 Good morning and welcome to the third meeting in 2015 of the Health and Sport Committee. I would ask everyone in the room to switch off mobile phones, as they can often interfere with our sound system. I would also ask you to note that you will see some of the committee members using tablet devices this morning, and this is instead of our hard copies of tablets. I welcome again to a party who joined us for agenda item number three. Our first item on the agenda today is to continue our stage 1 scrutiny of the Assisted Suicide Bill. This morning we have two round table sessions and the first of these is on pallid of care. As usual with a panel, we have introduced ourselves in much too long for me to do them, so we have also with us, I should introduce Dr Mary Neill, who is the adviser to the committee. My name is Duncan McNeill, I am the member of the Scottish Parliament for Greenland and Inverclyde and convener of the Health and Sport Committee. My name is Bob Doris, Deputy Minister of the Health and Sport Committee. I am MSP for Glasgow. My name is Pat Karaher, I am the medical director to Children's Hospice Association Scotland. I am Laura Finlay, I am the pallid of care lead for Wales, but I am also in the House of Lords and I am involved in the debate for Lord Faulkner's Bill. I have also been on the slack committee, I am sorry. I was on the slack committee on Assisted Dying that looked at Lord Jofi's Bill. Good morning, I am Dennis Robertson MSP for Aberdeenshire West. Good morning, I am Stephen Hutchison, just recently retired consultant physician in pallid of medicine at the Highland Hospice in Inverness. Good morning, I am Colin Keir MSP for Edinburgh Western. Mike McKenzie MSP Highlands and Islands region. Mark Hazelwood, Chief Executive of the Scottish Partnership for Pallidive Care. Annette Milne MSP for North East Scotland. Good morning, my name is David Jeffery, I am a lecturer in pallidive medicine at University of Edinburgh. Good morning, I am Richard Lyle MSP for the Central region. Good morning, I am Richard Mead Head of Policy in Public Affairs for Scotland from Eric Heary. Richard Simpson MSP for Mid Scotland in Fife. Patrick Harvie, member in charge of the bill. Thank you all for that. Welcome to you all and we will move directly to our first question which is from Richard Simpson. I should draw attention to my declaration as a member in past chair of Struthcarnan Hospice in the context of today's meeting. I want to open up by challenging our witnesses today all of whom's evidence is if I am not misrepresenting them broadly rather against this bill, some more definitely against than others. But can I open up by challenging our witnesses today to say if the Parliament decides to proceed to stage 2 of this bill and give agreement to the general purpose of the bill in stage 1, what changes do they think could be made to this bill to make it a bill that would work and be appropriate? Yes, Baroness, if you would, and I'll bring others in. Okay, thank you. Having myself worked at Struthcarnan many years ago as a doctor and I was a GP in Maryhill for five years, I would say that, first of all, the way the bill is written, most of my patients in Maryhill and Postall Park would just become automatically included because their life expectancy was much shorter than those people who lived in the wealthier area up the road in Bearsden and Mulgy. So I think that there is a fundamental problem with who you're trying to include. The second thing is that you have attempted in this bill to take it out of medicine, which is a good thing to do. By having medicine involved at all, you've got a fundamental problem. You've got 4 per cent of licensed palliative medicine doctors are prepared to have anything to do with this. 96 per cent are not. So even the way that this bill might work with that resistance amongst doctors, which is resistance for good reason, it's not going to work. I would suggest that you look seriously at taking any processes completely outside medicine so that the adjudication of eligibility or not is completely outside medicine. You've got a concept of licensed facilitators in there which you could build on. The title is Honest and is to be commended for its honesty. We had a big debate in Parliament over Lord Faulkner's Bill, which uses the euphemism assisted dying, and you're being quite clear about what this is. I think you need to specify who would be issuing the lethal drugs because this is not medication, this is not treatment, there's nothing to do with treatment, and this dose of drugs would not be in any formulary because there's no evidence base for it, but that needs to be in there. You also need to clarify the interface between suicide prevention policies and when the Mental Health Act would kick in because if somebody is turned down for whatever reason, I don't see how a doctor could turn them down the way the bill is written. You've got a real problem on the interface between the person who is seeking assisted suicide with lethal drugs and the person who is suicidal and who would be currently managed and supported and helped through mental health services, often working in conjunction with main medical services. The other thing that I do think becomes important in relation to the doctors is the conscience clause is reserved, as far as I've understood, so you cannot create a conscience clause in Scotland, but all of the professional guidelines and so on over conscience and what you do are actually probably not worth the paper they're written on, and we've seen that with the midwives at the moment over midwives being involved in managing patients who've had an abortion, but actually a conscience clause isn't going to hold water. Medicine knows that and has no faith in any talk about a conscience clause because they know that they'll get caught up in it. So, again, my advice would be that if you're serious about this and you really want to have a system that might actually work, then you put the adjudication with the court deciding who is or is not to be provided and you get a court-appointed person and a court system. I think I'll stop there because I could go on for longer. There are other responses in Mark Hazelwood. I just want to, just a point of clarification because Richard's characterised all the witnesses here as having a position of opposition to the bill, and I thought it was really important for me before saying anything else just to be clear about what the position of the partnership, the Scottish partnership for palliative care is, and in our submission we've said that we're not able to adopt a position on the principle of whether or not assisted suicide should be legalised, and that's because the topic raises a number of moral, personal, ethical issues upon which many of our member organisations, and I'm thinking here particularly of the Scottish health boards, they're institutionally unable to hold a position on issues of that sort. So, the partnership has adopted approach of providing information and then in regard to the interests of vulnerable people and also the provision and practice of palliative care of directing and suggesting to MAPs areas within this particular bill where there might be a need for particular consideration. So, I appreciate that that's a slightly nuanced position, but I wanted to be clear that we're not in the black and white category that Richard characterised us as. Thank you. Anyone else? Dr Karakor, did you indicate? I think that that's an interesting question to draw us out. I would represent those probably younger than 25 years old because that's my area of expertise, and I would have to say that I have considerable concerns about this bill if it would become law because I think children are different than young people, young people are different than adults and we know there's different maturing rates and I think for somebody 16 years and just over that to be able to make that sort of decision, to have the capacity and the full understanding of this increasing amount of work available to us now to show that people even up to the age of 25 don't fully understand the absolute significance that death would be final for them and I have to say in my own work only twice in the last couple of weeks we have the opposite that, we have do not attempt cardiopulmonary resuscitation that some youngsters decide to say I'll sign up to that because they think in the event of an acute deterioration they don't wish to have intervention. In two cases in the last couple of weeks, both of these youngsters who were very clear in their own mind when the push came to the shove, if I can use that phrase, actually elected for full resuscitation. Of course they were able to go for that full resuscitation, I don't need to follow the discussions through. I too could go on but probably would wish to stop there at this stage. I'll take those who haven't made a contribution and of course in these sessions we always defer to our panelist and ask the politicians to be patient and we'll bring them in when there's that and I will. Dr Geoffrey. Those comments, it's not just the doctors and the association of palliative medicine that are opposed to this, that all the major colleges, the College of Physicians, the BMA, the Royal College of General Practitioners are all against legalisation of assisted suicide or in England as it's called assisted dying. I want just to put that in the context of a huge problem that we face here in Scotland of recruitment of general practitioners and I would like the committee to think about the influence this will have on doctors. I think whatever the complicated ethical arguments that we have about euthanasia, at the bottom line doctors have a gut feeling and intuition that this is something that they just should not be involved with. Is there any other panelist who want to please Dr Hutchins? One of my concerns might seem like the rather tedious dictionary definitions but the bill is said to be founded on the principle of autonomy and I think if this was an important enough principle to state that the bill is founded on that then it's important enough that we should address and challenge the whole issue of autonomy and I've written extensively about this in the papers that I've submitted. I think autonomy is the wrong word, it's the wrong concept and autonomy has caused problems in Belgium as I understand it where essentially the patient's autonomy is the driver and it seems to supersede the professional judgment of other people and therefore the widening of the criteria for assisted dying in Belgium. I think that rather than talking about autonomy because I don't personally believe that autonomy actually exists when you think about it, we should on the other hand be talking about choice with responsibility. We function as a relational interdependent society and that's how it works, it doesn't work with autonomy and therefore I think that we need to look at choice with responsibility and that to me puts a completely different emphasis on this whole thing. It's not what the individual chooses and demands, that's part of the equation but that has to be balanced with a careful scrutiny of what the implications of that would be for the rest of society and in particular the vast numbers of frail, vulnerable, frightened people that we look after. Thank you. If I may come back and build slightly on what's already been said, firstly over the age and just to illustrate it for you I hope graphically, I had a patient young man who had his third tumour, testicular tumour and was adamant that he did not want any treatment and that he wanted to be helped to die and this discussion went on not just for weeks but for months and then he was in his 20s and then when he was unable to sit up in bed and was really I thought in the last 24 hours of life and his parents were sitting at his bedside he said to me is it too late for me to try to be treated? Now we had had weeks and weeks and weeks of discussion but it wasn't until death was absolutely staring him in the face that he really believed that his treatment refusal and desire to death for death was going to result in his death. Actually there was a happy outcome because I went and phoned the oncologist within an hour we started him on oncological treatment he had a debalking surgery against all odds and that was many years ago and he is still alive today and I see him fairly regularly out walking just socially and he is glad to be alive but he's very clear that his desire for death and his desire to have his life shortened wasn't just weeks as in this bill with two weeks but this went on for months and months and months and I think the age as well is important and up to 25 there is really good psychological developmental evidence that youngsters don't understand it. The other problem that you've got is that laws send messages and I think this is a public safety issue. This is about those who are vulnerable to coercion, vulnerable to pressure, vulnerable to feeling that they are a burden and if I can pick up on the point made by Dr Hutchison very clearly over autonomy, autonomy was the concept that came from Greek states about having their own rules within their society. Autonomy came as a concept about the fact that we have the ability to others and actually autonomy is relational and I'm concerned that there is no requirement here at all to think about what is the effect on others, what is the effect on children of a parent taking their life deliberately foreshortening their life and being assisted in doing so by the medical clinical services that that young person would then be dependent on in bereavement. How does that person go to the GP grieving and we know that young people can have a lot of problems and lack of support in grief? How do they go to them when it's been the GP that signed the forms? I put that out as a question to you. Richard, do you want to come? Yes, I think that the question of autonomy is really very interesting and maybe the witnesses would like to expand on one of the concerns that I have which is about vulnerability because from my own experience as a doctor, first of all I would agree with Elora, I have had at least three patients who have changed their minds when confronted with the absolute reality, when it has dawned, when their denial has stopped that they are going to die, they suddenly realise that they want to live and they are prepared to accept treatment at that point. However, what I am concerned about particularly is the situation between the family and the individual that again in my experience, convener, that individuals said to me, I do not wish to be a burden to my family and what one then did was get the family in to explain that they weren't a burden and they didn't have to go into a hospital, they could stay at home and they would be looked after. However, people do feel that at that stage when they are really quite ill that they become a burden. I would like to explore a little further how the bill could ensure, if it was passed, that those circumstances of vulnerability, given the psychological problems associated with terminal care, which are not understood by the public very fully, and really by any of us until we face that situation. How do you protect those who are going to make a decision that they wish assisted suicide when, in fact, they are not doing it for themselves to relieve an impossible burden for themselves but are doing it because of a vulnerability that may or may not be expressed by others, pressure by others? I start off with that. In the paper submitted by Dr Martin Wilson and myself, Dr Wilson is a consultant in the care of the elderly in Rhaigmoor hospital in Inverness. We have cited the whole issue of elder abuse in the society, which is a major problem. I think the concern is, and I can see that myself because I have been involved in family situations, I can see how the pressure could be there, the spoken or unspoken pressure to think, wouldn't it be good if so-and-so no longer was alive, their suffering would be over? Possibly for altruistic reasons or possibly for malicious reasons, the bill leaves itself wide open to malicious reasons for families wishing to see the end of life of somebody older in terms of their inheritance or the costs of care or whatever. The whole issue of being a burden is an interesting one, and I have approached that in a way in which some people might actually find surprising. Occasionally, my patients and their families did it. It would be very common for me to be speaking to, say, a husband and wife, one of whom was ill and the other whom was caring. Let's say the husband was ill and he would commonly say to me, look, I do not want to be a burden to my wife. We know that the fear of being a burden is a very significant driver for assisted suicide in Oregon, so it's a relevant issue. My response to that, perhaps to their surprise, was to say, well, you are a burden to her. Care is a burden, and I don't believe that we can realistically say, of course you're not a burden. We are burdens to each other. That is part of the relational nature of our society, and I contend that in a responsible society, we carry each other's burdens. In this hypothetical, but real husband and wife team, I would say, well, you are a burden. It is a burden for her to look after you. There are demands. She needs to have the opportunity to rest, bite and break, but if the tables were turned, would you do the same for her? I can't think of anybody who said no. I suppose I used to respond to her, but the weight of that burden, the weight of that burden you've went into that worry, the weight of that burden sometimes weighs heavily on carers and sometimes results in the premature death of carers, because carers are becoming older and looking after older people. That story prompts that response in me, but this is not just somebody who's able to give care freely. A burden can't just be dismissed as some sort of duty. It has, in itself, an impact on that other person, that other person's health, quality and life. I don't know whether it can be just gently pushed away as a burden. I'm certainly not pushing it away. A very substantial burden on that person means that that person also needs to be supported. One of the loadstones of the high quality of palliative care that we have in this country is that we don't just simply care for the patient, but we're caring for the family, the carers, the relatives. We're looking at social financial spiritual issues. We're looking very holistic with the situation. I hope that we can get to that in this session, which we'll deal with separately, about the limits that palliative end-of-life care has, because we know that that support is not available throughout Scotland. We know that the staffing levels are not available within Scotland. We know that caring levels are under strain and people are supported sometimes in the community, not satisfactory, but we'll maybe come to that, pardon this. Thank you, Chairman. I think that you've highlighted very eloquently the problem of carer fatigue, which is there and is real. Early mortality is amongst those who have bereaved, rather than amongst the carers. I think that that becomes important to remember, because, of course, however somebody dies at the end of the day, that the loneliness and the loss and the grief are the things that seem to actually impact on the immune system and there are physiological reasons why they then become more prone to infection to other diseases, illnesses, not loss of concentration, accidents and so on. There is a mortality significantly in the year after bereavement. The other thing, though, if I might pick up on your comments about powder care provision, the economist in its independent review of powder care services around the world rated the UK at the highest. I would agree with you that, yes, there are gaps, but I think that Scotland, like Wales, has got much better provision across the whole country than England has. We have much less variability in both those nations in the terms of provision of services and outreach. There have been huge educational efforts. People around the table with me have been involved in these for many years in trying to raise the level of education of healthcare professionals precisely to be sensitive to the needs of patients, to be able to look at how do we intervene early, what can we do. However, one has to remember that palliative care is not a universal panacea and it is not that it either works or does not work. It is not like a dose of antibiotics if you have a urinary tract infection. You take antibiotics, they either work or they do not work. If they do not work, you try a different antibiotic and you redo the cultures. Pallative care is a whole approach to the whole person and, as you rightly say, it covers not just the physical domain, but the emotional, social and, indeed, the spiritual domain. I do not mean religion in that. I mean much wider than that in terms of why is this happening to me and the impact on the whole family. That is its strength and I think that it is why, in palliative care particularly, there is a very strong feeling that the deliberate act of foreshortening life flies in the face of all of the acts that we undertake to try to improve quality of life on a day-to-day basis. Usually, when you find the thing that is really getting people down, it is not in a clinical domain. It is what you might call the trivia of life, but they can really undermine people and their sense of personal hood and personal worth. We look forward to hearing some evidence about palliative care and the end of life care, because the last review that we have had in our papers was in 2008 in Scotland. We do not know what is actually happening out there, which I think that some of us will testify to. Richard Mead and I see Mark Hizlwood. I want you to make two comments. First, continuing on the provision of palliative care, we know from studies done that Marie Curia has funded in partnership with Edinburgh University and NHS Lovian that access to primary care and palliative care can be very variable. For those with cancer, it can be as high as 75 per cent, but for those with non-malignant disease, it can be as low as 20 per cent, so only one in five. Again, when they are accessing it is only in the last couple of weeks or a couple of months of life, not much earlier, which is what a lot of professionals, including people around this table, would say they should be accessing it from. In terms of carers, we also know that carers, particularly those caring for people at the end of life, can often be overwhelmed as the patient deteriorates. We know from studies that a lot of carers, particularly when they are close family members, because they do not see themselves as carers, they see themselves as husbands or sons and daughters, they do not identify themselves as carers, so they do not reach out for the support that might be available for them. I think that we need to look at some of the statutory responses that we have in terms of supporting carers and making sure that carers are getting the support that they need to look after loved ones when they are terminally ill. Again, in terms of the provision of palliative care, we definitely need to have a greater focus and see it as a higher priority to make sure that people are actually getting palliative care when they would benefit from it. Mark Isherwood. I want to just to say a couple of things about access to palliative care. I think in this field sometimes it is easy to become confused between access to specialist palliative care. It is interesting that around the table a lot of palliative care at this session, we have mostly specialists in palliative care, but most palliative care in the health and social care system is not provided by specialists. If you look across Scotland's acute hospitals, you will see that one in three beds are occupied by somebody in their last year of life, and those are in general wards. They are not all in specialist palliative care beds. Good care for people towards the end of life, palliative care is a core function of our health and social care systems. It is one of the main things that our hospitals do. When you think about access to palliative care, yes, you can think about whether or not somebody gets to see a specialist or perhaps goes to a hospital, but that is in terms of activity. That is quite a small part of the picture. Whether somebody has access to palliative care will depend on things like does their GP have the skills, knowledge and confidence to initiate a discussion that might lead to the person being able to indicate what their preferences for care would be in the eventuality of their condition deteriorating, or access to palliative care might be down to, is the person admitted to one of the many hospital wards in Scotland where the team in charge of their care has the skills, knowledge, behaviours and attitudes to deliver good care towards the end of life, or perhaps they are admitted to one of the other wards where we know that those behaviours, skills and knowledge are not yet in place, so I just wanted to sort of paint that picture as a wider context. It is a huge part of what the health and social care system does across all settings. I think then I would follow up because I think you were starting to look for information about the extent to which people get access and the quality of care in Scotland. I think from what I have said in terms of access I think you get a sense that that is quite a difficult question to answer, and as Elora said, some things like management of symptoms and pain may be relatively easy to identify and quantify, but the extent to which somebody's psychological and spiritual needs are met is perhaps a bit more complicated as well. What I would finish by saying is that I do believe that there is an urgent and important need for us to develop better systems to measure the experience of patients and their carers and families in Scotland in terms of the care that they receive towards the end of their lives. Dr Carpenter, thank you convener. I would like to build on those remarks and also try and return to the question that Dr Simpson asks us, what do we think can make this bill more fit for purpose. Speaking of young people, I have really significant concerns in that because I think that the general population does not necessarily understand the parents of children that I am looking after at Children's Hospice Association Scotland aged 14 and 15 do not understand that if their child, when they reach the age of 16 and that child has moderate to significant cognitive abilities, their parents will have to apply under adults with incapacity act to be able to make legal decisions on behalf of their youngster. I am not sure that the bill gives me any reassurance that parents could not take that one stage further and decide that what was in the best interests of their child would be assisted suicide. We know that with looked after and accommodated children, that usually lasts up to the age of 25, does that allow local authorities to be making such decisions? I do not think that anybody that I know would be wanting to do those sorts of things, but I think that it is a real concern that the bill, if it was passed, might allow this degree of decisions that arguably would not be in the best interests. I am glad that you are here. I know that Dr Simpson's remarks and questions about safeguards. I think that one of the problems, I believe that safeguards in this area are totally illusory. We are kidding ourselves because the complexity of dealing and working with patients at this stage of life, we talk about feeling a burden, that could be an early symptom of depression. We know and there is hard evidence to show that we are not good at detecting depression in this particularly difficult group. If we fail and Linda Ganzini in Oregon has shown in her studies elegantly that patients who she has studied have gone forward and had assisted suicide, their depression that she has identified has not been picked up by their clinical carers and they have gone forward and had assisted suicide. Those are people with treatable depression. My thought of this in our work is that if you cannot diagnose depression, then all safeguards disappear. There is no safeguard there. You have missed the thing altogether and the patient will move forward because people do not have the time or the skills or the ability for having psychiatric referrals to find out that. On psychiatric referrals, psychiatrists themselves will note that both in Oregon and here are not keen to do this capacity work. They themselves admit their limitations. One of the messages that I would like to get across from clinicians to you is that we are saying that this is a really difficult area that we struggle with and it is not possible to have black and white answers that you require for the law. I have got some committee members who want some questions to go on. Rhoda Grant followed by Borddo. I just want to go back to access to palliative care. I think that what we seem to be picking up is concerns of people looking at the bill and looking for assisted suicide because they have or assume that they will have little control about their over their last weeks and months, the fear of pain, the fear of not having the assistance that they require. Although we have good quality palliative care where it is available, we do not always have that available. How do we empower people and equip people with the knowledge of what is available and give them choices that would then allow them to make decisions about themselves and retain autonomy and control over their own lives? The lack of control over their pain, their treatment and where they are going to be based can lead to a lack of autonomy. If the only choice is to take your own life, that surely is not a choice at all. How do we make sure that people have the access that they need and the choices that we should make available to them? Mark Hazelwood, do you want to respond to that? I have an observation that, within existing legal frameworks, there are many ways in which people in Scotland can exercise choice and control and increase the chances of arriving at the sort of care at the end of life and death that perhaps they would choose. I am thinking of things there like advanced directives. I am thinking of also wider things about funeral planning, making a will, writing a power of attorney so that if somebody loses capacity, then somebody they trust can take decisions for them. One of the interesting things is that the level of uptake of those vehicles that are there already is really quite low in Scotland. We have a wider problem here where we have a cultural reluctance to talk about end-of-life issues. Also, as a result of that, low levels of public knowledge and awareness. Also, it has to be said that high levels quite often have professional discomfort in initiating discussions around this area. Even leaving aside the issue that we are here this morning, we have an issue that we need to tackle in terms of creating a much greater open dialogue about death, dying and bereavement in Scotland, which has potential benefits for the 220,000 people who are bereaved each year in Scotland, and the 40,000 people who die in Scotland. It is much bigger. End-of-life issues are much bigger than the particular narrow issue that we are here to discuss today. We are coming back, convener, to one of the things that you said you wanted to address earlier, but we seem to be focusing on it at this point. That is the accessibility and availability of palliative care more widely, and Rhoda Grant is saying how can we do that? That is in the hands of our politicians, but it is quite well articulated in the Scottish Government's living and dying well document. My contention would be that, bearing in mind what Professor Finlay said, we lead the world in terms of the quality of palliative care. It would be a far more productive exercise for our Government rather than to be pursuing assisted suicide for the few, to be focusing our efforts, our care and our investment into all those people, not simply with cancer. Palliative care for people with cancer is good, but there are big gaps in palliative care for people with other chronic degenerative conditions and so on. One particular thing that I would encourage would be that the money that we have should be invested in community care. That is where there is a big gap in my mind, in that people are supported in their communities and that they have increased the profile, if you like, of palliative care issues, as Mark Hazelwood has said, and as Dr Jeffrey has said, increasing that and making sure that people have access to care and support in the community, not in hospitals. There are gaps there, I know, but not necessarily just hospitals or hospices, but in the community. You will get far more bang for your buck, I suggest, if we invest in community than we invest in buildings. Part of the reason that we have a panel that has taken into account Mark Hazelwood's declaration, which is generally opposed to the bills that we are testing, is that we are looking at limits and we are looking at the people involved in palliative care who offer that as an alternative to something that is unacceptable. That is where it takes us to the whole question about the limits of palliative end-of-life care and, indeed, access to, etc. The papers that we have in terms of the progress that has been made in the examples of living and dying well actions and progress in achieving them are disappointing. That is the evidence. There has been slow progress. 50 per cent of people still dying in hospitals. That is the case for the last 10 years. Almost people, the unmet need for palliative care and end-of-life care, who gets it, who doesn't. Those are important issues if you are putting that to us. The system that we have is much better than what would be proposed by the bill. We have to examine those areas. That is the context that we are examining this morning. On that front, I do concede that too many people die in hospital, but I just wanted to represent figures from our own organisation where a third of the youngsters are dying at home, a third of the youngsters are dying in hospital, a third are dying in a children's hospice. There is progress going on, just to answer that. I would like to see it quicker. I would very much agree that my first postgraduate training was as a general practitioner. I think that primary care services are the ideal environment in which to provide good palliative care, not specialist palliative care, because not everybody needs that specialist palliative care. Dying is ubiquitous, so it is really important to think about the generalist being educated in call palliative care skills, as well as having specialist services that are available. It is that availability that I was talking about. You have to start education in medical schools. You have to expose every medical student to being with somebody who is dying. That is not happening at the moment. You have to incorporate education in end-of-life care into all of your nursing curricula. You have not got that at the moment. You have to have seven-day services because disease does not respect the clock or the calendar. People have crises out of hours. They have to be able to access care. If you really want to address seriously a jurisdiction, the need of patients who are facing end-of-life care, you have to get seven-day services available. Whenever a problem arises, they can rapidly access support and they know who to go to. Yes, they have to have open discussion, but good palliative care is about empowering people to have choices. Choices in what they have, where they are looked after, who is looking after them, listening to what they need and helping them find a way through and adapt to the ever-changing situation of their disease. I will add that, as a clinician, patients who have expressed a desire for death have not been related to the quality of services available to them. That is a different construct internally. It is often because they have been unable to see a way through past the fears that were so clearly laid out by you just now, by Rhoda Grant. It is fear of the future that can be absolutely crippling. It is not until people experience what can be done and have the confidence in those around that they will see a way through. I would not want you as a committee to believe that it is either or. We look after patients who will express a very profound desire for death, but that desire for death evaporates when they get the care that enhances their dignity and their sense of personal worth. Can somebody say something about identifying people who may require palliative care in their life care? Before the access problem, there is a question of identifying the numbers of people who may benefit from it. Richard Mead was wanting in. I was wanting to return to some of the stuff that we were talking about—government policy and leadership in that area. The palliative care review that was carried out by Audit Scotland was in 2008, and living and dying well was in 2008. Those documents are both quite out of date now. Health and social care, as we know, has moved on significantly in terms of policy and organisation. The current 2020 vision that the Scottish Government has for healthcare makes no reference whatsoever to death, dying, termin illness or palliative care, a document that is our guiding light in terms of where we go with health and social care in Scotland. That needs to be addressed. The Scottish Government has committed to producing a new strategic framework for action for end-of-life and palliative care, which we have been promised would be published in April or the spring this year. We need to put a lot of scrutiny on that framework to make sure that it is fit for purpose and will help to support all those people across Scotland who might need palliative care and to make sure that they get it regardless of their condition. I think that all of us who have been practising palliative care and, indeed, anybody with general practice experience around this table will recognise that we acknowledge that we cannot fix everything, but it is important that we do not get drawn into the frame of mind where we feel that we should be able to sanitise the messy by ending it. Palliative care is a very, very difficult specialty. We are dealing with people with lots of distress and we acknowledge that. We are not pretending that that can all be fixed, but it is a holistic approach to tackling that. I think that we have to be careful that we do not see that this can be sanitised and made fine just by ending some people's lives or making that available to them. Rhoda, do you want to come back with anything? I have got a number of dentists, but I have got you on the list. I am sorry if I should have let you know. I think that that is interesting and certainly the availability of palliative care in the community. I suppose that one of the big issues for people is things such as pain control. If you are looking at communities, especially in rural areas, such as I represent, getting that pain control quickly into the community, so that people can understand that. How do you do that? How do you make that happen at home for people in the right location? Quickly, if you are in a lot of pain, you do not want to wait hours for a non-call somebody to arrive because they cannot save your life, so you fall in priority. We have a huge rural problem in central Wales, and what we have done is put in just-in-case boxes and try to have anticipatory prescribing. Early on, when somebody clearly has disease that may be unstable, that the family and whoever is there is taught what to do and it is clear to them what they should be giving somebody in the event of a crisis. Actually, if the drugs are in the house, you can talk through over the phone if you know the patient while somebody is going out to see the patient, but I would agree with you that it is unacceptable to wait, and I would agree that it is completely unacceptable to wait if you do not have seven-day services. I cannot stress that strongly enough, because why should somebody on a Sunday have to wait because nobody is thought ahead of time? It is about anticipating and making sure that things are there in the house. That is medication given at a specific dose. If I might return to the bill, what you are talking about is a massive, lethal quantity of drugs which it looks from this bill as if those might be left in the house for the person, and I am not sure from this bill how on earth you are going to make sure that somebody in extremis, or just because the family are fatigued at the weekend, is not coerced into taking their lethal drugs, because you do not have a system in this bill of the drugs being taken out at the time that somebody determines they want to end their life. I am trying to return to the bill for a moment and what we have on the table in front of us, but I think that that again is another problem. I do not see any way, any safeguard in here or any way of detecting coercion. I have been taken in by families, other people will have been taken in by families. I had one family, the family kept on that this woman's pain control was inadequate, and each time I went to her she said, no, I think I am fine, I am comfortable. Her birthday came, it was a muted birthday celebration, but then you would not go whoopee, it is your last birthday mum. So we all understood that it was a quiet celebration. After that the family did not visit much, and at night, one night she could not sleep, the nurse gave her a hot chocolate and sat with her and said, well, it is a pity your family do not get in as much. She said, well, no, because my fixed term life insurance policy expired on my birthday and they have lost out on £11,000. Now we all believe that this was a loving caring family. We were all completely taken in and I have got other families I have been completely taken in by and believe that they were loving and caring. The issue of coercion, and we have already heard about elder abuse, is real and I see that as a danger with the bill that you have got before you. I would concur what you have said, Baroness, in response to your question. I would say that with young people working across Scotland we are doing increasingly good anticipatory care, we are putting in just-in-case boxes which have these medicines and so I would also want to say in my experience in rural and remote Scotland we often have quicker response times than we have in the city areas because people are prepared to cross boundary with their jobs and I see that nearly every day in my job. On what Laura has said, one of my real concerns as a practitioner working with young people in pallative medicine is sometimes I have to use really high doses of medicine to control and to manage symptoms, higher than perhaps adult doses and my real concern is if this bill goes ahead is what sort of doses are going to be required to actually achieve suicide or if you don't achieve suicide where is the person going to be if the doses available don't actually do the job that they were. I'm not sure what the word is prescribed for but a real concern is on that front and we don't seem to have any evidence based on what sort of medicine doses to use for anybody but particularly for young people. I want you to return to the situation where someone for whatever reason feels they can't go on living with chronic pain or a life limiting condition that the quality of life is beyond the pale. I was struck by Barnett Finlay's comments in a GP in Mary Hill Estain in Mary Hill and I just wanted to check some figures for suicide rates in that part of North Glasgow at the moment and they are significantly higher than the Scottish average and I thought I would check prescribing rates for anxiety and depression so in Mary Hill it's 44 per cent above the Scottish average. It's 58 per cent above the Scottish average in Poesol Park for example. I say that because I'm feeling that those who are most likely to seek assisted suicide may have other factors that lead them towards that because of other poor outcomes they have in their lives separate from the physical health condition that they have and that this may happen in the future. It impacts socially and differently across the country so some comments on that would be appreciated but what I had in my head and this is following a line of questioning from last week would be if it's unavoidable that there would have to be a medicalisation of the whole process of assisted suicide so if someone is going to the GP in Mary Hill or Poesol Park or Springburn and whether it's heart disease or diabetes or but their quality of life is considerably poorer they have a life limiting condition it's progressive there are many many people in that situation should the GP have a responsibility should this legislation be passed to say you've got a variety of options available Richard Mead spoke about what the statutory obligations were and it doesn't say this in the bill at all but the bill is a very slimline bill without much additional guidance in the way of that so I'm just wondering whether you felt that whether it be those in palliative care or whether it be GPs or those providing social care on a statutory basis whether a natural progression of this bill if it was successful to be passed into law would mean that there should be an obligation and statutory partners including the medical profession to say to individuals given the points about 58% in Springburn on antidepressants 44% in Mary Hill to say to individuals you have another option available that other option is assisted suicide in other words who would be left to suggest to someone should anyone ever be suggesting to someone you have an option and that option is assisted suicide if that should happen what are the safeguards we would need around that if that shouldn't happen how would an individual get the knowledge and information to empower them to make a decision over ending their own lives I hesitate to come back in but I'm just brimming over my practice cover of the Postal Park I know it well and you're absolutely right the interface with mental health services is really important and has got to be addressed and that's why right at the opening I said I think that you need to take this out of medicine it's really hard trying to look after that population with multiple comorbidities who may see very little future ahead of them I would be very very worried about a doctor ever suggesting to a patient that they should think about ending their life because you give the message that I believe that you'd be better off dead you also reinforce the sense of hopelessness and you reinforce the sense of despair and I think it was the College of Physicians who said very eloquently and I paraphrase this because I can't remember it verbatim that actually the doctor's duty of care does not include being in any way part of a patient's suicide Bob can you just press that one away but you know because we referred to it earlier and it's in the evidence in terms of the difficulties and those necessary sometimes decisions with GPs, medical profession to discuss the end of that person's life and we know that that's a difficult process so how do we, where is that in the middle of this if it's, can you apply the same principle to well we can't really talk about your term on all of this because that's me giving up on you No, but that's not the case at all Just absolutely before you answer it, I mean the line I took in my questioning does show the concerns I have but just in the same spirit that Dr Simpson also said in his initial question at the tail end of it I did say how can you build in safeguards because the job of this committee not just as individuals to have views on this bill but to seek to improve it and make it more robust as it does go through parliamentary process so yes it's significant concerns but also in answering that how do you build in those safeguards Can I try and answer that one then and that is that when you have a patient in front of you who you believe may have a terminal illness nowadays you have a duty to be completely open with them not the old collusion type medicine that used to happen when I qualified but you talk openly with patients and listen to what their concerns are part of our job day in day out is to listen to people's views about their dying their fears about their dying and what they feel they want if you want to look at how to improve this bill I think that you should not make the doctor be the person who sits in judgment over whether or not they are suffering enough to be eligible for assisted suicide what you do is you maintain that doctor's duty of care to do everything they can to improve the person's quality of life and to carry on providing care but if you have a system within a legal framework that person can if they are intent on having assisted suicide apply to a court that your court could then take evidence of the medical condition and the predicted pathway of that person's condition prognosis is impossible to predict and we know it's fraught with inaccuracies but you can say what you think is likely to happen to somebody and as any court does it can gather evidence in the England and Wales system the family division of the high court is the place that takes those type of decisions already over treatment cessation, the management of the Siamese twins where one was going to be sacrificed difficult Jehovah's Witness blood transfusion decisions and so on and the evidence comes in but you leave the doctor carrying on providing the care you've already got the concept of a licensed facilitator and if that was sat with the courts I think that would be safer than potentially with the campaign groups which is where it could sit at the moment the way the bill's written and if we look for a moment at Oregon the campaigners describe themselves as the guardian of the law and I find that very worrying that a campaign group could see themselves as guardians of the law because it should be the jurisdiction of the land that is so the licensed facilitators could be contained and monitored and if you put in a monitoring commission that actually examines the processes and collects the data about what happened when somebody has died you will then pick up as happens but not very adequately their attempts to do it within the Dutch system the Oregon system doesn't adequately have a monitoring commission it just collects data but even from that we know that some patients have woken up again after they've had their lethal drugs they haven't gone on to commit suicide later on so that raises interesting questions and the time from taking the lethal dose to death is on average 26 minutes but it can be up to 102 hours which is a very long time but you take the whole thing out of medicine but you leave for that very vulnerable population and I remember them well who are living with all kinds of comorbidities and social problems and poverty really ingrained in a way that they're living that you don't allow the doctors to be suggesting that things look so bad but actually you ensure that their mental health services and everybody else is there to support the patient but if they are determined that they can then apply to a court Dr Jeffery I just want to return to Bob Doris's very pertinent question about the social issues and the present law that we have banning doctors being involved in any way in hastening patients death actually protects us as clinicians because we have a duty with patients who we suspect may be suicidal or certainly with patients who are depressed we have a duty to actively explore whether they have had suicidal thoughts so we might ask you know have things ever got so bad that you thought life isn't worth living now that's a very safe question for me to ask today because the patient in front of me knows well this doctor isn't he's asking me because he's concerned to see how depressed I am not that I'm going do I want to have my life ended but once you've got the law as a possibility that that is actually one of his choices two things happen one is you can't really have that conversation because they're going to think immediately well he doesn't think I'm worth bothering about and I think then the other thing I think to is that we need to be aware of Chochenoff's work on dignity which you may have heard before which people sometimes use the I can't go any longer will you help me to die as a test question to you do you think I still really matter doctor and they're looking to us as a mirror to see and to reflect that they still are of course of value and of worth and then we are open then to so my short answers is we can then explore these difficult issues because we're protected by the law if we bring in this assisted dying law those conversations will not be possible doctor Caracol and then doctor Hutchins Bob I too live in Maryhill and popping into supermarket there lets me see people in all different sorts of situations and I you know I think it must be very difficult to to to raise the profile of medicine and palliative care I suppose two things on that front one is the bill as I understand it means that you should have a terminal prognosis and certainly from my own field of medicine that's very very difficult to do in terms of young people and stating their pallitiveness the Baroness has already stated that a few minutes ago that I think and you were trying to take take us there earlier I can mean how do we decide if somebody has a terminal condition and how far down that disease trajectory are they before they're considered for this bill but I suppose and they do have a terminal prognosis of one to two years that's probably outside outside this bill but you know that that's going to even reduce ages less in these communities where we've already got this huge disparity in Scotland between different populations and the populations you've said have the lowest lung ever sees already Just to emphasise one of the points that Dr Jeffrey was making in that is that we have been able to enjoy the safe and supportive environment in which we can raise these issues with patients or respond to issues that they raise with us that has happened countless times throughout my career and I would say that if we're looking at the legal and technical nuances of this do I understand them all? Do I have a full grasp of all the moral moral and ethical issues about this? No I don't I've got some appreciation of all of these but certainly not full but please hear this I would say am I absolutely 100% cast iron sure that if assisted suicide had been available that would have compromised the care of the patients I've been looking after over the last 20 30 years the answer is yes Dennis Robertson Thank you convener It's a couple of comments and I think that you mentioned the term burden and prior to that you were mentioning autonomy and definition I'm not quite sure what the definition is of burden at the moment but I just wonder society we sometimes burden is a very emotive term again but we actually adjust to situations in terms of care and the provision of care and it does impact on how we live our lives and sometimes we're doing it as parents, as family members and sometimes we look to the wider community to assist us in that and I'm just wondering when we're looking at this it was a point that Baroness Finlay made when you introduced the coercion and fear It brought me to one of the submissions that in Belgium where the twins were deaf and the prospect of going blind now I suspect that they may have had ushers but it doesn't say in the submission and they opted for euthanasia Now my concern here is in going back to the burden and the fear is that people with recognised complex needs and especially those maybe we associate with disability We really don't want to convey the message that they are a burden and we don't want to sort of convey this aspect of fear in terms of living their lives how do we get over that? What I was saying about a burden earlier was a hope not taken as a sort of isolated rather dismissive discussion. It was in the context of the deep and meaningful discussion that we have in pallid to care and recognising the issue of being a burden is actually sometimes aimed at helping the patient to see that the carer also needs support but it's perfectly legitimate for that care to continue at home or whatever My point is that we have a lot of people in society at the moment if we had to take that forward that could fall into that category of being burdensome They're not really living their lives and they require maybe additional support to live their lives and this is why I introduced the people with disabilities and maybe complex needs and I'm just trying to ensure that we don't sort of affix a term to a group of people that are maybe very positive about their outcomes and living with conditions But it's the people who are not feeling very positive who are often raising the question about burden Absolutely One of the other examples was the one with the younger with anorexia Quite often people with anorexia often ask to die It's quite normal if we want to use that term for people with conditions like anorexia to actually say I really do want to die and they really don't But the condition itself is so prominent that that's how they feel at the time I'm really just trying to explore how we safeguard because within the bill I'm not sure we've got the safeguards there to help us to move away from the coercion and to help us to protect people with long term conditions And I'm not sure it's there and sort of trying to explore the fear aspect There are a couple of people with anorexia in the city This is one of the major points that we made in our submission of evidence Surely one of the things in respect of the groups that Dennis has just been talking about is that the criteria set out in the bill for eligibility for assisted suicide should be very clear So that it's quite possible to see from the bill the sorts of people who would be eligible and the sorts of people who wouldn't be And we made the point in our submission that the terms used in the bill, terminal or life shortening illness and progressive condition They're not really, we feel, precise enough to form part of clear eligibility criteria And the bill doesn't define either terminal or life shortening And it's also not clear what the intended difference between those two terms is And I think if the terms are not clear then the Scottish public and the health professionals are left not knowing who is eligible And who isn't eligible and then there's the potential for inconsistent application of different people's conceptions of what those terms might mean And I don't think it matters whether you're for this change in the law or against it actually I think everyone needs to be clear about what the eligibility criteria are and what the scope of the legislation is Thank you very much for raising this because I think there is a real danger in taking a very utilitarian approach And believing that if you are so-called able-bodied that somehow that you are better than somebody who has a disability And I think it would be helpful possibly for the committee if I pull out the speeches from Baroness Campbell And from Tanny Gray Thompson on the bill that's before the House of Lords at the moment Because Baroness Campbell for most of her life has fitted the definition of having a being terminally ill As would be either in Lord Faulkner's bill or actually within this bill she'd certainly fall in the ambit of it She's now on a ventilator and actually has her ventilator when she's in the chamber and can speak while she's on her ventilator Now those people with severe disability are very very frightened of any legislation along these lines Because they already find that it is difficult to be viewed as of equal worth within the healthcare system that we have She has had many occasions where it's been suggested to her that possibly this is the time that she should give up And particularly there was an instance a few years ago when she was already in the Lords but people thought that this was now the end of her life And she contributes greatly There is also sadly within our society a prejudice against particularly severe disability And I've heard people say and Tanny Gray Thompson spoke openly about it herself People will say to her well it must be awful to be incontinent Well actually she has no sensation particularly from the waist down and would classify as such But then lots and lots of able bodied people actually you discover have a bit of incontinence when you go into it And it doesn't make them any less worth But if people behave badly towards somebody and make them feel they are of less worth As Harvey Chochenost research has shown Then it undermines their sense of personal worth and can make them feel that the only option is that they should be dead And somehow they have a duty to be dead And I think that's behind some of the very powerful messages that have come from those with severe disability But if it would be helpful to the committee I'll extract those speeches Cos I think they put it far better than I can Thank you for that, that will fit I'm, were you permissioned, Dennis, I'm going to go to Colin Kear And then Richard Lyle Thanks, convener And nobody said it was going to be not interesting this I think the, from what I've heard And I was particularly taken by some of the stuff that Baroness Finlay's just said In terms of, and I think the key word here is some People may feel, some people may feel whatever It's not exact And the example that was given Baroness Campbell was it? Yeah, yeah Who had obviously made a conscious decision to fight and live her life as she wished to That would not bring her in any sense within the assisted suicide act Simply because of the fact that suicide is what it is It's not euthanasia, we're not asking for somebody else's input That's my take on that The other thing, if I may The other issue is, in terms of earlier on in the discussion When there was the way that I was hearing it May be it's being partially deaf, I may have cottoned it on slightly wrongly But it's almost as if at one point we're looking down the, and either or I think somebody else mentioned that as well In terms of palliative care and assisted suicide where I believe that If this was to be enacted, it's not a case of either or And surely palliative care is what it is I wouldn't actually expect anybody who's acting in the palliative care sector To actually be suggesting suicide to anyone And I say this through the experience I've had as a carer On a long-term relative with long-term degenerative illness So it's a case of, I hear reasons why we can't But the generalisation I find really quite off-putting In the way that it's been put across simply because I know that the person that I dealt with Extremely long-care went into palliative care But even at that point actually was contemplating suicide towards the end Now it's not the same as everybody because the people in the same care As my relative was That would not have contemplated this So I think, and I find extremely worrying that we start getting into the pressure Maybe it's something I have to think about more in my own view Before we take this bill to wherever it happens to go But certainly I find it rather worrying that we have very general considerations here Maybe we have to do that because of the type of people We're having But I do find that the individual is the one who's either going to decide Through the period of palliative care, surely I'm sorry, I've just had enough of this And at what point do we actually help someone go forward In either way talk to them that I would expect palliative care operatives To be trying to go through everything they could But at some point you're going to have a position somewhere Where a patient is just going to say No, I really have had enough And I'd like to see some consideration Of how that would be dealt with at that point Any takers? You want to make some clarification anyway I did, just for a point of fact I'm sorry that I should have explained Baroness Campbell herself at times in her life Has spoken openly about feeling suicidal And feeling that she had no purpose in life And about giving up, and that was some years ago And she would have fitted the definition of this bill And if I may, Camila, while I have your ear My own mother was actually in a situation Similar to the one you describe She was in a hospice bed It was at the time that I was opposing Lord Jofie's bill And she was extremely angry with me That I was opposing Lord Jofie's bill Because she was desperate to have assisted suicide And this went on for weeks And she was very desperate to have assisted suicide And this went on for weeks And she had excellent care It was nothing to do with the quality of care But she just did not want to carry on And did not want to be a burden And she had been fiercely independent all her life It was actually an argument with the chaplain That she had, which made her suddenly realise That her brain worked And he had the sense to say You're a very interesting lady Can I come back and talk to you tomorrow? And they argued about philosophy That she had been interested in And she began to think Well, perhaps I still have something to offer Thanks to his intervention And it was nothing to do with faith Because that didn't come on to her radar And she then came home against all odds And four years later Having been at home and lived independently She wrote and was very clear That she was glad that she had had those four unexpected years And they had been in some ways The most rich years of her life But at the time that she was in that hospice She was definitely somebody Who, irrespective of what I felt Would have gone for this bill But later on, and she made a radio programme about it as well Was glad that she wasn't able to Alda Rodd Thank you for your comments, Colin I would, in a sense, go further than what you're saying It's not just that people on occasions Reach the position where they're contemplating The end of their life Or wishing it would come sooner Or saying that they've had enough I would say that that happens And a huge number of the people that I look after And these are the people I'm concerned about Who might come under pressure and influence If this were to be the law Many of my patients have said that they've had enough And these are the people who were engaging In supportive conversations In the course of their care But I would have to say that Over 25 years or thereabouts Of working in pallidive care How many people can I count Who have had this determined and fixed wish That somebody would end their lives I can think of one when I worked in Edinburgh And I'm hard pushed to think of any others since then But what I do know Is that the vast majority of our patients And just reminding what I said earlier We can't make everything nice and rosy and pink In pallidive care, it's messy It's horrible, it's distressing and so on But what I do know Is that the vast overwhelming majority Of the people I've looked after Even those who have expressed this wish That they've had enough Will testify at the end And their families will confirm That pallidive care, good care Good individual involvement Good listening Good attention to detail Good hard work That's what made the difference to them That's what they appreciated And that's what they thank us for And I think that that could be repeated endlessly Around this room We all know the testimonials That we receive from our patients And their families I just want to echo what Stephen's saying there I've worked in children and young people's pallidive medicine For 18 years and exclusively for the last eight As a full-time job And as I've always said It's almost a surprise to me Because I've asked lots of open questions Trying to see where people are And no young person Or no young person's parents In that 18 years has said to me I want you to help my child Or that young person saying I want you to help end my life Nobody has said that And I think it's just worth putting that Necdotally on record Nobody has approached me like that Does Mark Hazelwood, and it's on me too Is there any nuances here In terms of your position? Mark, you indicated that caveat That you weren't necessarily As opposed to this bill Or it shouldn't be presumed That you're opposed to this bill Is it at this point That you're going to explain that? No, I think I've really set out Why we have the position that we have And it's to do with We're a membership organisation And many of our members, particularly The NHS boards Are institutionally unable to Adopt a position on the bill Because it covers moral, ethical Personal dimensions We're not seeking a change in the law At present and I think we would like To see the focus on making sure That palliative care, the kind of palliative care That Dr Hutchins just described Is available to everybody that might benefit from it Because at present in Scotland It's certainly the case that not everybody is And if they do get it, it often comes Much too close to the end And actually they could have been benefitting For far longer Dr Jaffle On what's been said about dealing with Intractable or unrelieved Suffering, of course this is very difficult And one of the privileges Of being a palliative care physician Is that very difficult cases Are referred to us by our colleagues And one of the other dynamics I want you to be aware of That it's not just carers who feel affected by this That through mechanisms of Transference and counter-transference Doctors themselves can perceive A situation to be hopeless And they feel helpless So the patient feeling helpless Can be transferred to the doctor Who begins to feel helpless It's not worth going on The treating team can begin to feel Particularly if they're not experienced In this work, yes they're right This is hopeless And it's only when someone perhaps comes in From outside and is able to have another look At this and say well maybe there's a different way Of doing this, maybe we can't make everything right But let's look at some of the things we can And the other thing which is perhaps Under mind is Is the promise that palliative care gives That I will not abandon you I will be with you And that might sound rather feeble In high-tech medicine But to have someone alongside you When you're suffering is a huge boost And I think makes an enormous difference In this type of work The other thing is that you were commenting I think Colin Kear That you're disappointed about The generalities All the palliative care physicians And health workers around this table Could give you very lurid individual cases Where we are bound by confidentiality Even after death I can't tell you about the people Who change their minds I can't make it identifiable to you But we can just trust us That this happens day in, day out In our practice I've got Richard Lyle From committee members I know other committee members Right Thank you, convener I couldn't agree more with Colin Kear I also have to listen intently To the comments you've made And I respect every one of you In the way that you've handled Your evidence and also what you do In the field that you do But if I turn to the point that Mark Heazle Would made earlier on None of us want to talk about this None of us want to talk about death When my mother-in-law and father-in-law Were nearing the end of their life They didn't want to talk about See how they would be buried And make arrangements etc When unfortunately my mother-in-law Died and my father-in-law We put him into an excellent home And we wanted him to go on But unfortunately three months later He didn't He was taken to the hospital one night With a heart attack He was in his nineties then He actually Said to the nurse Don't resuscitate me So he was ready to die We didn't know that At the time but if we didn't know that Where I said to the nurse No we want to keep him But unfortunately he didn't want to go that way And also there's a lot of people Who don't want to make a will Most people you know didn't I made a will actually about 20 years ago I haven't changed it recently But basically People don't want to make a will Powery attorney And it's about it until I have a friend who is mothers in hospital Just now well actually Part of care home And they're trying to get a powery attorney And it's very hard When you go to because you really need the person Who sadly Is the mind is not there now That they can't confirm That they want their relatives So The point that Colin Colin Cure was making earlier on At the end of the day I agree That people who Can change their mind Want to change their mind I don't agree with the point But there's people out there Who do want to die I wasn't at this committee last week I was attending a funeral of a family friend Who prior to Christmas Said to me and she was in the hospital She wanted to go home Medically she couldn't go home Even though people were there to look after her But medically she couldn't go home She said to me personally I just want to go And sadly she did go And I attended her funeral Last Tuesday morning So there are people out there Who want to go So why shouldn't we let them go And I'll put that to the witnesses Doctor Hutchinson Because we live In a society Where we relate to each other Can we legislate safely To allow these people Who you've described To have that legal right And my view is no we can't And it hasn't been legislated for safely Anywhere else in the world so far And we have to bear in mind That what does that That the availability of that For this group of people you're talking about What does that do For the vast majority Of other people in society I would think that there are numerous things About which we could say There are individuals who wish To be able to do certain things I wish not to pay the level of tax I pay I would like on occasions To be able to drive down the middle Of the road and not on the left And maybe I should stipulate which road And which time So that you can police that My rights By the availability of things Like that for me Has to be constrained by the effect And wider society You said to me why not let them go And I would say to you we do let them go We do not impose futile treatments On people And I have had people who yes They weren't medically Appropriate to go home But they wanted to go home That was their home however It was That was where they wanted to be And they went home I facilitated a patient flying back to Africa Because he wanted to die on African soil And died shortly afterwards That's what we do That's our job to support people In what they feel that they want And when they want to let go To support them letting go But that's quite different to saying That we're going to change the law To allow people Care to access Lethal drugs With which they can foreshorten their life By months or years And your background paper is very clear There will be people who foreshorten their lives by years And you have no idea What they would have done In those years And I do have permission from a patient To tell you one story And he was referred to me in 1991 And the GP said The only reason I'm referring him Is because I cannot give him a lethal overdose And that I thought his prognosis was three months As did the oncologist, the surgeon And his GP I looked after him, it was not easy He was very very difficult I was at the house the first night Till 11 at night 11 years later He phoned me His wife had been diagnosed with a cancer And was dying She died and he was left To bring up the children on his own He is still alive today Against all odds And says, Elora don't go there What would have happened to my kids They would have gone into care And I think you have to remember That we can't all have Everything we want in society We have a duty to provide care We have a duty to accept death Death is an inevitability for everyone But we don't legislate So that doctors Can bring forward in time As part of their so-called Clinical treatment This isn't a treatment Deliberately ending life I've said already I'm really worried about the interface Between mental health, mental health act And all the other bits that you have there Where they interface But on grounds of public safety I don't think that this bill Is fit for purpose I think it is dangerous And wide open And it will lead to confusion It will lead to people Not with mal intent But through not really understanding The issues in depth Deliberately being part Of a person's suicide And people feeling That at that time in their lives Their only option Is to go for assisted suicide But in a society In which we're interrelated That is a step too far and too dangerous Over that, Laura I wish I could give a few specific situations But confidentiality won't let me do that What I will say is that the Royal College of Pediatrics And child health for example Really states very clearly When I do not need to continue with treatment And when I'm a withdrawal treatment And from my own point of view I am involved in those decisions With young people where we allow them to go I think from my point of view That's a total different situation Than giving them some form Of prescribed medication Which finishes their life And as such, I think While there are some strengths within this bill There are areas certainly for young people I have significant doubts On The net Discussion extremely interesting I wanted to speak about The people who are totally Utterly incapacity People like terminal stages of MND Or MS Who can absolutely do nothing for themselves And I suppose this was the law of the land The role of facilitators in that And the very, very fine line Between assisted suicide And euthanasia And in you course the impact That could have on not only While the facilitators particularly But on other people And I'm interested in any comments around that I would certainly be very concerned That there's the Latitude in this bill And in the whole Ethos of assisted dying for Society which permits assisted suicide To move on to euthanasia And the original sponsor of this bill Made it very clear that she saw the two As being the same thing And I think the policy memorandum Has made it very clear that She had anticipated and the expectation That things would progress For patients You cite somebody with motor neurone disease At the very end you can do absolutely nothing for themselves They can certainly be very frail To be absolutely unable to do anything for themselves No, I don't, I mean it would be unusual For them to be so completely incapacitated That they couldn't do anything But certainly that group of people I think you're raising them because they then Would need more than The perhaps expected assistance To commit suicide And where's the line between that And ending their lives What do you do to use the words of the policy memorandum I think lifting the cup to the patient's lips Can you be sure that when that's happening The patient hasn't suddenly had a change of mind Or whatever, no you can't These are unnobles But it's areas like that Which I think make a law To enable the deliberate ending Of human life so dangerous Pardon me Can I just pick up on the wording That you've got in the bill before you In 19b It is to use the best endeavours To provide the person with comfort And reassurance Well reassurance of what Reassurance that they're doing the right thing I'm not sure what that reassurance Is meant to be But the other thing is that it doesn't define Exactly where the limits of assistance are What about the person who is on peg feeding What about the person who might be On intravenous feeding Who can't put the drugs Into that bag Themselves Or who hasn't got the strength To actually take the drugs And pull them down their own peg So There isn't a clear definition Of what is assistance and what isn't When I visited Oregon We had evidence that the view Was in Oregon That if they couldn't actually Take the drug themselves while it was too bad They were no longer eligible I have a sneaking suspicion From conversations I had Outside committee and with people That actually That's a blurry line Shall we say It's difficult and it isn't policed And you don't have a monitoring commission In here to examine after the event Exactly what happened And what went on I'm very worried about it Dr Jeffle I'd also be concerned that quite clearly The facilitators are going to be people Who are very pro-assisted suicide In fact the whole thing is going to be Administered by people who are pro-it So who's going to have that voice That check to say hang on I think you're worthwhile You think there might be another way of doing this So I have great concerns about the role Of the facilitator I also have great sympathy for The stresses of that job If that is what you're doing As your work it's going to be an extremely Stressful job And palliative care have built in In their job support For us that we always have people That we can relate to and talk to And have to have this form of supervision In our work and I hope that If this thing does go through The provision will be made For these facilitators as well Because it's going to be very stressful work Thank you Mike Mackenzie Thank you I've read a number of accounts Of palliative care Where the whole thing seems to be So high quality And such a rewarding experience That I can hardly wait Till I have that experience Myself But I think most of us have Experiences that suggest that That's not Strictly speaking true For a proportion of people And what I'm interested to Find out in terms of the status quo And understanding the status quo Of palliative care We've heard 40,000 people Or so die in Scotland every year What proportion of These people might Enjoy the kind of Experience that we hear of In the best case scenario Of a Things being as good as they might be And what proportion At the other end of the spectrum Experience Of end of life is one Of suffering Both physical suffering And psychological suffering That we would all I think agree To be unacceptable On terms of that 40,000 people Per annum can have some kind of Feeling for where we are In terms of palliative care Mark I think I said earlier That there's a really urgent need for better Data about palliative care And all sorts of domains And I think Richard made the point earlier That the Audit Scotland review Of palliative care services in Scotland Is, well it's, we're now Six plus years since publication And obviously some of the data That was based on was 2006 So there is a need for data Characterising the sector I was going to come in earlier And talk about anticipatory prescribing In the roll out of just in case boxes In Scotland and I was thinking well where would I go To give you current data On how far that's progressed And it's progressed a long way, it's a success story But if somebody had come back and said Well, you know, percentage of access With the Scottish population I wouldn't have Been able to do that, so I think it's a real need To develop data And then we've heard about The complexity of palliative care There's pain control We've heard really powerful stories About the importance of Human relation And spiritual care as well And how would we know whether people Had access to that So I think it's a difficult question to answer But I can have a go I think it's interesting to look south Of the border where there's a systematic Survey with really large samples And they ask bereaved relatives About their reflections Just a period following death About the reflections that the care And support that their loved one received And obviously that's not a perfect system But I think that the bereaved relative Provides a unique locus of information About the experience that happened Because people nearing the end of life Typically will move across different settings So you can run your surveys Perhaps in general practice Or perhaps on a hospital ward But you'll get part of a picture So I think that's one potential opportunity That we would have in Scotland Is to start to ask systematically On a national basis What was it like for your loved one And also for yourself The care that you received Towards the end of that person's life And I think if we had that sort of data That we'd be in a much better position To be able to answer your question at the moment And at the moment, and others may have other ways Of trying to answer it I suppose we could look at We've heard about people having a preference To die at home And we've also heard that the latest figure The latest data is that 53% of people In Scotland will die in hospital And I think it's important to say that Hospital is an appropriate place For some people to be cared for And to die at the end of their life And whilst generally people say That they wish to die at home If you unpack the data The answers tend to be a bit different For different people For example, for some of the older population And also interestingly for people Who have had experience of caring For a loved one at home They have less strong preferences To die at home as well But we can look at the data Which tells us the percentage of time That people spent at home Or in a community setting During the last six months of their life And that gives us an idea Of where care is taking place We can look at where people die So 53% in hospital 25% at home Or in an non-institutional setting 22% in a care home Relatively small percentages In Scotland's hospices But then Hospices aren't primarily a place That people go to die Most of the work that hospices do Is about enhancing quality of life And delivering it out in the community So I haven't given you a definitive answer But I've given you some suggestions About how we might start to answer That question in Scotland Reiterate Mark's point about the need for data We've had quality improvement in Scotland Produced palliative care indicators And knowledge There's been no published assessment Against those indicators In England They have the national survey of the bereaved voices We have no such similar survey Here in Scotland And that survey asks bereaved relatives About the care that their loved ones Received at the end of life And I think similar information Or something similar in Scotland Would certainly help Intervene To seek a more honest More honest answers to the question I had a friend recently Who held a party Very close to the end of her life And it might have been described as a very good death I can think easily Of nine other people who are deaths That I would not describe in any way As good deaths Is that proportion nine to one About correct or am I completely wrong? I mean It depends what they died of And how old they were And what happened You have to remember That people die in road accidents And they die of complications from illness And they die of infections And whether you're talking about People dying Because they've come to terms with everything That's going on They've come to terms with their own dying or not I really think That it's spurious to try to pluck A figure out the air But I would also go back to the statement That Mark made earlier That palliative care is provided By specialist palliative care Who is specialist trained Who are there to support the generalist services So even your question How many people access palliative care You have to go and see Whether each GP is practicing With a good palliative care approach Or whether that individual GP Lacks knowledge And one of the pressures that we have Outlined I think Is that you do need to address The availability of healthcare professionals Who have got Good core education Everywhere If you want to improve The standard of care of people who are dying And that means having people in A&E Well educated in how to managing Dying because a lot of people die in A&E And in many other parts Of the system and in nursing homes And so on I'm proud of healthcare in Scotland It's not perfect, but I'm proud of the quality Of care that I've seen we've been able to provide And the testimonials that I've heard From patients who've come from elsewhere And have commended what we have here And I think that we should be Looking in a far more wholesome way About how we deal with issues Than proposing assisted suicide Opportunity to affirm that Lead that we have and making sure That the level of care we provide For people with a whole range of conditions Is brought up to the standard Which is currently available to people Who suffer from malignancy Thank you very much, I think you've made that point Abundantly clear, I would have preferred it And you asked the question if a good move on To another area, convener Which is We heard from the Barnas Finlay about Cancer who subsequently recovered And at some stage He was refusing treatment And we, I think generally Accept That Patients, people do have a right To refused treatment Even if that's tantamount To effective suicide We accept that right And I'm struggling really To see the difference Between somebody refusing treatment Where as a society We condone the right In fact it's sacrosanct When, even if it is Tantamount to effective suicide And As allowing somebody To assist proactively In a suicide I'm not quite sure of the distinction And Given that we accept Or indeed condone one Or the other I would ask the question In medical terms In clinical terms In terms Of the public good even Or the individual good Is the refusal of treatment Better in some way Than some kind Of active suicide process I wouldn't put a value judgment On one or the other You have to remember that death Is everybody The issue when someone refuses treatment For whatever reason Is that they view that the balance Of risks and burdens Of that treatment to them Outweighs the potential benefit As they see it As they are dying of their disease Their disease process is carrying on What you're talking about With this piece of legislation Is deliberately For shortening life Before that disease process Would be Progressing on And I think what we're saying Is that the doctor's duty of care Continues Right on through While somebody Is dying whether or not They have had a treatment Because don't forget some treatments don't work So people go for treatment But actually it turns out to be futile And There was a very good study By Tamil and colleagues from the states Where people had early pallative care Intervention They had higher quality of life Lower depression scores But interestingly they lived longer Than those patients with lung cancer Who were going through the treatment Pathway and didn't have that pallative Care intervention But what you're talking about in this bill Isn't about accepting death Isn't about accepting the course Of treatment Or treatment refusal What you're talking about Is deliberately for shortening life By somebody giving a person Lethal drugs To assist their suicide Irrespective of how long that life Would have gone on for We've had some discussion Not necessarily part of the bill About a principle against the bill Doctors would be involved in this situation Where they were shortening people's life Have you agreed to withholding Isn't your The outcome will be shortening That person's life I think I'll just reiterate What Professor Finlay is saying If I was on a ventilator today And the ventilator was switched off I would start breathing If I had advanced cancer My chest was filled with fluid And I could no longer breathe And the intensive specialist Realised that continued ventilation Was futile If they stopped the ventilator Those underlying diseases Would shorten my life And I would die So there is a huge difference A moral difference A clinical difference Between being reasonable And saying, these treatments Are no longer beneficial To this person And are therefore futile If provided the patient has agreed And for the patient to choose Not to have treatment It completely alters the situation Once you bring in other individuals Once you've asked For assisted suicide You are then involving The autonomy of doctors, Nurses and pharmacists And one of the things we have not Actually dealt with today is It's not just a matter, this isn't just a doctory thing We work in palliative care as a team Most palliative care Is done by nurses How are they going to feel about it? Can you imagine working in a team The practicalities of working in hospitals And you all have a clear idea Of the sort of way, the sort of pressure Hospitals are under in Scotland And in the UK generally today Can you imagine the pressures Of working in that Where one person agrees with assisted suicide The pharmacist doesn't want to dispense it The nurse doesn't agree with it Imagine the disruption To the team that that's going to cause It's a huge problem getting a moral consensus In a team like that Might prove very difficult in some of these cases But I'll just reiterate I think there are very clear differences In the situation you came across And the other thing that you kind of pointed out Was sort of saying that we weren't being honest In our responses Because we were trying to sort of pretend That all suffering can be relieved I think one message that we've all tried To get across here Is that we have the humility to accept That we cannot relieve all suffering We realise that Dr Hutchison has reiterated that several times There are all sorts of areas in medicine We don't relieve suffering We don't terminate mothers lives Because they scream to have things Ended in the middle of childbirth Because their pain is intolerable We don't do that at that end of life We stay with people We do our best to relieve the pain I think that it's furious to suggest That because we can't relieve all suffering That it isn't important to do our very best To do as much as we can And here we are sitting round a table In a country which is rated number one In the world at this And we don't acknowledge that There are a lot to undertake By the committee members We are now at 20 minutes to 12 I haven't had the sponsor of the bill in I'm asking for your co-operation To bring Patrick Harvie in at this point And give him the opportunity of some time And then we're closing this session We've got another panel to go And further business in the committee as well Patrick Harvie Thank you very much, convener To be fair, just in relation to that I'll ask a comment I don't think I've heard anybody Either in this committee session Or at any other point in the discussion Of this bill suggesting that we shouldn't Actually suggesting that we shouldn't Give the best quality of palliative care That we can Clearly some people believe that it's compatible With also having the option of assisted suicide But I don't think anyone has argued That we shouldn't be providing that That level of care And staying with people And giving the greatest relief Of suffering that we can I was going to try, convener, To see if I could identify some common ground Between proponents And opponents of this bill Given the evidence that we've heard That might be a tough call I understand that But I wonder if I could suggest That something we might agree on Is that whatever Parliament chooses To do with this bill To pass it, to reject it, to amend it If it gives a prompt to greater focus Of mind and consideration of the issues Of palliative care, of the end-of-life situations That people may face Of the health inequalities And the need for decent, respectful And inclusive treatment of people That would be something that would be of benefit Simply through debating this bill If it encourages a more open And discussive culture In relation to the issue of death That would be a benefit Of even debating this bill And if the bill was passed The mechanism of preliminary declaration Would be one opportunity That I would like to hope There might be some common ground About the benefit that that mechanism could have The expectation that any one of us When we're fit and well Might have a discussion It might be normal for us to have a discussion With our doctor And have our general attitude To these issues recorded In our medical records Is that something that would create Some opportunities For a better, more open Cultural situation in which We discuss these issues And make our wishes clear? Summary, which I think is very apasite Yes, we all want to improve care Yes, these debates are important Because they've opened discussion Both within the political arena Within medicine Within society as a whole And they've raised awareness of dying You talk about your schedule one Your preliminary declaration If you wish to stick with that I would plead with you to change the wording Not of willingness to consider assisted suicide Because that makes it sound as whether you're willing Or unwilling But actually it's a declaration Of intent to possibly consider If you're going to leave that Determination with the individual Otherwise the way it's wording Makes it sound as if it's on offer And in terms of a consensus In a way forward, yes it is the politicians Who make the legislation And the legislative bodies Here you are talking about Involving another group of people You're talking about Involving doctors, nurses, pharmacists And so on The problem, I think, is just that The very people that you want to involve Are the very people who are saying This is too dangerous I suggested at the outset How the bill could be improved And I did not offer that As any flippant remark And I have many other suggestions As how the bill could be improved And I would willingly share them with you I know we don't have time now But I do honestly feel That you really wanted to find common ground You need to consider a system Whereby you take it out of medicine So medicine carries on providing care And cares for people In their distress In their long-term illness In their dying And the families after death And you set up a completely separate way That those who are determined To end their life Can access lethal drugs Without needing to think Of getting them off the internet illicitly Or go abroad And that you put in adequate policing Of such a process Mr Hazel would have his hand up A moment ago We're just really in your response To your comment around openness And I think that is something That we've all shared a position on this morning About the value of open discussion To inform and enable people To plan and think ahead In Scotland We have an alliance called Good Life, Good Death, Good Grief 800 individuals and organisations Who are doing all sorts of things To promote that national conversation About death dying and bereavement A personal reflection Because it's not something we covered In our formal evidence from the partnership It's the question that you asked About whether the early registration Early declaration might promote that openness And I'm not sure That it's a model Which perhaps is true where It's something that people do upstream Long before death And I agree that these sorts of discussions Should take place at that early stage Because I think they're easier to do there And no-one knows how long we've got But I think there's an alternative way Of looking at it And I don't know what the answer is But I think we already see that The discussion around end-of-life issues Is absolutely dominated And I think it's possible that people might Have that discussion And tick the box Of the early declaration And think that that's job done And I can see why we would want to do that Because we've heard that end-of-life can be Messy and complicated and difficult And it requires you to engage with some Difficult questions And I suppose there's a The other side of the coin and a possible concern Is that people well upstream Think they've dealt with it all But we've heard this morning How people's preferences and perspectives As death becomes more imminent As we all age Actually change And it might leave people thinking That they've dealt with it all But actually getting to that hospital ward And realising actually they'd wish That they'd learnt a bit more about All this sort of stuff And done the power of attorney And had a conversation with the GP About whether should their health deteriorate And be admitted into hospital So I'm not sure about it But I think there are two different ways Of looking at it Surely is a reason why it's An additional benefit that there's a Multiple stage process after that We're not talking about a bill Which simply says that a person Makes the request that's granted And there it has done It's a more involved process than that Yes, now I was really just commenting On the fact that well upstream Tick the box people then might be less Engaged with wider issues About planning, preparing For the end of life, that's all And I'm not saying I'm sure that would happen But I think it's a possibility That'd be different for different people I'm sure I think that would be very valuable I think that what you've set out there Would be very good I am concerned that we need To almost have this debate By what often called in I would like us to be having it As a primary conversation And I think it would still be very useful But I would also want to say at the bill I still have profound concerns about it Being applied to people, for example Under 25 The time for a further question Thank you There's been a Range of arguments made Some of which are about Practical consequences The risk of Wersion The perception that Passing this bill would undermine The political support for palliative care Other areas which I would categorise As practical consequences There have been other arguments Which are raised clearly In terms of principle Fundamental principle I'd just like to explore the balance Between the two The bill clearly envisages A range of circumstances in which There is no stress for assisted suicide If I could invite people to consider What I might call the most Clearly end of life End of that range Where someone may well have Had access to good quality palliative care Someone may well have had A long standing Clearly defined and articulated Principle about Their attitude to the concept Of assisted suicide A person may no longer be Completing other options Because their death is imminent They are dying and that death Is coming quickly And they have a clear will To die on their own terms To say their goodbyes On their own terms at their own time Is there a clear principle Reason why they Should not be able To exercise that decision Or is it entirely a question Of practical consequences Of society or other people Or the risk of coercion The balance between principle And practical consequences Your back though To involving another person In deliberately foreshortening That person's life That is a matter of principle Because you have to consider The effect on that person And the system you set up And your bill Of life at all It's not worded like that at all And if we We could talk on for hours About theoretical considerations But we've been trying to highlight To you the dangers of this As it's written now And ways that it could be improved I understand that, I'm just looking to explore the balance between the principle And the pragmatic arguments I think there is a Public safety issue For a society And never have a society in which everybody Has everything they want All the time But you have to put your boundaries Somewhere And I think it was a noroneal Who said Who said that laws are like nation states They are safer When they rest on clear boundaries And here What you would be doing Is fudging that And you have to think about what I'll name the collateral damage And I think our concern Is about potential Certainly my concern I can't speak for others Is about the public safety And who will get caught up And how you will ensure That people don't get caught up And it was Lord Faulkner on the Today programme Who admitted that there will be mistakes And no legislation Is watertight And that worries me Nobody's dead, they can't come back again Professor Rogers referred to this As the Rubicon That we stand on one side of the Rubicon And we can cross the Rubicon into this other world And doctors By their professional oath Stay on the side to know That they can't kill patients We're confident in that And that enables us to In all sorts of ways Not just in these difficult conversations With the users of drugs When they're necessary to combat pain We feel confident in that we are protected by the law A funny thing When someone heard I was coming here to give evidence A friend of mine who has a completely opposite view From me still remains a friend Said I really agree with assisted suicide But I wouldn't want to be looked after By a doctor who did And that kind of encapsulates The sort of dynamic here We want doctors who are on our side And will care for us And say, hang on a minute Is this the right thing? That kind of encapsulates it for me Anyone else? Patrick I think those are the issues I want to explore Thank you Remains for me then to thank you All for your attendance The evidence that was provided and written for them And your evidence here this morning Thank you all very much My apologies to committee members Richard Lyle and Richard Simpson For not getting them back in But to thank you all Again We need to quickly turn round now for our next panel We now We now Thank you We now reconvene And continue with agenda item number one A scrutiny of the assisted suicide Scotland Bill And We now move To our second round table Of the morning with Religious and Faith groups We're sorry that we're A bit behind schedule But I'm sure that you all found that Session as interesting as I did Then So We normally do with a panel We just go round the table and introduce ourselves And then we'll go on to our first question Which I think is from the Dennis Robertson We have with us today Dr Mary Neill Who is a committee adviser On this issue My name's Duncan McNeill I'm a member of the Scottish Parliament For Glasgow Good morning I'm Sally Foster Fulton I'm the convener for the Church and Society Council For the Church of Scotland Rhoda Grant Highlands and Islands MSP How it has Convened with the Doctrine and Committee With the Scottish Represible Church And good mornings I think we're just there I'm Dennis Robertson MSP for our region west I'll have to say good afternoon Since we've crossed the rubicon Efraim Broffski Scottish Council of Jewish Communities Good afternoon Colin Kear Edinburgh Western constituency Donald MacDonald Representing the Free Church of Scotland Mike Mackenzie MSP Highlands and Islands Region Nanette Milne MSP for North East Scotland Salah Biltegi Representing the Muslim Council of Scotland Good afternoon Dr Blile MSP's Central Region Hello I'm John Deegan I'm the Parliamentary Officer for the Catholic Bishops Conference of Scotland Richard Simpson MSP Mid Scotland in 5 Thank you all Oh sorry Member in charge of the bill It's just because I'm so quiet I know you are quite Given the previous session It's on this side of your summer Feel free to bring me back into central focus Dennis Robertson is going to ask the first question And then we'll see what responses take us And we'll have other questions as we go on Thank you Dennis Thank you convener In many of the submissions we've received Sanctity of life Seems to be quite prominent In a lot of the submissions I wonder if we could maybe explore with you What is meant by that Sanctity of life And if there is Any situation That you would ever envisage That assisting someone To take suicide would be totally against that Or would you see me being respectful Of the sanctity of life Any takers Yes Dr Biltegi Salah Biltegi It's not doctor of medicine by the way Well I actually am not a scholar In Islam So I had a gathering of My own scholars And I asked them is there any situation Where the sanctity of life As we know it can be Relaxed or can do something about it And they very clearly And very openly said no There is no excuse For changing the Time of death To change it anyway But there is no permission at all To interfere with life Of course there are situations Which are like legal and so on But that's the difference to me Never met Donald As we believe the sanctity Of life rests on the fact That we believe that we are made in God's image In other words that we are different from the animals That we are a spiritual Dimension To our beings Which makes it different for us And we have a responsibility Not just to maintain our own lives But to maintain the lives of others To respect their lives And to Care for one another Throughout our lives Now you might notice that In our submission we have said That we have no right To deliberately end an innocent human life You know there may be other Debatable things like Just war and things like that But leaving that aside at the moment We are dealing with people Who are going to die anyway They are facing problems Because of suffering And they won't help to end their lives Now The best way I think That we believe to respect That person's life is to help them To face up to life To relieve the suffering And to show compassion Means that we feel with them In their situation we understand them We go alongside with them Suffer alongside them if possible To some extent And relieve that suffering And prepare them for their death And as Christians we believe there is life beyond death For which we would point them as well But The question of sanctity Of life If you don't believe in God If you say in a materialistic view of the universe That all we are doesn't matter Then you have to account in some way For the importance That we give to human life We all realise that we are different We have responsibility We have Creation And gifts Instead of gifts all of these things And because of that we know we are different And you have to find some way then Of giving importance to our lives And some people say it's autonomy You know I will make my own decision I will make my own life And that is I think why many people Then who are and say Because it is my life and I have I find that I make my own Meaning to life Then I want to have control over my death as well Of course those of us who come from a faith perspective Say you know God has given us life And God will take away life We are responsible over here To maintain that life And to help others to maintain it In the best way possible So we believe there is never A reason, a good and sufficient reason For ending someone's life Even if they themselves want to end it They are free to do so It's not something we would encourage But if If on the other hand From a medical point of view And for 20 years I was a doctor and surgeon The person says that they want Don't want to go on living If they refuse treatment of all kinds They might even refuse food and water Then we would still support them through that That is their autonomy But they have no right we believe To demand that we as a helper Or as a care or as a doctor Actually deliberately Help to end their lives So sanctity of life Yes it is extremely important But it must also be taken Into consideration with personal autonomy And human dignity Thank you for asking your question Sanctity of life Is not exclusive To those around this table Who hold to a religious faith Sanctity of life means the Set asideness, the specialness Of life that fleeting, fragile Extraordinary experience That we share But share is the word that I'd like us To take a minute and focus on It may be my life But I share that little With others and that's what makes it Special and sacred The thing that concerns us About this bill Stems from the same for the folk Who support it It starts with dignity And dependence on how we see Those two things interrelate And human rights and compassion Everyone is dependent And that does not take away Dignity in fact actually That enhances it And anything that erodes That idea that if you are Dependent or at times Place your burdens down So that others can help you carry them That that's a loss of dignity Or a loss of your humanity Or a loss of the sacredness of your life Then we all need to be concerned And that's our concern about this bill Especially for those who find themselves Vulnerable, marginalized, afraid Coming to the end of their life To say to them Your life is somehow less worthwhile Than somebody who is healthy and fit And coherent and cognizant And also being able to be eloquent That erodes everybody So the sanctity of life is very complex And it's not a stark black and white Thou shout not It's how is this decision About my life Going to impact the others that I Share my life and this planet With Where we really need to grapple with this That's where our concerns lie Essentially I'd like to answer Dennis Robertson's question By referring to the question That Patrick Harvey asked right at the end Of the previous session Where he drew the distinction Between issues of principle And Mere practical questions Because I think that's a false dichotomy I think that if there are Sufficiently many practical questions About absolutely the aspect Of what is proposed Then it becomes an issue of principle It's not just a matter of knowing When the proposed criteria Might be satisfied But it's a question of knowing How we could know that those criteria Are satisfied And that seems to me to be at least Of legislating about these issues Because This isn't theology, this is law And law Is in the practical domain And it's therefore all these Practical questions That this committee and the Parliament Itself has to address in considering this Bill I think that both within faith Context and without faith context paths Can be chosen that Death is likely to be involved Whether it's difficult decisions to go to war Or to stand in the way of a Careering bus that's going to hit somebody else Or go ahead with a pregnancy That might well end your life I think what feels different About assisted suicide is that it feels like Death chosen for the sake of death Rather than death might welcome But it's for the sake of life I think that's what makes the difference For it that it's death chosen for its own sake Rather than death Because it's going to lead It's going to issue in life Elsewhere or further Anyone else? I concur with all The previous answers I think that the hub Of the argument I suppose Is the difference between Recognising the inalienable right To life that all of us have And seeing that as the foundation To make sure that everyone In our society is always safe And the point beyond Which we cannot go Is that where we deliberately hasten death Where we choose death as the outcome I think that you're right To point out that we should Respect the autonomy of individuals Support them in their autonomy As far as we can but in the context Of having a safe society Where that human dignity is always upheld Accepting death Is an actual part of life And I think that doesn't breach Of the fundamental human right To life Anyone else? I made a short statement Really But we're not just talking about the bill From that theological point Which is valid to us anyway But from the point is that Is there a reason that We break that rule For benefiting the society in any way And when I looked at the bill And other people looked at it We found that It will do a lot of things Which is not in the benefit Of the society as a whole Will be creating mistrust Between the medical profession And the general public It will create a culture Of suicide is one option Of Ending of treatment Of any person And if that's an option That will be a very attractive one For many young people Especially who are In depression or in any cases In a very bad way There was a case recently In Belgium where they actually Moved as this bill postulates From Assistants to Euthanasia And this was someone who was in jail for life And he asked it to have Assisted suicide And he was granted this And then there was Action from the communities And the Minister of Justice Reversed that decision Because there was An interesting thing here Is it ending life Is that a punishment or a treatment Is that his benefit Or a benefit of society or not That's something which could come And they reached this stage The important thing for us is really how It affects the behaviour Of society And the main ones I think Is this culture of suicide Becomes a normal part of treatment And also the mistrust between The patient The medical profession The family And we heard about the burden on the family And that's a real feeling For someone who is in a difficult situation So we have to consider all these things And look at it In fact the whole bill Is so tight from beginning to end If you go to the practical points Maybe these come other questions But from the beginning There is no advice and consultation Giving to the person Before he decides that he wants To be assisted If we go to any transaction In our life or any process in our life We ask a legal expert Financial expert Even a calm mechanic But in this end of life In the hands of the person You decide that you want to end your life And then everything falls So that's from the beginning More forward We find that there is no Monitoring process for For the procedure at all It's just this side And there's no monitoring There's no follow up There's no way that we can make sure That things go wrong And I'm reminded of something I was involved with him The certification of death Generally and there's a new law Which came two years ago I was involved in discussions From some years now And it's all based on one person Who was Dr Chipman Who was trusted by his people But he's killed so many of them So that's in just certification Of course he was killing them But if you have this kind of bill And you have this group Which we don't know whether they are medical people Or normal people or what And give them again The way to this Without any more in time go And it fall up it seems very very strange So we're not just crossing a principle But we're going from a principle To sort of open system Which nobody can say It's tight enough And the quote I was going to mention earlier Lord Faulkner himself said Those no safeguards Are watertight And this is not anything which we can Repair if it goes wrong I think this is why we stopped Capital punishment Because we thought that this is something If it happens we can't correct it And that's in a way similar Dennis It's a couple of points That we've heard Compassion And suffering We've heard sharing At some point Would we accept That the person And their family Have mutually Come to this decision Because the family Is respecting the will Of the individual And They're accepting that they don't want The person perhaps to Suffer any longer And the person's made that clear themselves And their compassion Is to agree Is it not then Right that that person Should be facilitated Towards that end of life Mr Deegan That choice of that individual Albeit It might be a sincere belief that they're better off dead It impacts on It creates a universal Categorisation of human beings in our society That the law enshrines That are right And we endorse that they're better off dead I think that's the protection we have to take into mind And I think that we also have to take into mind That the advances in medicine and technology Now afford us the opportunity To give care better than we ever have At any time in our lives So it maybe Should make us think about Why are people At this very time in history wanting To choose to die An existential question That perhaps needs addressed as well But part of that will be A breakdown In the bonds that we have in society And I think it's when you have that breakdown of bonds And you feel isolated and you feel you're not worth anything You don't mean anything to anyone else You're more liable to feel that you want to die And I think what assisted suicide does Is it puts a finality To that decision that yes We are breaking all of our bonds with you And you're breaking all of your bonds with society And I think that's something that we cannot do In the last series Of people giving evidence We heard compelling stories In support of assisted suicide And compelling stories against There are stories on either side But compelling stories do not make Good safe legislation And I think we need to distinguish between that I don't believe And a lot of the evidence that we've been hearing From the people who work day to day Are we cannot safeguard The slow erosion of the understanding Of the dignity and the worth of human life We cannot safeguard the most vulnerable The old person in a home Who feels that he or she is spending All her children's or his children's inheritance And it would be a really good Honourable thing To agree to assisted suicide For all these good reasons But they don't want to go There is no way to safeguard against that And it's not intentional pressure from families It can be internal pressure from themselves We can't safeguard, but when we say That there are times when One set of circumstances means that your life Or that type of life Might not be worth living You plant a seed and you begin to change things You have walked from one way of looking at things To another and it's very difficult then To walk back Once that legislative genie is out of the bottle You can't get it back in I support that I think the premise Of the question Is that It's in a sense Compassionate always to say yes But we all know That it's not compassionate to children Always to say yes when they say They want something And the same may well be true Of the other end of life as well Let me Make this point as well Today is, as everybody knows, Holocaust Memorial Day It's now A well-known Cliche that the Holocaust Didn't begin in Auschwitz It ended in Auschwitz But that is again A point to make the distinction That Patrick Harvie made A point about practicalities In terms of principle It began With the belief that some lives are not worth As much as others And that is precisely what we're faced with here And that's the point that Sally has just made as well Anyway, yes Sorry Reverend Harris and then Reverend MacDonald Thanks very much I think that we do always have to give Full recognition to The decisions people Have reached And fully hear them out On their assessment of their situation How they're feeling, how their relatives are feeling So yes, I think if people have As a family unit Perhaps or more extended Grouping comes to the decision We have to give full recognition to that It doesn't necessarily follow That we say that that route is possible For you, but actually to allow That to be said and to be recognised Brings a kind of healing And opens up other Possibilities As does, for example, when people say I feel like I'm a burden To some extent it's actually valuable To acknowledge that And it might be helpful And might relieve anxiety If family members say Yeah, you are a burden But you're a burden that we want to carry And we don't want to not carry you Or for people to say I want to end my life And you let them explore that fantasy And you might with a sibling who says I hate my sister who wants to kill her And you say okay Well, tell me a bit more about that But actually I don't mean to trivialise at all Because when people Have been allowed to say that And they've been able to go that far They've let themselves explore That in conversation And they then pull back from it So I do think it's really important To give full recognition When people reach that decision Let them explore it Doesn't mean necessarily that we should allow that In law, but to let them explore it Can actually Address some of the issues And they pull back from wanting to go that far Another point I think about That when somebody says I want to end it all now And the family thinks oh yes He's suffering terribly, he should go now And obviously that's the case Where there should be further consultation Especially pallidive care Consultation with it All round holistic Means of treating So that they probably would change their minds After some time So we shouldn't just take the first declaration That I want to end my life As that's their fixed world Any means And the other thing is That if you look at the figures Some years now The By far the biggest reason given For taking the Death under the Death with Dignity Act Is loss of autonomy Loss of independence Loss of enjoyment in the usual Activities etc It's not unbeatable pain That's very far down in the list Being a burden to others is perhaps In the middle of the list Of the kind of person Strong person Who just hates being dependent on others Who is He wants to keep control Of his or her life And he wants to say Now I want to end it And I want to end it on my terms And So the proponents of the bill Often say it's the unbearable suffering In other words The pain that can't be controlled Is a small percentage perhaps Of people for whom that is true But there are other means of doing it With the holistic care And sedation as well as Pain relief etc But it's not generally speaking That unbearable pain For which we of course We must feel along with them as well But it's really It's the loss of control The loss of independence That is the main reason In seeking assisted suicide And that I think Is not an adequate reason For changing the law Which is there to protect The vulnerable at the moment We heard in the earlier This distinction about Assisted suicide or The withdrawal Of treatment for anonymous On request Do you see a distinction there? As I said earlier We will all die And sometimes we do recognise That if a person is suffering Sometimes dying is a relief for them And it's a relief for the families as well But what we try and do is support them In the lives that they have You know alleviate pain as best we can And sometimes that means That you weigh up that this particular treatment Is not worth the effort It's too burdensome to the individual And so to forgo that treatment Is completely In line with the recognition That this person has an alienable dignity And we're just going to make sure That they see the way out of this life As comfortably as possible But it brings on the death earlier No, it's accepting death Now we have the capacity in this Perhaps it's a fear that motivates some Who are for assisted suicide Is that there is sometimes An endeavour that is Not worth the effort That puts people under further suffering That they don't need I mean it's called vitalism Where any effort to keep alive is pursued Simply because people Think that life Whether it's lived through Suffering just has to be kept there That's A misunderstanding Perhaps it needs to be teased out In the minds of people that accepting that I don't want to take any further treatment Is a completely Licipped, legally and morally Trots to take Anyone else? Yes please I think this goes to The understanding of us As families, you can call it Part of it is compassion and so on But a question of dignity And dying with dignity I think if someone is really suffering Much the dignity Is to see himself Ourself looked after And seen by His family Children That is dignity I think But to just Leave them alone to Who do you like? We finish it That's not really dignity Because having this cycle Between the father, the grandfather And then the children and so on And it's a complete cycle We should look after our parents As much as they have looked at us It's not just they have Go to invest and just forget about us And we forgot about them This is what, you know Human beings should be Even the animal world it happens sometimes So we're looking at How we live as human beings In this way, not just As commodities As someone would say And really having The compassion of the family And the friends and coming to see you That makes a change and we had Lots of examples about this And the other thing is nobody knows Exactly when death will happen Even if we do assisted suicide It might not work So why put ourselves in something Which is not definitely known Nobody knows exactly what will happen And many cases there will be failures And the statistics actually From Arwen shows that about 50% of the people who Had been prescribed The medicine to die Of poison have not used it So people can change their mind Very, very quickly in this And that could be because Things around them have changed Maybe people want them or when they saw them Want to die have changed their attitude Towards them so it's this Human feeling together We should not say that Forget it we can have A better way or an easy way And the other thing which has always happened I think the person When he is nearly dying Whether he's healthy or not Knows that this is the end And he can decide Without poison without anything That this is it and that's finished And I've seen this in many cases So why do we have to interfere In something which Is going to happen anyway Please I think there's a profound and distinct difference In assisted suicide And making an informed and supported decision Not to have treatment that can be At times incredibly invasive And have a profound impact on the quality Of the life that you have left I have terminal cancer There are things that can impact The length of my life but it's going to take away From the quality of my life and on balance I have made an informed decision With my physicians and my family That that treatment is going to impact Negatively the quality of my life While it might increase the quantity That's very different from saying I'm going to take a lethal dose Dose of medication that will end my life And that's a proactive move To end rather than take advantage Of the most of your life that you've got left Mike McKinnon Thank you, convener I was interested in exploring This idea of the sanctity Of life and the Concordant idea that that's always got A constant value And as much as We're all aware of deaths That we talk of as being Particularly tragic Maybe a child, maybe a young mother And on the other end of the spectrum Maybe somebody who's very elderly Haven't lived a Fulfilling, rewarding life And dying peacefully in their sleep So it seems to me that At one level at least We do Confer a differing value On That lives and on death And I just wondered What the witness felt that Is this a constant that remains Constant throughout our lives or is it That value subject to change Which I think is not being made In the question between Two different senses of the word life When you Evaluate Lives in the way in which you have Somebody's unfulfilled potential Someone who has achieved a lot You are Evaluating Their life in the sense Of their Passage through this world from Both to death When we talk about the Infinite value of human life We're talking about the state Of being alive and that I think Is a distinction which Needs to be kept in mind Which if I may say so The question elided Once a year please The two examples you gave Don't contradict one another In that if somebody has lived A full life Then you don't regard their death As a tragedy it might be sad news But it's not bad news necessarily And what you're valuing is Is the culmination of a very full life And when somebody's life is cut In a way that seems sort of a naturally short child Or a mother of young Children then the tragedy in that Is that their life hasn't had that fullness to it So they're consistent with one another Those contrary reactions Are both Consistently testifying to a Valuing of the science to you That's fine In every life and all through your life There are times when things are Really good and there are times when Things are really challenging That's with every life Whether it's at the end of your life At the beginning or somewhere in the middle So I think it's about how people walk with you During all the times of your life Good and bad so I think yes there's always qualitative I would say that you know there are times in my life When things were really really hard And looking back on them it was how people walked with me That defined the difference Again there are unexpected joys And unexpected pains in every life One of the things that concerns me about Assisted suicide You're curtailing any unexpected joys You are making a decision to end your life And the unexpected joys That may come that we never know about May not happen Mike, you'll get it Right, you'll get it For those answers Colin, Colin Ciar Science can be no Just been changing my question a little bit On the back of what I've said It's actually It's something that was said earlier Mr Dean there I do beg your pardon And it's about the acceptance of death And the fact that You know we're helping to curtail Or someone will be asked to Help someone to curtail their life Cos let's face it Suicide is not It's not illegal As such My question Really is Given the fact that we have Those who are For whatever reason Go out and commit suicide My concern By someone who's seriously Considering this course of action Through the end of a seriously Bad illness They are really having problems With getting to end of life And there are That small amount of people As I believe it is a small amount of people Who perhaps think I am definitely at the end of my tether I want to end this I will end this And is it fair on us to deprive them Of some help Or Possibly the fact that they head In their own direction And they take their own lives In a Not as pleasant manner Shall we say And they end up in a situation That is quite harrowing For the families particularly Would it not be better For the families if The issue was resolved Properly beforehand There would be An acceptance that this is going to happen As against Suddenly finding that The nearest and nearest or a family Or friend Is taking their own life In some degree of solitude And in a position that is not quite as Pleasant I think the thing about Suicies are a tragedy You know, it's people who are Desperate And what I think we have to offer Is some help and stand by them When they are desperate that's why We have suicide prevention measures Supported by the Scottish Government And many other charities I think the issue Of bereavement is huge We heard about that earlier I don't think we're going to be helped By the fact that a person chooses to End their own life with the help of a doctor In fact, I think the problem Arraised is that It undermines the foundation Of our laws that protect all of us That ensure that there is no discrimination Against certain people Because we think that there are less worth Than others By all means Let's support people But to hasten their death I think in no way helps Them I think we are capable Of trying to give support As far as we can And support the families To ensure that they do not go through They have as good a death as possible I think we had one of the The initiatives this morning Is good life, good death Good grief I think To allow people to do that Naturally and accepting death And supporting them as best we can There is a deep instinct With every human being In every culture Of self-preservation In the past You might have said that suicide is not illegal But I wouldn't say it's lawful If you look at some of the debates Around Westminster When they talked about this People who want to die Have some sort of problem Some level of depression Or desperation in their lives What they do not need to be prosecuted After attempting suicide I think that's where the suicide act In 61 was introduced It was out of compassion That they decided not to prosecute And that's why assisted suicide Had a penalty of 14 years Almost the same as murder And we try and help people through their lives To have as full a life as possible And not end in a desperate situation Where they feel they have to sever All their bonds with society And with their family Sorry, Donald Can I just pick up on something that John Deegan said About depression About the incidence of depression In those who are suicidal And we know what that's very common Say in young people Young men in Scotland for instance And that's why we have an anti-suicide strategy And it's the same towards the end of life People who are in terminal illness Often are depressed And it's often quite difficult to reach That diagnosis I think From a medical perspective This is where you have got to have a specialist examination of such patients And again I think it bothers me In the practical aspect of the bill Is that there's no necessity For having this kind of Psychological or psychiatric assessment Of the person who asks For assisted suicide So yes Towards the end of life Many people will get depressed And perhaps people don't Recognise it The family might not even recognise it Because they put down Their withdrawn state Or their refusal to face the future Put it down to the actual suffering The physical pain, the weakness etc Now that is part of it obviously But when the mind actually gets depressed Then it affects the whole of their system And with proper help And psychiatric help and of course Anti-depressants problem They can be got through that And then perhaps prepared for a better death Than just been put to sleep By their own action Yes please I think it's important that we return To the idea that this is law That we're talking about And anytime something is legislated for Against what you've got to do It's about a balance between the benefits And the drawbacks for an individual And the benefits and the drawbacks for society So what about all those people Who want, who aren't articulate Who are not well supported Who are vulnerable but desperately want To live with dignity until they die I think that's where we have to focus That and anytime you begin to erode The level of support for them Even in society And the way that they're perceived Then you're on a dangerous path I also wanted to go back to some of the talk That was going on in the last panel About palliative care We have a great system of palliative care In the United Kingdom But it is not perfect and it is patchy If you have a non-relignant disease Your chances of having good palliative care Are less If you move to a plan B Why not exhaust plan A And do absolutely everything we can To ensure that good Consistent deep palliative care Is offered throughout Scotland I think until we have exhausted that And can put our hands up and say We've done absolutely everything we can do In regards to palliative care Then why move to plan B I should point out for those Who sat through early this morning And are here now That we have been involved in a number of areas here The suicide bill is one of them Access to new medicines Which is another aspect Of all of this And we do intend In the new year To look at palliative care And end of life We are trying to As a committee see this In a broader setting So we put that on the record This morning Yes sir A couple of small points One is Assisted suicide to me Actually not involving one person Only doing something awful By killing himself It's also involving someone else To do the process And this will have very Difficult repercussions If something like this goes ahead Because you will have to Try to find a way That you don't discriminate against doctors And medical people who don't agree With this and go into this And we know that although there's usually Some conscious Close It doesn't always work that easy So this is another addition To the difficulties Going back to palliative care What I know is that It's not really completely funded By government like NHS for example A lot of it It depends on charities and so on So why not put some support Into this and that's something Which is to be looked at More than anything else Really Thank you Richard Lyon I'm very impressed with The amount of churches and faiths We have here this morning And I respect you all To ask the question We all know when we were born We could all say the day we were born None of us know when we're going to die No one can predict When they're going to die And the last panel basically went on about the factor Of to give more days and more years Now I know a friend of mine's mother Was told she'd cancer She'd only six months to live And she actually lived three years We all visit Our relatives sadly who have gone In cemeteries We all need to go to local cemeteries And see the flowers and the respect And everyone goes But the point I have to say is I have never heard so many scare stories This morning about You know We should let these people Go on and we shouldn't let them die And all this and all the different Other things you know Because no one wants their relatives to go We all want to keep them As I said in the previous panel But if a relative wants to go Why shouldn't we let them go And that's the point I want to make And I want to ask And I know the answers I'm going to get But basically But basically If someone is dying And they're lying there And they've said to you before The sort of And we all went into hospices And we went into hospitals And we all went in And seen our friends etc Relations And I've said I want to go Why shouldn't we let them go Or even help them go I'm sure we'll get some responses from that Yes of course John Deegan I think you had some scare stories Because there is something to be scared of Since the second world war It's been secular authorities That have created a human rights regime Life is the foundation for all other rights And that has been Increasingly recognised with more positive Obligations on states to ensure that People do realise their right to life So that was founded on Recognising How dark things get When people have that power That they can decide over life and death And how easily that is abused But not only can it Just be abused and we can Recognise that directly After it has happened But also it degrades this fundamental recognition That every human life is Special and to be nurtured And to be protected As much as possible But thirdly it also leads to temptations Which undermine everyone's right to life You know we've already seen in other jurisdictions People being refused treatment Because caring for them was too expensive Or it was cheaper just to give them A concoction that would kill them We've heard of jurisdictions where people found out That Tom Morty In Belgium for example His elderly mother who was suffering in dementia He got a phone call to say that your mother Has been put to death yesterday He knew nothing about it We've heard of Kate Cheney, a case in Oregon Where her daughter was coaching her what to say So that she could get assisted suicide And this was recognised by a doctor But she was just the family Were able to take her out and find another doctor Who had her life put to an end We've now seen the development of this Where people are nominating themselves For death in Switzerland just because they're tired of living We had the case this morning About the twins going blind Who wanted to die We've seen the extension of it now In Holland and in Belgium now Where children can be put to death That's why you're hearing scare stories Because it's something to be scared about When you take away a foundation that's been recognised Through our religious traditions That are testifying to that as well But also our secular institutions Have tried to uphold this Because it's very dangerous to take that platform away Yes, please I'm not going to justify scare stories I'm going to address The question again And it seems to me that the question That Richard Lyle has asked Is one that would have been appropriate Had we today been Discussing Making suicide illegal Or making it illegal To strive officially to keep alive That's not the question That's before us The question before us Is about assisting suicide In other words, the boundary That is being crossed here By this proposed legislation Is not to do with people dying But to do with what their Agents do And that is what we heard Loudly and clearly From the medical profession At the previous panel And to some extent, it's language again We're calling this Assisted suicide We might just as well refer to it As requested euthanasia And then I don't think it would have quite so many supporters That you are involving someone else In the act But those who commit suicide Don't stop them No one stops them The question mentioned Why keep people alive when they don't want to Now I think there's a lot of misunderstanding Amongst people Especially the people who are well at the moment And I've heard people say I have heard a good Christian man say Of a member of the church saying When my time comes, I just want to let me go Don't keep me alive by necessarily People seem to think that doctors nowadays Because they're so specialised And they're so keen to do an experiment That they just keep people alive And alive and alive When they don't have to And that's a complete misunderstanding Because when a person does come to that level When they're ill And perhaps their life is at risk They want treatment, they don't want to die It's only later on perhaps When they realise the end is coming That they might say, well, just end it now But then again, if we've heard from The palliative care specialist If they're given proper palliative care Then they change their minds So we've got a whole lot of education Of people while they're still well About what end-of-life issues are Get them talking about it And It's not a question of keeping people alive Against their will When somebody says, I refuse treatment Then you must respect that Unless of course they've got a Illness where they can be certified As they say, that's a different situation But somebody in the right mind Who says, I can't take any more Just the thought treatment And then you respect that And let them go and that's not the same As giving somebody a lethal dose And I would be very much against The medical profession being involved In that whatsoever The other thing that strikes me is About, it's a good thing I think for people to talk about Dying even, perhaps when they're young But again remembering That's a great risk of increasing The tendency towards suicide in young people And that's what worries me perhaps About this preliminary declaration In the bill, that it can be made From the age of 16 Now they have to be told about that When they're coming of age of 16 Now you can sign a declaration And it's a very wrong time To be put in ideas of Suicide of end-of-life They can talk about death Perhaps especially when they see friends dying As it sadly happens Somebody dying in an accident And that has to be talked about It has to be done in the context of affirming life And giving them a mechanism To deal with the thought of their own life's ending And not to think of suicide The deliberate ending of the life As a way out of a problem That's what I think is the big problem here I think that letting people go Is really important And sometimes helping people to go Is really important And a really important ministry In a very skilled one There's a kind of midwifery type Aspect of helping people to go Doesn't have to involve I mean this bill would be about That involving giving drugs That kill them But often what stops people From dying isn't Medical as such Other reasons Their bodies might be ready But they're holding out for a critical conversation They need to have with somebody Or something has really bothered them And they're not quite sure what it is But a skilled conversation will bring that out And then they relax and let themselves go So there's an awful lot of skill In helping people to die And it would be great for there to be more resources To enable that to go well And I wonder if that were generally There'd probably be less Concerned to see a bill like this Get passed through Parliament Just briefly I think that what you heard Weren't scare stories They were real stories And some of them are scary And we need to listen to all the stories That people tell because they have something To add to this conversation This is such a complex Conversation to be having It's not black or white It's grey But grey areas are where people tend to get lost And my concern again Is all about those people Who might get lost If this legislation passed I respect Many of the faces that are around here But the point is At the end of the day I'm told that if you smoke You're going to cut years off your life Eat healthily You're going to cut years off your life As I said earlier on We know when we were born None of us know when we're going to die But if we are At a point where I'm looking at this bill As in people who are really Chronically sick Ill And what I heard with the panel before Was We still want to give you more days For people who want to go My view is that Let them Thank you That was a comment more than a question I think that Is it possible For that cohort that you're talking about Is it possible to ensure That it only happens to them That is the problem that's been explored It's not possible It spills over And it puts the weak and the vulnerable The powerful or the articulate But to defend the weakest Yes please Suicide happens everywhere We just take it that it's not a crime Anything But when suicide happens As they call it in custody in prisons Which is where You know expected a lot There's a big noise happening And there's a big inquire and everything So in our hearts all of us We think suicide is not really something good If somebody commits suicide himself Is one thing But helping someone with it Is another thing It's adding a load on someone else You know suppose Richard's alluded to And some of the people we have here And Mike and the others There are people who don't share your faith Or your view And exercise another conscious Decision And we've had I think it was a response To the horror stories Some examples But Not every family is looking for the inheritance They would see This as an act of Love Respect For that person I'm just worrying that That this area of nature And the strong views Don't cloud Some of that out today I don't know whether there is a response to that But everyone who would wish If they were Requested to do So by a loved one To assist in that would probably say Don't be so daft You're not a burden There would be a whole process there And that person would still insist And we've seen them You know leave the country They're motivated By the love of that person Not necessarily a bad thing Is there No situation That you could perceive That assisted suicide Would be anything other than a violation Of that humanity Or that you know Is there There isn't any situation And the intention Can be a good one But it's not only intentions We have to look at the other consequences of it And the actual action that we're Legalising in this society And that is that there is a power Now being granted to some people To bring a person's life to an end You mentioned that it's our faith tradition But I was trying to point out That it's not just a faith It's a natural instinct Within every human being Within every human society Which has been endorsed by our human rights regimes That we have to protect this foundation That makes sure that every life Is inalienable And we have a complete recognition That there's no discrimination against anyone In our society I think that our society needs that foundation I've got no other Members I just want to comment on what you said About The Respecting The loving attitude of a family Who want to help their Loved one to end their lives Now what concerns me is that It's not just their decision Or the person's decision It's the way it'll affect The person who gives that help Who prescribes a lethal drug Or Provides the lethal apparatus Whatever it is And It would not be right for them to do that I firmly believe that As a doctor and as a Christian That it would not be right to give them The means whereby they can end their lives Now Especially as a doctor Because it's also been a tradition Of the medical profession from the time of the procrates To protect life, to care For life until it's very end And not to do any delivery To bring about the end of life And although this will attempt To distance the medical profession And the caring professions From the actual act of suicide When a doctor prescribes A drug He has to say how much it's To be taken, how to take it So he's actually instructing The person to end their lives He's given an order to end their lives The person might not take it fair enough But once he takes it the doctor is involved The carers who are around They will also be involved And they would have conscientious objections too Which is not mentioned in the book And the facilitator Who would be involved He or she would also You know Have severe psychological Results from Eating a person to end their lives So I would believe it's not the loving thing to do To give people the means to end their lives And the means are You know, not specified in this book It could be anything, it could be You know a mask with And a narrowed gas like nitrogen In it It could be A lethal injection even If a person was on a drip The stuff could be Provided And the person who was ending their lives Would just flick a switch Or perhaps with a movement of the eyelid If they couldn't move anything else It could be arranged But there again that's so close to euthanasia It is euthanasia I believe You know, the principle of it is I believe that we should never Aide people to end their lives Yes, we can agree with people Who want their lives Just to come to an end naturally Because they get no further treatment The illness kills them Or even perhaps dehydration might kill them Although they still will get supportive treatment All the way through Even when they're dry they can get their mouth Moistened which will relieve a lot of their suffering But to actually Deliberately to end a person's life That I think is Should be completely outlawed And never entertained Yes, please I firmly believe that the vast majority of families Do what they do out of intense love And concern for the person who is dying But that does not change What the law would be saying It's making a qualitative judgment About life In broad terms that are quite hard to define Is another issue that we could talk about But we're saying that folk who are terminally ill Or who have a life shortening illness Diabetes is a life shortening illness There are lots of life shortening illnesses But there is a qualitative statement being made That some life is Not quite as worth living as Other life And how does that impact those Who suffer from those debilitating illnesses Or diseases or life shortening conditions Who quite frankly would like to live And be supported in that We're making a judgment Invertently, unintentionally But that's what the law will do I've no other community members At this point indicating they want to come in Of course that leads me to Patrick Harvie Thank you, Patrick Thanks very much, convener I'm glad because I was hoping to explore This particular issue that we were just Talking about the How we respond to the Reality that Sometimes and people are acknowledging it An act of assisting someone To commit suicide Might be undertaken entirely Out of love and compassion The witnesses will be aware That there have been as well as attempts To change the law Both in this jurisdiction And south of the border And elsewhere There have also been repeated attempts To clarify what the current law is South of the border There's now guidelines On prosecution We don't have that here There's a lack of clarity As to whether there are circumstances In which somebody could be prosecuted Even for arranging For a relative to travel to dignitas There's a lack of clarity About what the current law is Given that If somebody assisted the suicide Of There would be Perhaps inquiries, perhaps police Investigation, perhaps a court case In those circumstances If all of the facts lend Themselves to the conclusion that someone Had acted out of love and compassion And with The complete Respect for the autonomy And the decision making of the person involved Is it the view of the witnesses Here That they should in fact be prosecuted Convicted and sentenced For a very serious crime Or does the recognition of compassion Come into the question at all It would be up to the court At the moment the situation is that The court, first of all The procurator, fiscal Crown office Would have the responsibility Of deciding whether to prosecute And they need not prosecute It's a legal matter I'm not making any moral or ethical But the situation is that they have to decide Whether it's a case Whether it's in the public interest And then once it's in before the court The court can decide There may be extenuating circumstances For any crime So it's really under the homicide law Which I think is common law There's no statute of law I don't think But it would be The court would be free to Do what it could do But I think the moral and ethical question Is slightly different from the All of what it leaves I wouldn't support what they did But it might not be A prosecutable offence under law I would I'll give you the time to come back I'll give you the time to come back I'll give you the time to come back I'll give you the time to come back This is actually the great lines Which was issued two years ago By the public prosecution in England And the main thing That he will look at the case Whether it's in the public interest Or not and that sort of thing So we'll take it case by case Because this is something which is Considered as an offence now But you will make it an offence And that's a different thing Very good play It's another yes no question That presupposes that all cases are identical And that all cases have to have the same answer Either they're all prosecuted Or that none of them are prosecuted But as a couple of people have already said That is itself a matter of judgment By a number of public officials Before it gets that far And I don't think anybody around the table Is suggesting that that is in any way wrong But in fact it's implicit in that That we don't need a new law That says that the answer Is always no It should never be prosecuted Which is the proposal before us The on the ground situation For probably all faith groups Or ministers within them Is that on the ground If you knew the family You would be supporting them And that's why you don't have ministers on juries Because their job is They're on the ground job Is to be alongside with people On their morning bench or in their compassion Or with whatever they've done Whether you agree with it or not You just sit with them It does just strike me That we're perhaps Not fully expressing the compassion That we're talking about If we are leaving people with that Complete lack of clarity About whether an action they take Might be legal or illegal Whether it be prosecuted Or not prosecuted Whether in fact it is Culturally and socially sanctioned Or not You know I suppose what I'm asking is Do you think the current situation Is satisfactory Just as you were saying The DPP's guidance Been given out to the law advocate Commented in Scotland That the law was quite clear I'm not sure if that's precisely The phrase that was used But I think there have certainly been many other views Suggesting that the current situation Is not clear Perhaps I could come on to another question I beg your pardon Whether it is satisfactory Well I believe it is satisfactory But again there should be more education Of the public as to end of life issues What I was saying earlier In that people have a whole lot of misunderstandings About that And that's why they get so Head up about it and say Oh yes people have been kept live artificially And we should have some legislation Whereas when the situation is explained to them That's why we can't rely on public opinion polls Because they change depending on the question You ask And the understanding of the person is Once you explain to them about The end of life issue and palliative care The number in favour of Legalising assisted suicide Comes a way down I believe So it's not just a Straight forward thing People are suffering and struggling And feeling that they don't have the support That they need it's not satisfactory I think what might help Is earlier intervention and people walking Alongside in those early struggles And letting them have those questions Those explorations How can we best help you And support you as you walk through this And not just the person but the whole family So I think that's one of the things Faith groups can do it's one of the things Communities can do it's one of the things That healthcare professionals can do Is get in there early and walk alongside Folk so that they don't have to suffer I appreciate that and I respect The sentiment of it very much I do still worry that We would be asking that question How best can we support you While still At the back of my mind saying If you give one answer I'm not going to help There's another question I wanted to ask Which Reverend Dr MacDonald mentioned Opinion polls and it's about The balance of views Some people will place a lot of importance On opinion polls and others say Questions Lead one way or the other Or that people haven't considered The question in depth But there's very little evidence As far as I can see that the balance of views Whatever level of importance you place On opinion polls is particularly different Between the population at large And the major denominations It's also clear that there are Albeit not amongst the panel of witnesses Who have been invited to speak today A range of views amongst religious Communities including People who are very committed And involved Within religious organisations About these issues I'll mention Reverend Scott McKenna Who spoke at the launch of the bill When Margot MacDonald published and introduced the bill Talking about this is an attempt Merely to bring peace of mind And spoke very clearly That he regarded it as An act of Christian compassion We've also heard elsewhere In the UK From a former Archbishop of Canterbury Lord Carey Who said Those arguments that persuaded me in the past Not to support a change in the law Seem to lack power and authority now When confronted with the experiences Of those suffering a painful death He went on in talking about Lord Faulkner's Bill to say There is nothing anti-Christian About embracing the reforms that Lord Faulkner's Offers Rabbi Dr Jonathan Romain Said That this debate is not as it is often thought A battle between the religious and secular camps But within the religious community too There are many He says who have both a deep faith And a desire to see assisted dying Legalise in Britain as a voluntary option For the terminally L He says that there are a growing number Of clergy like myself Who are only too familiar with those dying In pain And want to see them allowing the option Of assisted death if they so wish And at a global level Perhaps one of the most famous religious figures In the world Desmond Tutu Has also written about this I revere the sanctity of life But not at any cost And he goes on to acknowledge Many of the issues of context Which have been reflected In the discussion today But also to Say that he would not be against I think he said I think a lot of people would be upset If I said I wanted assisted dying I would say I wouldn't mind actually So I wonder Whether the witnesses could reflect On why none of the organisations Have chosen to Acknowledge that I think Ephraim Borowsky's written evidence Does acknowledge this but most of the others And certainly the discussion here Doesn't reflect the range of views Which exist Both among those who subscribe to a religious affiliation And those who Are extremely active And have given the matter great thought In that context Yes please Just to follow on from that Thank Patrick Arvie for acknowledging That we did acknowledge the range of views Within the Jewish community I think it's fair to say That there is what one might call A traditional split within the Jewish community The Orthodox community Is steadfastly Opposed to the proposals The liberal community Is by and large in favour With caveats And the reform community Is I think yet making its mind up So I acknowledge that However I think Where there is I'm cautious about saying unanimity Because it's the Jewish community That we're talking about But there is well nigh Unanimity I think about the need for Far greater safeguards Than there are in the proposals As they are before us at the moment And you've referred kindly To our written submission That goes through a large number Of issues where We feel that there is a need for Considerably greater safeguards And now I think To go through those one by one But that again Takes us back to practicalities As opposed to principle But the principle of the Bill As it stands before us Is one which I think The Jewish community by and large Would be opposed to Any other witnesses? The SEC is a mission We did say That there are diverse views Within the SEC That the Jewish feel quite conflicted And we made reference to Hans Coon, an important Roman Catholic Theologian who Has made a case for dignified dying In this kind of a way And I think it's really important That each of That there are voices That enable the arguments Then to become very good It's iron sharpening iron If you can have that debate Within a faith community And you know If Desmond Tuti, you know I'm very great A follower of Desmond Tuti So you know it's influential For him to say something like that I think what's troubling What concerns me About the context of this conversation Is that we, as we heard in the last panel Our cultural context Is one that tends to not Look at death, not feel very comfortable Around death and we know That the writing of wills And powers of attorney And advanced directors and things Is Is very low As is the There's an increasing trend towards people Not wanting to have funerals So there's a sort of In some way A denial that death will come And then a denial that death has happened A discomfort about looking at death And that lack of familiarity of death Does make us frightened of death And I'm conscious that we have On the one hand a kind of denial of death And on the other hand a strenuous effort To allow us to choose it and have other people kill us And it's that context That troubles me I suppose I think the voices that Patrick Harvie mentioned are really Minority voices in all the Christian denominations Certainly now Small denomination Which is a conservative with a small C Denomination And I don't know if anybody who would support Assisted suicide There are no doubts there are individuals But I don't know about them So I think the majority of the faith Communities would be against this In general And sadly I think many of those Who would be in favour of it again Haven't really studied it in enough detail As we are doing at the moment And as you are, the committee is doing And I'm glad about that I'm very impressed with the deep interest And I encourage you to weigh up All the evidence that you've heard Because I think the evidence is very much Against legalising This assisted suicide In any form whatsoever The Church of Scotland is a broad church And so almost on every issue There's going to be different opinions And that's a good thing because it makes For good discussions Not that long ago this issue Came to the General Assembly And this is the policy that we have At the last General Assembly It was asked of the Church and Society Council And we embraced it that we reflect again On this, there will be a round table In the next couple of months And we will continue those conversations Quite widely and deeply But again it comes down to Not looking at We look at death as Very personal And private And my death And we sometimes And if you look at it that way Then my right to decide Seems completely and utterly sensible It's when you dig a bit deeper And you look at the community aspect Of all our lives And how my life And my death and the way I choose May have implications that are Unforeseen for others And for that reason I think that's one of the main reasons For the Church of Scotland's To oppose this legislation There are also so many safeguards That need to be put in place with this particular Piece of legislation That it is quite troubling I thank you all for your attendance here The written evidence that you've provided And indeed the oral evidence today Thank you very much indeed We very much appreciate the valuable time you've given us Thank you We're now in private session For how long we don't know