Assisted Dying Bill completes stage 2 in the Scottish Parliament

The Assisted Dying for Terminally Ill Adults (Scotland) Bill has now completed stage 2 proceedings which saw MSPs on Holyrood’s Health, Social Care and Sport Committee consider almost 300 amendments over the course of four weeks.

We maintain our neutral position on whether the law on assisted dying should be changed. However, as the Scottish Bill includes a key role for registered nurses, we have engaged extensively with stakeholders, Liam McArthur MSP (the Bill’s sponsor), and other MSPs to improve the safeguards for nursing staff. We also held a well-attended member engagement event in September where we highlighted our priority issues and gained feedback from members.

During stage 2 we successfully secured some important changes to the Bill which help address some of our concerns.

The Bill establishes the role of the “authorised health professional” who, on the day of the assisted death, will provide an eligible individual with an approved substance which they may take to end their life. Registered nurses can take on this role, if authorised by the doctor who is coordinating the process.  

One of our key concerns was that the Bill would have allowed a registered nurse to provide an adult with assistance to end their own life while working alone. Our position is that it’s essential that a registered nurse is accompanied by another registered health professional to prevent accusations of misconduct or coercion, to support and safeguard both the attending professional and the individual, and to help deal with any complications or challenges that may arise.

We argued strongly that this safeguard must be included in the legislation as, without a legal requirement for two registered professionals to attend, workforce shortages will likely result in registered nurses being expected to attend alone. We are pleased that a majority of MSPs on the Committee agreed with this position, and the Bill has now been amended to ensure a registered nurse cannot act as authorised health professional without another registered health professional present.

Another important change we secured is that a doctor must undertake the final assessments on capacity and coercion, before an individual can be provided with an approved substance to end their life. The Bill as amended now means that, once the doctor is satisfied that the individual retains capacity and is not being coerced, a registered nurse could then provide an individual with the approved substance and provide the end-of-life care and support to the individual and their families during the rest of the process.

Other important changes that we influenced include amendments to the conscientious objection clause, which has been replaced with a broader provision which states that no person is under any duty to participate directly in anything authorised by the Bill. This means that health professionals are under no duty to participate and no longer need to claim a conscientious objection if they do not wish to be involved.

The Bill did not contain any provisions about training for health professionals, and while it did state that Scottish Ministers could specify the qualifications and experience that a doctor must have, it didn’t include any equivalent provisions for nursing. After highlighting our concerns about these omissions, the Bill has now been amended to state that, after consulting with relevant organisations, Scottish Ministers must set out in secondary legislation the training, qualifications and experience that a registered nurse should have to take on the role of authorised health professional. 

Colin Poolman, RCN Scotland Executive Director, commented:

“We maintain our neutral position on whether the law on assisted dying should be changed. However, as the Bill includes a key role for registered nurses, we have a responsibility to work to influence the legislation so that, if it does become law, it includes the necessary safeguards.

“We have engaged extensively with MSPs to ensure that our serious concerns with the Bill are addressed and to improve the protections for nurses who may wish to participate in assisting a death under the framework established by the Bill, and for those who do not want to participate.

“It is welcome that MSPs have listened to our concerns and that some important improvements have been made to the Bill at stage 2. We engaged with our members ahead of developing these amendments, and it was clear many of you had significant concerns, particularly about the prospect of a nurse being asked to provide someone with assistance to die while working alone. These amendments are intended to make the system safer for both our members and individual patients. They are not about creating barriers, nor do they reflect a stance on the principle of assisted dying.”

We are reviewing the Bill as amended at Stage 2 and updating our positions. Our influencing work will continue ahead of stage 3 proceedings. We have also urged the Parliament to allow adequate time to scrutinise changes made at Stage 2 and for considering Stage 3 amendments ahead of the final debate.