Hansard

It is a great privilege to follow Edward Mountain’s speech.

I address my first remarks to my constituents. This is a debate unlike any other. It is a free vote, but given the importance of the debate, I say to my constituents that I take my responsibilities very seriously. My position reflects both the views that have been communicated to me over my time as an MSP, since 2016, which have broadly been in favour, and the views that have been more critical. In particular, it reflects the balance of views that I have heard in recent weeks, including at the event that I held last week in my constituency.

I believe that society’s views have changed. This is an important issue for the Parliament to discuss, and we should try, as best we can, to form a settled view. Above all else, we must do so on the basis of principles. That is why I will vote for the bill at stage 1; however, I will reserve my position because I have a number of concerns, which I will set out.

When I have observed friends and family members facing their final moments of life, I have found myself reflecting: should they have this option? I have thought to myself, as I have seen them face the end of their life: what would I want?

Should we be giving people the choice, while capacity, capability and opportunity are being removed from them? Should we be giving them this final piece of control and final element of decision making over their lives? My answer to that basic fundamental principle is yes.

We can call that bodily autonomy and decision making of the individual, but, fundamentally, it boils down to that question. Would you want that choice? Would you want that choice for others? That is not to say that that choice needs to be made, but should it be available?

In facing these matters, I also think about the harm principle, which is that the only purpose for which people can be prevented from doing things is to prevent causing harm to others. In that basic act, I do not see the harm, which is why I think that Parliament needs to fully consider these matters. It must expose all the detail through stage 2 in order to challenge whether the bill can meet the concerns that I think are there.

There are wider harms that we must consider, such as the pressure on the individual and the potential for changed relationships with family members and professionals, particularly clinicians. We must also consider, in terms of social outcomes, the changed expectations that people might have at the end of life. I believe that there are provisions in the bill that address some of those issues, but it could perhaps go further.

For me—this is an important point—it is about ensuring an autonomous act. The final act is one that the individual would need to take for themselves. I could not have voted for the previous bills because that would not have been the case under them.

That is important for clinical relationships, which would be fundamentally altered if the final act were to be delivered by a clinician. Most importantly, it is about consent—the ability to remove one’s consent and to withdraw it at that final moment can be achieved only if it is an autonomous act. However, I have concerns about whether that element of the bill is robust. I recognise that the issue is covered in the policy memorandum, but is what is in the bill sufficiently strong?

Likewise, the definition of “terminal illness” is incredibly important. We have seen the expansion of similar legislation in other countries. It is important that it is about the acceleration of a process that is inevitable for the individual. It is important that it is not about providing death where death is not there. The definition is critical to avoid dangerous social outcomes and to meet those changed expectations. I worry that the bill as currently framed allows for the possibility of expansion, that the curtailment-of-life requirement is not sufficiently clear and that those with long-term chronic conditions with reduced life expectancies could meet the definition. The definition needs to be tightened up. Above all else, we must be alive to the possibility of social effects.

All of those aspects can be looked at throughout the parliamentary process. They need to be resolved. I am not saying that any of those conditions would necessarily be sufficient, but those are the areas that need to be looked at most closely. We need to look at the definition.

Another issue is the timing. It is also important that, in making a declaration, clinicians are clear that the person is free of coercion or pressure. Above all else, it is vitally important that the no-detriment principle applies to individuals and organisations that opt out.

In the end, death is an inevitability for all of us. The bill is about providing options and control in a situation in which those are being removed from people because of life itself. It is about a balance of competing but equally strong and compelling arguments. Ultimately, I take the view that death in itself is not a harm but that the nature of death can be. Our decision tonight is about whether we can improve those circumstances and people’s situation as their life comes to an end. I know that colleagues will make the right decision based on their conscience.