Exclusive:GPs warn Scotland's assisted dying plans 'not fit for purpose' in call for opting in

The organisation representing GPs in Scotland has branded Liam McArthur’s assisted dying proposals “not fit for purpose” amid a plea to allow doctors to opt into the controversial system rather than actively abstain.

Mc McArthur made history on Tuesday night after his Bill passed stage one of the Holyrood process - the third attempt for assisted dying legislation to be supported at the first hurdle.

Doctor Geri Hignett protests against a change in the law on assisted dying, beside protesters demonstrating in support, outside the Scottish Parliament in Edinburgh, ahead of the debate and vote on the Assisted Dying for Terminally Ill Adults (Scotland) Bill | PA

In his appeal to MSPs to back his proposals at stage one, Mr McArthur urged those who had reservations about the detail of his plan to lend their support in order for amendments and a greater degree of scrutiny to be placed on the legislation at the next stage of the Holyrood process.

Mr McArthur said that “public attitudes have changed”, adding that “political attitudes have started to catch up”.

READ MORE: Assisted dying Scotland: The expected amendments to be considered ahead of next vote

The majority of medical and clinical organisations have taken a neutral stance on the legislation.

But the leading body representing GPs in Scotland has told The Scotsman that the Bill, as it stands, is “not fit for purpose”.

The Royal College of GPs Scotland, has also called for a system to be set up that would mean doctors and medics would need to opt into taking part in administering assisted deaths to those patients that choose to take it up and qualify.

Currently, Mr McArthur’s Bill states that no “individual health professional is under any legal duty to play an active, participatory role” in the assisted dying process, if it becomes law.

Speaking to The Scotsman before his legislation was approved at stage one, Mr McArthur said his proposals have “fundamentally been about choice”.

GPs ‘have significant concerns about the Bill as currently drafted’

The chairman of the Royal College of GPs Scotland, Dr Chris Provan, said: “In March the Royal College of General Practitioners moved to a position of neither supporting nor opposing assisted dying following a UK-wide membership survey.

“We recognise it is the will of Scottish Parliament to give this Bill further consideration. However, we have significant concerns about the Bill as currently drafted, and believe that it is not fit for purpose.”

Liam McArthur’s legislation will move to the amendments stage | Lisa Ferguson/National World

He added: "It is our belief that should assisted dying be legalised that there must be a specialised service which GPs can opt into, should they want to participate.

“GPs must also have the right to refuse to participate in assisted dying, and it must be unlawful to discriminate against or cause detriment to any doctor on the basis of their decision to take part or not to take part.

“We are also concerned about the Bill’s proposals relating to identifying patients who may be under any form of coercion.”

Dr Provan added that if the assisted dying proposals become law, it will be “imperative that palliative care is strengthened to deliver the best possible care to patients who are approaching the end of their lives”.

READ MORE: Scotland's assisted dying law passes landmark first step - but the really hard work begins now

He added: “As a college, we will be considering any amendments proposed to the Bill to ensure that any assisted dying service is a standalone opt-in service with robust protections for patients and GPs in Scotland.”

The legislation states that “no one, including any individual health professional, is under any legal duty to play an active, participatory role in anything authorised by the Bill".

The British Medical Association has previously suggested that doctors should be able to decline requests to carry out these types of activities for any reason and appealed for a general right to object, not just on matters of conscience.

Mr McArthur has indicated to The Scotsman that we is willing to be flexible on the issue of medics’ participation, when amendments are tabled on his legislation at stage two.

“I've always been of the view this Bill has fundamentally been about choice - choice of the patient to take control at the end of life if that’s what they wish to do,” he said.

“But there needs to be reciprocity in a sense, the choice of those expected to support that process and for those that have an objection, whether it’s faith-based or another reason, they should have the opportunity to opt out.”

The Liberal Democrat MSP has also raised the prospect of medics being able to cap their involvement in assisted deaths.

READ MORE: Assisted dying Scotland: Here is how every politician voted on Bill at the Scottish Parliament

Mr McArthur said: “I’ve spoken to medics involved in delivery of assisted dying in California, for example, who spoke of the fact that they and some of their colleagues will cap the number of patients that they agree to support with assisted dying over the course of a year.

“I could envisage a situation where it’s not just a kind of all in, all out. There is the option for medics to manage the extent to which they are involved in the process.

“I think it’s perfectly reasonable to make the argument that your conscientious objection is personal to you. But I think there should be an expectation on those medical professionals who assist the patient, to find somebody who can provide that support. I don’t think that’s an unreasonable expectation.”

During the stage one debate on Tuesday, SNP MSP Clare Haughey asked Mr McArthur how far he would “be willing to push” the criteria around conscientious objection for healthcare professionals.

She added: “My understanding is that the conscientious objection in relation to abortion law covers only directly involved clinicians and not admin staff or support staff.

“How far would Mr McArthur be keen to go with his bill on assisted dying?”

In response, Mr McArthur said it was a “crucially important point”.

READ MORE: Assisted dying Scotland: Historic moment as legislation passes first stage at third attempt

He added: “Fundamentally, the bill is about choice, and choice works both ways.

“I am open to discussions about how far that could be extended, assuming that a system could be put in place that would not impede the access of those who met the eligibility criteria.

“I would probably have a concern about institutional conscientious objection, but that could be explored further at stages two and three. I look forward to doing that.”

The Royal College of Psychiatrists (RCPsych) in Scotland said it remained neutral on the Bill.

However spokesman Dr Stephen Potts added: “It is vital that the varying positions of our members across jurisdictions of the UK are clearly conveyed in relation to the two Bills currently proceeding through Holyrood and Westminster respectively.”

Similar but fundamentally different legislation for England and Wales, The Terminally Ill Adults (End of Life) Bill, will come before MPs in the House of Commons on Friday for further debate for the first time since a historic yes vote at Westminster in November.

Psychiatrists’ ‘serious concerns’ over assisted dying legislation at Westminster

In what has been branded by one opponent as a “blow to its foundations”, the RCPsych south of the Border has announced it has “serious concerns” and cannot support the proposed legislation in its current form.

Attempts to change the law to allow assisted dying are being made in both the Scottish and UK parliaments (Picture: Leon Neal) | Getty Images

The college, which remains neutral on the principle of assisted dying, said it has “unanswered questions” about the safeguarding of people with mental illness and warned of a shortage of consultant psychiatrists to meet the demands of a Bill which would currently require a psychiatrist to sit on a panel to assess a terminally ill person’s application.

Conservative MP Danny Kruger, who is opposed to the Bill for England and Wales, said the RCPsych statement was a “very significant intervention”, and Labour’s Melanie Ward, who also voted against it last year, said it was a “blow to (the Bill’s) foundations”.

Dr Lade Smith, president of the RCPsych, said the Bill for England and Wales, as it stands, fails to honour the role of psychiatrist to consider how people’s unmet needs affect their desire to live nor does it “require other clinicians involved in the process to consider whether someone’s decision to die might change with better support”.

She said: “We are urging MPs to look again at our concerns for this once-in-a-generation Bill and prevent inadequate assisted dying/assisted suicide proposals from becoming law.”