Hansard

I will come on to that point.

The acts that I mentioned were designed to ensure that, when decisions carry profound consequences, they are made with proper scrutiny, appropriate expertise and a full understanding of a person’s circumstances. However, the bill as it is currently drafted risks bypassing the safeguarding structures that the Parliament has already put in place.

Medical practitioners would be central to the assisted dying process—no one is doubting that—but they cannot be expected to assess alone the complex issues of social risk, coercion or safeguarding that may shape a person’s decision. Those factors are social, relational and often deeply contextual.

Social workers and safeguarding professionals hold expertise in identifying coercion, undue influence, domestic abuse, financial exploitation and situations whereby individuals may feel pressure. Those pressures might be from others, from circumstances or even from the self-belief that they are a burden.

Local authorities also hold statutory duties and records that might be directly relevant to an assessment of a person’s capacity and vulnerability. Without consultation, medical practitioners would simply not have access to that information.

Members should consider what that could mean in practice. A person seeking assisted dying might already be subject to safeguarding inquiries, capacity assessments or protective measures under existing law. However, if the co-ordinating medical practitioner would not be mandated to consult the local authority, those safeguards could theoretically remain unknown, which cannot be considered safe.

Amendments that were agreed to at stage 2 recognised the importance of multidisciplinary input by allowing referral to social services. I note that the member in charge of the bill, whose engagement on these matters I welcome, has stated his belief that the discretionary inclusion of social services would be a proportionate measure. However, I disagree, because I do not believe that leaving such a referral solely to the judgment of the co-ordinating medical practitioner would resolve the problem. Medical practitioners cannot reasonably be expected to determine whether social work input is required if they do not have the information or the training that is needed to identify safeguarding risks in the first place.

Evidence from jurisdictions that are examining similar legislation increasingly highlights the need for multidisciplinary assessment. The recent review by the assisted dying citizens jury and the review panel in Jersey concluded that clinicians alone cannot always identify coercion, safeguarding dynamics or complex capacity issues without input from professionals with expertise in social care and safeguarding.

The Parliament had a lengthy debate yesterday on the existence of coercion. We heard a range of views on the prevalence of coercion and the potential for coercion in other jurisdictions. Whatever side of that argument members may be on, we must try to avoid having confirmation bias, whether that is that coercion is not an issue or that it is a problem that cannot be overcome. If practitioners do not have the tools and resources to identify coercion, it will self-evidently be difficult to confirm that it is taking place at all.

As we all know, coercion is rarely obvious. It might not present as an overt force or threat, and it might instead appear through subtle family dynamics, emotional dependency, financial pressure or, as was mentioned earlier, an internalised belief that one’s life has become a burden.

Coercion can also be systemic. Societal narratives about the cost of care, the strain on families or the value of independence can shape a person’s decision in ways that are deeply powerful and extremely difficult to detect in a purely clinical assessment. For that reason, safeguarding against coercion requires multidisciplinary scrutiny.

My amendment 171 would establish a simple but essential safeguard, which is a duty for the co-ordinating medical practitioner to consult the local authority and ensure that relevant information about safeguarding, capacity assessments or existing statutory processes is taken into account.

If members do not think that coercion is a major issue, they should know that the amendment would give added peace of mind to those who believe that it is. If members are concerned about the costs of such a proposal, I would note that, in most cases, it would amount to a simple background check. If nothing is found, there would be no need for further social service involvement. However, if something is found, would that not make the proposal worth while? Is that not what we are trying to identify?

This may also lead to arguments about resource implications. However, I want members to note that the Scottish Association of Social Work, Social Work Scotland and the Scottish Social Services Council welcome the amendments. In fact, they insist that we vote for the amendments today, which I will come back to. They welcome the additional work—minimal as it would be—because they believe, as I do, that our primary consideration should be safety, not finance.

Another argument is about autonomy and whether someone would wish for a social work referral. I do not believe that the amendment would impede a person’s autonomy, as a person’s choice can be truly autonomous only if it is made free from coercion, free from hidden pressures and with full understanding of their circumstances. Ensuring consultation with social work services would allow medical practitioners to make decisions with the fullest possible picture. That would strengthen the integrity of the process—