Exclusive:Plan to 'cap' doctor involvement in Scotland's assisted dying plans as 'sceptical' claims addressed

Some MSPs who remain sceptical about the assisted dying plans could support the first hurdle to allow for greater scrutiny.

Doctors could be allowed to cap the number of people they support with an assisted death, the MSP behind the proposed legislation has suggested.

Liam McArthur has also told The Scotsman that some MSPs who remain “sceptical” about his legislation will vote the Bill through at its first Holyrood hurdle on Tuesday to pave the way for a detailed debate about concerns to take place.

Scottish Liberal Democrat MSP Liam McArthur introduced the Assisted Dying for Terminally Ill Adults (Scotland) Bill (Picture: Jeff J Mitchell/Getty Images)

The Bill would allow terminally ill people aged 18 and older to undergo an assisted death.

On Thursday, First Minister John Swinney announced he would not be supporting the legislation at Tuesday’s crunch vote. He claimed the legislation could “fundamentally alter the relationship between patients and clinicians” and raised fears some could face “undue pressure to end their life prematurely”.

READ MORE: John Swinney reveals how he will vote on assisted dying next week in 'incredibly difficult' decision

Mr McArthur’s initial plans stated the minimum age for an assisted death was 16 years old, but he has confirmed he will amend the law to 18 after appeals from some MSPs.

He said: “I think increasingly over the last year, I’ve come to the conclusion that, looking at the international evidence in place in states in Australia and New Zealand and the US, 18 is pretty consistently the age threshold.

“It seemed to me that was a logical step to take and that it would be helpful for MSP colleagues to understand that ahead of the debate and vote next week. “

The Liberal Democrat MSP said he believed some MSPs would “reserve” their position for a stage three final vote, but vote to help the legislation pass the first hurdle to allow amendments to be added.

MSPs will vote on assisted dying plans on Tuesday. Picture: Yui Mok/PA Wire

He said: “Some colleagues recognise that whatever their views on this, until you get into the amending stage it’s difficult, if not impossible, to see whether concerns that colleagues have and questions that they have can be clarified.

“I think there are those who are very strongly in favour of a change in the law - they are willing to vote at stage one in support of the Bill. But many of them have changes they want to see enter the Bill and continue to take those forward.

“But equally there are [those who are] intuitively more sceptical, but again recognise that this is an issue now that we can’t be seen to duck.”

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Mr McArthur added: “It’s all very well to say you have concerns, but unless we get into the amending stages, there is no opportunity to see whether those are addressed. Therefore I think there will be a few colleagues who reserve their position in relation to stage three, but will vote in favour of the Bill at stage one.”

The MSP has warned the status quo is not adequate for people campaigning for assisted death to be legalised, insisting that “doing nothing has serious consequences”.

He said: “We know suicide levels for those with a terminal illness are around two-and-a-half times that for the population at large. We see many many examples of individuals who, faced with the options at the end of life beyond what palliative care can deal with, are taking matters into their own hands.

“Many are choosing to go to Switzerland and using the services available through Dignitas. But very many more who do not have the resources to do that are taking matters into their own hands here in Scotland - often with traumatic impacts.”

Mr McArthur stressed “this is an issue that’s not going to go away”.

“What is telling is compared to 2015, when we last voted on this, so many more people have their own personal stories to tell - either those with a terminal illness who are desperate for at least the choice”, he said.

“There are very many people who have come forward to tell their stories of how they have lost a loved one to a bad death and the impact it has had on them.

“The last impact, almost the abiding memory of that person, can be one that is just overwhelmed by what has happened in the final days and weeks of that person’s life. We can and must do better.”

READ MORE: 'Doctor shopping' fears as Holyrood committee refuses to take assisted dying position

Under the plans, two separate doctors must assess the person to ensure they meet the criteria for an assisted death.

BMA Scotland has pointed to a so-called "conscientious objection" clause in the Bill and stressed it should be widened to allow professionals to exercise an objection to being involved in assisted dying, whether that was for reasons of conscience or not.

Mr McArthur indicated he was willing to be flexible on that issue. He has also raised the prospect of medics being able to cap their involvement in assisted deaths.

“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.”

READ MORE: Entire Assisted Dying Bill may be beyond Holyrood's powers, warn legal experts

Mr McArthur added: “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.”

A spokesperson for BMA Scotland said: “The BMA has a neutral position on a change in the law on assisted dying and neither supports, nor opposes attempts to change the law.

“If assisted dying were to be legalised, we would want to see an ‘opt-in system’ for doctors, so that only those who positively choose to provide assisted dying are able to do so. We believe that doctors should be given the choice of whether and, if so, to what extent they were willing to participate.”