Some terminally ill patients have faced "undue influence" from friends or faith groups not to opt for assisted dying but there is no evidence that people are being pressured to end their lives early, Australian experts have told MSPs.

Holyrood's health committee has begun taking evidence on the issue for the first time as the Scottish Parliament prepares to debate proposed changes to the law in Scotland which would allow mentally competent and terminally ill adults the right to assistance to end their lives.

MSPs are expected to debate and vote on Stage 1 of the Assisted Dying for Terminally Ill Adults (Scotland) Bill, brought by LibDem MSP Liam McArthur, before the end of 2024.

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Australia first introduced voluntary assisted dying (VAD) in the state of Victoria in June 2019, enabling adults with an advanced terminal illness - including neurodegenerative conditions which are expected to cause death within 12 months - to be prescribed a lethal dose of pentobarbital.

This can be self-administered or administered by injection by a doctor if someone has decision-making capacity but is physically unable to take the medication, for example due to disability.

MSPs heard evidence about Australia's experience from Julian Gardner, a human rights lawyer and chair of the Victoria's Voluntary Assisted Dying Review Board, and Professor Ben White of the Australian Centre for Health Law Research.

Mr Gardner told the committee that 0.84% of deaths in Victoria are now the result of assisted dying, but this rises to 2% in other parts of Australia.

The request for an assisted death is subject to approval by two doctors, independent of one another, who are trained to evaluate patients for signs of coercion.

Mr Gardner said: "The system is very much reliant on the two assessing medical practitioners.

"If they form the view that there is no evidence of undue influence or coercion or abuse then we have no way really, as a Review Board, of assessing how they did that, how they came to that conclusion.

"What we do do though is talk to a reasonable percentage of family members after the event, and we have not had - in the five years in Victoria - any reports of that nature.

"The only reports we have had have been the reverse, where people have experienced coercion - maybe that's too strong a word, but undue influence - not to go ahead with it.

"Generally from relatives who have objections, or from institutions that may be faith-based."

MSPs took evidence on the Australian experience remotely from Julian Gardner (left) and Professor Ben White (right)MSPs took evidence on the Australian experience remotely from Julian Gardner (left) and Professor Ben White (right) (Image: ScottishParliamentTV) Doctors in Australia can opt into providing assisted dying only once they have completed "rigorous" training, MSPs were told.

Mr Gardner said that one of the concerns has been that too few doctors - especially those in "very busy GP practices" - have felt unable to take on the additional training and workload.

"We do have a concern that we're over-reliant on a small cohort that do a very large number of cases," he added.

Prof White said the training was designed to teach doctors "what sort of conversations to have" to detect coercion, capacity, and ensure that assisted dying was what the patient wanted.

He said: "Voluntary assisted dying in Australia is the most scrutinised end of life decision that there is.

"There are decisions to withdraw or sustain life-sustaining treatment, there's palliative sedation, there's a range of other end of life decisions which don't have anything like this level of scrutiny.

"For voluntary assisted dying to occur you need not only one doctor but a second, independent doctor who will have a separate conversation on their own, with that patient, to explore all of these issues."

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MSPs were also told that 80-81% of those in Victoria who had accessed assisted dying had also received, or were receiving, palliative care.

Mr Gardner said he was "not aware of any evidence, anecdotal or empirical" to support an argument that people were opting for assisted dying due to gaps in palliative treatment.

He said a recent survey in Australia "indicated that there had been an increase in demand for palliative care because - they speculated - there had been more conversations about the options for end of life care generally".

He added: "The way it operates in Australia, they're not alternatives. It's not an either-or.

"I think the Palliative Care Australia survey would indicate that there has been no negative in terms of taking people away from accessing palliative care."

A rally in support of assisted dying by campaigners in Perth, AustraliaA rally in support of assisted dying by campaigners in Perth, Australia (Image: Getty) Prof White said that there was a legal requirement in Australia to inform people about palliative care options whenever they initiated the process of requesting an assisted death.

He said: "It's a legislative duty, so to the extent that individuals are seeking voluntary assisted dying we can have confidence that they are aware that palliative care exists in a way that others in the community may not.

"I suspect some of that is what is driving the high rate of utilisation of palliative care.

"That's replicated largely across Australia, so that those seeking voluntary assisted dying are highly likely to be engaged and receiving palliative care."