END OF LIFE ASSISTANCE (SCOTLAND) BILL COMMITTEE Tuesday 5 October 2010 Session 3 Parliamentary copyright. Scottish Parliamentary Corporate Body 2010 Applications for reproduction should be made in writing to the Information Policy Team, Office of the Queen’s Printer for Scotland, Admail ADM4058, Edinburgh, EH1 1NG, or by email to: [email protected]. OQPS administers the copyright on behalf of the Scottish Parliamentary Corporate Body. Printed and published in Scotland on behalf of the Scottish Parliamentary Corporate Body by RR Donnelley. Tuesday 5 October 2010 CONTENTS Col. END OF LIFE ASSISTANCE (SCOTLAND) BILL: STAGE 1 ................................................................................... 281 END OF LIFE ASSISTANCE (SCOTLAND) BILL COMMITTEE 9th Meeting 2010, Session 3 CONVENER *Ross Finnie (West of Scotland) (LD) DEPUTY CONVENER *Ian McKee (Lothians) (SNP) COMMITTEE MEMBERS *Helen Eadie (Dunfermline East) (Lab) *Michael Matheson (Falkirk West) (SNP) *Nanette Milne (North East Scotland) (Con) *Cathy Peattie (Falkirk East) (Lab) *attended THE FOLLOWING GAVE EVIDENCE: David Cullum (Scottish Parliament Chamber Office) Margo MacDonald (Lothians) (Ind) CLERK TO THE COMMITTEE Douglas Thornton LOCATION Committee Room 2 281 5 OCTOBER 2010 282 emphasis on the requirement for the practitioner to Scottish Parliament know the patient and to be able to distinguish whether there was any undue internal or external End of Life Assistance (Scotland) influence on the patient’s choice. The clarification that Margo MacDonald has provided is at odds Bill Committee with the written evidence that we have received from various respondents to our call for evidence, Tuesday 5 October 2010 who believe that it is important for practitioners to have detailed knowledge of patients so that they [The Convener opened the meeting at 10:16] can determine whether there has been undue End of Life Assistance (Scotland) internal or external pressure. I invite you to respond to that concern. Bill: Stage 1 Margo MacDonald (Lothians) (Ind): First, the The Convener (Ross Finnie): Good morning. bill makes no reference to the medical practitioner Welcome to the ninth meeting of the End of Life in the practice with which the patient is registered. Assistance (Scotland) Bill Committee. As usual, I We have tried to be as flexible as possible. We remind everyone in the room to switch off any went into detail for rather a negative reason: we electronic equipment that might interfere with anticipated that some people might think that there transmission. No apologies have been received. I would be suicide tourism, or something like that. apologise for the slight delay in commencing We wanted to ensure that the approach could not proceedings; traffic jams delayed members getting be regarded in that way, so we talked about the to the meeting. qualifying period and the need to be registered with an appropriate medical specialist and so on. There is only one item on the agenda. As a matter of courtesy, I note that members have It might well be that a person’s general received three communications since we last met. practitioner would not want to take part in the The first is from the Cabinet Secretary for Health procedure, so we did not want to be too and Wellbeing and relates to the applicability of prescriptive. However, we said that, if the person the National Health Service (Scotland) Act 1978. was unable to contact someone who was willing to The committee has also received a helpful letter help, the GP would have a duty to help them. from the bill’s sponsor, Margo MacDonald, and a There is an entirely reasonable supposition that further letter from the Solicitor General for the person would be known to one or other of the Scotland clarifying issues relating to the practice of medical specialists, whether that was the person procurators fiscal in respect of post-death to whom they first mentioned the issue or the certification and investigation. person to whom they were subsequently referred. This is the final oral evidence session, subject to Helen Eadie: Do you think that the person to the committee not requiring to call further whom they were referred would be able to carry witnesses. We welcome the bill’s sponsor, Margo out checks via the other GPs? Would they know MacDonald, who is accompanied this morning by the patient well enough? David Cullum, head of the non-Executive bills unit Margo MacDonald: We have said that the in the Scottish Parliament, and Peter Warren, who requesting person would have to have two is a researcher for the member in charge. I invite witnesses, who would have to be able to say that questions from members. the person was not being coerced and so on. Helen Eadie (Dunfermline East) (Lab): My There must also be recourse to specialist question may be answered by any member of the psychiatric or psychological advice. There would panel. I thank Margo MacDonald and her team for be a network of support, so the person would be their letter providing us with further clarification. At unlikely to be unknown to everyone that they met. the bottom of the first page, it says: Mr Cullum is reminding me that there are “there is no requirement on the requesting person to General Medical Council guidelines on how seek assisted dying from a doctor at the practice with which professionals should act. they are registered or to involve the practice in any other way in the processes set out under the Bill. There is also no Helen Eadie: Let us consider the bill’s direction requirement on the requesting person to have been and purpose. It covers euthanasia and physician- registered with the designated practitioner for 18 months assisted suicide. Professors Mason and Laurie prior to seeking assistance. Section 4(1)(b) merely requires said that the approach is the requesting person to have been registered with any practice or series of practices in Scotland for this “largely uncharted territory for any jurisdiction.” continuous period of time.” Is it practicable to cover euthanasia as well as However, in the evidence that we have heard physician-assisted suicide? If so, are the throughout stage 1, there has been considerable provisions applicable to both practices? 283 5 OCTOBER 2010 284 Margo MacDonald: The bill’s intention must be are here when a double-effect draught of whatever weighed up in its entirety. There are two points to is given at the end of life has changed, and make. First, the bill talks about the autonomy of doctors now feel that they can declare what has the patient. Secondly, the possibility of anyone happened much more freely. I think that it is a else taking the decision for the patient would be question of how deaths are reported rather than of prevented by provisions throughout the bill. If more deaths being brought about by Dutch someone exercised their autonomy and decided physicians. that their life had come to an end for them and that The evidence is very shaky and it is questioned they were left with just a shell of intolerability, the by the people in the Netherlands. The experience bill would give them the legal right to seek help, there seems to me to run in quite close parallel but no other person could instigate that process or with the experience in Oregon, which has a make the decision. completely different legal system, but the end That is why, when we were drawing up the bill, it result is that a very small percentage—let us say was difficult to decide whether to use the word about 2 per cent—of deaths each year are brought “euthanasia”. This might be entirely personal, but I about through assisted death. maintain that euthanasia is associated with Helen Eadie: So as not to hog the questioning, I someone else taking the decision, rather than the have one last question for now, if that is okay with requesting patient. I accept that some people think the convener. that, in the final analysis, it is euthanasia if the requesting patient cannot self-administer the drug If you have seen the letter that we have and a clinician gives assistance at the very end. received from the Cabinet Secretary for Health and Wellbeing, Nicola Sturgeon, you will be aware I am trying not to split hairs, but the intention that she says that was to ensure that people understand that no clinician can do as they can do at present and “The Scottish Government takes the view that the make the decision by giving a double-effect dose provisions of end of life assistance as set out in the Bill of medication near the end of life to shorten life. would not be within the powers as set out in the 1978 act and therefore is not within the powers of Health Boards in The bill says that the only person who can make terms of that Act. It follows from this that the Scottish that decision is the patient. When Professor Government believes that NHS General Practitioners or McLean gave evidence, she said: any other health professionals who provide services through the NHS in Scotland could not provide such “If we accept the fundamental principle of choice at the assistance while acting in that capacity.” end of life, it would be illogical to limit the bill to assisted suicide ... If the bill were to cover only assisted suicide, That presents some difficulties for you. How would those who want to die but who need the simple assistance you see your bill operating when its provisions do of a doctor would be deprived of that assistance on the not fall within the scope of the National Health basis of a legal rule that even the highest judges in the land do not think is applicable in such circumstances.” —[Official Service (Scotland) Act 1978? Report, End of Life Assistance (Scotland) Bill Committee, Margo MacDonald: It is not an unusual 14 September 2010; c 87.] circumstance; in fact, it is very common to have a Helen Eadie: At last week’s committee meeting, piece of legislation make another bit of legislation there was an exchange between you and John redundant or archaic.