Stuart McMillan
Scottish National Party · Scotland
“Can the cabinet secretary provide any details about when funding will be in place to replace the Port Glasgow health centre with a new health hub? Can she advise when there will be investment to improve the fabric of Inverclyde royal hospital?”
“Will the member give way? Mark Simpson: I would love to. Stuart McMillan: Reform’s policies are about taking money out of the public sector, but Mr Simpson is now asking for more money to be spent on throughcare support. Where is that money coming from? I am genuinely interested to know.”
“Millions of people globally are impacted by climate change today, and that will also be the case for future generations, as has already been touched upon by Sanne Dijkstra-Downie.”
“It is important that they are successful in delivering the heat that we all need, but the issue of their environmental impact is also vital. District heating systems play an important role in communities up and down the country, but they come in a range of scales. Are they operating effectively?”
“I touched on the CPA a minute ago, and the issue of AI data centres has been raised time and again at both international and regional conferences. We are not the only people who are talking about the issue. Helpfully, it is on the agenda for this year’s festival of politics.”
“I look forward to the contributions from MSPs in the open debate, which I am sure will help the committee’s discussions on Thursday, when we meet for the first time, and during the rest of the parliamentary session. I will touch briefly on three items, for wider consideration.”
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“In addition to PHS recording the number of people who had sought assisted dying, which could be broken down into characteristics such as the number of people who had made a first declaration but decided not to go through with an assisted death, amendment 280 would require PHS to capture data on those who were too young—that is to say, under 18—who may have made a request. I absolutely understand Liam McArthur’s position. He was right to say that that would apply to a small number of cases, but it is important that we understand the issue, which I come to from the perspective of someone who wants to ensure the protection of children. The collection of such data would inform the shaping of approaches to palliative care.”
“If amendment 310 was agreed to, the regulations would be subject to both procedures, which I am sure that Mr Kerr would agree would be a legal first that we should strive to avoid at this stage in the parliamentary session. That error aside, I am content, as was the Delegated Powers and Law Reform Committee when it considered the bill, that the regulations in question should be subject to the negative procedure. Jackie Baillie: Amendment 280, in this last group, is my last amendment. It seeks to add to the information that Public Health Scotland would be required to report to the Scottish ministers.”
“Liam McArthur: I do not accept that, because of the other provisions in the bill as drafted and the provisions that have been added to the bill as a result of the amendments that have been agreed to during stage 3. It is legitimate to make an argument in support of an amendment, but if it ignores what is already in the bill as things stand, it misrepresents the position. The either/or with regard to palliative care and assisted dying is not reflected in the way that Mr Kerr suggests. Stephen Kerr’s amendment 310 seeks to make the regulations in section 24 subject to the affirmative procedure. I should note that those regulations are currently subject to the negative procedure, and Mr Kerr has not sought to alter that provision.”
“As I have said repeatedly and say again, assisted dying must not be conflated with suicide. I also do not believe that amendment 296 is necessary, given the bill’s existing provisions on the code of practice for palliative care. Stephen Kerr: I gently push back on Liam McArthur’s conclusion on amendment 296. Throughout the process, he has been careful to say that he does not see the provision of palliative and end-of-life care services and the provision of assisted dying as an either/or. Amendment 296 would represent the fulfilment, in part, of what he has repeatedly said, because it would make consideration of the impact on palliative and end- of-life care services part of the required reporting. Does he not accept that that reflects his position on the either/or scenario that he has often spoken about?”
“It is not at all clear how, for example, Public Health Scotland would be expected to verify information that is provided to it under the terms of the act, so I am not persuaded by amendment 290. Likewise, I do not consider Sue Webber’s amendment 116 to be necessary or that it would aid the reporting and review processes. As I have said, the bill would require annual reports to be produced. It would also provide for a comprehensive review to take place after five years, which would allow a suitable period of time for assistance to be lawfully available so that trends in meaningful data and experience could be considered, to inform any future decisions. 13:15 I turn to Murdo Fraser’s amendments. I do not support amendments 294 and 295, which relate to the impact of the bill on suicide prevention services.”
“However, I do not support Stuart McMillan’s amendment 289, as it duplicates and cuts across the annual reporting provisions that are already set out in the bill. I am also not persuaded of Stephen Kerr’s amendment 291, which similarly risks duplicating and confusing the existing reporting and review requirements. The bill would already require the reporting of information, including laying each annual report before Parliament, and would also provide for a full review after five years of operation, which must include reporting on the effect of operation of the act, including the Government’s response to any concerns. I also consider Stuart McMillan’s amendment 290 to be unnecessary and perhaps overly burdensome in terms of what would be asked of Public Health Scotland.”
“Amendment 286 relates to reporting on the numbers of patients who are assessed as having been provided or not provided with palliative care, which I consider to be reasonable, and I support those amendments. Amendment 284, from Emma Roddick, would, in my view, add further reporting requirements on Public Health Scotland, which risks duplicating the annual reporting and five-year review processes in an overly prescriptive way. I am not persuaded that such amendments would be helpful but, again, I am content to accept it if Parliament takes a different view. Miles Briggs’s amendment 288, which I support, would add reporting requirements around the availability of health and social care services to patients making a first declaration.”
“Again, I do not consider the amendment necessary, given the other provisions in the bill that would ensure that such matters are appropriately recorded and reported on. The amendment would simply duplicate and confuse the bill’s existing provisions. Bob Doris’s amendments 281, 282, 283 and 286 would add to the information that Public Health Scotland must report to ministers. Amendment 281, I believe, would be captured by existing provision of section 24(2)(b) and is not necessary. Amendments 282 and 283 would add reporting requirements relating to the period of reflection and time between statements being made under section 8 and a person’s death. Information on the number of times the period of reflection is shortened is captured on the statement forms, but I have no issue with that being set out in section 24 as well.”
“Any terminally ill adults aged 18 who request assistance under the bill would be captured by the bill’s existing record- keeping review and reporting provisions. Those under 18 are not eligible for assistance and the likelihood of anyone under 18 seeking assistance is extremely remote. I think that it would be very difficult for such data to be collected in any meaningful way, so I am not persuaded on amendment 280, although, again, I am prepared to accept it if Parliament takes a different view. Amendment 115, from Sue Webber, would mandate that Public Health Scotland includes in its reporting information on potential complications, adverse reactions and unintended effects.”
“As it stands, the inclusion of the words “in so far as known” allows, for example, Public Health Scotland to record reasons given by a person for wishing to be provided with assistance, where they are known, recognising that a person is not forced to provide such reasons and may prefer not to do so. Given the comprehensive extent of the review and reporting provisions that are contained in the bill, including requirements to report on any complications and adverse effects, I do not see the need for Mr Doris’s amendments 278 and 285. However, I am not opposed in principle and, although I am not persuaded, I am prepared to accept them if Parliament takes another view. Similarly, I question whether Jackie Baillie’s amendment 280 is necessary.”
“The amendments seek to ensure that any information that is provided is balanced, comprehensive and accurate, which I consider would already be a requirement of the duty on the Scottish ministers. Amendment 275 would also require that public communication features suicide prevention information. Without rehearsing the arguments that I made in the earlier group, international experts on suicide prevention, as I said then, have been explicit about the harm that conflating suicide prevention and assisted dying presents, so I do not support Ms Nicoll’s amendments in that area. On Stuart McMillan’s amendment 279, I do not see a benefit in asking Public Health Scotland to report on matters that are not known to it.”
“Neil Gray: I heard what Mr McArthur said about Mr Doris’s amendment 61, and I was going to cover the issue in my remarks. Because amendments 23 and 22, which cover the issue, have been agreed to, is he concerned that there may be inconsistency in the bill if amendment 61 is also agreed to? Liam McArthur: That is a helpful clarification from the cabinet secretary. He may want to develop that argument in his remarks later on. I will certainly reflect on that, as I am sure colleagues across the chamber will. I turn to Audrey Nicoll’s amendments 275, 276 and 277, which all seek to amend section 23A, on the provision of information about assisted dying.”
“Although I am not opposed, in principle, to the requirement under amendment 63 for Public Health Scotland to collect data on the number of practitioners undertaking training, I note the Government’s view that the amendment raises potential competence concerns and, therefore, I would not support it. In better news for Mr Doris, I am inclined to support his amendments 61 and 62. Amendment 61 would reinforce the safeguard in the bill that ensures that patients have been offered or provided with appropriate social care by reflecting that in reporting. Amendment 62 may strengthen safety monitoring, as it will ensure that Public Health Scotland publishes the total number of complications, adverse reactions and unintended effects. That would fit well with the safety monitoring framework under the bill as it stands.”
“Elena Whitham: I wonder whether Public Health Scotland would be able to use the data that we already have access to with regard to people who are ranked 1 on the Scottish index of multiple deprivation and so on as some type of indicator that could address the issues that Bob Doris raises. Liam McArthur: That is a very reasonable point to make. I understand that there is a bill before us at the moment, and members will see that as the way in which they can address the concerns that they have. However, it may very well be that there are other ways in which those concerns can be addressed and the relevant information can be gathered, without putting further requirements in the bill.”
“I think that the point that Bob Doris made in his intervention was that we would all understand the rationale for why we would want to understand such things. However, what we are trying to do here is put in place a bill that has deliverable provisions, and I think that, for example, the concept of the level of household deprivation lacks a clear definition, and it is not appropriate for clinicians to make judgments on that. In an intervention on Bob Doris, Jamie Hepburn talked about potential privacy issues, given the numbers that would be involved. I listened carefully to Bob Doris’s response to that, and I took some reassurance from it. However, requiring terminally ill people to disclose financial details might feel intrusive and could risk undermining their relationship with their doctor.”
“I say that just to inform members who might be considering other amendments that that amendment is unlikely to be moved. Liam McArthur: That is helpful. Brian Whittle: Listening to Mr Doris speak to his amendments, it struck me that we have to be careful here. The collection of data in relation to the legislation should not be restricted, because we need the ability to interrogate it. If some of the data does not reach the threshold that is required in order for it to be properly interrogated, so be it. However, we should not restrict the collection of data, because I think that what we learn from it could be incredibly important as we move forward. Liam McArthur: Brian Whittle makes an important point.”
“I understand the rationale that he has set out, but, in particular, amendment 64 would require the collection of information on a person’s household status, receipt of welfare benefits, level of deprivation and housing status, which would create intrusive monitoring that is not clearly related to the bill’s core safeguards. The reporting framework in the bill is designed to report on data that is collected by clinicians. The collection of the kind of information that would be required by amendment 64 falls outside the clinical role of doctors. Bob Doris: I want to briefly make the point to Parliament and to Mr McArthur that I deliberately separated the issues in amendment 64 from those in my other amendments on data collection. I recognise the issues with the amendment, and I am minded not to move it.”
“Liam McArthur: I thank the members who have spoken so far for setting out the rationale for their amendments. My amendments in the group, amendments 57 and 58, are technical and would ensure that Public Health Scotland reports on the number of assessments that conclude that a person is eligible and the number that conclude that a person is not. In response to Audrey Nicoll’s query, under the bill as it stands, the number of statements would be captured but not the number of people deemed eligible and not eligible. I think that the amendments represent a valuable strengthening of the provisions. I do not support Bob Doris’s amendments 59, 60 or 64, as I think that reporting requirements should remain targeted, purposeful and proportionate.”
“Transparency and parliamentary oversight are essential to ensuring that the operation of the eventual act remains within its intended scope, as has already been touched on today and previously. The evidence from overseas jurisdictions shows that assisted dying regimes can broaden, over time, in terms of eligibility, practice or application. Therefore, the regulation, publication and scrutiny of reports will help Parliament, stakeholders and the public to identify emerging trends or risks at an early stage and take corrective action when necessary, thereby safeguarding against unintended expansion and maintaining public confidence in the law. The Deputy Presiding Officer: I call Liam McArthur to speak to amendment 57 and other amendments in the group.”
“Amendments 279 and 290 would strengthen the reporting duties in section 24 by removing the vague qualifier “in so far as known to Public Health Scotland” and replacing it with a clear obligation on Public Health Scotland to “take all reasonable steps to obtain, verify and … assess the completeness” of the required information. That would ensure that gaps in data were transparently identified and explained, rather than obscured by uncertainty, which would improve the reliability, accountability and credibility of reporting, enabling effective oversight and helping Parliament and the public to identify risks, trends or deficiencies in the operation of the act at an early stage. Amendment 289 would require reports on assisted dying to be published and scrutinised by the Scottish Parliament.”
“Amendment 236 disagreed to. Section 20—Civil liability for providing assistance Amendment 109 moved—[Sue Webber]. The Presiding Officer: The question is, that amendment 109 be agreed to. Are we agreed? Members: No. The Presiding Officer: There will be a division. The vote is closed.”
“For Adamson, Clare (Motherwell and Wishaw) (SNP) Allan, Alasdair (Na h-Eileanan an Iar) (SNP) Baillie, Jackie (Dumbarton) (Lab) Baker, Claire (Mid Scotland and Fife) (Lab) Balfour, Jeremy (Lothian) (Ind) Bibby, Neil (West Scotland) (Lab) Carson, Finlay (Galloway and West Dumfries) (Con) Choudhury, Foysol (Lothian) (Ind) Doris, Bob (Glasgow Maryhill and Springburn) (SNP) Dowey, Sharon (South Scotland) (Con) Duncan-Glancy, Pam (Glasgow) (Ind) Eagle, Tim (Highlands and Islands) (Con) Ewing, Fergus (Inverness and Nairn) (Ind) Fairlie, Jim (Perthshire South and Kinross-shire) (SNP) Findlay, Russell (West Scotland) (Con) Forbes, Kate (Skye, Lochaber and Badenoch) (SNP) Fraser, Murdo (Mid Scotland and Fife) (Con) Gallacher, Meghan (Central Scotland) (Con) Gosal, Pam (West Scotland) (Con) Gougeon, Mairi (Angus North and Mearns) (SNP) Grant, Rhoda (Highlands and Islands) (Lab) Griffin, Mark (Central Scotland) (Lab) Halcro Johnston, Jamie (Highlands and Islands) (Con) Hoy, Craig (South Scotland) (Con) Johnson, Daniel (Edinburgh Southern) (Lab) Kerr, Stephen (Central Scotland) (Con) Leonard, Richard (Central Scotland) (Lab) Marra, Michael (North East Scotland) (Lab) Mason, John (Glasgow Shettleston) (Ind) Matheson, Michael (Falkirk West) (SNP) McCall, Roz (Mid Scotland and Fife) (Con) McMillan, Stuart (Greenock and Inverclyde) (SNP) McNair, Marie (Clydebank and Milngavie) (SNP) McNeill, Pauline (Glasgow) (Lab) Mundell, Oliver (Dumfriesshire) (Con) Nicoll, Audrey (Aberdeen South and North Kincardine) (SNP) O’Kane, Paul (West Scotland) (Lab) Regan, Ash (Edinburgh Eastern) (Ind) Roddick, Emma (Highlands and Islands) (SNP) Ross, Douglas (Highlands and Islands) (Con) Russell, Davy (Hamilton, Larkhall and Stonehouse) (Lab) Sarwar, Anas (Glasgow) (Lab) Smith, Liz (Mid Scotland and Fife) (Con) Stevenson, Collette (East Kilbride) (SNP) Sweeney, Paul (Glasgow) (Lab) Webber, Sue (Lothian) (Con) Wells, Annie (Glasgow) (Con) White, Tess (North East Scotland) (Con) Yousaf, Humza (Glasgow Pollok) (SNP) Against Adam, George (Paisley) (SNP) Adam, Karen (Banffshire and Buchan Coast) (SNP) Beattie, Colin (Midlothian North and Musselburgh) (SNP) Briggs, Miles (Lothian) (Con) Brown, Keith (Clackmannanshire and Dunblane) (SNP) Brown, Siobhian (Ayr) (SNP) Burgess, Ariane (Highlands and Islands) (Green) Burnett, Alexander (Aberdeenshire West) (Con) Callaghan, Stephanie (Uddingston and Bellshill) (SNP) Carlaw, Jackson (Eastwood) (Con) Chapman, Maggie (North East Scotland) (Green) Clark, Katy (West Scotland) (Lab) Coffey, Willie (Kilmarnock and Irvine Valley) (SNP) Cole-Hamilton, Alex (Edinburgh Western) (LD) Constance, Angela (Almond Valley) (SNP) Dey, Graeme (Angus South) (SNP) Don-Innes, Natalie (Renfrewshire North and West) (SNP) Dornan, James (Glasgow Cathcart) (SNP) Dunbar, Jackie (Aberdeen Donside) (SNP) FitzPatrick, Joe (Dundee City West) (SNP) Gibson, Kenneth (Cunninghame North) (SNP) Gilruth, Jenny (Mid Fife and Glenrothes) (SNP) Grahame, Christine (Midlothian South, Tweeddale and Lauderdale) (SNP) Greene, Jamie (West Scotland) (LD) Greer, Ross (West Scotland) (Green) Hamilton, Rachael (Ettrick, Roxburgh and Berwickshire) (Con) Harper, Emma (South Scotland) (SNP) Harvie, Patrick (Glasgow) (Green) Haughey, Clare (Rutherglen) (SNP) Hepburn, Jamie (Cumbernauld and Kilsyth) (SNP) Hyslop, Fiona (Linlithgow) (SNP) Kerr, Liam (North East Scotland) (Con) Kidd, Bill (Glasgow Anniesland) (SNP) Lennon, Monica (Central Scotland) (Lab) Lochhead, Richard (Moray) (SNP) Lumsden, Douglas (North East Scotland) (Con) MacDonald, Gordon (Edinburgh Pentlands) (SNP) MacGregor, Fulton (Coatbridge and Chryston) (SNP) Mackay, Gillian (Central Scotland) (Green) Mackay, Rona (Strathkelvin and Bearsden) (SNP) Macpherson, Ben (Edinburgh Northern and Leith) (SNP) Martin, Gillian (Aberdeenshire East) (SNP) McAllan, Màiri (Clydesdale) (SNP) McArthur, Liam (Orkney Islands) (LD) McKee, Ivan (Glasgow Provan) (SNP) McLennan, Paul (East Lothian) (SNP) Minto, Jenni (Argyll and Bute) (SNP) Mochan, Carol (South Scotland) (Lab) Rennie, Willie (North East Fife) (LD) Robertson, Angus (Edinburgh Central) (SNP) Robison, Shona (Dundee City East) (SNP) Rowley, Alex (Mid Scotland and Fife) (Lab) Ruskell, Mark (Mid Scotland and Fife) (Green) Slater, Lorna (Lothian) (Green) Somerville, Shirley-Anne (Dunfermline) (SNP) Stewart, Alexander (Mid Scotland and Fife) (Con) Stewart, Kaukab (Glasgow Kelvin) (SNP) Stewart, Kevin (Aberdeen Central) (SNP) Sturgeon, Nicola (Glasgow Southside) (SNP) Swinney, John (Perthshire North) (SNP) Thomson, Michelle (Falkirk East) (SNP) Todd, Maree (Caithness, Sutherland and Ross) (SNP) Torrance, David (Kirkcaldy) (SNP) Tweed, Evelyn (Stirling) (SNP) Villalba, Mercedes (North East Scotland) (Lab) Whitfield, Martin (South Scotland) (Lab) Whitham, Elena (Carrick, Cumnock and Doon Valley) (SNP) Whittle, Brian (South Scotland) (Con) Wishart, Beatrice (Shetland Islands) (LD) Abstentions Arthur, Tom (Renfrewshire South) (SNP) Boyack, Sarah (Lothian) (Lab) Gray, Neil (Airdrie and Shotts) (SNP) Mountain, Edward (Highlands and Islands) (Con) The Presiding Officer: The result of the division is: For 49, Against 69, Abstentions 4.”
“Amendment 108 disagreed to. Amendment 236 moved—[Stephen Kerr]. The Presiding Officer: The question is, that amendment 236 be agreed to. Are we agreed? Members: No. The Presiding Officer: There will be a division.”
“For Adamson, Clare (Motherwell and Wishaw) (SNP) Allan, Alasdair (Na h-Eileanan an Iar) (SNP) Baker, Claire (Mid Scotland and Fife) (Lab) Balfour, Jeremy (Lothian) (Ind) Bibby, Neil (West Scotland) (Lab) Carson, Finlay (Galloway and West Dumfries) (Con) Choudhury, Foysol (Lothian) (Ind) Doris, Bob (Glasgow Maryhill and Springburn) (SNP) Dowey, Sharon (South Scotland) (Con) Duncan-Glancy, Pam (Glasgow) (Ind) Ewing, Fergus (Inverness and Nairn) (Ind) Fairlie, Jim (Perthshire South and Kinross-shire) (SNP) Findlay, Russell (West Scotland) (Con) Forbes, Kate (Skye, Lochaber and Badenoch) (SNP) Fraser, Murdo (Mid Scotland and Fife) (Con) Gallacher, Meghan (Central Scotland) (Con) Gosal, Pam (West Scotland) (Con) Gougeon, Mairi (Angus North and Mearns) (SNP) Grant, Rhoda (Highlands and Islands) (Lab) Griffin, Mark (Central Scotland) (Lab) Halcro Johnston, Jamie (Highlands and Islands) (Con) Hoy, Craig (South Scotland) (Con) Kerr, Stephen (Central Scotland) (Con) Leonard, Richard (Central Scotland) (Lab) Marra, Michael (North East Scotland) (Lab) Mason, John (Glasgow Shettleston) (Ind) Matheson, Michael (Falkirk West) (SNP) McCall, Roz (Mid Scotland and Fife) (Con) McMillan, Stuart (Greenock and Inverclyde) (SNP) McNair, Marie (Clydebank and Milngavie) (SNP) McNeill, Pauline (Glasgow) (Lab) Mundell, Oliver (Dumfriesshire) (Con) Nicoll, Audrey (Aberdeen South and North Kincardine) (SNP) O’Kane, Paul (West Scotland) (Lab) Roddick, Emma (Highlands and Islands) (SNP) Ross, Douglas (Highlands and Islands) (Con) Russell, Davy (Hamilton, Larkhall and Stonehouse) (Lab) Sarwar, Anas (Glasgow) (Lab) Smith, Liz (Mid Scotland and Fife) (Con) Stevenson, Collette (East Kilbride) (SNP) Sturgeon, Nicola (Glasgow Southside) (SNP) Sweeney, Paul (Glasgow) (Lab) Webber, Sue (Lothian) (Con) Wells, Annie (Glasgow) (Con) White, Tess (North East Scotland) (Con) Whittle, Brian (South Scotland) (Con) Yousaf, Humza (Glasgow Pollok) (SNP) Against Adam, George (Paisley) (SNP) Adam, Karen (Banffshire and Buchan Coast) (SNP) Baillie, Jackie (Dumbarton) (Lab) Beattie, Colin (Midlothian North and Musselburgh) (SNP) Briggs, Miles (Lothian) (Con) Brown, Keith (Clackmannanshire and Dunblane) (SNP) Brown, Siobhian (Ayr) (SNP) Burgess, Ariane (Highlands and Islands) (Green) Burnett, Alexander (Aberdeenshire West) (Con) Callaghan, Stephanie (Uddingston and Bellshill) (SNP) Carlaw, Jackson (Eastwood) (Con) Chapman, Maggie (North East Scotland) (Green) Clark, Katy (West Scotland) (Lab) Coffey, Willie (Kilmarnock and Irvine Valley) (SNP) Cole-Hamilton, Alex (Edinburgh Western) (LD) Constance, Angela (Almond Valley) (SNP) Dey, Graeme (Angus South) (SNP) Don-Innes, Natalie (Renfrewshire North and West) (SNP) Dornan, James (Glasgow Cathcart) (SNP) Dunbar, Jackie (Aberdeen Donside) (SNP) FitzPatrick, Joe (Dundee City West) (SNP) Gibson, Kenneth (Cunninghame North) (SNP) Gilruth, Jenny (Mid Fife and Glenrothes) (SNP) Grahame, Christine (Midlothian South, Tweeddale and Lauderdale) (SNP) Greene, Jamie (West Scotland) (LD) Greer, Ross (West Scotland) (Green) Hamilton, Rachael (Ettrick, Roxburgh and Berwickshire) (Con) Harper, Emma (South Scotland) (SNP) Harvie, Patrick (Glasgow) (Green) Haughey, Clare (Rutherglen) (SNP) Hepburn, Jamie (Cumbernauld and Kilsyth) (SNP) Hyslop, Fiona (Linlithgow) (SNP) Johnson, Daniel (Edinburgh Southern) (Lab) Kerr, Liam (North East Scotland) (Con) Kidd, Bill (Glasgow Anniesland) (SNP) Lennon, Monica (Central Scotland) (Lab) Lochhead, Richard (Moray) (SNP) Lumsden, Douglas (North East Scotland) (Con) MacDonald, Gordon (Edinburgh Pentlands) (SNP) MacGregor, Fulton (Coatbridge and Chryston) (SNP) Mackay, Gillian (Central Scotland) (Green) Mackay, Rona (Strathkelvin and Bearsden) (SNP) Macpherson, Ben (Edinburgh Northern and Leith) (SNP) Martin, Gillian (Aberdeenshire East) (SNP) McAllan, Màiri (Clydesdale) (SNP) McArthur, Liam (Orkney Islands) (LD) McKee, Ivan (Glasgow Provan) (SNP) McLennan, Paul (East Lothian) (SNP) Minto, Jenni (Argyll and Bute) (SNP) Mochan, Carol (South Scotland) (Lab) Regan, Ash (Edinburgh Eastern) (Ind) Rennie, Willie (North East Fife) (LD) Robertson, Angus (Edinburgh Central) (SNP) Robison, Shona (Dundee City East) (SNP) Rowley, Alex (Mid Scotland and Fife) (Lab) Ruskell, Mark (Mid Scotland and Fife) (Green) Slater, Lorna (Lothian) (Green) Somerville, Shirley-Anne (Dunfermline) (SNP) Stewart, Alexander (Mid Scotland and Fife) (Con) Stewart, Kaukab (Glasgow Kelvin) (SNP) Stewart, Kevin (Aberdeen Central) (SNP) Swinney, John (Perthshire North) (SNP) Thomson, Michelle (Falkirk East) (SNP) Todd, Maree (Caithness, Sutherland and Ross) (SNP) Torrance, David (Kirkcaldy) (SNP) Tweed, Evelyn (Stirling) (SNP) Whitfield, Martin (South Scotland) (Lab) Whitham, Elena (Carrick, Cumnock and Doon Valley) (SNP) Wishart, Beatrice (Shetland Islands) (LD) Abstentions Arthur, Tom (Renfrewshire South) (SNP) Boyack, Sarah (Lothian) (Lab) Gray, Neil (Airdrie and Shotts) (SNP) Mountain, Edward (Highlands and Islands) (Con) The Presiding Officer: The result of the division is: For 47, Against 69, Abstentions 4.”
“The amendments in the group highlight the wider concern and, alongside my colleagues, I have been presenting a series of amendments that would remove the legal ambiguity and provide certainty for doctors, carers, patients and families. I will press amendment 108. The Presiding Officer: The question is, that amendment 108 be agreed to. Are we agreed? Members: No. The Presiding Officer: There will be a division.”
“Sue Webber: I do not feel that I know the answer but, with the amendments in this group, I am trying to ensure that patients and healthcare professionals who face this profound legal and ethical uncertainty, at what would be an extraordinarily difficult moment for everyone, have a clear line so that they know whether their actions are legal or illegal. Families must also understand what the law permits. As Mr Kerr said, assistance must never become anything more than assistance. Patients could be placed at risk because the law offers no clear framework for how such a situation could and should be handled, and that is not how serious legislation should operate.”
“Edward Mountain: What I am trying to get my brain around is that we voted for an earlier amendment that means that the medical professional has to sit with the patient until the patient has died, and I am still not clear about what happens when things do not work out as anticipated after they take the drugs. That can happen for a variety of reasons. What is that medical professional supposed to do? Are they supposed to sit on their hands, do nothing, wait to see whether the drugs work and let that person go through the most appalling pain and suffering, or are they supposed to do something? No one has given me the answer, and I am not sure whether the member knows the answer or whether she feels that I have missed something when I have been listening.”
“Does Sue Webber agree that the bill badly needs that clarity or that we should at least ask the member in charge to be much more specific about what he would expect medical professionals to do beyond the form of words that he has been careful to use? I respect the fact that he has been careful in his choice of words, but I think that we need some expansion on their meaning. Sue Webber: Indeed, Mr Kerr. I believe that the original text fails to define the scope of immunity with the precision that legislation of this gravity demands. Without that clarity, doctors and carers could find themselves unsure of their legal position if a patient survives the initial attempt.”
“That is the answer that we have been seeking. The clarification is in the amendments that we have presented today, because the provisions that we are considering demonstrate that the bill falls short of that. Without the amendments in this group, the bill will be deeply silent on the serious scenarios that we have outlined. What if that lethal substance does not end a person’s life? Stephen Kerr: I tried to elicit a definitive answer from the member in charge. My concern is that we are continuing to have this discussion because we are not clear about the answer to the serious moral conundrum that I do not particularly want doctors and healthcare professionals to have to face when it is not clear exactly what they should do in a situation when the substance that the individual has taken has not worked.”
“Liam McArthur: It might be helpful if I refer Sue Webber and other members to section 15(3A), which says: “For the avoidance of doubt, nothing in this section authorises any person to administer an approved substance to the adult on their behalf with the intention of bringing about the adult’s death.” The situation is perfectly clear under the bill as it stands, and murder will remain murder if the bill passes. Sue Webber: I am sorry, but I do not accept that. We have asked Mr McArthur today, yesterday, last night and at stage 2 what would happen and what a healthcare professional should do if an individual takes a substance and it does not lead to their death. Do they then perform their traditional role—I think that was it—and intervene to save their patient’s life, or do they take steps that would lead to that patient’s death?”
“Fergus Ewing’s amendments on lawful assistance would ensure a clear understanding of what lawful behaviour was and of the practical expectations in law. We have challenged Mr McArthur on his statement that the clinician would provide care and take steps to make the patient comfortable and on what would happen when the substance did not work, but I do not think that we have had that clarity from him today. That is where my amendment and the other amendments in the group— Liam McArthur: Will the member take an intervention? Sue Webber: Yes, I will.”
“The Presiding Officer: I call Sue Webber to wind up and press or withdraw amendment 108. Sue Webber: As we have heard, the issue in this group of amendments goes to heart of both the legal framework surrounding the bill and, frankly, the fundamental principles that underpin our criminal law. In any other circumstance, taking a person’s life is a crime. Enabling or assisting a suicide is also a crime. Right now, our laws rightly contain strong protections to prevent anyone from encouraging, facilitating or enabling another person’s death. Those safeguards exist to protect the vulnerable and to ensure that the law remains firmly on the side of preserving life. Stephen Kerr’s amendments have sought to reinforce the importance of those legal boundaries.”
“The bill is also clear that the final act to bring about death must be taken by the person themselves. Meanwhile, Fergus Ewing’s amendment 237 seeks to clarify and reiterate provisions that are already contained in the bill and in the law in Scotland as it stands. Although I understand the intent behind amendment 237, further detail would be set out in guidance produced by the General Medical Council, the Scottish ministers and others. Taken together, those mechanisms should provide sufficient clarity for practitioners. Adding a further provision would potentially create a backdrop against which medical practitioners might be concerned about the potential for civil litigation arising for minor record- keeping issues or for questions about how particular guidance has been followed. As such, I cannot support amendment 237.”
“It is not open to the medical professional, which is where Sue Webber is trying to direct the discussion, to euthanise the patient. There is standard practice at the moment for medical professionals to use their judgment in certain situations to relieve suffering and make the patient comfortable—in essence, to palliate the patient. That is what would occur in this situation. For the same reasons, I do not support Stephen Kerr’s amendment 236, which seeks to avoid doubt that I do not think legally exists and to clarify areas that I do not believe require further clarification. As I said, the bill is absolutely explicit in making it clear that the actions specified in the bill with regard to assisting a terminally ill adult to end their own life would be lawful.”
“The patient would have an opportunity to air and discuss any concerns or questions with a medical professional. Sue Webber: Perhaps Mr McArthur can help me to understand. When he is talking about that informed discussion between the healthcare professional and the patient seeking the assisted death, is he suggesting that there would be a conversation between those people, in which the patient said, “Should I take the substance and it did not kill me, I would want you to make sure that my life ended”? Liam McArthur: The answer remains the same as the response that I gave to the questions that were posed yesterday. It would be up to the judgment of the clinician, who would use their professional skills and experience in order to make the patient comfortable.”
“19:30 Liam McArthur: We are going back over the discussion that we had—I think—last night, but I certainly understand why we are all losing our sense of time at this stage. As I said earlier, it is a matter of ensuring that clinicians respond to those instances in an appropriate way that is relevant to their training. Going back to some of our discussions around advance care planning, it is also a question of ensuring that the discussions that happen when medical professionals are talking to patients about the available options, once they are certain that they wish to proceed with an assisted death, cover the medications, the process that will happen and the effect that it will have. That will result in an informed discussion between the patient and the medic.”
“Is Liam McArthur saying that he would expect the healthcare professionals to fulfil their traditional role in helping the person to overcome that distress and, where practical, to make a recovery from the effects of the substance that they had taken—as opposed to what Sue Webber and I are trying to do with our amendments, which is to create a clear legal boundary between assistance that was provided under the bill to someone who had requested and received approval to have an assisted death, and euthanasia, where healthcare professionals’ involvement might lead to the person’s death? That is the point on which we are seeking clarity in this group. Will Liam McArthur comment on the assumptions that I have made in the scenario that I have described, which I have tried to describe as sensitively as I can?”
“The bill also makes it clear that the final act to bring about death must be taken by the person themselves, while the management of complications would remain subject to standard clinical practice. It is not clear how the requirements in amendments 108 and 109 would interact with the doctor or nurse providing care and taking steps to make the person comfortable, so I cannot support them. Stephen Kerr: At some point in the past few days, we had an exchange about the phrase, “making people comfortable”. Frankly, I am still not clear what that might mean, but I ask Liam McArthur to test an assumption that I am making about what he is saying. Let us consider a situation in which someone had taken a substance, it had not worked and they were clearly in distress.”
“I am sorry—I requested to speak by accident. The Presiding Officer: I call the cabinet secretary. Neil Gray: The Scottish Government has no comment to make on any of the amendments in this group. The Presiding Officer: I call Liam McArthur. Liam McArthur: I thank Sue Webber and Stephen Kerr for setting out the rationale for their amendments. Sue Webber’s amendments 108 and 109 seek to provide that it would be a crime, and that it would give rise to civil liability, to assist someone to end their life after the point at which they had been provided with the substance and had not died as a consequence. The bill makes it absolutely clear that only the actions that are specified in it with regard to assisting a terminally ill adult to end their own life would be lawful.”
“I would not want the level of confusion in this debate to result in members coming to the debate on Tuesday doubting whether we can have a competent bill. If we vote for those amendments, we can have a competent bill and then we can make a final decision on the core ethical question that is in front of us.”
“20:15 I want to emphasise that, through the combination of the section 30 order and amendments 110, 111, 133 and 133A, we could have a bill in front of us on Tuesday that is competent and has safeguards on drugs and poisons, on employment protections, on conscientious objection and on minimum training and qualification requirements for the professionals who are involved. At that point, it will be up to members to decide whether we believe that that would result in a system that is sufficiently safe and operable. The combination of those amendments—I say again that they are amendments 110, 111, 133 and 133A—would resolve the issues of legislative competence and would result in a bill that has safeguards on drugs and poisons, on employment protections, on conscientious objection and on minimum training and qualification requirements.”
“The Deputy Presiding Officer: As we are nearing the agreed time limit, under rule 9.8.4A(c), I consider it necessary to allow the debate on this group of amendments to continue beyond the limit in order to avoid the debate being unreasonably curtailed. Ross Greer: I did not plan to speak on this group, so I promise to be brief. I want to address the debate on competency that has arisen from the approved substance issue. I say this as someone who is still undecided on the bill—I am not trying to swing the debate one way or another. I am deeply frustrated that we have got to this point and the issues of competence are still so deeply contested. I would love to know how that has happened, but right now I frankly do not really care where fault lies. What is in front of us is a bill and amendments to it—and those should be our only concern.”
“There is perhaps an issue about public awareness, but there is also an issue about the lack of research that has been undertaken into the reliability of drugs that are used in assisted dying. For example, a recent article in the Journal of Law and the Biosciences set out that point very clearly. I share the member’s concerns. Although amendment 224 would not address all issues relating to complications, it would make the identification of trends in complications more possible. The recording of basic information on what drugs are used is a necessary step in firming up accountability and prioritising patient safety. I therefore urge members to support amendment 224.”
“Ruth Maguire: Further to what Audrey Nicoll said about the information that is available on the use of death row drugs, does she share my concern that, according to the Government of Oregon’s most recent data, one person took more than 137 hours to die—that is five and a half days—and that more than half of assisted deaths in Oregon in 2023 took between 53 minutes and 137 hours? Does she agree that those facts, and particularly the uncertainties about the pain that patients experience as a result of the drugs or of vomiting while trying to get the drugs down, give a really strong challenge to the notion that all assisted suicides are guaranteed to be quick and painless? That is not a guarantee that we can give to citizens, is it? Audrey Nicoll: To answer Ruth Maguire’s first point, yes, I share her concerns.”
“The recording of information would also be relevant for identifying trends in complications that are experienced by patients during the process of dying from lethal drugs. Although, unfortunately, there are no studies into the physical experience of patients as they go through assisted dying, we know that there can be a crossover with drugs that are used on death row, which have undergone research. It is suggested that, due to the combination of the drugs that are used and their side effects, prisoners are conscious and possibly aware of pain but unable to communicate. Palliative care experts warn that questions remain unanswered as to whether patients who are dying with the same or similar combinations of drugs under assisted dying in fact feel any painful sensations.”
“Dr Ramona Coelho serves on the Medical Assistance in Dying Death Review Committee, which works with the province of Ontario’s Office of the Chief Coroner to identify and address public safety concerns. She was asked to give evidence to the Scottish Parliament and to reflect on her experience of reviewing the practice of MAID. She advised MSPs that, in Ontario alone, more than 400 violations of MAID have been identified since 2018, and that doctors with many complaints to their names have been allowed to continue in their practice. No matter what members’ position is on the workability of the bill, we will all be keen to use all the means at our disposal to make it harder for the same issues to be replicated in Scotland.”
“If I am clear that we cannot regulate healthcare professionals, and the Government is clear that we cannot regulate healthcare professionals, let us agree to the amendment and bring forward regulations that are competent. Audrey Nicoll: My amendment 224 is a straightforward amendment that seeks to ensure that, after a patient dies from the lethal drugs injected, the doctor’s final statement contains sufficient information on those drugs for insurance claims, regulatory review and investigations. That will improve transparency, traceability and accountability. From the evidence that was provided at the committee stage on assisted dying abroad, we know that, unfortunately, there are cases of malpractice. In those situations, it is important that police forces and others have that basic information available.”
“The meaning would be much wider, in my view. It would not be an administrative process, as the Government suggested it could be. Other amendments to the bill are about the recording of instances of things that are covered by provisions. I have not defined “management”, but it would be management of the individual’s wellbeing. I have not defined “management” for exactly the same reasons as the Scottish Government been concerned about legislative competence. I do not think that amendment 44 will raise issues of legislative competence in relation to the regulation of healthcare professionals, and that is not my intention. I would expect the Scottish Government to consult on and develop the regulations with greater certainty, and not to introduce regulations that also regulate healthcare professionals.”
“However, I hope that we all agree that those things should feature in guidance and regulations and in normal medical practice. If the conversation drags us to the position where we say that we must account for all and every scenario in the bill before we agree to it, I do not think that that would be appropriate or practical. Bob Doris: I associate myself with Jamie Greene’s comments, which I absolutely agree with, but I note that amendment 44 would not put those details in the bill. It would be a regulation- making power. Amendment 70, which is a consequential amendment, would ensure that such regulation was subject to the affirmative procedure. For clarity, on the Scottish Government’s concerns, it asked what would be meant by “management” in such circumstances—would it be clinical care or other forms of care or wellbeing?”
“There must be clear regulations, as far as possible, on what must or must not happen in such circumstances. I think that Mr Kerr was trying to get to that point during his commentary. Such regulations are important in ensuring that the public and families are clear about what a healthcare professional must, can or cannot do in such circumstances. Jamie Greene: My intervention follows on from the previous discussion and from other amendments about such hypothetical scenarios. I do not have a problem with the quite difficult conversations that we must have about the substance, the method and the ifs and whens when something goes wrong. However, the question that some people are battling with is how much of that needs to be in legislation. We cannot in any way, shape or form account for every medical scenario in primary legislation.”