalises assisted dying, the safeguards would ensure that young adults’ assessments are safer and more ethical and consistent.”
“Uncertainty is also greater among young adults, which makes terminal illness harder to determine. Such decisions carry irreversible consequences and require consistently high clinical standards. Amendment 147 would establish mandatory minimum national training standards that would include: assessing capacity in young adults with complex or fluctuating conditions; identifying subtle or relational coercion that is often experienced by young disabled adults; understanding the prognostic uncertainty that is associated with rare or unfamiliar conditions in people under 25; communicating sensitively with families during emotionally complex decisions; and signposting palliative, hospice and home‑based care options across Scotland. Those standards would ensure that assessments are safe, informed and nationally consistent.”
“Like Jackie Baillie, I have been working with CHAS, and my amendment 147 would ensure that, if Scotland legalises assisted dying, any professionals who are involved in eligibility assessments, information provision or application support have the specialist training that is required to work safely with adults aged under 25. Young adults often receive paediatric or transitional care, including from CHAS, and present with unique clinical, developmental and social needs. Why is such protection needed? Evidence that was given at earlier stages of the bill process shows that assessing capacity in young adults with complex conditions is challenging and demands specialist expertise. Coercion might be harder to identify due to reliance on family and carers for communication and support.”
“Taking those safeguards away while providing no reassurance that they will return as part of a section 104 agreement is incredibly worrying for those who want to ensure that the legislation—if the Parliament passes it—is the best that it can be. 21:30 Miles Briggs: To pick up where Jackie Baillie left off, the regulation of training for authorised health professionals is a devolved issue. I will support all the amendments in group 5, which do exactly what we want: they ensure that training opportunities are put in place.”
“Jackie Baillie: I am finished, but I am happy to stand again and take an intervention if that clears things up. The Deputy Presiding Officer: We will pretend that you had not finished. Neil Gray: As I have already set out, the contents of a section 104 order will be for negotiation. I must correct some of what Ms Baillie has said. It is not just our assertion that some of the amendments that we are talking about are outwith legislative competence; as I have previously put on the record, that decision has also been arrived at through consultation with UK ministers. Jackie Baillie: I welcome the intervention, but I am sure that the cabinet secretary realises that people are trying to build safeguards into the legislation.”
“I also support amendment 147, in the name of Miles Briggs, which would strengthen assessments, safeguarding and support in the bill for young people who are under 25. All that said, the central difficulty with the amendments is that the Scottish Government believes that many of them are not legislatively competent. However, those are the amendments that would provide reassurance. When he comes to speak, will the cabinet secretary give an on-the- record commitment from the Scottish Government that the provisions in the amendments will all be included in the section 104 agreement? If he cannot do that, what assurances do we actually have? Neil Gray: [Made a request to intervene.] The Deputy Presiding Officer: Is Ms Baillie finished?”
“That directly mirrors CHAS’s concern that young people may be more vulnerable to coercion or self- duress when they face life-limiting illness, especially during such a difficult time in their life as when they transition from child to adult services and when much of the support that they rely on falls away. Amendment 146 seeks to strengthen the clinical framework. It states that regulations must include a method such as certification for doctors to verify that they have the appropriate training and experience to carry out the roles that are specified by the bill. It should not just be assumed that a doctor is qualified; there needs to be a formal system to show that they meet the required standard to ensure patient and workforce safety.”
“Amendment 145 would require the Scottish Government to set specific rules about the “training, qualifications and experience” that doctors need when assessing young adults who are under 25 and living with prognostic uncertainty or fluctuating conditions. It would ensure that such regulations provide equivalent safety to existing national frameworks that recognise reduced cognitive maturity in people under 25, such as is the case with the Scottish sentencing guidelines. Justice sentencing acknowledges that young people who are under 25 are more vulnerable, more susceptible to influence, less able to weigh complex risks and more likely to enter harmful relationships.”
“Without tailored safeguards, there is a risk that assessments could be inconsistent or unsafe. We know that such protections are needed because evidence that was submitted throughout stages 1 and 2 made it clear that assessing capacity in young adults with complex conditions is highly specialised and requires advanced clinical knowledge. Coercion can be more difficult to detect where communication relies heavily on family or carers, and diagnoses in that age group often fluctuate, making terminal illness harder to determine with confidence. Those are not routine clinical judgments; they carry significant ethical weight and irreversible consequences, which requires a robust, nationally consistent framework.”
“Jackie Baillie: I will speak to amendments 145 and 146, in my name, which I was asked to lodge by Children’s Hospices Across Scotland. The amendments seek to ensure that, if Scotland legislates for assisted dying, the legislation explicitly recognises the unique complexities that are faced by young people who are under the age of 25 and living with prognostic uncertainty and fluctuating conditions. Although the bill applies to adults, the Parliament has already acknowledged that many young adults—particularly those with serious or life-limiting conditions—continue to receive care in paediatric or transitional environments, including the service that is provided by CHAS. Those young people often have different cognitive, social and clinical development compared to older adults.”
“We are not in a position to set out what that order may contain, albeit that it will be through agreement between the Scottish and UK Governments and relate to the commencement provision in amendment 133. As I explained, I am sympathetic to the principle at the heart of amendments 133A and 133B. However, Parliament should be clear about the effect of imposing further brakes on commencement, and must ensure that the legislation is not framed in a way that could prevent Parliament’s intention from being realised. On that basis, I encourage Parliament to back Ross Greer’s amendment 133A, which gives effect to the substance of the issues that were debated earlier, but to reject amendment 133B, which would apply a brake in a way that Parliament may find difficult to release in due course. Again, I thank Ross Greer for lodging those amendments.”
“As I highlighted earlier, and consistently throughout stage 2, I consider it of the utmost importance that participating medical professionals receive the right level of professional training and have the level of qualifications and experience deemed necessary to ensure confidence in the delivery of assisted dying services. I have also spoken of the importance of ensuring that all provisions in the bill are within legislative competence, and of the agreement of both the Scottish Government and the UK Government that the best way to achieve requirements in relation to those factors is through a section 104 order. The content of such an order is a matter for the Westminster Parliament.”
“It provides that the precondition prescribed by amendment 133A be satisfied only through the conferral of power on Scottish ministers to specify the training, qualifications and experience that must be held by participating health professionals. It also requires that the Scottish ministers have exercised the power to make such provision. As the cabinet secretary set out in his letter to the Health, Social Care and Sport Committee on 5 March, the expected route for making provision for the training, qualifications and experience of participating health professionals would be via a section 104 order. I understand that that route could not be used for conferring regulation-making powers, as is required as a precondition in amendment 133B.”
“However, I consider that, for the reasons set out, it would be better to reject those amendments and consider how to take the issue forward in the context of the amendments that I will turn to now—namely, Ross Greer’s amendments 133A and 133B, which are amendments to my earlier amendment 133. Amendment 133A includes conditions, in addition to those made by amendment 133, which must be satisfied before ministers can make regulations to commence the bill as enacted and bring it into effect. The additional precondition that must be satisfied—through a section 104 order or otherwise—is that provision has been made for the training, qualifications and experience of participating health professionals. Amendment 133B is also an amendment to amendment 133.”
“I note that regulations made under amendment 238 would require the agreement of the secretary of state, and that Mr Greer’s amendment 239 provides that the secretary of state may set out in regulations the training, qualifications and experience that are required in order to carry out the role of registered medical practitioner and so on. The cabinet secretary will no doubt state his own view, but my understanding is that that would not address the competence concerns that have been raised by the Government. I very much acknowledge the principle behind the amendments, as well as the huge amount of work that Ross Greer and his team have put in on the issue ahead of stage 3.”
“I also cannot support Paul O’Kane’s amendment 136 or Miles Briggs’s amendment 147, which would require the regulations to specify minimum training standards. Those are all very reasonable proposals, which I would expect to be addressed in due course, but which fall to be dealt with through the section 104 order process. Ross Greer’s amendment 238 provides that Scottish ministers may set out in regulations the training, qualifications and experience that are required in order to carry out the role of co- ordinating registered medical practitioner, independent registered medical practitioner and authorised health professional. It therefore adds to the legislative competence concerns raised by the Scottish Government.”
“I turn to Daniel Johnson’s amendments 3 to 6. I fully agree that training is essential and, for that reason, I lodged related amendments at stage 2. However, as already explained, given the concerns raised that including training provisions in the bill may touch on reserved competence, I believe that the most appropriate and secure way of enacting any training requirements will be by way of a section 104 order. For that reason, I cannot support amendments 3 and 5, and my amendments 86 and 88 pre-empt amendments 4 and 6, making them redundant. In light of my amendments, I also cannot support Jackie Baillie’s amendments 145 and 146, which would require the regulations—which I am seeking to have removed—to include a certification process for medical practitioners to evidence their training, qualifications and experience.”
“However, as I set out earlier, we must ensure that all the provisions of the bill as passed are within the legislative competence of this Parliament, otherwise they cannot have legal effect as Parliament intends. Taking a constitutionally precautionary approach is the only sensible thing to do in such circumstances. I refer again, as I did earlier in relation to the protections, to the strong commitments made by both Scottish and UK Governments and the constructive approach that has been adopted at pace to respect and reflect the will of this Parliament. That gives me confidence, and it should also give Parliament confidence, that these provisions—and those on protections—will be taken forward appropriately through the section 104 order route. Therefore, I urge members to vote for these amendments in my name.”
“As discussed, the Scottish Government considers that these provisions may relate to the reserved matter of the regulation of health professionals, under section G2 of schedule 5 of the Scotland Act 1998. As a whole, amendments 86 to 89, 101, 104, 105, 120, 121, 123 and 125 would remove those regulating powers from the bill, including consultation requirements and other procedural matters, with a view to their being taken forward under a section 104 order. I am also conscious of the need to ensure that the public, and particularly any person who wishes to access assisted dying, can have the fullest confidence in the assisted dying process. It is therefore imperative that only health professionals with the appropriate level of professional training, qualifications and experience can participate.”
“As a consequence, I am minded to accept, under rule 9.8.5A, a motion without notice to propose that the time limit be extended by 30 minutes. I invite the Minister for Parliamentary Business and Veterans to move such a motion. Motion moved, That, under rule 9.8.5A, the time limit for group 5 be moved by up to 30 minutes.—[Graeme Dey] Motion agreed to. Liam McArthur: I will speak first to my amendments in the group. The bill, as amended at stage 2, allows the Scottish ministers, by regulations, to set out the training, qualifications and experience required of co-ordinating registered medical practitioners, independent registered medical practitioners and authorised health professionals.”
“Yes, those judgments would be made with a great deal of expertise, training, insight and understanding, but they would nonetheless be subjective judgments. Therefore, a number of the amendments in this group are worthy of a great deal of consideration. With regard to training on coercion and capacity, although I will move amendment 3 in order to enable the debate to proceed, I intend to withdraw it, and not to press amendment 6, should it be called. I urge members to support the amendments in Miles Briggs’s name, which make a far more comprehensive effort to cover the key elements that require training. I move amendment 3. The Deputy Presiding Officer: I advise members that we will shortly reach the next time limit. We still have to debate two more groups of amendments.”
“Secondly, I do not believe that my amendments cover those aspects of training as effectively as other members’ amendments do. However, I will reflect on what was said previously. What Michael Matheson said is incredibly important. Coercion is an evolving concept, and we need to think carefully about it. However, the most important point with regard to his contribution is that detecting and dealing with coercion comes down to ensuring that individuals who come into contact with people who may be subject to coercion have the necessary training, expertise and ability to detect it. The bill must cover that effectively. With regard to the broader amendments in this section, as I said in some of my earlier contributions, we all need to accept that the effect of this legislation, if it were passed, would come down to subjective judgments.”
“I point out that, if amendment 86 is agreed to, I cannot call amendment 4, and, if amendment 88 is agreed to, I cannot call amendment 6, due to pre-emption. Additionally, if amendment 125 is agreed to, I cannot call amendment 301, which is to be debated in group 7—which is on assessments, including support, of terminally ill adults—also due to pre-emption. I call Daniel Johnson to move amendment 3 and to speak to other amendments in the group. 21:15 Daniel Johnson: One of the jeopardies of any stage 2 or 3 proceedings is that we do not quite know where in a grouping our amendments will be called. I stand up somewhat self-consciously for two reasons. First, my amendments in this very important group would, in some ways, have been better covered in the previous group. In my view, they are about training with regard to coercion and capacity.”
“We must address the risks structurally in the bill in order to give people the protections that they require. As I set out in my opening statement, I am mindful of colleagues’ time. I do not believe that we can safeguard these issues sufficiently. I have come on some journey on that, even since lodging my amendments. It is on that basis that I seek to withdraw amendment 144. Amendment 144, by agreement, withdrawn. The Deputy Presiding Officer: We turn to group 5, which is on training, qualifications and experience of health professionals. Amendment 3, in the name of Daniel Johnson, is grouped with amendments 86, 4, 145, 146, 87, 147, 5, 88, 6, 156, 89, 238, 239, 120 to 123, 125, 133B and 133A.”
“What was discussed at that point, and agreed to in committee, was that linking to the guidance on coercion—which certainly acknowledges internal coercion and other societal factors—is a more appropriate way of addressing the issue than dealing with it in the bill, which would take us away from legal concepts that are well understood, increase the risk of confusion and put both medics and patients at risk. Michael Marra: That wraps up my two points quite well. The first is that it is, in part, a question of how powerfully we perceive those fractures in society and the risks that are inherent in them. We must also recognise that this would be a significant departure in the law with regard to what the state would be enabled to do and that the current structures are not appropriate.”
“On almost any other policy issue, whether it relates to health, addiction, mental health or educational outcomes, we recognise that the circumstances in which somebody is born set them on a path of outcomes. Internal coercion is absolutely part of that. Pam Duncan-Glancy—as ever—set out powerfully how that is represented in the disabled community and how that feels on a day-to-day basis. She is a powerful advocate on those issues. The idea that we reject systemic risk on the basis of how we perceive society—namely, that people do not feel those pressures—is not something that I recognise in how we approach almost any policy area in this Parliament. Liam McArthur: I do not think that anyone is rejecting the concept of internal coercion—that was reflected very much in the debates that we had at stage 2 on similar amendments in this area.”
“We have to deal with protections for the laws that are before us. Brian Whittle’s amendments are a good contrast to the situation in Victoria, Australia, and to the options that members are considering in some of the other amendments. On the proliferation of coercion, we should also consider that the World Health Organization says that 16.6 per cent of people over the age of 60 suffer elder abuse. Clearly, people over the age of 60 would be more likely than others to avail themselves of the assisted dying option. Overall, Liam McArthur rejected in his analysis the fact that internal coercion exists at all. Maybe that is a question of how we see society and whether we consider that class and poverty determine outcomes. For me, that is self-evident. That is how society works, whether we like it or not, and I certainly do not.”
“Michael Marra: Liam McArthur says that we do not. That goes to the heart of some of the problems with the bill. We do not seem to be addressing the issue of appropriate palliative care. The member said in the stage 1 debate that palliative care had to be a viable alternative to assisted dying, yet now he is saying that it is not a viable alternative because people are receiving care that is inappropriate. I will leave it there; it is perhaps a debating point. The bill would introduce a law that would give the state the power to be involved in the taking of someone’s life or to allow them to take their own life. That is the substantive difference—that is what we are dealing with. To draw an equivalence with the provision of other forms of services at different times is a fallacy; it does not tally.”
“Would Mr Marra at least accept that the protections for those who find themselves subject to coercion, whether that is coercion into unpleasant, horrible, protracted death or coercion into medical treatment that may not be appropriate, are not there and that the bill at least sets out a system—which was noted in graphic detail by Christine Grahame earlier—for putting in protections that do not currently exist? With training requirements alongside that to reflect the clearer understanding of coercive controlling behaviour, those protections would only be enhanced. Michael Marra: I think that it is a false equivalence. Some people receive care that they feel is inappropriate and does not suit their needs. We should—and we can—address that situation through the NHS. Liam McArthur: But we do not.”
“In Victoria, Australia, the training on coercion identification amounts to about five minutes: a two-minute video and a two-minute PowerPoint presentation. Perhaps there is a minute in between. That is the level of training to identify coercion. When we say that no coercion has been identified in those circumstances, it is little wonder. We have to look to the practices that are adopted when we draw on different evidence. Liam McArthur: What Michael Marra has just said does not necessarily reflect the evidence that the Health, Social Care and Sport Committee heard from representatives involved in the assisted dying process in Victoria.”
“Finlay Carson: I will take this opportunity to present a quote that sums things up for me. It is from Michael Marra’s former colleague Johann Lamont. She tweeted: “I did not always think this way but I have concluded that, if my freedom of choice at the end of my life is at the expense of those who are vulnerable to coercion, that is not a cost that I can accept. Coercion is often invisible but all the more devastating for being hidden.” Michael Marra: It is always good to hear from Johann Lamont—a wise woman, in my experience. That is a fine point that, I think, emphasises where the vast majority of the public are on this issue. They perceive risks in what we are doing, and we must do our best to guard against them. Rona Mackay said that there was no evidence of coercion.”
“There has been growing concern among MSPs about the issue of coercion since stage 1—and before that, in fact. If the Parliament does not put in place restrictions in this area, it will be at odds with the public. I read in The Herald today that “twice as many” Scots agree that “MSPs should reject” any law that would increase risk, that three times as many Scots agree that safeguarding would not be able to detect domestic abuse in assisted dying, and that 68 per cent of Scots fear that “victims of domestic abuse would feel pressured into ending their lives”. That is a snapshot of what people outside this building—people across Scotland—feel about the risks. When we balance those risks, as Ruth Maguire set out, those are the considerations that the public have.”
“Ruth Maguire was correct in describing the core of this debate on coercion as being about consent, choice, free will and autonomy. The real question is, who has it? We are talking about giving some rights to some people in the country— we have already discussed the eligibility limits that we would set on that—but there is a question about who is able to exercise their choice, free will and autonomy and whether they are actually able to give their consent freely. That is the core of the argument on coercion that we have been having for the past hour or so. Paul O’Kane identified this point as the significant hole in the bill, and I would say that he is absolutely correct in that regard. Bob Doris talked about having to ensure that there was scaffolding in place to address these issues. That is a good way of putting it.”
“Ross Greer: I agree with Michael Marra on that point, and I will vote against amendment 50. On the point that he makes about the people watching at home, does he agree that it is important to be very clear that we are talking only about summary conviction? In this case, conviction on indictment would carry a maximum sentence of up to 14 years. It is important to reassure our constituents that that would remain the case. Michael Marra: I agree that that is important. The member in charge, Liam McArthur, put that on the record earlier. It is welcome that Mr Greer reiterates that, although I do not think that that diminishes the core point that we are discussing. Moving on to the need to have regard to social work status, Paul O’Kane made the case for that very well.”
“It is absolutely reasonable to take on board the existing frameworks within which social workers currently operate, and we should take very seriously the objections that they have made. Ruth Maguire: To go back a little, to the sentencing issue, does Michael Marra agree that our constituents, whether they are for or against the principles of the bill, would expect the penalty for coercion to reflect the seriousness of what is happening and the fact that someone’s life is being ended against their will? Michael Marra: I fully agree. Anybody watching these proceedings would be astonished that, while we are making such a profound change, not just the member in charge but the Government is seeking to reduce the sentence on the basis of a tidying-up exercise and coherence.”
“Paul O’Kane’s point in relation to social work and his engagement with social work organisations tells the story itself. I also declare an interest, as I, too, am married to a social worker. I am referring to the way in which that point was addressed by the member in charge of the bill. When Paul O’Kane talked about the bill’s lack of coherence with the current social work framework, which is based on the idea of protecting life, Liam McArthur said that such an approach would be disproportionate. However, that gets it the wrong way round, as Daniel Johnson described. In actual fact, we have to think about what is proportionate to the scale of the change that we are proposing in the bill.”
“Michael Marra: Mr Johnson makes a very good point, which covers an issue that I was just coming to. Reverting to sentencing guidelines actually diminishes the scale of the change that we are talking about. We have to get the penalties right when we are talking about life or death, and it is absolutely right that we consider each instance on its own merits. I believe that reducing the penalty in the bill from two years to 15 weeks is inappropriate and that the Parliament should take a strong view on that. It speaks to my sense that there is perhaps, in the way that parts of the bill have been dealt with and discussed—including the discussion of the amendments in this group—an implication that it would not be making a profound change. It is a profound change, however, and the consequences are very significant.”
“We heard arguments about consistency with sentencing guidelines, but—to be frank, cabinet secretary—if those are the guidelines, they are an ass and they should not be applied in this area. There has been no substantive defence, and I hope that members will reject the amendment on that basis. I feel that what we have heard speaks a little to the tone of some of the approach that has been taken. Daniel Johnson: I wonder if it is, in fact, worse than Michael Marra has suggested. To suggest that the Scottish Sentencing Council somehow has primacy over this place regarding penalties is to get the precedent round the wrong way. Surely it is for Parliament to legislate for what the penalties should be; the Sentencing Council’s role is merely to guide thereafter.”
“It could also have implications for the ability of the assessing registered medical practitioner to determine whether the person is acting voluntarily. On amendment 181, setting up a panel or multiple panels would be likely to have major financial implications. With regard to the remaining amendments in the group, the Scottish Government has no comments. The Deputy Presiding Officer: I call Michael Marra to wind up and say whether he wishes to press or withdraw amendment 144. Michael Marra: I thank members for their contributions to the debate. I will start my closing comments with amendment 50. To be frank, I do not think that we have heard any proper defence of the substance of the change in reducing the penalty for coercing someone to take their own life from two years to 15 weeks.”
“21:00 The effect of amendments 177 and 180 would be that the assistance under section 15 could be provided only where the co-ordinating registered medical practitioner and the independent registered medical practitioner were both satisfied that the adult was seeking the assistance solely due to their terminal illness and for no other reason. While I fully appreciate the intent behind those amendments, it is possible that including such provision in the bill could have the effect of people feeling that they could not be open or honest about their reasons for seeking an assisted death for fear that doing so could lead to their request being denied. That may prevent open conversations from taking place about the alternatives and the support that is available to the person to help them with any other issues that may factor in their decision.”
“Introducing a new statutory role of an independent assessor might require the establishment of qualification standards, regulatory oversight and sufficient workforce capacity, which could be challenging to implement consistently across Scotland. According to concerns expressed by third parties, the trigger for referral lacks a clear threshold and could add delay and uncertainty to the process. There are also questions about how an independent assessor’s conclusions would interact with existing clinical judgments and safeguarding duties, and about the proportionality of mandatory referral to Police Scotland. Taken together, those amendments could add procedural complexity and delay.”
“On amendment 174, it is not clear who an “independent assessor” might be, but it is noted that amendment 182 seeks to insert a provision into section 8 of the bill, on medical practitioners’ statements. On that basis, if it is a duty of the Scottish ministers to make regulations setting out qualifications and experience in relation to medical practitioners, that might raise issues of legislative competence in a similar way to other provisions of that nature in the bill that we have already debated. More broadly, amendment 174 and related amendments 182, 187, 189, 193, 209 and 305 also raise deliverability challenges.”
“That might reduce flexibility for professional judgment and could have implications for deliverability, including the increased time and resource demands that would be associated with assessment, record keeping and training. In relation to amendments 151, 152, 158, 175, 178, 315 and 320, the extent to which the amended provisions are linked to the offence of coercion or pressure in section 21 of the bill is not clear. Amendment 172 would introduce significantly more prescriptive requirements in relation to assessment, training and procedure, which could have practical implications for delivery, including a substantial increase in the time required to carry out assessments and, ultimately, an increased financial burden.”
“Amendment 93 would significantly expand the requirements that would be placed on the co- ordinating registered medical practitioner at the point at which a second declaration is made by directing, in detail, the nature of the assessment to be carried out; the specific forms of coercion to be considered; the steps to be taken where concerns are identified; and the matters that must be recorded in the adult’s medical records. Although the bill already requires the practitioner to be satisfied that declarations are made voluntarily, the amendment goes further in seeking to set out a structured and highly specified assessment framework in primary legislation.”
“Jeremy Balfour: I wonder whether the cabinet secretary can give me a wee bit more information on this. Mr McArthur has said that he has done this on the Government’s understanding, but we had a fairly clear statement just a few moments ago that that should not be linked to the bill. Can the Government at least give us some idea of why it feels that the statutory time limit should be reduced and why that should be included in the bill? Neil Gray: I thank Mr Balfour for his intervention. As I have said, it would ensure consistency with the general approach to summary penalties. It is about the requirement for legal consistency.”
“I am not in any way passing comment on the merits of the arguments that have been made by colleagues in setting out their amendments. I understand them and, in Mr Doris’s case, I understand that they come from a deep- rooted conviction. All that I am saying is that what has to be weighed up is the case that colleagues have made in speaking to their amendments and some of the considerations that the Government wishes to put on the record with regard to deliverability and technical and legislative competence issues. Amendments 50 and 51 would ensure consistency with the general approach to summary penalties. Mr McArthur has already set out that we have co-operated on those amendments. Amendment 93— Jeremy Balfour: Will the cabinet secretary give way? Neil Gray: I will.”
“As for amendment 27 leading to a lack of consistency in practice, I remind the chamber that the amendment seeks to encourage a conversation between the medical practitioner and the person applying for an assisted death about the possibility of indirect pressures. That is what amendment 27 would do. If such conversations do not take place, we will have absolute consistency, won’t we? If we do not ask for those conversations to take place, we will consistently not have them. Of course we must ask for that to happen. Perhaps the cabinet secretary should reflect on that. Neil Gray: I say again to Mr Doris, as I said to all colleagues at the start of my remarks on this group, that I can only set out the issues or concerns that the Government has with certain amendments.”
“Although professional guidance already supports clinicians to assess capacity and voluntariness, as Christine Grahame pointed out, embedding those requirements in statute could increase the complexity and length of assessments, which could have potential implications for training, consistency of practice and practitioner confidence. The careful development of guidance would also be required, to avoid creating an expectation that all forms of indirect pressure could be identified or mitigated uniformly. Bob Doris: [Made a request to intervene.] Neil Gray: I happily give way to Bob Doris. Bob Doris: I thank the cabinet secretary for giving way. Would my amendments require the careful development of guidance? Absolutely—of course they should, and that is why amendment 27 should be agreed to. That is absolutely clear.”