Health, Social Care and Sport Committee 18 November 2025
I thank the convener for her flexibility in allowing me to speak on behalf of Ross Greer, who has lost his voice. It is very tempting to abuse the privilege. However, to be clear, I will simply read the statement that Ross has given me, so references in the first person should be taken as referring to him.
As I mentioned at stage 1, I have two primary concerns about the bill. The first is in regard to the proposal for a dispersed rather than a specialist service. My amendments on training, in a later group, are intended to address that concern.
This group of amendments is intended to address, in part, my other concern, which is about the risk of coercion of and undue influence on someone considering making the choice to end their own life.
To summarise my amendments in the group: amendment 242 would create a right to access independent advocacy for those who were considering making a request for assistance under the act; amendment 243 would require the provider of independent advocacy services to comply with minimum standards that would be set by ministers in regulations; amendment 274 sets out that those regulations should be subject to the affirmative procedure; amendment 279 sets out that provisions on the right to advocacy and advocacy service standards would commence on the day after royal assent; and amendment 283 sets out that substantive provisions on assisted dying services could not commence before the minimum advocacy standards were set.
10:45The key amendment is 242, which would create for those who engage with the assisted dying system the right to high-quality, independent and rights-focused advocacy. A neutral third party would be able to support a person through what is a potentially complex system and put their interests first.
That right mirrors other statutory provisions for independent advocacy—for example, in the Social Security (Scotland) Act 2018. As is the case with the 2018 act, which I drew on for drafting purposes, advocacy would be optional and would be intended for those who would benefit from an advocate’s support to ensure that they could make their choice with all the relevant information available to them and with the safeguard of someone whose only role in the process would be to represent their interests and help them navigate the system.
I envisage that the advocate would not already be known to the person and that they would otherwise not be involved in the person’s care. They would be able to advocate for a person from the point at which that person first contemplated assisted dying until the point of their death, should that be the choice that they ultimately make. Among other services, the advocate would support the person in navigating the system, ensure that the person’s rights were respected and act as a safeguard against coercion or other forms of undue influence.
The intention of amendment 242 is to embed a patient’s rights throughout their interaction with the assisted dying process. In particular, in recognition of the potential increased risk to a patient’s rights from a dispersed rather than a centralised service delivery model, the advocate is intended to protect against potential infringements of those rights and to identify and intervene in cases of potential coercion, pressure or undue influence.
I thank Dr Sandra Lucas and Dr Rhona Winnington from the school of health and life sciences at the University of the West of Scotland for their support with these amendments. Their briefing helped to shape my thinking ahead of the stage 1 debate, and the amendments stem from that briefing and my subsequent discussions with them. They both have invaluable experience of assisted dying systems in Australia and New Zealand.
My advocacy amendments reflect the voluntary assisted dying statewide care navigator service system that is operated in Victoria, Australia. Research, including the Ben White report in the Medical Journal of Australia, which was a qualitative study of the Victoria scheme, has called the advocate—the navigator—the “jewel in the crown” of that scheme, facilitating crucial discussions with compassion and giving people the confidence and knowledge to assert their rights. If the Parliament passes the bill, I want people in Scotland who will access or will consider accessing the system to have that same confidence and knowledge of their rights.
Other jurisdictions that have adopted assisted dying have included navigator or advocacy schemes, such as the Queensland voluntary assisted dying support service. The Victoria model is staffed by trained allied health professionals, but the Queensland scheme is open to social workers, psychologists and lawyers as well. I can see the advantage of the role’s being fulfilled either by medical professionals or by those with a degree of separation from the health service entirely; my amendments therefore do not specify either way. It could reasonably be up to ministers to set that out via regulations, although I would be happy to look at revisions ahead of stage 3 to clarify some details about the advocacy scheme, if colleagues felt that further detail was required in the bill.
I am grateful to various stakeholders for supporting the amendments. The Equality and Human Rights Commission’s briefing for stage 2 supports including a statutory right to access independent advocacy, and I am aware that the British Medical Association has welcomed debate on the issue of advocacy at stage 2.
I clarify that the intention is that everyone who was contemplating or undergoing assisted dying would be entitled to advocacy akin to the care navigator in other jurisdictions. Amendment 242’s proposed subsection (3)(b) is intended to capture that anyone who would benefit from advocacy would be entitled to it.
The intention is not to replace the role of assessing doctors in spotting coercion. The advocates would complement that, providing an additional safeguard. That goes to the heart of my concern about putting on to the doctor, under a dispersed model, the burden of spotting something as complex and contestable as coercion. To me, that feels too much like risking a single point of failure in the system. Part of the training that I envisage for the mandatory service standards would be in identifying coercion and spotting warning signs of undue influence.
I am nearly finished, convener. On interaction between advocacy and a potential information service, my intention is for advocates to take on the role similar to that of the Victoria and Queensland navigators, who are more than just a source of information and signposting; they are a source of fuller support and safeguarding, particularly emotional support for patients and, importantly, their families.
I would be happy to work with the British Medical Association and other interested stakeholders and members ahead of stage 3 to add further details if they believe that that is necessary. I certainly do not oppose provisions for an information service as proposed by others, but I do not think that that would be enough. If we are providing independent advocacy for those accessing social security, for care-experienced young people and others, we should provide it for those who are considering making a decision as significant as this.
I move amendment 242.