S3M-7821 Certification of Death (Scotland) Bill: Stage 1

The Deputy Presiding Officer (Alasdair Morgan): The next item of business is a debate on motion S3M-7821, in the name of Shona Robison, on the Certification of Death (Scotland) Bill.

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Stewart Stevenson (Banff and Buchan) (SNP):

I find myself at both an advantage and a disadvantage in this debate, as I am a doctor’s son and therefore have much of the language of the medical profession but almost none of the understanding. As my father once said, that is a perfect fit for politics, because one is a plausible ignoramus.

The registration system that we have today came into operation in 1855. For many years after, it was not uncommon, in situations in which a doctor was not reasonably to hand, for the cause of death to be shown on the certificate as “Doctor not present” or something similar. As a person who has pursued genealogical studies for 50 years, I have come across many instances of that, almost invariably on the islands. It is interesting that, 150 years on, we are still confronting the issues that are associated with population sparsity and remoteness.

We have come a long way from the situation in 1855. In particular, cremation is now a significant option that is chosen by families. Even when my father became a GP in the 1940s, it was pretty much the exception. Of course, there were practical reasons for that. For example, where my father practised, in Cupar, there was no crematorium to hand. In my constituency, where the crematoria are some distance away, it is a less significant part of funeral arrangements than it might be elsewhere.

I hope to be cremated about a year after my death because, like others in my family, I have recorded my wish to be sent for medical research, and the arrangements are that the various bits come together a year later and are cremated. If I get my wish—it is increasingly difficult for the wish to be delivered, I have to say—I will be most thoroughly examined post mortem. Of course, for me, as for one or two others here who are perhaps, arguably, in the last quarter of our lives, this is not a matter of philosophical debate but a matter of practical concern.

The proposed measures will make more systematic and robust the system of checks and balances that oversees our system of registration. Of course, the bill is not simply about implementing a new process. It is about what that process has to deliver, and about detecting statistically significant variations from the norm and, crucially, the factors of personnel or treatment with which they are associated. In that sense, like others, I believe that we will have to move sooner rather than later to a process that, however it is achieved, allows the analysis of robustly captured data on computer systems. As a genealogist, however, I hope that we will continue to see the signature of the person who registers the death in the electronic record, because it is fascinating to see one’s ancestors’ signatures. Indeed, in one case, the signature showed me, to my surprise, that my father registered the death of someone I had not previously realised he was in contact with at that stage in his life, and that was before he was a doctor.

In one of its variants—I recognise that there are many—the Hippocratic oath includes the phrase:

“I will neither prescribe nor administer a lethal dose of medicine to any patient even if asked nor counsel any such thing”.

Not all doctors take the Hippocratic oath, which is perhaps diminishing in importance, but, after a period of 2000-plus years, it does still capture something important about the relationship between doctors and their patients. Above all, the ignoramus that is the general public in relation to medical matters places an immense trust in doctors and, if the bill can further build confidence in doctors and other health professionals, it will serve a good purpose indeed. What we do in the bill must address that issue.

When I was a trainee nurse some 47 years ago now—it is quite alarming how long ago it was—ours was essentially the ward that people came to if they were expected to die. When someone died, we did not necessarily wait for a doctor before laying out and moving the remains to the mortuary. I believe that practices such as that have been much refined and there is now clear involvement of doctors or other qualified health professionals. The fact that they are masters of the fact of death is important.

Let me talk about statistics and inspection. The issue of cover, be it 25 per cent, 50 per cent, 4 per cent or 100 per cent, is not a trivial one. Superficially, the higher the figure, the better it sounds, but a higher figure does not necessarily deliver better outcomes. What is equally important is what is examined and the depth of the examination. In many areas and different professions, if a large number of examinations are conducted for little return and there is little resulting intervention, the psychological phenomenon of ennui comes in, and when a case comes along that requires attention, people are more likely to miss it because there is less time to devote to each individual activity that is undertaken. I do not come up with any answer to that. I merely say that we have to be careful.

Returning to electronic recording, I point out that there is a system that is operated by the registrars of births, marriages and deaths, and that is the system into which the data go. I wonder—without having any answers myself—whether it would be an idea to roll the system out more widely with mild adaptations to allow conditional registration by health practitioners and to capture data relatively early. However, I know that it can often be quite difficult to adapt computer systems.

It is remarkably easy to make errors. When, in 1984, I registered my mother’s death, I forgot her father’s name and put her grandfather’s name on the death certificate by accident. I had not known those grandparents; they were not familiar to me. There is plenty of scope at all levels for getting things wrong.

Ian McKee said that we will all die. Arguably, we will all die from heart attacks. It is not at all clear that there is no room for judgment and debate about what should go on a death certificate. Indeed, in these days of mechanical apparatus that keep the body functioning, if not alive, it is not always entirely clear when death might happen.

I hope that we respect the rites and practices of a wide range of religions—in fact, I am sure that we will—and I very much support the bill.

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