Wow. [Laughter.] Thank you, convener. It is extraordinary how in such evidence-taking sessions simple questions can give rise to very complex and lengthy answers. Of course, that was probably inevitable.
I want to pick up briefly on a number of areas in which I think there might be misunderstanding, or on which there have been comments that might be misinterpreted. I am sure that there has been no deliberate attempt to misrepresent what is in the bill.
Various statements have been made about people being licensed to take action that brings about someone else’s death. That is clearly prohibited under the bill. We are talking about assistance to allow someone to take their own action at the end of their life.
There is also the notion that value, dignity, worth and quality of life are the same thing. They are all important concepts but they are different. It is important to restate that dignity—whether inherent or non-inherent dignity—is not defined in the bill. We talk about a judgment that a person makes about the quality of their own life.
I think that it was also implied at one point that the bill could apply to people who have not made a judgment about the quality of their own life, including people who were incapable of doing so because of unconsciousness. That is clearly not set out in the bill.
I will ask two questions, one of which is specifically for Dr Smith and one of which is more general. The general question is about the comparisons that we might make to other ethical considerations. Because autonomy is not an absolute concept in any of our lives—because, as Dr MacKellar said, we are all reliant on one another and all depend on one another as part of a society every day of our lives—the ethical considerations will become complex, particularly in the provision of care to people who are at the end of their lives or people with complex needs. However, that is not the same as a comparison with suicide in other circumstances.
Debbie Purdy died recently. There can be no doubt that she wanted assisted suicide—she campaigned for it over a long time. It was not available to her and the only option that she had was to refuse nutrition. In effect, she starved herself to death. She said clearly, “I do not want to die but I am dying.” There is a difference between taking control of a process that is happening and suicide in other circumstances. Surely the comparison that we might make with other ethical considerations concerns the actions that people might take in assisting someone to decide to refuse treatment, for example.
For instance, placing a note that says “Do not resuscitate” is an action that someone would take to assist someone else—a patient—to give effect to their own decision. Last week, we heard about the comparison with a patient coming off dialysis in the knowledge that they might die within days. There are other circumstances, although they are perhaps rare, such as someone choosing to participate in an experimental drug trial in the full knowledge and with their doctor knowing fully that it will not give them any particular benefit and might even hasten their death but could generate research data. That surely gives rise to a far more complex set of ethical considerations that has a closer bearing on the one that we are talking about than the comparison with suicide in other contexts does.
My specific question for Dr Smith is about the comment that he made on the 14-day period and whether it could be perceived as, or have the same effect as, a form of coercion. He described the affirming effect of someone having access to the drug—the person having the drug on hand and knowing that, each day, they might wake up and think, “I can get through today. I do not need it today.” Is he convinced that that is due to the physical presence of drugs in the room, house or building or is it due to the knowledge of control—that is, the knowledge that the decision rests with the person and that there are people who are willing and able to assist them to give effect to their decision?
Margo MacDonald chose the 14-day period to balance the ability to know that the judgment of capacity was recent and, therefore, still had some relevance with the other considerations that Dr Smith mentioned. Can we assume that the affirming effect comes from the person knowing that the decision is in their hands rather than from the drugs being on the bedside cabinet?