Terminally Ill Adults (End of Life) Bill 2024-26

NC13(b)

Line 24, at end insert- "(5A) The Secretary of State may only approve a device under subsection (5) if the Medicines and Healthcare products Regulatory Agency has approved the device for that purpose. (5B) Before making any regulations under this section, the Secretary of State must consult the Medicines and Healthcare products Regulatory Agency."

NC13(c)

Line 24, at end insert- "(5A) Regulations under subsection (5) must forbid the use of any device used for the self-administration of a gas."

NC14(b)

Line 8, leave out from "exceptions" to the end of line 11 and insert- "() for the following- (a) communication made in reply to a particular request by an individual for information about a voluntary assisted dying service; (b) communication which is— (i) intended for health professionals or providers of voluntary assisted dying services, and (ii) made in a manner and form unlikely to be seen by potential service users. (3) Regulations under this section may make provision that could be made by an Act of Parliament, but may not amend this Act or the Suicide Act 1961."

NC15(a)

Line 2, leave out from "section" to "(medical" in line 9 and insert "20 of the Coroners and Justice Act 2009"

77(a)

Line 2, leave out “(Regulation of approved substances and devices for self-administration),”

77(b)

Line 6, leave out "and Scotland"

NC13(a)

Line 28, leave out subsection (7)

NC14(a)

Line 10, leave out subsection (3)

108

Clause 36, page 27, line 31, at end insert— "(h) how the provisions of this Act, including but not limited to section 23, interact with the provisions of the Abortion Act 1967."

105

★ Clause 38, page 29, line 4, leave out subsection (6)

106

★ Clause 39, page 29, line 16, leave out subsection (2)(a)

107

★ Clause 39, page 29, line 22, leave out subsection (4)(a)

103

✩ Clause 50, page 34, line 24, leave out from “under” to end of line 29 and insert "any provision of this Act unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament."

104

✩ Clause 50, page 34, line 32, at end insert— "(5A) If they reasonably consider it urgent and necessary for the protection of others, the Secretary of State or the Welsh Ministers may dispense with the requirement to lay a draft statutory instrument.”

101

Clause 5, page 3, line 7, after "person" insert ", unless the person has Down syndrome or a learning disability, in which case a registered medical practitioner must not initiate, suggest, or raise the matter of assisted dying with that person"

102

Clause 5, page 3, line 12, at end insert- "(3A) Before conducting a preliminary discussion under subsection (2) the registered medical practitioner must ensure that the person has no remediable suicide risk factors which pose a significant risk to their life.”

NS2

To move the following Schedule— "SCHEDULE STATISTICS TO BE COLLECTED Characteristics 1 The Voluntary Assisted Dying Commissioner must collect the following information about persons requesting assisted dying— (a) sex, (b) age, (c) self-reported ethnicity, (d) level of education, (e) Index of Multiple Deprivation based on postcode, (f) region of residence, (g) marital status, (h) living status (alone, with others, in a care home etc), (i) main condition leading to "terminal illness” fulfilment, (j) other medical conditions, (k) other psychiatric / mental health conditions, (l) presence of physical disability, and (m) presence of intellectual disability. Health and Care Support 2 The Commissioner must collect statistics on the following information about health and care support— (a) whether the person was, before the request— (i) under a specialist palliative care team, and (ii) under a psychiatry team, (b) whether following the request there has been— (i) referral to specialist palliative care team, and referral to psychiatry team following request. (ii) Information about requests 3 The Commissioner must collect statistics on the following information about the requests for assistance—

NC10(a)

Line 37, at end insert— "(8A) Nothing in Schedule (Protection from Detriment) prevents an employer who has chosen not to participate in the provision of assistance in accordance with this Act from prohibiting their employees or workers from providing such assistance in the course of their employment or work with that employer.”

NC20

To move the following Clause- "Guidance about operation of Act (1) The Secretary of State must issue guidance relating to the operation of this Act. (2) The guidance need not (but may) relate to matters about which the Welsh Ministers may issue guidance under subsection (4) (“Welsh devolved matters"). (3) Before issuing guidance under subsection (1), the Secretary of State must consult- (a) the Chief Medical Officer for England, (b) the Chief Medical Officer for Wales, (c) such persons with learning disabilities and other persons who have protected characteristics as the Secretary of State considers appropriate, (d) such persons appearing to represent providers of health or care services, including providers of palliative or end of life care, as the Secretary of State considers appropriate, (e) if any part of the guidance relates to Welsh devolved matters, the Welsh Ministers, and (f) such other persons as the Welsh Ministers consider appropriate. (7) When preparing guidance under this section, an appropriate national authority must have regard to the need to provide practical and accessible information, advice and guidance to- (a) persons (including persons with learning disabilities) requesting or considering requesting assistance to end their own lives; (b) the next of kin and families of such persons; (c) the general public.

NC21

To move the following Clause- "Provision about the Welsh language (1) In this section “relevant person” means a person in Wales who wishes to be provided with assistance to end their own life in accordance with this Act. (2) Subsection (3) applies where the Welsh Ministers make regulations under section 39 (voluntary assisted dying services: Wales). (3) Regulations under that section must make such provision as the Welsh Ministers consider appropriate for the purpose of ensuring that, where a relevant person indicates that they wish to communicate in Welsh, all reasonable steps are taken to secure that- (a) communications made by a person providing a voluntary assisted dying service to the relevant person are in Welsh, and (b) any report about the first or second assessment of the relevant person is in Welsh. (4) Where a relevant person informs the Commissioner that they wish to communicate in Welsh, the Commissioner must take all reasonable steps to secure that- (a) communications made by the Commissioner to the relevant person are in Welsh, (b) each member of the panel to which the relevant person's case is referred speaks Welsh, and (c) communications made by that panel to the relevant person are in Welsh, and any certificate of eligibility issued by that panel must be in Welsh. (5) Regulations under section 7, 9, 10, 17 or 26 that specify the form of- (a) a first or second declaration, (b) a report about the first or second assessment of a person, or (c) a final statement, must make provision for the forms to be in Welsh (as well as in English). (6) Before making regulations in pursuance of subsection (5), the Secretary of State must consult the Welsh Ministers. (7) In this section— "panel” and “referred” have the meaning given by paragraph 1 of Schedule 2; "voluntary assisted dying service" has the meaning given by section 38.”

NC16

To move the following Clause- "Wish to end one's own life (1) A person does not have a wish to seek assistance to end their own life in accordance with this Act under section 5(5) if they are substantially motivated by- (a) not wanting to be a burden on others or on public services, (b) a mental disorder (including depression), (c) a disability (other than the terminal illness), (d) financial considerations, including lack of adequate housing, (e) lack of access, or delayed access, to treatment or other service which a public authority is required (or can reasonably be expected to) provide, or (f) suicidal ideation."

NC17

To move the following Clause- "No detriment for care home or hospice not providing assistance (1) No regulated care home or hospice shall be subject to any detriment by a public authority as a result of not— (a) providing assistance in accordance with this Act, or (b) permitting such assistance to take place on their premises. (2) No funding given by a public authority to a regulated care home or hospice can be conditional on that care home or hospice- (a) providing assistance in accordance with this Act, or (b) permitting such assistance to take place on their premises."

NC18

To move the following Clause- "Care Homes and Hospices to decide their own involvement (1) Nothing in this Act prevents any regulated care home or hospice from deciding whether (and if so to what extent) it wishes to provide assistance under this Act or to allow it on its premises.”

NC19

To move the following Clause- "Collection of statistics (1) The Voluntary Assisted Dying Commissioner must ensure that the statistics specified in Schedule (Statistics to be collected) are collected. (2) The Commissioner must publish a yearly report setting out those statistics. (3) The Secretary of State may, by regulation, vary the contents of Schedule (Statistics to be collected)."

80

Clause 2, page 2, line 4, leave out "and" and insert- "(aa) As a result of that illness or disease the person is experiencing (or will likely experience) severe pain and discomfort that cannot be reasonably relieved to the person's satisfaction through palliative care, and”

81

Page 2, line 16, leave out Clause 3

87

Clause 9, page 6, line 2, at end insert- "(1A) The coordinating doctor must take all reasonable steps, including by asking the person, the Commissioner, and the relevant Chief Medical Officer, to find out whether that person has previously made a first declaration."

96

Clause 25, page 21, line 5, at end insert- "(1A) A drug or other substance may only be approved under this Act if the Secretary of State is reasonably of the opinion that there is a scientific consensus that this drug (or other substance) or combination of drugs (or other substances), is effective at ending someone's life without causing pain or other significant adverse side effects."

97

Clause 25, page 21, line 5, at end insert— "(1A) A drug or other substance may only be approved under this Act if it has been licensed by the Medicines and Healthcare products Regulatory Agency for that purpose."

98

Clause 25, page 21, line 5, at end insert- "(1A) Nothing in subsection (1) requires the Secretary of State to approve any drugs or other substance if they conclude that there are no appropriate drugs or other substances to approve.”

99

Clause 25, page 21, line 7, at end insert- "(2A) The Secretary of State may not lay a draft statutory instrument containing (whether alone or with other provision) regulations under subsection (1) before both Houses of Parliament unless they also lay before both Houses a report setting out all relevant information on the likely time to death, complications (including pain) and likely side effect.”

91

Clause 26, page 21, line 22, leave out paragraph (a) and insert- "(a) the person's full name, date of birth, sex, ethnicity, and last permanent address; (aa) whether, immediately before death, the person had a disability within the meaning of section 6 of the Equality Act 2010 (other than a disability consisting of the illness or disease which caused the person to be terminally ill within the meaning of this Act);"

89

Page 28, line 7, leave out Clause 37

92

Clause 39, page 29, line 13, leave out from "Wales” to end of line 14

93

Clause 39, page 29, line 27, at end insert- "(b) a reference to provision about voluntary assisted dying services includes in particular provision securing that arrangements are made for the provision of such services."

90

Page 33, line 18, leave out Clause 47

100

Clause 50, page 34, line 24, after “10(9),” insert “25(1)”

88

Clause 50, page 34, line 25, after “39” insert "or (Collection of statistics)"

94

Clause 54, page 36, line 25, leave out "Wales" and insert "sections 39(1) and (2) and (Provision about the Welsh language)(2) and (3) which come into force on such day as the Welsh Ministers may by regulations appoint.”

95

Clause 54, page 36, line 26, leave out subsection (6)

82

Schedule 2, page 41, line 18, leave out sub-paragraph (1) and insert- "(1) The Judicial Appointments Commission must make arrangements for the appointments to a list of persons eligible to sit as members of panels."

83

Schedule 2, page 41, leave out lines 23 to 26 and insert “but has not reached the age specified in section 11 (Tenure of office of judges of Senior Courts) of the Senior Courts Act 1981.”

84

Schedule 2, page 42, line 2, leave out “or deputy judge”

85

Schedule 2, page 42, line 2, at end insert- "(4) All judges of the High Court are automatically on the list and will remain so for the duration of their appointment to the High Court.

86

Schedule 2, page 43, line 5, at end insert- "(3) Panels shall have the same powers, privileges and authority as the High Court."

NC10

To move the following Clause—<br> <b>“No obligation to provide assistance etc</b><br> (1) No person is under any duty to participate in the provision of assistance in accordance with this Act.<br> (2) No registered medical practitioner is under any duty to become—<br> (a) the coordinating doctor in relation to any person, or<br> (b) the independent doctor in relation to any person.<br> (3) No registered medical practitioner, other than the coordinating doctor or the independent doctor, is under any duty to perform any function under or in connection with this Act other than—<br> (a) a function relating to the giving of notifications, or<br> (b) a function relating to the recording of matters in a person’s medical records.<br> (4) No health professional or social care professional is under any duty to respond when consulted under <br> section 11(3)(b)<br> (requirement for assessing doctor to consult professional with relevant qualifications or experience).<br> (5) No registered pharmacist or registered pharmacy technician is under any duty to participate in the supply of an approved substance to a registered medical practitioner for use in accordance with section 23.<br> (6) No person is under any duty to—<br> (a) act as a witness under this Act, or<br> (b) act as a proxy under this Act.<br> (7) Nothing in this section affects—<br> (a) any duty relating to the giving of notifications under this Act or the recording of matters in a person’s medical records,<br> (b) any duty relating to a requirement to keep records or to provide information, or<br> (c) any duty of a professional to respond to enquiries made under <br> section 11(2)(b)<br> (enquiries by assessing doctor) relating to health or social care the professional is providing, or has recently provided, to a person seeking assistance under this Act.<br> (8) Schedule (<i>Protection from detriment</i>) amends the Employment Rights Act 1996 to make provision to protect employees and other workers from being subjected to any detriment for—<br> (a) exercising (or proposing to exercise) a right under this section not to participate in an activity or perform a function, or<br> (b) participating in the provision of assistance in accordance with this Act or performing any other function under this Act.<br> (9) In this section—<br> (a) a reference to a duty includes any duty, whether arising from any contract, statute or otherwise;<br> (b) “registered pharmacist” and “registered pharmacy technician” have the same meaning as in the Pharmacy Order 2010 (S.I. 2010/231) (see article 3 of that Order).<br> article 3 of that Order”

<p>This new clause, intended to replace clause 28, expands the protection currently provided by that clause by broadening the persons to whom it applies and the functions to which it relates; and it introduces NS1 which makes provision for enforcement of the right not be subject to detriment in connection with the Bill.</p>

NC11

To move the following Clause—<br> <b>“Replacing the coordinating or independent doctor where unable or unwilling to continue to act</b><br> (1) This section applies where—<br> (a) after a first declaration has been witnessed by the coordinating doctor, that doctor is unable or unwilling to continue to carry out the functions of the coordinating doctor, or<br> (b) after a referral is made under , but before a report under section 10 has been made by virtue of that referral, the independent doctor is unable or unwilling to continue to carry out the functions of the independent doctor,<br> section 9(3)(c) (including a referral to which section 12(4) applies)<br> section 12(4) applies<br> <span class="wrapped">and in this section such a coordinating or independent doctor is referred to as “the outgoing doctor”.</span><br> (2) The outgoing doctor must as soon as practicable give written notice of their inability or unwillingness to continue to carry out their functions under this Act to—<br> (a) the person seeking assistance,<br> (b) the Commissioner, and<br> (c) if the outgoing doctor is the independent doctor, the coordinating doctor.<br> (3) Any duty or power of the outgoing doctor under this Act that arose in consequence of the declaration or referral mentioned in subsection (1) ceases to have effect from the time the outgoing doctor complies with subsection (2); but this does not apply to any duty under subsection (8) or (9).<br> (4) The Secretary of State may by regulations make provision relating to the appointment, with the agreement of the person seeking assistance, of a replacement coordinating doctor who meets the requirements of <br> section 7(5)<br> and who is able and willing to carry out the functions of the coordinating doctor.<br> (5) Regulations under subsection (4) may, in particular, make provision to ensure continuity of care for the person seeking assistance despite the change in the coordinating doctor.<br> (6) Where the independent doctor gives a notice under subsection (2)—<br> (a) a further referral may be made—<br> (i) under (if section 12 does not apply), or<br> section 9(3)(c)<br> (ii) where section 12 applies, under subsection (2) of that section, and<br> (b) the registered medical practitioner to whom that referral is made becomes the independent doctor (replacing the outgoing doctor) and sections 10 to 12 (and this section) apply accordingly.<br> (7) Subsections (8) and (9) apply where the coordinating doctor—<br> (a) gives a notice under subsection (2) to the person seeking assistance, or<br> (b) receives a notice under that subsection given by the independent doctor in relation to the person seeking assistance.<br> (8) Where the coordinating doctor is a practitioner with the person’s GP practice, the coordinating doctor must, as soon as practicable, record the giving of the notice in the person’s medical records.<br> (9) In any other case—<br> (a) the coordinating doctor must, as soon as practicable, notify a registered medical practitioner with that practice of the giving of the notice, and<br> (b) the practitioner notified under paragraph (a) must, as soon as practicable, record the giving of the notice in the person’s medical records.”

<p>This new clause makes provision about the replacement of the coordinating doctor or the independent doctor where the doctor is unable or unwilling to continue to carry out their functions under the Bill.</p>

NC12

To move the following Clause—<br> <b>“Report where assistance not provided because coordinating doctor not satisfied of all relevant matters</b><br> (1) This section applies where a person is not provided with assistance under section 23 because the coordinating doctor is not satisfied as to all of the matters mentioned in .<br> section 23(5)<br> (2) The coordinating doctor must make a report which—<br> (a) sets out the matters as to which they are not satisfied, and<br> (b) contains an explanation of why they are not satisfied of those matters.<br> (3) The Secretary of State may by regulations make provision about the content or form of the report.<br> (4) The coordinating doctor must give a copy of the report to—<br> (a) the person,<br> (b) if the coordinating doctor is not a practitioner with the person’s GP’s practice, a registered medical practitioner with that practice, and<br> (c) the Commissioner.”

<p>This new clause (intended to be inserted after Clause 27) requires the coordinating doctor to produce a report where assistance is not provided because they are not satisfied of all of the matters mentioned in Clause 23(5).</p>

NC13

To move the following Clause—<br> <b>“Regulation of approved substances and devices for self-administration</b><br> (1) The Secretary of State must by regulations make provision about approved substances.<br> (2) The regulations must make provision about—<br> (a) the supply or offer for supply, or administration, of approved substances;<br> (b) the transportation, storage, handling and disposal of approved substances;<br> (c) the keeping of records of matters relating to approved substances.<br> (3) The regulations may in particular make provision—<br> (a) about the manufacture, importation, preparation or assembly of approved substances;<br> (b) for or in connection with the monitoring of matters relating to approved substances;<br> (c) requiring persons specified in the regulations, in specified cases, to give information to the Secretary of State.<br> (4) The regulations may in particular—<br> (a) make provision relating to approved substances that is similar to, or that corresponds to, any provision of the Human Medicines Regulations 2012 (S.I. 2012/1916);<br> (b) make provision applying any provision of those Regulations, with or without modifications, in relation to approved substances.<br> <span class="wrapped">(The regulations may also amend the Human Medicines Regulations 2012.)</span><br> (5) The Secretary of State may by regulations make provision about devices made for use or used for, or in connection with, the self-administration of approved substances.<br> (6) Regulations under this section must make provision about enforcement (which must include, but need not be limited to, provision imposing civil penalties).<br> (7) Regulations under this section may make any provision that could be made by an Act of Parliament; but they may not amend this Act.<br> (8) In this section “device” includes information in electronic form for use in connection with a device.”

<p>This new clause (which is intended to replace clause 34) imposes a duty to make regulations about approved substances, and a power to make regulations about devices intended for use, or used, in connection with the self-administration of approved substances.</p>

NC14

To move the following Clause—<br> <b>“Prohibition on advertising</b><br> (1) The Secretary of State must by regulations make provision prohibiting—<br> (a) the publication, printing, distribution or designing (anywhere) of advertisements whose purpose or effect is to promote a voluntary assisted dying service;<br> (b) causing the publication, printing, distribution or designing of such advertisements.<br> (2) The regulations may contain exceptions (for example, for the provision of certain information to users or providers of services).<br> (3) Regulations under this section may make any provision that could be made by an Act of Parliament.<br> (4) But regulations under this section—<br> (a) may not amend this Act, and<br> (b) must provide that any offence created by the regulations is punishable with a fine.<br> (5) In this section “voluntary assisted dying service” means—<br> (a) any service for or in connection with the provision of assistance to a person to end their own life in accordance with this Act, or<br> (b) any other service provided for the purposes of any of sections 5 to 27.”

<p>This clause imposes a duty to make regulations prohibiting advertisements to promote services relating to voluntary assisted dying under the Bill.</p>

NC15

To move the following Clause—<br> <b>“Investigation of deaths etc</b><br> (1) In section 1 of the Coroners and Justice Act 2009 (duty to investigate certain deaths), after subsection (7) insert—<br> section 1 of the Coroners and Justice Act 2009<br> (2) In section 20 of that Act (medical certificate of cause of death), after subsection (4) insert—<br> section 20 of that Act<br> (3) In <br> Schedule 1 to that Act<br> (suspension of investigations etc), in the definition in paragraph 1(6) of “homicide offence”, after paragraph (d) insert—<br> “(e) an offence under section 31, 32 or 33 of the Terminally Ill Adults (End of Life) Act 2025;”

<p>This new clause provides that references in Chapter 1 of the Coroners and Justice Act 2009 (investigations into deaths) to unnatural deaths do not include deaths caused by self-administration of approved substances provided in accordance with the Bill. It makes offences under clauses 31 to 33 “homicide offences” for the purposes of that Act. It also amends the powers in that Act in respect of medical certificates of cause of death.</p>

NC7

To move the following Clause—<br> <b>“Doctor independence</b><br> (1) Any same two registered medical practitioners may not be involved in the assessment of any one person (whether as co-ordinating doctor or independent doctor) more than three times in any 12-month period.<br> (2) Where section 13 applies the Commissioner may authorise one additional instance in any relevant 12-month period.<br> (3) The Secretary of State may, by regulations, modify the time periods specified in subsections (1) and (2) if, in the reasonable opinion of the Secretary of State, such modification is—<br> (a) necessary to ensure the availability of assisted dying, and<br> (b) does not compromise the independence of the two assessments.”

<p>This new clause limits the number of times two doctors can both act in the assessment of any one person to three times a year. It allows for the Commissioner to increase that limit in the case of death or incapacity of a doctor. Finally, the Secretary of State is given the power to modify that limit. Amendment 50 is consequential to this and ensures such regulations are made using the affirmative procedure.</p>

NC8

To move the following Clause—<br> <b>“Novel treatments not authorised by the Medicines and Healthcare products Regulatory Agency</b><br> (1) For the purposes of this section, a "novel treatment" means any medicinal product, therapy, or medical intervention that does not currently hold full marketing authorisation from the Medicines and Healthcare products Regulatory Agency (MHRA) for use in the United Kingdom.<br> (2) Where, in fulfilling their duty under subsection (5)(5)(b) - to explain to and discuss with that person any treatment available and the likely effect of it - a registered medical practitioner advises that a novel treatment may be available and could provide therapeutic benefit, the patient may request the administration of such a treatment, provided that—<br> (a) the practitioner, exercising their professional judgment, reasonably believes the treatment could offer a meaningful therapeutic benefit to the patient, especially where conventional, fully approved treatments are ineffective, inappropriate, or have been declined by the patient; and<br> (b) the practitioner obtains the patient’s informed consent (or that of their legally authorised representative), after—<br> (i) fully informing them of the novel status of the treatment;<br> (ii) explaining the potential risks, anticipated benefits (if any), and uncertainties associated with its use; and<br> (iii) presenting any available evidence regarding its safety and efficacy, including the limitations of such evidence.<br> (3) Notwithstanding any provision of the Human Medicines Regulations 2012, or any other enactment, regulation, or statutory instrument now or previously in force, where the conditions in subsection (2) are satisfied, the registered medical practitioner may procure, prescribe, administer, or import the novel treatment for the sole use of that named patient, provided that—<br> (a) the treatment is imported, procured, or prescribed solely for the patient under the direct care and supervision of the registered medical practitioner;<br> (b) the practitioner notifies the MHRA in writing, within a specified and reasonable timeframe, of the importation, procurement, or administration of the novel treatment;<br> (c) the treatment is administered under conditions ensuring appropriate patient safety, monitoring, and care;<br> (d) the treatment is not advertised, promoted, or otherwise publicised beyond what is clinically necessary to facilitate its lawful provision and administration; and<br> (e) before administering the treatment, an independent registered medical practitioner—<br> (i) who has not been involved in the patient’s care or treatment, is not related to the patient, and does not stand to benefit materially from the patient’s decision—<br> (ii) has reviewed the proposed treatment and provided a written second opinion, using a proscribed proforma, confirming that the conditions set out in subsection (2) are met and that, in their professional judgment, the proposed treatment has a plausible scientific rationale and may provide a therapeutic benefit to the patient.<br> (4) Any decision to consider, procure, import, or administer a novel treatment under this section must be fully documented in the patient’s medical record, including—<br> (a) the clinical rationale for recommending the novel treatment;<br> (b) details of the process and confirmation of informed consent obtained from the patient or their representative;<br> (c) any relevant evidence, data, or professional guidance considered in support of the decision;<br> (d) written confirmation of the notification to the MHRA, including details and the date thereof;<br> (e) a copy of the written second opinion obtained under subsection (3)(e); and<br> (f) a record of the clinical outcome in terms of safety and efficacy.”

NC9

To move the following Clause—<br> <b>“Standard of proof</b><br> (1) Where a registered medical practitioner is required to be satisfied of a matter (other than under section 23(5)), the applicable standard of proof is a balance of probabilities but if they are not satisfied beyond reasonable doubt they must indicate in their report or statement that they are not so satisfied.<br> (2) Where an Assisted Dying Review Panel is required to be satisfied of a matter, the applicable standard of proof is beyond reasonable doubt.<br> (3) Where a registered medical practitioner is required to be satisfied of matters arising under section 23(5), the applicable standard of proof is beyond reasonable doubt.”

<p>This new clause would require the co-ordinating and independent doctor to flag if they are unsure whether one of the eligibility requirements is met or not. It also requires that a panel has to be sure that all the eligibility requirements are met. Finally, it requires the doctor administering the lethal substance to be sure that the person has capacity, a clear settled and informed wish to end their life, and is acting voluntarily without coercion and pressure.</p>

55

Clause 2, page 2, line 8, leave out “, disease or medical condition” and insert “or disease”

<p>This amendment aligns the wording of subsection (2) with the wording used in subsection (1) (which defines what it means to be “terminally ill” for the purposes of the Bill).</p>

56

Clause 7, page 4, line 14, at end insert—<br> “(2A) The coordinating doctor must give a copy of the first declaration to the Commissioner as soon as reasonably practicable after it has been made.”

<p>This amendment requires the coordinating doctor to give a copy of the first declaration to the Commissioner.</p>

57

Clause 7, page 5, line 14, leave out “include training about” and insert “provide that the practitioner must have had training about the following”

<p>This clarifies that the obligation under subsection (7) is to specify training about certain matters.</p>

58

Clause 7, page 5, line 18, leave out “specific and up-to-date training on”

<p>This clarifies that the training is to be about adjustments and safeguards for autistic people and person with a learning disability (rather than training about training about such matters).</p>

59

Clause 7, page 5, line 19, at end insert—<br> “(d) domestic abuse.”

<p>This is a drafting change (moving the duty for the regulations to require the coordinating doctor to have received training on domestic abuse so that it is located with other similar duties). See also amendment 74, which defines “domestic abuse” for the purposes of the Bill.</p>

60

Clause 9, page 7, line 1, at end insert—<br> “(6) Where—<br> (a) a referral is made under <br> subsection (3)(c)<br> ,<br> (b) the independent doctor dies or through illness is unable or unwilling to act as the independent doctor, and<br> (c) no report under section 10 has been made by virtue of the referral,<br> <span class="wrapped">a further referral may be made under </span><br> <span class="wrapped">subsection (3)(c).</span><br> (7) Where a referral is made to a registered medical practitioner by virtue of subsection (6), that practitioner becomes the independent doctor (replacing the registered medical practitioner to whom a referral was originally made) and sections 10 to 12 and (<i>Replacing the coordinating or independent doctor where unable or unwilling to continue to act</i>) apply accordingly.”

<p>This amendment makes provision, corresponding to the provision in clause 12 about the death or illness of a doctor from whom a second opinion is sought, for a further referral to be made where, before reporting, the independent doctor dies or through illness is unable or unwilling to act.</p>

61

Clause 10, page 8, line 22, leave out “include training about” and insert “provide that the practitioner must have had training about the following”

<p>This clarifies that the obligation under subsection (10) is to specify training about certain matters.</p>

62

Clause 10, page 8, line 25, at end insert—<br> “(c) domestic abuse.”

<p>This is a drafting change.</p>

51

Clause 11, page 9, line 10, at end insert—<br> “(v) whether, according to any reasonable body of medical or scientific opinion, there are risks of complications (including pain), and what those complications are, from the substance to be ingested;”

<p>This amendment requires doctors to inform persons seeking assisted dying of any reasonable medical and scientific opinion according to which the lethal drugs have a risk of complication and what those complications are.</p>

63

Clause 11, page 9, line 44, leave out “, disease or condition” and insert “or disease”

<p>This amendment aligns the wording used here with the wording used in Clause 2(1) (which defines what it means to be “terminally ill” for the purposes of the Bill).</p>

64

Clause 12, page 10, line 40, leave out “section 10 and 11” and insert “sections 10, 11 and (<i>Replacing the coordinating or independent doctor where unable or unwilling to continue to act</i>)”

<p>This amendment is consequential on NC11.</p>

65

Clause 12, page 11, line 3, at end insert “and section (<i>Replacing the coordinating or independent doctor where unable or unwilling to continue to act</i>)”<br>(6)(a)(ii)

<p>This amendment is consequential on NC11.</p>

66

Clause 23, page 19, line 21, leave out “subsection (3)” and insert “subsection (2)”

<p>This is a drafting change.</p>

67

Clause 23, page 19, line 32, at end insert—<br> “(6A) An approved substance may be provided to a person under subsection (2) by—<br> (a) preparing a device which will enable that person to self-administer the substance, and<br> (b) providing that person with the device.<br> <span class="wrapped">In the case of an approved substance so provided, the reference in subsection (3) to the approved substance is to be read as a reference to the device.”</span>

<p>This amendment clarifies how the clause works in cases where an approved substance is provided by preparing a device and providing a person with the device.</p>

68

Clause 23, page 19, line 36, leave out paragraph (b)

<p>This amendment is consequential on amendment 67.</p>

69

Clause 25, page 21, line 8, leave out subsection (3) and insert—<br> “(3) See section (<i>Regulation of approved substances and devices for self-administration</i>) for powers to make provision about—<br> (a) approved substances, and<br> (b) devices for use or used in connection with the self-administration of approved substances.”

<p>This is consequential on NC13.</p>

52

Page 22, line 28, leave out Clause 28

<p>This amendment is consequential on NC10.</p>

53

Page 25, line 24, leave out Clause 34

<p>This amendment is consequential on NC13.</p>

54

Page 25, line 34, leave out Clause 35

<p>This amendment is consequential on NC15.</p>

70

Clause 36, page 27, line 20, at end insert—<br> “(ca) ensuring effective communication in connection with persons seeking assistance under this Act to end their own lives, including the use of interpreters;”

<p>This amendment provides that a code of practice must be issued covering ensuring effective communication in connection with persons seeking assistance under the Bill.</p>

71

Clause 36, page 27, line 35, leave out subsection (3)

<p>This amendment is consequential on amendment 70.</p>

50

Clause 50, page 34, line 24, after “10(9),” insert “(Doctor independence)”

<p>This amendment makes regulations under NC7 [Doctor independence] subject to the affirmative procedure.</p>

72

Clause 50, page 34, line 24, at end insert “(<i>Regulation of approved substances and devices for self-administration</i>),”

<p>This amendment provides that regulations under NC13 are subject to the draft affirmative procedure.</p>

73

Clause 50, page 34, line 25, leave out “or 39” and insert “39, or (<i>Prohibition on advertising</i>)”

<p>This amendment provides that regulations under NC14 are subject to the draft affirmative procedure.</p>

74

Clause 52, page 35, line 20, at end insert—<br> ““domestic abuse” has the meaning given by <br> section 1 of the Domestic Abuse Act 2021<br> (and accordingly includes behaviour that is controlling or coercive or that constitutes economic abuse);”

<p>This amendment defines “domestic abuse” for the purposes of the Bill.</p>

75

Clause 52, page 35, line 31, at end insert—<br> ““learning disability” has the meaning given by section 1(4) of the Mental Health Act 1983;”

<p>This amendment defines “learning disability” for the purposes of the Bill.</p>

76

Clause 53, page 36, line 12, at beginning insert “Subject as follows,”

<p>This amendment is consequential on amendment 77.</p>

77

Clause 53, page 36, line 12, at end insert “only.<br> (2) Sections (<i>Regulation of approved substances and devices for self-administration</i>), (<i>Prohibition on advertising</i>), 50 and 52, this section, and sections 54 and 55 extend to England and Wales, Scotland and Northern Ireland.<br> (3) Section (<i>No obligation to provide assistance etc</i>)(8) and Schedule (<i>Protection from detriment</i>) extend to England and Wales and Scotland.”

<p>This amendment provides for NC13 (regulation of approved substances etc) and NC14 (prohibition on advertising), and the general provisions of the Bill, to extend to each part of the United Kingdom; and for NC10 (no obligation to provide assistance etc) and NS1 (protection from detriment) to extend to England and Wales and Scotland.</p>

NS1

To move the following Schedule—<br> <span class="num-note"><span class="num">“Schedule</span><span class="note">Section (No obligation to provide assistance etc)</span></span><br> <span class="schedule-heading">PROTECTION FROM DETRIMENT</span><br> 1 The Employment Rights Act 1996 is amended as follows.<br> 2 After section 43M insert—<br> exercised (or proposed to exercise) a right conferred on the worker under section (<i>No obligation to provide assistance etc</i>) of the Terminally Ill Adults (End of Life) Act 2025 (no obligation to provide assistance etc), or<br> Subsection (1) does not apply where—”<br> <span class="sub-para subparagraph sub-para-indented"><span class="sub-para-num">(1)</span><span class="sub-para-text">Section 48 (complaints to employment tribunals) is amended as follows.</span></span><br> <span class="sub-para subparagraph sub-para-indented"><span class="sub-para-num">(2)</span><span class="sub-para-text">After subsection (1) insert—</span></span><br> <span class="sub-para subsection sub-para-indented"><span class="sub-para-num"></span><span class="sub-para-text">section 43N(1)”</span></span><br> <span class="sub-para subparagraph sub-para-indented"><span class="sub-para-num">(3)</span><span class="sub-para-text">In subsection (2), after “(1)” insert “, (1WA)”.</span></span><br> <span class="sub-para subparagraph sub-para-indented"><span class="sub-para-num">(1)</span><span class="sub-para-text">Section 49 (remedies) is amended as follows.</span></span><br> <span class="sub-para subparagraph sub-para-indented"><span class="sub-para-num">(2)</span><span class="sub-para-text">In subsection (1), after “section 48(1)” insert “, (1WA)”.</span></span><br> <span class="sub-para subparagraph sub-para-indented"><span class="sub-para-num">(3)</span><span class="sub-para-text">In subsection (2), after “subsections” insert “(5YA),”.</span></span><br> <span class="sub-para subparagraph sub-para-indented"><span class="sub-para-num">(4)</span><span class="sub-para-text">After subsection (5) insert—</span></span><br> <span class="sub-para subsection sub-para-indented"><span class="sub-para-num"></span><span class="sub-para-text">the complaint is made under section 48(1WA),</span></span><br> <span class="sub-para subsection sub-para-indented"><span class="sub-para-num"></span><span class="sub-para-text">any compensation must not exceed the compensation that would be payable under Chapter 2 of Part 10 if the worker had been an employee and had been dismissed for a reason specified in section 98C.”</span></span><br> 5 After section 98B insert—<br> exercised (or proposed to exercise) a right conferred on the employee under section (<i>No obligation to provide assistance etc</i>) of the Terminally Ill Adults (End of Life) Act 2025 (no obligation to provide assistance etc), or”<br> 6 In section 105 (redundancy), after subsection (2A) insert—<br> This subsection applies if the reason (or, if more than one, the principal reason) for which the employee was selected for dismissal was one of those specified in section 98C.”<br> 7 In section 108 (qualifying period of employment), in subsection (3), after paragraph (aa) insert—.<br> section 98C applies,”<br> 8 In section 205 (remedy for infringement of certain rights), after subsection (1) insert—<br> In relation to the right conferred by section 43N(1), the reference in subsection (1) to an employee has effect as a reference to a worker.”<br> 9 In section 230 (definitions of employees, workers etc) in subsection (6)—<br> (a) after “43K” insert “, <br> 43N(3)”;<br> (b) after “Part IVA” insert “, section 43N”.”

<p>This new Schedule amends the Employment Rights Act 1996 so as to provide remedies for persons subjected to detriment for exercising or proposing a right conferred by NC10 or for participating in the provision of assistance in accordance with, or performing any other function under, the Bill.</p>

78

Schedule 2, page 42, line 26, at end insert “, or<br> (b) abstains from voting on such a decision.”

<p>This amendment ensures that a panel must not grant certificate of eligibility unless all members consider that such a certificate should be granted.</p>

79

Schedule 2, page 43, line 7, at end insert—<br> <span class="sub-para subparagraph sub-para-indented"><span class="sub-para-num">(2)</span><span class="sub-para-text">As soon as reasonably practicable after making a decision, a panel must give the following a document containing its reasons for the decision—</span></span><br> <span class="sub-para subparagraph sub-para-indented"><span class="sub-para-num">(a)</span><span class="sub-para-text">the person to whom the referral in question relates;</span></span><br> <span class="sub-para subparagraph sub-para-indented"><span class="sub-para-num">(b)</span><span class="sub-para-text">the coordinating doctor in relation to the person;</span></span><br> <span class="sub-para subparagraph sub-para-indented"><span class="sub-para-num">(c)</span><span class="sub-para-text">the Commissioner.”</span></span>

<p>This amendment requires a panel to give the persons mentioned a document containing its reasons for any decision made by the panel.</p>

45

Clause 9, page 6, line 3, leave out from “person” to end of line 16 and insert— <br> “(1) On completion of the first declaration, the coordinating doctor must convene a clinical panel to carry out the first assessment.<br> (1A) the “first assessment” is an assessment to determine a person’s eligibility for assistance under this Act.<br> (1B) The clinical panel must consist of—<br> (a) a registered social worker,<br> (b) a registered psychiatrist,<br> (c) a palliative care consultant, registered on the GMC Specialist Register,<br> (d) a doctor who is—<br> (i) a consultant in a specialty of the patient’s diagnosis, if the coordinating doctor is a GP, or<br> (ii) a GP, if the co-ordinating doctor is a consultant, and<br> (e) the coordinating doctor.<br> (1C) All registered health and social worker professionals on the clinical panel must have—<br> (a) received relevant training as determined by the Secretary of State, and<br> (b) opted in to determine that they are eligible to be on that panel.<br> (1D) The Secretary of State may by regulations establish a system for registered health and social worker professionals to opt in under subsection (1B).<br> (1E) For the first assessment, the clinical panel must establish—<br> (a) why the person wants to end their life through an assisted death and the alternatives they have considered,<br> (b) the person’s understanding of their disease or illness and how this can be palliated,<br> (c) whether there have been any intrinsic or extrinsic coercion which has led to the person seeking an assisted death,<br> (d) what support is available to the person and their carers for the duration of the person’s life,<br> (e) that the person—<br> (i) is terminally ill,<br> (ii) has capacity to make the decision to end their own life,<br> (iii) was aged 18 or above at the time the first declaration was made,<br> (iv) is in England and Wales,<br> (v) is an ordinary resident in England and Wales and has been so resident for at least 12 months ending with the date of the first declaration,<br> (vi) is registered as a patient with a general medical practice in England or Wales,<br> (vii) has a clear, settled and informed wish to end their own life,<br> (viii) made the first declaration voluntarily and has not been subject to coercion or pressured by any other person into making it,<br> (ix) is secure in their decision, and<br> (x) is not having their decision making impacted by their mental health.<br> (1F) The clinical panel must provide the person with information on the support available for the duration of their life, including future care planning.<br> (1G) The members of the clinical panel must meet with the patient.<br> (1H) For the purposes of subsection (1G), the person may meet the clinical panel members separately or as a group, depending on the person’s wishes.<br> (1I) When all assessments are complete all the members of the clinical panel must meet to discuss the patient’s safety, eligibility and care plan, including referral to specialist services.<br> (1J) Should the panel come to the view that the criteria set out in subsection (1E)(e) are not met, they must prepare a written statement and a member of the panel must meet the patient to discuss their findings.<br> (1K) When presenting the report under subsection (1J), the member of the panel must discuss with the person—<br> (a) the options available to the person, which can include the provision of more information, and<br> (b) access to the clinical or other support they require.”

46

Clause 9, page 6, line 27, leave out from “if” to “refer” in line 28 and insert “clinical the panel is satisfied of all the matters listed in subsection (1E)(e),”

47

Clause 14, page 11, line 33, at end insert— <br> “(2A) The Commissioner must give notice of the referral to any persons who are likely to have an interest in being notified by virtue of being persons properly interested in the welfare of the person to whom the referral relates, and other persons they are close to.<br> (2B) Those persons may either become parties to the proceedings before the panel or may give evidence to the panel without becoming parties, at the Panel’s discretion.<br> (2C) The Commissioner must issue a practice direction relating to the matters in subsection (2A) and (2B).”

48

Clause 14, page 11, line 33, at end insert—<br> “(2A) The Commissioner must give notice of the referral to the designated authority and make them a party to the proceedings.<br> (2B) The designated authority must send a representative or advocate to the panel who will be tasked to make all reasonable arguments to the panel for why a certificate of eligibility should not be granted.<br> (2C) The designated authority shall be one of the following as chosen by the Secretary of State in regulations—<br> (a) the Official Solicitor,<br> (b) the King’s Proctor,<br> (c) the Attorney General, or<br> (d) any other body so designated by the Secretary of State.”

49

Clause 16, page 13, line 23, leave out subsections (1) to (4) and insert—<br> “(1) The person applying for assisted dying, any parties to the proceedings, or the registered medical practitioners who are treating them may apply to the Commissioner for the Panel’s decision to be reconsidered.<br> (2) Anyone with evidence, which was not before the Panel, showing that a certificate of eligibility should not have been issued may apply to the Commissioner for the Panel’s decision to be reconsidered.<br> (3) The Commission must consider, without a hearing, whether an application under subsection (1) or subsection (2) raises an arguable case that the Panel’s decision was—<br> (a) wrong, or<br> (b) unjust because of a serious procedural or other irregularity in the proceedings.<br> (4) Upon receiving an application under subsection (2) the Commissioner must—<br> (a) if satisfied that there is an arguable case that either of the criteria in subsection (3) are met, refer as soon as reasonably practicable the person’s case to a different Assisted Dying Review Panel for a determination of whether either of the criteria in subsection (3) are met,<br> (b) in any other case, dismiss the application.<br> (5) If the new Assisted Dying Review Panel concludes that the either criterion under subsection (3) is met, they must consider the person’s eligibility for a certificate of eligibility application afresh.<br> (6) The new Assisted Dying Review panel may consider whether either of the subsection (3) criteria are met and the fresh application under subsection (5) together.<br> (7) An assisted death must not take place for a person whose application for assisted dying is subject to the process under subsections (1) to (6) until the conclusion of that process.”

39

Clause 47, page 33, line 19, after “provided” insert “in Wales”

<p>This amendment specifies that this section applies only to services provided in Wales.</p>

40

Clause 47, page 33, line 24, at end insert—<br> “(2A) Any entity providing a service or fulfilling a function under this Act must take all reasonable steps to ensure the particular health professionals providing a service or fulfilling a function under sections 5, 9,10, 12, 15, and 23 have fluent proficiency in the Welsh language, if the services are to be provided to a person in Welsh under subsection (1).<br> (2B) For the purposes of subsection (2A), “fluent” includes speaking fluent Welsh in order to enable conversations with the person in Welsh.<br> (2C) The Commissioner must take all reasonable steps to ensure members of Assisted Dying Panels will, if the person to whom the referral relates has asked for services to be provided in Welsh, when hearing from or questioning that person under section 15(4)(b), do so in Welsh.”

43

Clause 50, page 34, line 25, after “39” insert “or 54(3)”

<p>This amendment would require commencement orders to be subject to the affirmative procedure.</p>

44

Clause 50, page 34, line 33, leave out subsection (6)

<p>This amendment is consequential on Amendment 43.</p>

42

Clause 54, page 36, line 16, leave out subsections (2) to (5) and insert—<br> “(2) In relation to England, the provisions of this Act not brought into force by subsection (1) come into force on such day or days as the Secretary of State may by regulations appoint.”

<p>This amendment will mean that, except as provided by subsection (1), provisions of the Bill will only be commence in England when the Secretary of State makes a commencement order, and not automatically.</p>

41

Schedule 2, page 41, line 34, at end insert—<br> <span class="sub-para subparagraph sub-para-indented"><span class="sub-para-num">(3A)</span><span class="sub-para-text">In Wales, the Commissioner must take all reasonable steps to ensure each member of a panel has fluent proficiency in the Welsh language if services or functions in the Act are to be provided to an individual in Welsh under section 47(1).</span></span><br> <span class="sub-para subparagraph sub-para-indented"><span class="sub-para-num">(3B)</span><span class="sub-para-text">For the purposes of subsection (3A), “fluent” includes speaking fluent Welsh.”</span></span>

38

Clause 2, page 2, line 6, at end insert—<br> “(1A) A person who would not otherwise meet the requirements of subsection (1) shall not be considered to meet those requirements solely as a result of refusing standard medical treatment or taking any action intended to bring about a state of terminal illness.”

<p>This amendment clarifies that an individual who is not already terminally ill under the definition in subsection (1) cannot qualify by refusing standard treatment or taking steps to induce a terminal condition.</p>

NC5

To move the following Clause—<br> <b>“Implications for civil procedure rules and probate proceedings</b><br> (1) The Secretary of State must, within six months of the passing of this Act, publish a report setting out the implications of this Act on—<br> (a) the civil procedure rules, and<br> (b) probate proceedings.<br> (2) The report in subsection (1) must include an analysis of likely consequential changes to the civil procedure rules and probate proceedings in consequence of this Act.”

NC6

To move the following Clause—<br> <b>“Board to consult communities</b><br> (1) The Commissioner must, within six months of being appointed under this Act, appoint a consultation board.<br> (2) The role of the board is to consult communities in order to report to the Commissioner on the impact of the Act on those communities.<br> (3) The Board must report to the Commissioner and the Secretary of State every 12 months from its appointment on its findings.<br> (4) The communities that the Board must consult include people from Black, Asian and Minority Ethnic communities.<br> (5) The Board may consult other groups in addition to those listed in subsection (4) as it considers appropriate.<br> (6) The Secretary of State must, within 3 months of receiving a report under subsection (3), lay that report before both Houses of Parliament.”

33

Clause 11, page 9, line 24, at end insert—<br> “(fa) ask the person whether they have discussed the request with their next of kin and other persons they are close to and, where they have not done so, discuss their reasons for not doing so.”

<p>This amendment would require the assessing doctors to ask the person whether they have discussed their request for an assisted death with family and friends, and to discuss their reasons if not, in order to decide whether to advise that they should do so under subsection (g).</p>

34

Clause 37, page 28, line 14, at end insert—<br> “(ii) persons from Black, Asian and Minority Ethnic communities and advocate groups representing those communities, and<br> (iii) representatives of the healthcare sector, including persons who work in hospices.”

35

Clause 45, page 32, line 20, after “characteristics” insert “, including persons representing Black, Asian and Minority Ethnic communities,”

36

Clause 46, page 33, line 11, after “disabilities” insert ”, and<br> (ii) persons from Black, Asian and Minority Ethnic communities”

37

Clause 54, page 36, line 21, leave out subsection (4) and insert—<br> “(4) Regulations under this section cannot be made unless the Secretary of State has previously—<br> (a) made a statement to the effect that in their view the provisions of the Act are compatible with the Convention rights; or<br> (b) made a statement to the effect that although they are unable to make a statement under subsection (4)(a), the Government nevertheless wishes to proceed with commencing provisions of the Act.<br> (4A) The statement required by subsection (4) must be laid before both Houses of Parliament.<br> (4B) A statement under subsection (4)(b) must include the steps the Government plans to take to resolve any incompatibility.”

30

Clause 9, page 6, line 8, at end insert—<br> “(ca) has relevant and available palliative care options,”

<p>This amendment would mean that someone is only eligible for assistance in ending their own life under this Act if they have relevant and available palliative care options.</p>

32

Clause 10, page 8, line 6, at end insert—<br> “(aa) is a practitioner approved as having special experience in the diagnosis or treatment of mental disorder for the purposes of subsection (2) of Section 12 (General provisions as to medical recommendations) of the Mental Health Act 1983,”

<p>This amendment would require the independent doctor to have special experience in the diagnosis of mental disorder.</p>

31

Clause 15, page 12, line 17, at end insert—<br> “(da) that the person has relevant and available palliative care options,”

<p>This amendment, which is linked to Amendment 30 would mean that someone is only eligible for assistance in ending their own life under this Act if they have relevant and available palliative care options.</p>

NC4

To move the following Clause—<br> <b>“Monitoring by Chief Medical Officer</b><br> (1) The relevant Chief Medical Officer must—<br> (a) monitor the operation of the Act, including compliance with its provisions and any regulations or code of practice made under it,<br> (b) investigate, and report to the appropriate national authority on, any matter connected with the operation of the Act which the relevant national authority refers to the relevant Chief Medical Officer, and<br> (c) submit an annual report to the appropriate national authority on the operation of the Act.<br> (2) The relevant Chief Medical Officer’s report must include information about the occasions when—<br> (a) a report about the first assessment of a person does not contain a statement indicating that the coordinating doctor is satisfied as to all of the matters mentioned in section 9(2)(a) to (h),<br> (b) a report about the second assessment of a person does not contain a statement indicating that the independent doctor is satisfied as to all of the matters mentioned in section 10(2)(a) to (e),<br> (c) a panel has refused to grant a certificate of eligibility,<br> (d) the coordinating doctor has refused to make a statement under section 17(6).<br> (3) An annual report must include information about the application of the Act in relation to—<br> (a) persons who have protected characteristics, and<br> (b) any other description of persons specified in regulations made by the Secretary of State.<br> (4) When preparing an annual report, the relevant Chief Medical Officer must consult—<br> (a) The Commissioner, and<br> (b) such persons appearing to the relevant Chief Medical Officer to represent the interests of persons who have protected characteristics as the relevant Chief Medical Officer considers appropriate.<br> (5) An appropriate national authority must—<br> (a) publish any report received under this section,<br> (b) prepare and publish a response to any such report, and<br> (c) lay before Parliament or Senedd Cymru (as the case may be) a copy of the report and response.<br> (6) In this section “appropriate national authority” means the Secretary of State or the Welsh Ministers.<br> (7) In this section “protected characteristics” has the same meaning as in Part 2 of the Equality Act 2010 (see section 4 of that Act).<br> (8) In this section “relevant Chief Medical Officer” has the meaning given by section 37(5).”

<p>This new clause would require the monitoring, investigation and reporting functions set out in the Bill to be carried out by the Chief Medical Officer instead of the Voluntary Assisted Dying Commissioner.</p>

29

Clause 40, page 30, line 5, at end insert—<br> “(5) Any notification to the Commissioner made pursuant to regulations under this section must be forwarded by the Commissioner to the relevant Chief Medical Officer.<br> (6) The relevant Chief Medical Officer may exercise any power granted to the Commissioner under subsection (2).<br> (7) In this section “relevant Chief Medical Officer” has the meaning given by section 37(5).”

28

Page 31, line 32, leave out Clause 45

<p>This amendment is linked to NC4.</p>

25

Clause 9, page 6, line 3, leave out from “person” to the second “the” in line 5 and insert “convene a panel to carry out the first assessment.<br> (1A) The clinical panel should consist of—<br> (a) a social worker,<br> (b) a psychiatrist,<br> (c) a palliative care consultant, who is on the GMC Specialist Register,<br> (d) the patient’s consultant if the co-ordinating doctor is a GP or the patient’s GP if the Co-ordinating doctor is a consultant, and<br> (e) the co-ordinating doctor.<br> (1B) The clinical panel must first establish why a person wants to end their life through an assisted death.<br> (1C) The clinical panel must provide the person with information on the support available to the patient for the duration of their life.<br> (2) “The first assessment” is an assessment to ascertain whether, in the opinion of the clinical panel,”

<p>This amendment would establish a clinical panel to conduct the first assessment. The panel would be required to establish why the person wants to end their life through an assisted death and provide the person with information on the support available to the person for the duration of their life.</p>

24

Clause 3, page 2, line 18, at end insert “except that section 1(2) of that Act shall not apply”

<p>This amendment would disapply the presumption that a person has capacity unless the opposite is established.</p>

26

Clause 5, page 3, line 20, leave out “, hospice or”

<p>This amendment leaves out reference to a hospice, since this is a setting for the provision of palliative care.</p>

22

Clause 11, page 9, line 28, leave out from “must” to end of line 33 and insert “consult such other health and social care professionals with qualifications in, or experience of, a matter relevant to the person being assessed, including but not limited to clinical, psychological and social matters.”

<p>This amendment would require the assessing doctor to consult other health professions and other persons as the assessing doctor sees fit on clinical, psychological and social matters relevant to the person.</p>

23

Clause 15, page 13, line 14, at end insert—<br> “(ca) where the person to whom the referral relates is under the age of 25, their next of kin;”

27

Clause 25, page 21, line 7, at end insert—<br> “(2A) The doses and types of lethal drugs specified in any regulations made under subsection (1) must be licensed by the Medicines and Healthcare products Regulatory Agency.<br> (2B) The doses and types of lethal drugs to bring about the person’s death must be recommended by the guidelines of either—<br> (a) the National Institute of Clinical Excellence, or<br> (b) the All Wales Medicines Strategy Group in Wales,<br> <span class="wrapped">as appropriate, prior to licensing.”</span>

<p>This amendment will require the doses and types of lethal drugs to be licensed by the Medicines and Healthcare products Regulatory Agency and to be recommended by either the National Institute of Clinical Excellence or the All Wales Medicines Strategy Group in Wales as appropriate prior to licensing.</p>

21

Clause 43, page 31, line 15, at end insert—<br> “(4) For the first reporting period referred to under subsection (2) (a) the report must set out an assessment of the state of health services to persons with palliative and end of life care needs and the implications of this Act on those services.<br> (5) The report under subsection (4) must, in particular, include an assessment of the availability, quality and distribution of appropriate health services to persons with palliative and end of life care needs, including—<br> (a) pain and symptom management;<br> (b) psychological support for those persons and their families;<br> (c) information about palliative care and how to access it.”

<p>This amendment would require the Secretary of State for Health and Social Care to prepare and publish an assessment of the availability, quality and distribution of palliative and end of life care services as part of the first report on implementation of the Act (to be undertaken within 1 year of the Act being passed). This would mirror the assessment already required as part of the 5 year review of the act.</p>

18

Clause 2, page 2, line 6, leave out from “expected” to end

<p>This amendment would remove the six-month time limit for a person to be eligible for an assisted death.</p>

17

Clause 3, page 2, line 18, at end insert—<br> “(2) For the purposes of the assessment of a person’s capacity under this Act the information relevant to the decision as specified under section 3(1)(a) of the Mental Capacity Act 2005 must include, but is not limited to—<br> (a) the options for care and treatment of the terminal illness, including—<br> (i) the extent of prognostic certainty of their illness or condition, and<br> (ii) the likely effects on day-to-day functioning, symptom management, and pathway to and experience of death of—<br> (A) relevant and available care and treatment including palliative care, hospice or other care,<br> (B) withdrawal or absence of care and treatment,<br> (b) the likely pathway to and experience of death, including relevant risks of complications, following proceeding to self-administer a substance to end their own life under the provisions of this Act,<br> (c) a decision to proceed under this Act does not prevent or make unavailable any care and treatment provision that would normally be provided,<br> (d) the person’s decision to proceed under this Act must be theirs alone and not bound or directed by the views or decisions of others,<br> (e) the person is able to change their mind at any stage of the process for requesting assistance to end their own life under the provisions of this Act, regardless of previous decisions,<br> (f) a decision to proceed under this Act is a decision to self-administer a substance to end their own life,<br> (g) the self-administration of such a substance is not a medical treatment for their terminal illness but a personal choice concerning life and death, and<br> (h) relevant legal consequences from proceeding with a request for assistance to end their own life, including life insurance and categorisation of death certification.”

16

Clause 28, page 22, line 35, insert—<br> “(3) There is no obligation on any care home or hospice regulated by the Care Quality Commission or the Care Inspectorate Wales to permit the provision of assistance under this Act on their premises.”

<p>This amendment prevents there being any obligation on a care home or hospice which is regulated in England or Wales to permit the provision of assistance under the Act on their premises.</p>

19

Clause 36, page 27, line 17, an end insert—<br> “(ba) how the provisions of this Act relate to the operation of—<br> (i) the Government’s strategy on suicide prevention,<br> (ii) the duties on clinicians and others to secure the right to life, including of those at risk of suicide, under paragraphs 1 and 2 of Article 2 (Right to Life) set out in Schedule 1 of the Human Rights Act 1998,<br> (iii) the Mental Health Act 1983,<br> (iv) deprivation of liberty safeguards as set out in Schedule A1 to the Mental Capacity Act 2005, and<br> (v) liberty protection safeguards as set out in Schedule AA1 to the Mental Capacity Act 2005.”

20

Clause 36, page 28, line 5, leave out subsection (8) and insert—<br> “(8) If it appears to a court or tribunal conducting any criminal or civil proceedings that—<br> (a) a provision of a code, or<br> (b) a failure to comply with a code,<br> <span class="wrapped">is relevant to a question arising in the proceedings, the provision or failure must be taken into account in deciding the question.”</span>

14

Clause 2, page 2, line 6, at end insert—<br> “(1A) A person who would not otherwise meet the requirements of subsection (1) shall not be considered to meet those requirements solely as a result of voluntarily stopping eating or drinking.”

<p>This amendment means that someone who is not terminally ill within the meaning of subsection (1) cannot bring themselves within that definition by voluntarily stopping eating or drinking or both.</p>

13

Clause 4, page 2, line 22, at end insert—<br> “(2A) A person may not be appointed under subsection (2) unless the appointment has the consent of the Health and Social Care Select Committee of the House of Commons.<br> (2B) In this section, references to the Health and Social Care Committee shall—<br> (a) if the name of that Committee is changed, be taken (subject to paragraph (b)) to be references to the Committee by its new name;<br> (b) if the functions of that Committee at the passing of this Act with respect to matters relating to the provision of assistance under this Act become functions of a different committee of the House of Commons, be taken to be references to the committee by whom the functions for the time being exercisable.”

12

Clause 38, page 28, line 36, leave out subsections (4) and (5) and insert—<br> “(4A) Regulations under subsection (1) may not amend, modify or repeal section 1 of the National Health Service Act 2006.”

<p>This amendment would prevent section 1 of the National Health Service Act 2006, which sets out the purposes of the NHS, from being amended by regulations. Its effect would be to require changes to be made by an Act of Parliament instead.</p>

15

Clause 38, page 29, line 5, at end insert—<br> “(6A) Regulations under this section must provide that, where a body other than a public authority provides voluntary assisted dying services under subsection (1), that body must publish an annual statement that includes information on the following—<br> (a) the number of persons to whom the body has provided a preliminary discussion under section 5(3);<br> (b) the number of to persons whom the body has assessed under section 9(1);<br> (c) the number of persons whom the body has assessed under section 10(1);<br> (d) the number of persons to whom assistance has been provided under section 23(2);<br> (e) the cost and revenue associated with providing such assistance; and<br> (f) any other matter that the Secretary of State may specify.”

<p>This amendment would require private providers of the services permitted under the Act to publish annual statements of the numbers of people to whom they have provided those services. It would also require them to disclose their associated costs and revenue.</p>

9

Clause 11, page 9, line 25, leave out paragraph (g) and insert—<br> “(g) ask the person whether they have discussed the request with their next of kin and other persons they are close to and, where they have not done so, discuss their reasons for not doing so.”

10

Clause 15, page 12, line 36, at end insert—<br> “(ba) must ask the person whether they have discussed the request with their next of kin and other persons they are close to and, where they have not done so, discuss their reasons for not doing so;”

<p>This amendment would require the Voluntary Assisted Dying Panel to ask the person whether they have discussed their request for an assisted death with family and friends, and to discuss their reasons if not, in order to determine whether to grant a certificate of eligibility.</p>

11

Clause 15, page 13, line 4, leave out subsection (6) and insert—<br> “(6) If the panel is of the opinion that there are exceptional circumstances which justify not hearing from the person, then the duties under subsections (4)(b) and (4)(ba) do not apply.”

<p>This amendment is connected to Amendment 10.</p>

6

Clause 15, page 12, line 33, leave out “may” and insert “must”

<p>This amendment would require the panel to question the coordinating doctor or the independent doctor.</p>

7

Clause 15, page 12, line 35, leave out “may” and insert “must”

<p>This amendment would require the panel to question the person seeking an assisted death.</p>

8

Clause 15, page 12, line 38, at end insert—<br> “(ca) must consider hearing from and questioning—<br> (i) persons properly interested in the welfare of the person to whom the referral relates, and other persons they are close to; and<br> (ii) any other person who has provided treatment or care for the person to whom the referral relates in relation to that person’s terminal illness;”

<p>This amendment would require the panel to consider hearing from those with an interest in the welfare of the person and those who have provided treatment to them.</p>

5

Clause 15, page 12, line 29, at end insert—<br> “(j) that there are no psychological, social or environmental factors influencing the person to make the decision.”

<p>This amendment ensures that the panel must be satisfied that no psychological, social or environmental factors are influencing the decision of a person to seek assisted dying.</p>

NC3

To move the following Clause—<br> <b>“Guidance: administration of pain relief to people who are terminally ill</b><br> (1) Within six months of the passing of this Act, the Secretary of State must issue guidance to—<br> (a) chief officers of police, and<br> (b) healthcare professionals about the application of the criminal law in respect of the administration of pain relief by healthcare professionals to people who are terminally ill.<br> (2) The guidance must in particular include guidance about the application of the criminal law in cases where a healthcare professional administers pain relief to a person who is terminally ill shortly before the end of their life.<br> (3) In preparing guidance under subsection (1), the Secretary of State must consult—<br> (a) people who are terminally ill and their families;<br> (b) healthcare professionals;<br> (c) the Director of Public Prosecutions;<br> (d) the Attorney General;<br> (e) the Welsh Ministers; and<br> (f) such other persons as the Secretary of State considers relevant.<br> (4) The Secretary of State may revise guidance issued under this section.<br> (5) The Secretary of State must arrange for guidance issued under this section to be published.”

<p>This new clause would require the Secretary of State to issue guidance on the administration of pain relief to people who are terminally ill, including on the application of the criminal law in cases where a healthcare professional administers such pain relief.</p>

4

Clause 2, page 2, line 6, leave out “within 6 months” and insert—<br> “(i) in the case of a neurodegenerative illness or disease, within 12 months; or<br> (ii) in the case of any other illness or disease, within 6 months.”

NC1

To move the following Clause—<br> <b>“No health professional shall raise assisted dying first</b><br> No registered medical practitioner or other health professional shall raise the subject of the provision of assistance in accordance with this Act with a person unless that person has first raised it.”

1

Clause 2, page 2, line 2, leave out “within 6 months” and insert—<br> “(i) in the case of a neurodegenerative illness, disease, or medical condition, within 12 months; or<br> (ii) in the case of any other illness, disease, or medical condition, within 6 months.”

<p>This amendment changes the definition of a terminal illness for the purposes of the Act to include neurodegenerative illnesses, diseases or medical conditions where a person’s death in consequence with such an illness can reasonably be expected within 12 months.</p>

NC2

To move the following Clause—<br> <b>“No health professional shall raise assisted dying with a person under 18</b><br> No registered medical practitioner or other health professional shall raise the subject of the provision of assistance in accordance with this Act with a person under the age of 18.”

2

Clause 5, page 3, line 5, leave out subsection (2)

<p>This amendment is consequential to NC1.</p>

3

Clause 54, page 36, line 22, leave out “four” and insert “three”

1

Clause 2, page 2, line 2, leave out “within 6 months” and insert- "(i) in the case of a neurodegenerative illness, disease, or medical condition, within 12 months; or (ii) in the case of any other illness, disease, or medical condition, within 6 months."

NC1

To move the following Clause— "No health professional shall raise assisted dying first No registered medical practitioner or other health professional shall raise the subject of the provision of assistance in accordance with this Act with a person unless that person has first raised it."

NC2

To move the following Clause— "No health professional shall raise assisted dying with a person under 18 No registered medical practitioner or other health professional shall raise the subject of the provision of assistance in accordance with this Act with a person under the age of 18."

2

Clause 4, page 2, leave out subsection (2)

518(b)

As Amendments to Dr Marie Tidball's proposed Amendment 518:— Line 3, after "person or organisation," insert "including where the person is in an intimate or family relationship with that other person,"

520(b)

As Amendments to Dr Marie Tidball's proposed Amendment 520:— Line 3, after "person or organisation," insert "including where the person is in an intimate or family relationship with that other person, "

546

Clause 42, page 24, line 18, after "Sections” insert “(Reporting on implementation of Act),"

547

Clause 42, page 24, line 19, at end insert- "(1A) Section (Voluntary Assisted Dying Commissioner), except subsection (4) of that section, and Schedule (The Voluntary Assisted Dying Commissioner) come into force at the end of the period of one year beginning with the day on which this Act is passed."

548

Clause 42, page 24, line 23, leave out "2" and insert "4"

545

Clause 39, page 23, line 6, leave out subsections (3) to (5) and insert— "(3) The Secretary of State may not make a statutory instrument containing (whether alone or with other provision) regulations under section 5(3A), 8(6A), 30(3), (Voluntary assisted dying services: England) or (Voluntary assisted dying services: Wales) unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament. (4) Any other statutory instrument made by the Secretary of State containing regulations under this Act is subject to annulment in pursuance of a resolution of either House of Parliament. (5) The Welsh Ministers may not make a statutory instrument containing regulations under section (Voluntary assisted dying services: Wales) unless a draft of the instrument has been laid before, and approved by a resolution of, Senedd Cymru.”

NC36(a)

★ Line 4, at end insert- "(1A) Regulations under subsection (1) cannot authorise the National Health Service in England to provide voluntary assisted dying services."

NC36(c)

★ Line 4, at end insert- "(1A) Regulations under subsection (1) cannot authorise a body other than a public authority to provide voluntary assisted dying services if that body is to be contracted by a public authority to do so."

NC36(b)

★ Line 10, leave out subsections (4) and (5) and insert- "(4) Regulations under subsection (1) may not amend, modify or repeal section 1 of the National Service Act 2006."

NC36(d)

★ Line 17, leave out subsection (6)

NC36(e)

★ Line 18, at end insert- "(6A) The Secretary of State may not lay a draft statutory instrument before either House of Parliament that makes provision containing (whether alone or with other provision) regulations under subsection (1) unless they also lay before both Houses an impact assessment on such regulations. (6B) The impact assessment under subsection (6A) must include an assessment of the impact of such regulations on the workforce of health professionals and on the National Health Service."

537

Clause 32, page 19, line 27, after “assistance” insert “by a registered charity but not”

538

Page 19, line 20, leave out Clause 32

539

Clause 33, page 19, line 34, leave out subsections (1) and (2) and insert- "(1) The Secretary of State may by regulations make provision requiring a registered medical practitioner to notify the Commissioner of the occurrence of an event of a specified description."

540

Clause 33, page 20, line 17, at end insert- "(2A) The Secretary of State may by regulations make provision enabling the Commissioner, by notice, to require persons (or a specified description of persons) to give the Commissioner information (or a specified description of information).”

541

Clause 33, page 20, line 18, leave out "subsection (1)” and insert "this section"

542

Clause 33, page 20, line 19, leave out "the notification” and insert "a notification under subsection (1)"

543

Clause 33, page 20, line 20, leave out second "the" and insert "such a"

544

Clause 33, page 20, line 22, leave out from “section” to end of line 23 and insert ““specified” means specified in the regulations."

NC36

To move the following Clause- "Voluntary assisted dying services: England (1) The Secretary of State must by regulations make provision securing that arrangements are made for the provision of voluntary assisted dying services in England. (2) In this section “commissioned VAD services” means services provided by virtue of regulations under subsection (1). (3) The Secretary of State may by regulations make other provision about voluntary assisted dying services in England (whether or not the services are commissioned VAD services). (4) Regulations under this section may for example provide that specified references in the National Health Service Act 2006 to the health service continued under section 1(1) of that Act include references to commissioned VAD services. (5) Regulations under this section must provide that section 1(4) of that Act (services to be provided free of charge except where charging expressly provided for) applies in relation to commissioned VAD services. (6) Regulations under this section may make any provision that could be made by an Act of Parliament; but they may not amend this Act. (7) In this section “voluntary assisted dying services” means- (a) services for or in connection with the provision of assistance to a person to end their own life in accordance with this Act, and (b) any other services provided by health professionals for the purposes of any of sections 4 to 22 except section (Determination by panel of eligibility for assistance)."

NC37

To move the following Clause- “Voluntary assisted dying services: Wales (1) The Welsh Ministers may by regulations make provision about voluntary assisted dying services in Wales, including provision securing that arrangements are made for the provision of such services. (2) Regulations under subsection (1) may make any provision that— (a) could be made by an Act of Senedd Cymru, and (b) would be within the legislative competence of the Senedd if it were contained in such an Act. (3) The Secretary of State may by regulations make provision about voluntary assisted dying services in Wales. (4) Regulations under subsection (3) may make any provision that— (a) could be made by an Act of Parliament, and (b) would not be within the legislative competence of the Senedd if it were contained in an Act of the Senedd. (5) Regulations under this section may not amend this Act. (6) In this section “voluntary assisted dying services” has the meaning given by section (Voluntary assisted dying services: England)."

NC38

To move the following Clause- "Information sharing (1) The Commissioner may disclose information to a person within subsection (3), for the purposes of any function of either of them. (2) A person within subsection (3) may disclose information to the Commissioner, for the purposes of any function of either of them. (3) The persons within this subsection are— (a) the Care Quality Commission; (b) the General Medical Council; (c) the General Pharmaceutical Council; (d) the Nursing and Midwifery Council; (e) any other person specified in regulations made by the Secretary of State. (4) The Commissioner and the Secretary of State may disclose information to each other, for the purposes of- (a) any function of the Commissioner, or (b) any function of the Secretary of State relating to the operation of this Act."

NC39

To move the following Clause- "Obligations of confidence etc (1) A disclosure of information which is required or authorised by or under this Act does not breach- (a) any obligation of confidence owed by the person making the disclosure, or (b) any other restriction on disclosure (however imposed). This is subject to subsection (2). (2) This Act does not (and regulations under it may not) require or authorise the disclosure of information which would contravene the data protection legislation (but in determining whether a disclosure required or authorised by or under this Act would do so, the requirement or authorisation is to be taken into account). (3) In this section "the data protection legislation” has the same meaning as in the Data Protection Act 2018 (see section 3 of that Act)."

NC40

To move the following Clause- "Reporting on implementation of Act (1) As soon as reasonably practicable after the end of each reporting period, the Secretary of State must prepare and publish, and lay before Parliament, a report about— (a) progress made in that period in connection with the implementation of this Act, and (b) the Secretary of State's plans for implementing the Act in subsequent reporting periods (including the expected timetable for implementation). (2) For the purposes of this section the reporting periods are— (a) the period of one year beginning with the day on which this Act is passed; (b) each subsequent period of 6 months (subject to subsection (3)). (3) The sixth reporting period under subsection (2)(b) is the last reporting period."

NC35

To move the following Clause- "Disability Advisory Board on the implementation and implications of the Act for disabled people (1) The Commissioner must, within six months of the Commissioner being appointed under this Act, appoint a Disability Advisory Board to advise on the implementation and impact of this Act in its operation on disabled people. (2) The Board must include- (a) people who have a disability under the Equality Act 2010, (b) representatives from disabled people's organisations, and (c) other such persons or organisations as the Commissioner considers relevant to the impact of the Act on disabled people. (3) Within six months of its appointment, the Advisory Board must report to the Secretary of State and the Commissioner to advise on the implementation of the Act and then annually thereafter report on the impact of the Act's operation on disabled people. (4) The Secretary of State must, within three months of receipt of any report under subsection (3), lay the report before both Houses of Parliament.”

536

Clause 42, page 24, line 23, leave out “2” and insert “5”

535

Clause 42, page 24, line 25, at end insert— "(3A) Subsections (2) and (3) do not apply in relation to Wales. (3B) In relation to Wales, the provisions of this Act not brought into force by subsection (1) come into force on such day or days as the Welsh Ministers may by regulations appoint (and such regulations may not be made unless a draft of the statutory instrument containing them has been laid before, and approved by a resolution of, Senedd Cymru)."

520(a)

Line 3, leave out ", with the intention of inducing that other person to make the relevant declarations or to self-administer an approved substance under this Act against that other person's will”

NC32

To move the following Clause- "Transparency of private providers (1) Any persons, not being a public authority, providing assisted dying under this Act must publish a yearly report setting out for that person— (a) the number of persons who have requested assistance from them, (b) the number they have actually assisted, (c) the cost and revenue associated with providing such assistance, and (d) any other matter that the Secretary of State may by regulations specify.”

NC33

To move the following Clause- "Collection of Statistics (No.2) (1) The Voluntary Assisted Dying Commissioner must ensure that the statistics specified in Schedule [Statistics to be collected] are collected. (2) The Commissioner must publish a yearly report setting out those statistics. (3) The Secretary of State may by regulation vary the contents of Schedule [Statistics to be collected]. "

NC34

To move the following Clause- "Assisted Dying Not a Medical Treatment Assisted dying under this Act shall not be considered to be a medical treatment."

496

Clause 18, page 12, line 28, after "professionals” insert “, and such other persons,”

497

Clause 18, page 13, line 9, leave out "decides” and insert "informs the coordinating doctor that they have decided"

498

Clause 18, page 13, line 10, leave out “that the substance is not” and insert “to believe that the substance will not be"

532

Clause 18, page 13, line 12, at end insert— "(12) The Secretary of State must by regulations make provision about what the coordinating doctor is legally permitted to do if it is determined by the coordinating doctor that the procedure is failed. (13) The regulations under subsection (12) must include what specific actions can legally be taken by the coordinating doctor if— (a) there is a greatly prolonged time to death, (b) the person has been rendered unconscious, or rendered unfit to make a second attempt at self-administration, but has not died, or (c) the person is otherwise undergoing complications.”

533

Clause 18, page 13, line 12, at end insert— "(12) For the purposes of subsections (2) to (11), the Secretary of State must, by regulations, specify where the provision of assistance under this Act may take place. (13) Before making regulations under subsection (12), the Secretary of State must consult such persons as the Secretary of State considers appropriate. (14) The persons to be consulted under subsection (12A) may include- (a) persons requesting or considering requesting assistance to end their own lives, and (b) professionals working in palliative and end-of-life care, including hospice staff, and (c) persons from disadvantaged and marginalised communities, and (d) registered medical professionals and other healthcare professionals."

499

Clause 19, page 13, line 25, at end insert— "(3A) Where a registered medical practitioner who is authorised under subsection (1) is not satisfied of all of the matters mentioned in section 18(4), they must notify the coordinating doctor immediately.”

500

Clause 21, page 14, line 10, at end insert— "(3A) Regulations under subsection (3)(a) must provide that a final statement contains the following information— (a) the person's full name and last permanent address; (b) the person's NHS number; (c) the name and address of the person's GP practice (at the time of death); (d) the coordinating doctor's full name and work address; (e) the date of each of the following- (i) the first declaration; (ii) the report about the first assessment of the person; (iii) the report about the second assessment of the person; (iv) the certificate of eligibility; (v) the second declaration; (vi) the statement under section 13(5); (f) details of the illness or disease which caused the person to be terminally ill (within the meaning of this Act); (g) the approved substance provided; (h) the date and time of death; (i) the time between use of the approved substance and death."

521

Clause 28, page 17, line 11, leave out subsection (3) and insert- "(3) The Secretary of State may not make a statutory instrument containing (whether alone or with other provision) regulations under subsection (1) unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament.”

522

Clause 29, page 17, line 14, leave out subsection (1)

504

Clause 24, page 15, line 11, leave out from second “of” to end of line 12 and insert “— (a) providing assistance to a person to end their own life in accordance with this Act, or performing any other function under this Act in accordance with this Act, or (b) assisting a person seeking to end their own life in accordance with this Act, in connection with the doing of anything under this Act.”

505

Clause 24, page 15, leave out lines 22 and 23 and insert “— (a) providing assistance to a person to end their own life in accordance with the Terminally Ill Adults (End of Life) Act 2025, or performing any other function under that Act in accordance with that Act, or (b) assisting a person seeking to end their own life in accordance with that Act, in connection with the doing of anything under that Act.”

501

Clause 25, page 15, line 31, leave out subsection (1) and insert- "(1) The doing of any of the following does not, of itself, give rise to any civil liability- (a) providing assistance to a person to end their own life in accordance with this Act; (b) performing any other function under this Act in accordance with this Act; (c) assisting a person seeking to end their own life in accordance with this Act, in connection with the doing of anything under this Act. (1A) Subsection (1) does not apply- (a) in relation to an act done dishonestly, or in some other way done otherwise than in good faith, or (b) to any liability in tort arising from a breach of a duty of care owed to a person."

502

Clause 25, page 15, line 34, after "life" insert ", or to attempt to do so,"

503

Clause 25, page 15, line 36, leave out subsection (3)

506

Clause 26, page 16, line 7, leave out "in accordance with" and insert "under"

507

Clause 26, page 16, line 9, leave out "or (2)"

508

Clause 26, page 16, line 10, at end insert— "(4) A person who commits an offence under subsection (2) is liable, on conviction on indictment, to imprisonment for life.”

509

Clause 26, page 16, line 10, at end insert- "(5) Proceedings for an offence under this section may be instituted only by or with the consent of the Director of Public Prosecutions."

510

Clause 27, page 16, line 18, leave out "wilfully” and insert “intentionally or recklessly"

511

Clause 27, page 16, line 22, leave out "that person" and insert "a relevant matter"

512

Clause 27, page 16, line 23, at end insert- "(2A) In subsection (2) “relevant matter” means a matter relating to any function under this Act."

513

Clause 27, page 16, line 24, leave out subsection (3) and insert- "(3) A person commits an offence if they intentionally or recklessly fail to comply with an obligation under- (a) section 14(1A) or (2) (notification of cancellation of declaration), or (b) section 17 (recording of cancellations).”

514

Clause 27, page 16, line 28, leave out subsection (4)

515

Clause 27, page 16, line 31, leave out from beginning to “an” and insert “A person who commits"

516

Clause 27, page 16, line 36, at end insert— "(6) Proceedings for an offence under this section may be instituted only by or with the consent of the Director of Public Prosecutions."

517

Clause 30, page 18, line 30, at end insert— "(da) arrangements for a qualifying person requesting assistance to end their own life to receive the support of an independent advocate under section [Independent advocate]. "

534

Clause 30, page 18, line 30, at end insert— "(da) the forms of proof of identity that are acceptable for the purposes of section 6."

523

Clause 30, page 18, line 31, leave out paragraph (e) and insert- "''(1A) The Secretary of State may issue one or more codes of codes of practice in connection with any matters relating to the operation of this Act not required under subsection (1) as the Secretary of State considers appropriate."

524

Clause 30, page 18, line 40, leave out from “have regard to” and insert “comply with”

525

Clause 32, page 19, line 26, leave out subsection (2)

528

Clause 32, page 19, line 27, at end insert— "(2A) Regulations under subsection (1) cannot authorise a body other than a public authority from providing such assistance even if that body is to be contracted by a public authority to do so.”

529

Clause 32, page 19, line 28, leave out subsection (3)

530

Clause 32, page 19, line 31, at end insert— "(5) The Secretary of State may not lay a draft statutory instrument before either House of Parliament that makes provision containing (whether alone or with other provision) regulations under subsection (1) unless they also lay before both Houses an impact assessment on such regulations. (6) The impact assessment under subsection (5) must include an assessment of the impact of such regulations on the workforce of health professionals and on the National Health Service."

493

Clause 35, page 21, line 31, leave out “5-year” and insert “3-year”

494

Clause 35, page 21, line 36, leave out “5-year” and insert “3-year”

495

Clause 35, page 21, line 36, leave out “5 years” and insert “3 years”

491

Clause 35, page 22, line 2, after “health” insert “and care”

492

Clause 35, page 22, line 2, after “palliative” insert “and end of life”

526

Clause 35, page 22, line 10, at end insert— "(4) A Minister of the Crown must make arrangements for— (a) a motion in neutral terms, to the effect that the House of Commons has considered the report, to be moved in that House by a Minister of the Crown within the period of 14 Commons sitting days beginning with the day after the report is laid before Parliament, and (b) a motion for the House of Lords to take note of the report to be moved in that House by a Minister of the Crown within the period of 14 Lords sitting days beginning with the day after the review is laid before Parliament."

518

Clause 40, page 23, line 24, at end insert— ““coercion” means behaviour of a controlling or threatening character, including but not limited to emotional or financial control, or improper interference with another person's decision-making autonomy, which is exerted by a person or organisation, with the intention of inducing that other person to make the relevant declarations or to self-administer an approved substance under this Act against that other person's will (and “coerced” is to be read accordingly);"

519

Clause 40, page 23, line 27, at end insert— "“dishonesty” means not being truthful, or not acting in good faith;"

520

Clause 40, page 23, line 37, at end insert—

527

Clause 40, page 24, line 14, at end insert “provided that such remuneration is not structured in a manner where it would be greater as a result of the registered medical practitioner approving the request.”

531

Clause 42, page 24, line 21, at end insert— "(2A) The Secretary of State may not make a statutory instrument containing (whether alone or with other provision) regulations under subsection (2) bringing sections 1 or 24 into force unless they have previously laid before Parliament a report containing an analysis of— (a) the readiness of services to provide assistance and related functions of this Act, and

490

Clause 42, page 24, line 30, at end insert— "(7) The Secretary of State may not make a statutory instrument containing (whether alone or with other provision) regulations under subsection (2) unless

NC24

To move the following Clause- "Falsification of documentation etc with intention that another will obtain assistance to end own life (1) A person commits an offence if, with the intention of facilitating the provision of assistance to a person (B) under this Act to end their own life, they— (a) make or knowingly use a false instrument which purports to be— (i) a first declaration, (ii) a second declaration, or (iii) a certificate of eligibility, (b) provide a medical or other professional opinion in respect of B which is false or misleading in a material particular, or (c) fail to comply with an obligation under section 14(1A) or (2) (notification of cancellation of declaration). (2) In subsection (1) the reference to assistance under this Act includes assistance purporting to be under this Act. (3) A person who commits an offence under this section is liable, on conviction on indictment, to imprisonment for a term not exceeding 14 years. (4) Proceedings for an offence under this section may be instituted only by or with the consent of the Director of Public Prosecutions."

NC25

To move the following Clause- "Independent advocate (1) The Secretary of State must by regulations make provision as to the appointment of persons as independent advocates. (2) The regulations may, in particular, provide— (a) that a person may act as an independent advocate only in such circumstances, or only subject to such conditions, as may be specified in the regulations; (b) for the appointment of a person as an independent advocate to be subject to approval in accordance with the regulations; (c) persons that may appoint independent advocates; (d) provision for payments to be made to, or in relation to, persons carrying out the function of an independent advocate under this section; (e) training that such advocates must undertake before being appointable; and (f) obligations on persons performing functions on this Act to ensure the presence of an independent advocate for a qualifying person. (3) The role of independent advocates is to provide support and advocacy to a qualifying person who is seeking to understand options around end of life care, including the possibility of requesting assistance to end their own life, to enable them to effectively understand and engage with all the provisions of this Act. (4) For the purposes of subsection (2) a person is a “Qualifying person” if they— (a) have- (i) a learning disability; (ii) a mental disorder under section 1 of the Mental Health Act 1983; or (iii) autism; or (b) they may experience substantial difficulty in understanding the processes or information relevant to those processes or communicating their views, wishes or feelings; or (c) they meet criteria that the Secretary of State may specify by regulations. (5) Regulations may not be made under this section unless a draft of the statutory instrument containing them has been laid before and approved by a resolution of each House of Parliament."

NC26

To move the following Clause- "Transparency of private providers (1) Any persons, not being a public authority, providing assisted dying under this Act must publish a yearly report setting out for that person— (a) the number of persons who have requested assistance from them, (b) the number they have actually assisted, (c) the cost and revenue associated with providing such assistance, and (d) any other matter that the Secretary of State may by regulations specify. (2) The Secretary of State may not make a statutory instrument containing (whether alone or with other provision) regulations under subsection (1) unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament.”

NC27

To move the following Clause- "Disability programme board on the implications of the Act for disabled people (1) The Commissioner must, within six months of the passing of this Act, appoint a programme board to advise on the impact of this Act and its operation on disabled people. (2) The Board must include— (a) people who have a disability under the Equality Act 2010, (b) representatives from disabled people's organisations, and (c) other such persons or organisations as the Commissioner considers relevant to the impact of the Act on disabled people. (3) The programme board must report to the Secretary of State and the Commissioner within one year of the passing of this Act, and annually thereafter. (4) The Secretary of State must, within three months of receipt of any report under subsection (3), lay the report before both Houses of Parliament.”

NC28

To move the following Clause- "12-month Assessment of this Act (1) The Secretary of State must undertake, prepare and publish an assessment, within 12 months from the day this Act is passed, of— (a) the extent to which the Act is on course to meet its aim of allowing adults who are terminally ill, subject to safeguards and protections, to request and be provided with assistance to end their own lives; (b) the extent to which the Act is likely to meet that aim; (c) an assessment of the state of health and care services to persons with palliative and end of life care needs and the implications of this Act on those services; (d) any emerging concerns relating to the current or future operation of the Act; and (e) steps the Secretary of State plans to take in response to those concerns. (2) The assessment in paragraph (1)(c) must include the quality and distribution of appropriate health and care services to persons with palliative and end of life care needs, including- (a) pain and symptom management; (b) psychological support for those persons and their families; and (c) information about palliative care and how to access it. (3) The Secretary of State must lay any report under subsection (1) before both Houses of Parliament."

NC29

To move the following Clause- "Collection of Statistics (1) The Voluntary Assisted Dying Commissioner must ensure that the statistics specified in Schedule [Statistics to be collected] are collected. (2) The Commissioner must publish a yearly report setting out those statistics. (3) The Secretary of State may by regulation vary the contents of Schedule [Statistics to be collected]. (4) The Secretary of State may not make a statutory instrument containing (whether alone or with other provision) regulations under subsection (1) unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament."

NC30

To move the following Clause- "Relatives seeking assistance at the same time (1) This section applies where the coordinating doctor, the independent doctor, or any other medical or other healthcare professional involved in the person's care receives any indication that the person is seeking assistance to end their own life under this Act contemporaneously as any one of their family members. (2) Such a professional as mentioned in subsection (1) must notify the person's coordinating doctor and a registered medical practitioner from the person's GP practice of the matter as mentioned in subsection (1). (3) If the assessing doctor is notified of a matter as mentioned in subsection (1), the assessing doctor must— (a) refer the person for assessment by a registered medical practitioner who is registered in the specialism of psychiatry in the Specialist Register kept by the General Medical Council, (b) refer the person for assessment by a social worker who is registered with Social Work England or Social Care Wales, and (c) take account of any opinion provided by that other registered medical practitioner or registered social worker. (4) Any opinion provided to one assessing doctor under subsection (3)(a) or (b) must be shared with the other assessing doctor.”

NC31

To move the following Clause- "Requests for assistance from persons under the age of 18 (1) No registered medical practitioner may raise the subject of the provision of assistance in accordance with this Act with a person who is under the age of 18. (2) Where a person under the age of 18 indicates to a registered medical practitioner their wish to seek assistance to end their own life in accordance with this Act, the registered medical practitioner is prohibited from conducting a preliminary discussion as mentioned in section 4. (3) The registered medical professional must notify both a registered medical practitioner with the person's GP practice and a parent or legal guardian of the person, of the matter as mentioned in subsection (2).”

NS3

To move the following Schedule— "SCHEDULE STATISTICS TO BE COLLECTED Characteristics 1 The Voluntary Assisted Dying Commissioner must collect the following information about persons requesting assisted dying— (a) sex, (b) age, (c) self-reported ethnicity, (d) level of education, (e) Index of Multiple Deprivation based on postcode, (f) region of residence, (g) marital status, (h) living status (alone, with others, in a care home etc), (i) main condition leading to “terminal illness” fulfilment, (j) other medical conditions,

432

Clause 12, page 8, line 31, leave out paragraph (a)

483

Clause 23, page 15, line 5, after “assistance” insert “, or in any activity closely related to the provision of assistance,”

484

✩ Clause 23, page 15, line 8, after "Act” insert ", or in any activity closely related to the provision of assistance under this Act,”

481

✩ Clause 23, page 15, line 9, at end insert- "(3) Nothing in subsection (2)— (a) prevents an employer who has chosen not to participate in the provision of assistance in accordance with this Act from prohibiting their employees from providing such assistance in the course of their employment with that employer, or (b) prevents an employer from specifying occupational requirements in relation to the provision of assistance in accordance with this Act in accordance with Schedule 9 of the Equality Act when hiring employees."

485

Clause 28, page 17, line 11, leave out “negative” and insert "affirmative”

NC21(e)

Line 45, at end insert— "(4A) Where the panel considers it appropriate for medical reasons, it may make provision for the use of pre-recorded audio or video material for the purposes of subsection (4).”

469

★ Clause 13, page 9, line 11, leave out "subsection (1)” and insert "this section"

470

★ Clause 13, page 9, line 26, at end insert— "(3A) Regulations under subsection (3)(a) must provide that a second declaration contains- (a) the following information— (i) the person's full name and address; (ii) the person's NHS number; (iii) contact details for the person's GP practice; (iv) specified information about the certificate of eligibility; (b) the following further declarations by the person- (i) a declaration that they have made a first declaration and have not cancelled it; (ii) a declaration that they understand that they must make a second declaration in order for assistance to be provided under this Act; (iii) a declaration that they are making the second declaration voluntarily and have not been coerced or pressured by any other person into making it; (iv) a declaration that they understand that they may cancel the second declaration at any time. In this subsection “specified” means specified in the regulations.”

471

★ Clause 13, page 9, line 27, leave out from “if” to "that" in line 28 and insert "the coordinating doctor is satisfied (immediately before witnessing it)”

472

★ Clause 13, page 9, line 41, at end insert— "(6A) Regulations under subsection (6)(a) must provide that a statement under subsection (5) contains- (a) the following information— (i) the person's full name and address; (ii) the person's NHS number; (iii) the coordinating doctor's full name and work address; (iv) specified information about the certificate of eligibility;

482

★ Clause 20, page 13, line 39, leave out "negative” and insert "affirmative”

473

★ Clause 15, page 11, line 3, leave out from “person” to end of line and insert “of a description specified in regulations made by the Secretary of State.”

474

★ Clause 16, page 11, line 17, at end insert— "(1A) In this section “recordable event” means an event mentioned in a paragraph of subsection (1)."

475

★ Clause 16, page 11, line 19, leave out from second “the” to “in” in line 21 and insert "occurrence of the recordable event"

476

★ Clause 16, page 11, line 24, leave out from “the” to ", and" in line 26 and insert "occurrence of the recordable event"

477

★ Clause 16, page 11, line 27, leave out from “the” to “in” in line 29 and insert "occurrence of the recordable event"

478

★ Clause 16, page 11, line 30, leave out from second "a" to end of line 32 and insert "declaration, report or statement within subsection (1) must include the original declaration, report or statement."

479

★ Clause 17, page 11, line 37, leave out "at" and insert "with"

480

★ Clause 23, page 15, line 3, leave out subsection (1) and insert- "(1) No individual is under any duty (whether arising from any contract, statute or otherwise) to be involved, directly or indirectly, in the provision of assistance in accordance with this Act. (1A) In particular, no individual is under any duty (whether arising from any contract, statute or otherwise) to— (a) provide information about assisted dying; (b) participate in an initial discussion; (c) participate in the request and assessment process; (d) supply, prescribe or administer an approved substance; (e) be present at the time of administration of an approved substance; or (f) dispense a prescription of an approved substance. (1B) Nothing in subsections (1) or (1A) of this section shall affect any duty to— (a) signpost someone to where they can obtain information about assisted dying (under section 4(5) or otherwise); (b) perform acts of a clerical, secretarial, or ancillary nature; or (c) perform any acts necessary to save the life of or to prevent grave injury to a person."

486

Clause 29, page 18, line 9, at end insert— "(4) A report provided under subsection (3) must include statistical analysis of— (a) demographic information relating to those who have received assistance under the Act, including breakdowns by the protected characteristics defined under section 4 of the Equality Act 2010; (b) the length of time between the taking of approved substances and the time of death; and (c) any complications that occurred as a result of the administration of a substance under the provisions of this Act.”

453

Clause 35, page 21, line 36, leave out subsection (2)

487

Clause 38, page 23, line 1, leave out "negative” and insert "affirmative"

488

Clause 42, page 24, line 22, leave out subsection (3) and insert— "(3) The Secretary of State may not make a statutory instrument containing (whether alone or with other provision) regulations which bring section 18 into force unless the condition in subsection (3A) is met. (3A) The condition is that a Minister of the Crown has made a statement to each House of Parliament that sets out— (a) that, in their opinion, all regulations necessary for the effective provision of assistance have been made under this Act; and (b) a list of the regulations that have been made for the purposes of paragraph (a).”

489

Clause 42, page 24, line 22, leave out subsection (3)

NC21(d)

Line 33, leave out paragraphs (a) to (d) and insert— "(a) must hear from, and must question, the coordinating doctor and the independent doctor; (b) must (subject to subsection (5)) hear from, and must question, the person to whom the referral relates; (c) in a case to which section 15 applies, may hear from and must question the person's proxy; (d) must consider hearing from and questioning— (i) persons properly interested in the welfare of the person who made the application for the declaration and other persons they are close to; and (ii) any other person who has provided treatment or care for the person being assessed in relation to that person's terminal illness; and (e) may hear from and may question any other person, including any person appearing to it to have relevant knowledge or experience to report to it on such matters relating to the person to whom the referral relates as it considers appropriate."

NC22

To move the following Clause- "No obligation for occupiers and operators of premises (1) Any individual, business, organisation, or association who occupies or operates premises has the right to refuse to permit the self-administration of an approved substance on their premises. (2) Nothing in subsection (1) confers any right on anyone with an interest in the land but who is not occupying or operating those premises."

NC23

To move the following Clause- "No detriment for care home or hospice not providing assistance (1) No regulated care home or hospice shall be subject to any detriment by a public authority as a result of not— (a) providing assistance in accordance with this Act, or (b) permitting such assistance to take place on their premises. (2) No funding given by a public authority to a regulated care home or hospice can be conditional on that care home or hospice- (a) providing assistance in accordance with this Act, or (b) permitting such assistance to take place on their premises."

NS2(d)

Line 54, leave out sub-paragraphs (1) and (2) and insert— "(1) Panels are to determine referrals in private (but this is subject to sub-paragraph (2)). (2) The chair of a panel may— (a) with the approval of the person to whom a referral relates, or (b) where the person does not approve, for any reason the panel deems necessary or desirable, decide that the panel is to sit in public. (3) The panel should only sit in public in exceptional circumstances where there is a clear public interest in doing so."

None

Clause 8, page 5, line 1, leave out subsection (4) and insert— "(4) The independent doctor must, where possible, undertake the second assessment jointly with the coordinating doctor. (4A) If the independent doctor is unable to undertake the second assessment jointly with the coordinating doctor under subsection (4), the independent doctor must confer with the coordinating doctor before completing that assessment.”

468

★ Clause 9, page 5, line 37, at end insert— "(aa) ask the person why they are seeking an assisted death."

461

★ Clause 11, page 7, line 15, leave out "or otherwise"

458

★ Clause 10, page 6, line 45, after "declaration” insert “and if there has been a material change of circumstances,"

459

★ Clause 10, page 7, line 3, at end insert— "(2A) (a) Where a referral is made to a registered medical practitioner under subsection (1), the coordinating doctor must provide that new registered medical practitioner with the report by the independent doctor setting out their reasons for refusal. (b) If the new registered medical practitioner reaches a different conclusion from the original independent doctor, they must produce a report setting out why they disagree. (c) Those two reports must be made available to any subsequent decision maker under this Act and to the Commissioner."

460

★ Clause 10, page 7, line 9, leave out “particular"

457

Clause 13, page 9, line 17, after "made," insert "and have not voluntarily stopped eating and drinking"

431

Clause 15, page 11, line 1, leave out paragraphs (a) and (b) and insert "the donee of Lasting Power of Attorney for Health and Welfare decisions, who has the ability to give or refuse consent to life-sustaining treatment, as registered with the Office of the Public Guardian."

462

Clause 18, page 12, line 20, at end insert— "(3A) When providing a substance under subsection (3) the coordinating doctor must explain to the person that they do not have to go ahead and self administer the substance and they may still cancel their declaration.”

463

Clause 18, page 12, line 34, leave out paragraph (c)

435

Clause 18, page 13, line 6, at end insert- "(9A) Where the procedure has failed, the coordinating doctor must escalate the care of the person by making the appropriate referral to emergency medical services."

429

Clause 18, page 13, line 7, leave out subsection (10)

436

Clause 18, page 13, line 8, after “provided” insert— "(10A) If complications occur as a result of the provision of assistance the coordinating doctor must- (a) make a detailed record of the complications in the patient's medical records, (b) make a declaration on the final statement issued under section 21, and (c) make a report to the relevant Chief Medical Officer and the Voluntary Assisted Dying Commissioner.”

464

Clause 18, page 13, line 8, at end insert- "(10A) If the person loses consciousness and it appears to the coordinating doctor that the procedure is failing, the coordinating doctor- (a) must not do anything with the intention of causing the person's death, and (b) must seek to revive the person."

433

Clause 19, page 13, line 26, leave out subsection (4)

465

Clause 20, page 13, line 36, at end insert- "(1A) A drug may only be approved under this Act if it has been approved by the Medicines and Healthcare products Regulatory Agency for that purpose."

466

Clause 20, page 13, line 36, at end insert— "(1A) A drug may only be approved under this Act if the Secretary of State is reasonably of the opinion that there is a scientific consensus that this drug or combination of drugs, is effective at ending someone's life without causing pain."

437

Clause 20, page 13, line 38, at end insert- "(2A) The doses and types of lethal drugs specified in any regulations made under subsection (1) must be licensed by the Medicines and Healthcare products Regulatory Agency."

438

Clause 20, page 13, line 38, at end insert— "(2A) The doses and types of lethal drugs to bring about the person's death must be recommended by either the National Institute of Clinical Excellence or the All Wales Medicines Strategy Group in Wales' guidelines as appropriate prior to licensing.”

467

Clause 20, page 13, line 38, at end insert— "(2A) Regulations under subsection (1) are subject to the affirmative procedure and when tabling the draft of the statutory instrument the Secretary of State must at the same time lay before both Houses of Parliament a report setting out all relevant information on the likely time to death, complications and likely side effect."

439

Clause 21, page 14, line 20, at end insert— "(7) The relevant body must supply- (a) full medical records, (b) court records, and (c) all documentation relating to the assessments and procedures, relating to bringing about the death of the person in accordance with this act must be made available to the Chief Medical Officer and the Assisted Dying Commissioner. (8) For the purposes of subsection 7 the “relevant body" is—"

440

Clause 22, page 14, line 34, at end insert- "(4) For the purposes of subsections (2) and (3)(b), the information recorded must include- (a) any interventions made by a medical practitioner in response to the procedure failing, and (b) the timing of those interventions.”

441

Clause 23, page 15, line 9, at end insert- "(3) There is no obligation on any care home or hospice regulated by the Care Quality Commission or the Care Inspectorate Wales to permit the provision of assistance under this Act on their premises."

442

Clause 28, page 17, line 3, leave out "may" and insert "must"

443

Clause 28, page 17, line 4, after “substances” insert “as approved through the Medicines and Healthcare products Regulatory Agency and either the National Institute for Clinical Excellence or the All Wales Medicines Strategy Group processes"

444

Clause 28, page 17, line 6, after "substances" insert "including specifying that approved substances must at no time be left unsupervised by a medical practitioner"

445

Clause 28, page 17, line 9, leave out "may" and insert "must"

446

Clause 29, page 18, line 9, at end insert— "(4) The Secretary of State must, by regulation, specify the data sets which must be made available by the Registrar General for England and Wales. (5) Any regulations made under subsection (4) are subject to the affirmative procedure."

447

Clause 30, page 18, line 12, leave out “may” and insert "must"

448

Clause 30, page 18, line 27, after “of” insert “registered and qualified"

430

Clause 30, page 18, line 30, at end insert- "(da) responding to unexpected complications that arise in relation to the administration of the approved substance under section 18, including when the procedure fails;"

449

Clause 34, page 20, line 32, after "to" insert “Parliament or Senedd Cymru as appropriate and"

450

Clause 34, page 20, line 33, at end insert— "(1A) The relevant Chief Medical Officer must produce an annual equality impact assessment of access to both palliative care and assisted dying on the basis of- (a) protected characteristics as set out in the section 4 of the Equality Act 2010, (b) socioeconomic status, (c) geographical location.”

451

Clause 34, page 20, line 43, at end insert— “(e) there were complications in the procedure. (2A) The Commissioner's report must include analysis of the following— (a) information about the patients' diagnosis/es; (b) information about the patients' prognosis; (c) any instances where concerns were raised about the patients' capacity;

455

Clause 34, page 20, line 43, at end insert- "(2A) An annual report must include information about the application of the Act in relation to- (a) persons who have protected characteristics, and (b) any other description of persons specified in regulations made by the Secretary of State. (2B) When preparing an annual report, the Commissioner must consult- (a) the Chief Medical Officer for England, (b) the Chief Medical Officer for Wales, and (c) such persons appearing to the Commissioner to represent the interests of persons who have protected characteristics as the Commissioner considers appropriate."

456

Clause 34, page 21, line 28, at end insert— "(8) In this section “protected characteristics” has the same meaning as in Part 2 of the Equality Act 2010 (see section 4)."

452

Clause 35, page 21, line 30, leave out from “must” to end of line 31 and insert "every 12 months after the passing of this Act—"

434

Clause 36, page 22, line 16, leave out paragraph (c)

454

Clause 36, page 22, line 26, at end insert— "(e) any person who would not have capacity to request assistance to end their own life under this Act."

NC17(a)

Leave out from line 1 to line 12 and insert- "(1) The person applying for assisted dying, their next of kin, any of their relatives (within the meaning of the Family Law Act 1996), the registered medical practitioners who are treating them and anyone who took part in proceedings before the panel or gave evidence to the panel may apply to the Commissioner for the Panel's decision to be reconsidered. (2) The Commissioner will allow the application for reconsideration if the Panel's decision was- (a) wrong, or (b) unjust because of a serious procedural or other irregularity in the proceedings. (3) The Commissioner may consider the application without a hearing if they consider it in the interests of justice to dispense with a hearing."

NC21

To move the following Clause- "Determination by panel of eligibility for assistance (1) This section applies where a person's case is referred under section (Referral by Commissioner of case to multidisciplinary panel) or (Reconsideration of panel decisions refusing certificate of eligibility) to an Assisted Dying Review Panel ("the panel"). (2) The panel's function is to determine whether it is satisfied of all of the following matters- (a) that the requirements of sections 5 to 9 have been met in relation to- (i) the first declaration, (ii) the first assessment and the report under section 7 on that assessment, and (iii) the second assessment and the report under section 8 on that assessment; (b) that the person is terminally ill; (c) that the person has capacity to make the decision to end their own life; (d) that the person was aged 18 or over at the time the first declaration was made; (e) that before making the first declaration, but when the person was aged 18 or over, a registered medical practitioner conducted a preliminary discussion with the person; (f) that the person is ordinarily resident in England and Wales and has been so resident for at least 12 months ending with the date of the first declaration; (g) that the person is registered as a patient with a general medical practice in England or Wales; (h) that the person has a clear, settled and informed wish to end their own life; (i) that the person made the first declaration voluntarily and was not coerced or pressured by any other person into making that declaration. (3) Subject to the following and to Schedule (Assisted Dying Review Panels), the panel may adopt such procedure as it considers appropriate for the case. (4) The panel- (a) must hear from, and may question, the coordinating doctor or the independent doctor (and may hear from and question both); (b) must (subject to subsection (5)) hear from, and may question, the person to whom the referral relates; (c) in a case to which section 15 applies, may hear from and may question the person's proxy; (d) may hear from and may question any other person; (e) may ask any person appearing to it to have relevant knowledge or experience to report to it on such matters relating to the person to whom the referral relates as it considers appropriate. In paragraphs (a) to (c) the reference to hearing from or questioning a person is to hearing from them, or questioning them, in person or by live video or audio link. (5) The duty under subsection (4)(b) to hear from the person to whom the referral relates does not apply if the panel is of the opinion that there are exceptional circumstances which justify not hearing from that person. (6) The panel- (a) must, if it is satisfied of all of the matters mentioned in subsection (2), grant a certificate to that effect (a “certificate of eligibility”); (b) must refuse to do so in any other case. (7) The panel must notify the following of its decision- (a) the person to whom the referral relates; (b) the coordinating doctor; (c) the Commissioner; (d) any other person specified in regulations made by the Secretary of State. Where it grants a certificate of eligibility, it must give a copy of the certificate to each of these persons. (8) If the panel is notified that the first declaration has been cancelled, it must cease to act in relation to the referral (and, in particular, it may not grant a certificate of eligibility)."

NC21(c)

Line 43, at end insert- "(aa) if it considers that the matters mentioned in subsection 2(c), (h) or (i) are established on a balance of probabilities but still considers that there is a real risk that they are not satisfied, then the panel must stay its proceedings until such further inquiries it orders are made,"

NC21(a)

Line 50, after “satisfied” insert “beyond reasonable doubt"

NC21(b)

Line 50, after "subsection (2)" insert "unless it believes that there are particular circumstances which make it inappropriate for the person to be assisted to end their own life,”

NC20

To move the following Clause— "Annual impact assessment of assisted dying (1) The Secretary of State must lay before both Houses of Parliament an annual report on the effect of this Act. (2) The report in subsection 1 must include an analysis the effect of this Act on people's access to— (a) healthcare, (b) palliative care, and (c) assisted dying. (3) For the purposes of subsection 2, the analysis must include an examination of people's access by reference to— (a) protected characteristics, and (b) socioeconomic status. (4) The first annual report is to be laid before each House on their first sitting day after one calendar year from the passing of this Act. (5) Each subsequent report is to be laid on the first sitting day one calendar year after the preceding report."

NS2(c)

Line 44, at end insert- “(3) The Commissioner must ensure that each member of a panel has had training in respect of domestic abuse, including coercive control and financial abuse."

186(a)

Line 7, at end insert- "(c) specific and up-to-date training on reasonable adjustments and safeguards for autistic people and people with a learning disability."

186(c)

Line 7, at end insert- "(c) culturally responsive, and trauma-informed care, and in assessing and challenging discrimination in end-of-life care decision-making, including into how- (i) culture, (ii) discrimination on the basis of the protected characteristics set out in section 4 (The protected characteristics) of the Equality Act 2010, and (iii) trauma may intersect and influence capacity and coercion assessments. Training must include specific considerations for the intersectionally marginalised.”

198(b)

Line 7, at end insert- "(c) culturally responsive, and trauma-informed care, and in assessing and challenging discrimination in end-of-life care decision-making, including into how- (i) culture, (ii) discrimination on the basis of the protected characteristics set out in section 4 (The protected characteristics) of the Equality Act 2010, and (iii) trauma may intersect and influence capacity and coercion assessments. Training must include specific considerations for the intersectionally marginalised.”

NC16(a)

Line 30, leave out paragraphs (a) to (d) and insert- "(a) must hear from and must question the person to whom the referral relates and (in a case to which section 15 applies) their proxy; (b) must hear from and must question the coordinating doctor and the independent doctor; (c) must consider hearing from and questioning— (i) persons properly interested in the welfare of the person who made the application for the declaration and other persons they are close to; and (ii) any other person who has provided treatment or care for the person being assessed in relation to that person's terminal illness; and (d) may hear from and may question any other person, including any person appearing to it to have relevant knowledge or experience to report to it on such matters relating to the person to whom the referral relates as it considers appropriate.”

NS2(a)

Line 46, at end insert- "(3) Each member of a panel must have fluent proficiency in the Welsh language if services or functions in the Act are to be provided to an individual in Welsh."

NS2(b)

Line 61, leave out sub-paragraphs (1) and (2) and insert- "(1) The Commissioner must give guidance about the practice and procedure of panels."

418

Clause 5, page 3, line 12, at end insert— “(2A) Regulations under subsection (2)(a) must provide that the first declaration contains- (a) the following information— (i) the person's full name and address; (ii) the person's NHS number; (iii) contact details for the person's GP practice; (b) the following further declarations by the person- (i) a declaration that they meet the initial conditions for eligibility (see subsection (2B)); (ii) a declaration that they have had a preliminary discussion with a registered medical practitioner, that they were aged 18 or over when they had that discussion, and that they understand the information referred to in section 4(4)(a) to (c) that was provided during that discussion; (iii) a declaration that they are content to be assessed, for the purposes of this Act, by medical practitioners;

427

Clause 5, page 3, line 23, at end insert- "(3A) In Wales, all reasonable steps must be taken to ensure the practitioner under subsection (3) has fluent proficiency in the Welsh language if services or functions in the Act are to be provided to an individual in Welsh."

428

Clause 8, page 5, line 25, at end insert- "(6A) In Wales, all reasonable steps must be taken to ensure the practitioner under subsection (6) has fluent proficiency in the Welsh language if services or functions in the Act are to be provided to an individual in Welsh."

414

★ Clause 4, page 2, line 25, at end insert— "(3A) If a registered medical practitioner conducts such a preliminary discussion with a person, the practitioner must first ensure the provision of adjustments for language and literacy barriers, including the use of interpreters."

413

★ Clause 4, page 2, line 31, at end insert— "(4A) In Wales, a medical practitioner conducting a preliminary discussion under subsection (4) must also discuss with the person their preferred language of Welsh or English."

425

★ Clause 4, page 2, line 31, at end insert- "(4A) Where a person indicates to a registered medical practitioner their wish to seek assistance to end their own life in accordance with this Act, they must be referred to a multidisciplinary team to explore options for relevant care and support. (4B) The Secretary of State may by regulations specify the requirements for the multidisciplinary team under subsection (4A). (4C) The regulations must include a requirement for the multidisciplinary team to include all of- (a) a registered medical practitioner or registered nurse, (b) a person registered as a social worker in a register maintained by Social Work England or Social Work Wales, and (c) a practising psychiatrist registered in one of the psychiatry specialisms."

(b)

★ Line 7, at end insert- "(c) culturally responsive and trauma-informed care, and in assessing and challenging discrimination in end-of-life care decision-making, including into how- (i) culture, (ii) discrimination on the basis of the protected characteristics set out in section 4 (The protected characteristics) of the Equality Act 2010, and (iii) trauma, may intersect and influence capacity and coercion assessments. Training must include specific considerations for the intersectionally marginalised. (d) For the purposes of subsection (3B)(c)— (i) "culturally responsive care” means care which is respectful of, and relevant to, the health beliefs, health practices, culture and linguistic needs of diverse communities; (ii) "trauma-informed care” means an approach to health and care interventions which is grounded in the understanding that trauma exposure can impact an individual's neurological, biological, psychological and social development; (iii) "trauma” means the lasting adverse effects, limiting a person's ability to function and achieve mental, physical, social, emotional or spiritual well-being resulting from an event, series of events, or set of circumstances that is experienced by that person as harmful or life threatening.”

419

★ Clause 6, page 3, line 35, at end insert- "(3B) The coordinating doctor may witness the first declaration only if- (a) the coordinating doctor has conducted a preliminary discussion with the person or is satisfied that another registered medical practitioner has conducted such a discussion, and (b) the coordinating doctor has made or seen a written record of the preliminary discussion."

420

★ Clause 7, page 4, line 16, leave out subsection (3) and insert- "(3) After carrying out the first assessment, the coordinating doctor must- (a) make a report about the assessment (which must meet the requirements of regulations under subsection (4)); (b) give a copy of the report to— (i) the person who was assessed ("the assessed person"), (ii) if the coordinating doctor is not a practitioner with the person's GP practice, a registered medical practitioner with that practice, and (iii) any other person specified in regulations made by the Secretary of State; (c) if satisfied as to all of the matters mentioned in subsection (2)(a) to (g), refer the assessed person to another registered medical practitioner who meets the requirements of section 8(6) and is able and willing to carry out the second assessment (“the independent doctor"). (4) The Secretary of State must by regulations make provision about the content and form of the report. (5) The regulations must provide that the report must- (a) contain a statement indicating whether the coordinating doctor is satisfied as to all of the matters mentioned in subsection (2)(a) to (g); (b) contain an explanation of why the coordinating doctor is, or (as the case may be) is not, so satisfied; (c) contain a statement indicating whether the coordinating doctor is satisfied as to the following— (i) that a record of the preliminary discussion has been included in the person's medical records; (ii) that the making of the first declaration has been recorded in the person's medical records; (iii) that the first declaration has not been cancelled; (d) be signed and dated by the coordinating doctor.”

426

★ Clause 7, page 4, line 26, at end insert- "(4) The coordinating doctor may not take the steps set out in subsection (3) unless they receive confirmation from a multidisciplinary team that the person has had a meeting with that multidisciplinary team as specified in section 4.”

421

Clause 8, page 5, line 4, leave out subsection (5) and insert- "(5) After carrying out the second assessment, the independent doctor must- (a) make a report about the assessment (which must meet the requirements of regulations under subsection (5A)), and (b) give a copy of the report to— (i) the person who was assessed, (ii) the coordinating doctor, (iii) if neither the independent doctor nor the coordinating doctor is a practitioner with the person's GP practice, a registered medical practitioner with that practice, and (iv) any other person specified in regulations made by the Secretary of State. (5A) The Secretary of State must by regulations make provision about the content and form of the report. (5B) The regulations must provide that the report must- (a) contain a statement indicating whether the independent doctor is satisfied as to all of the matters mentioned in subsection (2)(a) to (e); (b) contain an explanation of why the independent doctor is, or (as the case may be) is not, so satisfied; (c) contain a statement indicating whether the independent doctor is satisfied as to the following- (i) that a record of the preliminary discussion has been included in the person's medical records; (ii) that the person signed the first declaration; (iii) that the making of the first declaration has been recorded in the person's medical records; (iv) that the first declaration has not been cancelled; (d) be signed and dated by the independent doctor.”

422

Clause 9, page 5, line 36, after “records” insert "make such enquiries of professionals who are providing or have recently provided health or social care to the person as the assessing doctor considers appropriate,"

423

Clause 9, page 6, line 20, at end insert— "(2A) To inform their assessment, the assessing doctor must- (a) consider whether they should consult a health professional or social care professional with qualifications in, or experience of, a matter relevant to the person being assessed; (b) consult such a professional if they consider that there is a need to do so. (2B) Where an assessing doctor consults a professional under subsection (2A)(b), the assessing doctor must give a written record of the consultation to the other assessing doctor.”

415

Clause 9, page 6, line 20, at end insert— "(2A) When making an assessment under subsection (2), the assessing doctor must first ensure the provision of adjustments for language and literacy barriers, including the use of interpreters.”

416

Clause 30, page 18, line 25, leave out paragraph (c)

417

Clause 30, page 18, line 32, at end insert— "(1A) The Secretary of State must, within six months of the passing of this Act, issue one or more codes of practice in connection with the arrangements for ensuring effective communication in connection with the provision of assistance to persons in accordance with this Act, including the use of interpreters."

424

Clause 40, page 23, line 37, at end insert- ""preliminary discussion” means a discussion of a kind mentioned in section 4(3);"

NC19

To move the following Clause- "Recording of preliminary discussion (1) This section applies where a registered medical practitioner (“the practitioner") conducts a preliminary discussion with a person. (2) Where the practitioner is a practitioner with the person's GP practice, they must, as soon as practicable, record the preliminary discussion in the person's medical records. (3) In any other case— (a) the practitioner must, as soon as practicable, give a written record of the preliminary discussion to a registered medical practitioner with the person's GP practice, and (b) that registered medical practitioner must, as soon as practicable, include the record in the person's medical records."

NC18

To move the following Clause- "Provision of information in English and Welsh (1) Any service, report, declaration or certificate of eligibility provided under this Act to a person seeking assistance to end their own life must either be— (a) in the person's first language, if that language is English or Welsh, or (b) their preferred language of English and Welsh. (2) The person's choice of language under subsection (1) must be recorded in that person's medical records. (3) Any regulations made under sections 5, 7, 8, 13 or 21 specifying the form and content of declarations or statements must make provision for their being in both the English and Welsh language. (4) No regulations that contain provision for the Welsh language under the requirements of subsection (3) may be made unless a draft has been laid before and approved by a resolution of Senedd Cymru. (5) The Assisted Dying Review panel must make certificates of eligibility available in either English or Welsh depending on the person's choice of language under subsection (1)."

412

Clause 4, page 2, line 32, leave out subsection (5)

405

Clause 5, page 3, leave out line 20 and insert- "(d) who has taken all reasonable steps to satisfy themselves that they are not and that there is no reason to believe that they are—”

None

Clause 12, page 8, line 14, at end insert ", and (i) is acting for the primary purpose of avoiding physical pain.”

406

Clause 8, page 5, leave out line 22 and insert- "(f) who has taken all reasonable steps to satisfy themselves that they are not and that there is no reason to believe that they are—"

410

Clause 12, page 8, line 27, leave out subsection (6)

407

Clause 12, page 8, line 19, leave out "may" and insert "must"

411

Clause 15, page 11, line 3, leave out paragraph (b)

408

Clause 19, page 13, line 18, after "provided” insert “has been consulted and"

409

Clause 20, page 13, line 35, leave out from "specify" to "for" and insert "two or more drugs or other substances with different techniques of administration”

403

Schedule 1, page 25, line 25, at end insert— "7. I have- 1. informed my family of my wish to be provided with assistance to end my life and taken their opinions into consideration 2. decided not to inform my family of my decision 3. no family to inform of my decision"

404