Health, Social Care and Sport Committee 11 November 2025
Thank you, convener. I start with an apology that my remarks are, again, going to be on the lengthy side. Again, it is a reflection of the fact that I want to do justice to the amendments in the group. I thank Miles Briggs for helpfully setting out the rationale for his amendments and the case for an opt-in model; that has always been my intention and I think that my amendments in the group reinforce that.
Amendments 39 to 41 amend the current conscientious objection provision in the bill to broaden it out and ensure that no person is under any duty to directly participate in anything that is authorised by the bill. That provision is broader than the conscientious objection provision, as a person no longer needs to claim a conscientious objection to participating but can decide not to directly participate for any reason.
My original policy intention was to include a conscientious objection provision similar to that provided in abortion law, so that health professionals would not be under a duty to participate in the provision of assisted dying if they had a conscientious objection to doing so. It has always been my intention that no health professional would be expected to participate if they did not wish to, and this approach should cover anyone who is directly and actively involved in the process—by which I mean anyone carrying out functions in the process as set out in the bill’s provisions.
Following stage 1, I have reflected carefully on how best to ensure that the bill fully reflects my intended policy, and I have concluded that, to simplify the matter further, the bill, instead of relying on a CO provision, should allow anyone carrying out such functions to not participate directly for any reason, thus ensuring that only those who are content to participate directly do so. That will have implications for overall training need, thereby reducing some of the cost issues that have been raised by the Scottish Government.
Amendment 39, which adds the word “directly” after “participate”, is in line with my view that there should be no blanket provision that would allow any person, however peripherally involved in some aspect of the wider process, to be able to not perform their role. Instead, it is intended to ensure that the provision is focused on those people who are directly involved—for example, the independent registered medical practitioner or the authorised health professional, who might be approached by the co-ordinating registered medical practitioner to undertake the duties under sections 6 and 15. Amendments 39, 40 and 41 enable a debate to be had on the pros, cons and potential consequences of a change from CO to only those directly participating who are willing to do so.
On amendment 27, it has always been my policy that a person first seeking assistance should be directed to another medical professional if the medical professional whom they first approach does not wish or is unable to perform the role of co-ordinating registered medical practitioner. My understanding is that such signposting already takes place in healthcare settings and, therefore, it was not specifically provided for in the bill as introduced. On reflection, however, I have decided to lodge amendment 27 to ensure that someone seeking an assisted death is either directed towards a registered medical practitioner who is willing and able to participate, or given further information on how to proceed.
That will not require formal referral of the person to a specific registered medical practitioner, but it will require a registered medical practitioner who is approached by a terminally ill adult looking to make a first declaration and who is unwilling or unable to participate to signpost the person to where they can receive information on how to proceed and/or where they can make a first declaration. That might involve, for example, a GP at a medical practice directing a person to another GP at the practice who is willing to participate in assisted dying provision. In later groupings, we will have a chance to consider amendments on the provision of information.
As for other amendments in this group, amendments 151, 154, 186, 198 and 213, in the name of Miles Briggs, form part of the debate on how best to provide for health professionals in deciding whether they wish to participate directly in the provision of assistance. Indeed, we have heard as much from Mr Briggs himself. At the heart of the amendments is a requirement for
“Scottish ministers, by regulations,”
to
“establish and to maintain a register of persons willing to carry out functions under this Act of ... a co-ordinating registered medical practitioner ... an independent registered medical practitioner ... an authorised health professional”
and
“a registered pharmacist ... supplying”
the
“substance.”
I considered such an approach when I was originally looking at how best to proceed on the issue and came to the view that the establishment of such a register was not necessary. In practice, it is, as has been seen in other jurisdictions, likely that such registers will form part of the information that is held in each health board, and nothing in the bill at the present time will prevent that from happening. However, I am not persuaded that mandating the establishment and maintenance of a central register and requiring individuals to notify Scottish ministers of their willingness to participate is appropriate or proportionate.
That said, I again pay tribute to Miles Briggs for the way in which he has engaged with me on these and, indeed, other issues, particularly around palliative care. I am keen to continue working with him to see how the bill might be further strengthened, and I thank him for the constructive approach that he has taken throughout, not just with me but with other colleagues.
On related amendments that were lodged by the equally constructive Jackie Baillie, and which are being spoken to by the ever-constructive Daniel Johnson, amendments 74 and 80 to 82 relate to the establishment of a register of psychiatrists who can undertake assessments, as set out in the bill. The amendments provide that psychiatrists may apply to be on the register and, to do so, must be approved medical practitioners or must
“meet criteria specified by the Scottish Ministers in regulations”.
I recognise Ms Baillie’s work with the Royal College of Psychiatrists on those provisions.
09:45It is important that the assessing registered medical practitioners are able to seek input from specialists when assessing capacity, which is why the bill provides for that in section 7(2)(b). That provision allows for such referrals to be made by either assessing doctor to
“a registered medical practitioner who is registered in the specialism of psychiatry”
or who
“holds qualifications or has experience in the assessment of capacity”.
Section 7(2)(c) provides that the views of such specialists must be taken into account by the assessing doctors. I firmly believe that such specialists will be capable of assessing the capacity of an individual for the purposes of the bill without any need for the creation of a new register, just as currently takes place in other matters of determining capacity.
Section 3(2) sets out the capacity requirements for a person to be judged as eligible to request assistance. I note that the Scottish Government has highlighted legal and technical concerns, and deliverability challenges, with the amendments, which, on balance, I do not believe to be necessary.
Amendment 74 would be pre-empted by amendment 159 in the group dealing with the assessment of terminally ill adults. Several amendments in that group are concerned with the issue of providing for variations of a no-detriment provision to ensure that no person suffers any detriment as a result of a decision on whether to participate, as Miles Briggs explained. Those amendments include Daniel Johnson’s amendment 11, Jeremy Balfour’s amendment 192, Paul Sweeney’s amendment 248 and Miles Briggs’s amendment 194, which establishes
“Employment and partnership protection (for involvement or non-participation)”.
Employers
“must ensure that there is no employment detriment to their employee”
for actually, or potentially, participating, or not participating, in the act. As I have stated, it is important that those who do not wish to participate directly in the process are protected and I support the principle of individuals suffering no detriment.
I note that the Scottish Government has indicated that such amendments may relate to the reserved matter of employment rights and duties and industrial relations. As I have previously said, I am aware that the Scottish Government is working with the UK Government to ensure the full operation of the bill, should it be passed. The Scottish Government will consider the effect that this amendment and others might have on current engagement with its UK Government counterparts and I hope that the cabinet secretary will continue keeping the committee informed about those discussions. In the meantime, Parliament might wish to return to and address the issue when further amendments are addressed at stage 3.