Live Debate: Commons Chamber

Commons Chamber

Friday 16th May 2025

(began 6 hours, 5 minutes ago)

09:34

None

**** Possible New Speaker ****

Order, Order, order.

**** Possible New Speaker ****

Order, order. The Order, order. The question Order, order. The question is

**** Possible New Speaker ****

Order, order. The question is this House sit in the private. As many are of that opinion say, "Aye", many are of that opinion say, "Aye", and of the contrary, "No". The question is this House set in

09:36

question is this House set in private. As many are of that opinion say, "Aye", and of the contrary, say, "Aye", and of the contrary, "No". OK, division. Clear the Lobby. "No". OK, division. Clear the Lobby. Sorry, the Noes have it, let's carry Sorry, the Noes have it, let's carry on. Right... The clerk will proceed

**** Possible New Speaker ****

to read the orders of the day. Terminally ill adults end-of-life

**** Possible New Speaker ****

bill, as amended, to be considered. No.

**** Possible New Speaker ****

No. Before I begin, I would like to say a few words about today's proceedings. New clauses and amendments are grouped into groups for debate, this is to enable coherent debate on aspects of the Bill. Shortly, I will call the member in charge to move her new clause 10, debate on the first group will take place on the question that new clause 10 be added a second time. If that is agreed to, I will select amendment A.

A decision. We have more than 90 members who have indicated they wish to speak. Not all honourable members would be called. It is not customary to impose a speech limit on Private Members' bills but I hope that members in charge of the bill and the Speaker after that, Embers will restrict themselves in the early part of the debate, to no more than 15 minutes. That includes taking interventions. It will have to drop accordingly thereafter. The chair will review the guidance as the debate progresses.

We need to ask for shorter speeches to enable more members to contribute, I should make it clear that the chair retains the right to impose a formal limit, but rather colleagues help each other. This is an important debate, so please, today is an opportunity, primarily, for Back Benchers. I do not expect a call frontbenchers to speak until at least 1:30 PM. We will now begin with new clause 10, with which it will be convenient to consider other selected new clauses consider other selected new clauses and amendments in group 1, as listed on the Selection paper.

I call Kim on the Selection paper. I call Kim Leadbeater to move clause 10. Leadbeater to move clause 10.

09:37

Kim Leadbeater MP (Spen Valley, Labour)

- -

Thank you, it is a privilege to open the debate on this important stage of this Bill. It seems a long time ago since we held the second reading debate in November and what I think many of us felt was a very proud today for Parliament where we saw an emotional and passionate but respectful debate on what is a hugely important subject which means so much to so many people. I know that there are a number of views and I know that today is not about revisiting the fundamental principle

09:38

New Clause 10 Kim Leadbeater MP (Spen Valley, Labour)

- -

09:59

Report: New Clause 10 Kim Leadbeater MP (Spen Valley, Labour)

- -

10:09

Rebecca Paul MP (Reigate, Conservative)

- -

10:28

Dame Meg Hillier MP (Hackney South and Shoreditch, Labour )

- -

10:51

Dr Neil Shastri-Hurst MP (Solihull West and Shirley, Conservative)

- -

10:57

Rt Hon Anneliese Dodds MP (Oxford East, Labour )

- -

deep sorrow and solidarity for the families of those who have died and families of those who have died and our heartfelt best wishes to the two firefighters who remain in a serious firefighters who remain in a serious condition. Were grateful for their heroism and that of their colleagues when as ever they ran towards when as ever they ran towards I'm grateful for the opportunity to speak to these amendments. When this bill first came before the house, I was a minister attending cabinet and

10:57

Points of Order Gregory Stafford MP (Farnham and Bordon, Conservative)

- -

was a minister attending cabinet and unable to speak on this subject. I want to genuinely thank my honourable friend for Spen Valley and every single member of this and every single member of this House who has served for so many hours within the bill committee for this incredibly important bill. I

10:57

Rt Hon Anneliese Dodds MP (Oxford East, Labour )

- -

11:10

Rt Hon Sir Edward Leigh MP (Gainsborough, Conservative)

- -

Thank you, I wish to speak to new clause 16 and 17. I think that powerful testimony on behalf of somebody who runs a care home should be heard by the House. I want to quote, as briefly as possible, from Darren Hayes, who runs a care trust who run care homes in Lincolnshire. We believe that the Bill as drafted is flawed and the risk to vulnerable people is substantial. We believe any assumption by those drafting a final legislation is not intended for use by those living with conditions regarded as part of the ageing process would be mistaken.

Any legislation would be tested and assumed to be accessible to such a cohort of people. To that end, we believe that in order to provide the necessary protections to such a venerable part of society, the Bill must be explicit in his reference to all the people living in residential services. That is why these new clauses are so important. The Bill must take account of the current unfairness and instability at the heart of social care systems and question whether such legislation can be introduced while such problems exist.

The Bill must recognise an individual's ability to remove themselves from the process of assisted dying is so difficult that specific occlusion on the care home sector should be a feature of the Bill. In any case, organisations should be given the ability to exclude themselves from the act of an assisted death without prejudice to their approval, as provided of services to the state. And we do have experience of this with regard to catholic adoption, there is a real risk that some care homes might feel they have to withdraw from the sector.

I carry on quoting, those who fund their own care pay substantial sums, often saved over a lifetime, including property wealth. These savings will have been set aside for retirement and to pass on to loved ones. Instead, they are used to fund the cost of residential care and substantially subsidised the same date -- the state. We see the prospect that those who might fit the criteria for assisted dying will have no wish to accelerate the death would feel a dilemma between prolonging their own life and the future quality of life of their loved ones.

For illustrative purposes, a six-month period stated in the current Bill would equate to between £25,000 and £40,000 worth of expenses borne by an individual paying their own residential care in the current system. Failings in the system mean that all the people, who should not be in hospital, are held there, causing a burden to the NHS. An ever-growing portion of funding needed to support social care without an increase from central government. I wish to be careful of other people so I will proceed and make this one simple point.

During the pandemic, we saw the attempts at a widespread use of do not attempt resuscitation for older people. This is a clear demonstration of an existing, broken system, facing a lower value on the lives of older people than on others. Relation... This is important point, relationships within residential care for older people are both professional and intimate. Carers, care leaders, and service managers are all competent health and social care professionals, but they are also friends and confidant of those who live within social care services, the relationships are familial in the sense of contact for hours each day, and supporting issues outside the scope of normal healthcare professionals.

Employees deliver loving care and build relationships in a way that residents come to depend on and take comfort from. Such relationships are key to excellent Permission and these important relationships these important relationships enhance and prolong loads by -- lives by providing a sense of purpose and place. I have been around these care homes, they are fantastic places, such love and care for the most vulnerable. I carry on quoting, in such a setting, it gives the ability for an individual to refuse to partake as useless.

In a care home, there is no way in which a professional could be fully separated from assisted dying. Should a resident find that$$JOIN... Should a resident seek to enquire about or make a request. Imagine a scenario where an individual, living in social care, is at the point where they will be provided with the approved substance to bring about their own death, this is like to be in their own room, which will be in close proximity to other people, old people, who live within the setting.

It will be commonplace and understandable of the magnitude of the event which means the individual will wish to have company and comfort up to and immediately before and during the period where the substance is taken. A request for the company of a care professional would create a substantial moral dilemma for that person, profoundly so that if they are individually opposed to assisted dying, this is a sort of choice and pressure on these loving care workers that they will have to make.

Even where they are not, it will mean they will intimately witness the death of somebody with whom they have a somebody with whom they have a Imagine that pressure on those workers in that care home. The scenario is made worse by the prospect of assisted death not resulting in a quick or painless death. There are examples from other jurisdictions of significant complications leading to painful deaths and deeply traumatic experiences from loved ones. Social care professionals should not be exposed to the risk of such experiences.

Finally, in conclusion, we ask this House of Commons to consider the unworkable nature of individual exclusion from the processes of the said -- of assisted dying in the social care environments. Consequently, the exclusion of the care home sector should be a feature of the bill. In any case, organisations should and must be given the ability to exclude themselves from the act of assisted death.

**** Possible New Speaker ****

I rise today to speak in support

**** Possible New Speaker ****

I rise today to speak in support of new clause 10, which is about choice. In fact, the bill is about choice. Choice at the end of life, choice to have a dignified death, choice that is currently being denied to many in untreatable, denied to many in untreatable, excruciating pain at the end of their lives. Choice that the majority in this country want for themselves. This new clause is in themselves. This new clause is in the same spirit. It offers practitioners a choice by showing there is no wrong by ensuring there there is no wrong by ensuring there is no obligation -- by ensuring there is no obligation.

My constituents grandmother who repeatedly asked her, when will it repeatedly asked her, when will it end, from her husband's bed. Staff were medically unable to treat her constant pain and unable to make constant pain and unable to make good on her wish to be helped to go. The previous version of the bill The previous version of the bill allowed for doctors to choose not to participate in the assisted dying process if they so wished. This new clause improves the bill, extending that to all registered medical practitioners, health professionals, social care professionals, pharmacists and pharmacy technicians.

Also makes clear that no person is under any duty to act as a witness in the process or a proxy in the process. It further amends the Employment Rights Act to make sure no one can be subjected to pressure by an employer to assist with those seeking assisted death. It respects people's choices. Some will not want to aid someone seeking an assistant death because of religious objections or other principled objections. But some,

11:20

Tom Rutland MP (East Worthing and Shoreham, Labour)

- -

like my constituent Karen, will want to. ' Wrote to me setting out her father-in-law's terminal diagnosis father-in-law's terminal diagnosis for a brain tumour. His loss of for a brain tumour. His loss of Condition progressed and his hope Condition progressed and his hope that the bill would pass and timeframe to benefit from it. Karen is not simply a relative of a terminally ill person. She spent years working in palliative care. She watched people lose their independence and dignity as a result of their illness.

Patients were of their illness. Patients were asking her how they can end the suffering for themselves and their families. She was heartbroken to witness their distress and pain over days, weeks or even months. She knew there was nothing they could be done for -- nothing that could be done for -- nothing that could be done for them. Some felt suicidal, some felt a burden. For that reason, I must pose new clause 16 which would must pose new clause 16 which would rule ineligible for assisted dying anyone who is substantially motivated by a number of factors, including feeling a burden or

**** Possible New Speaker ****

suicidal ideation. I will give way. I'm surprised by the objection to new clause 16 given we were sure new clause 16 given we were sure throughout this bill only applied to throughout this bill only applied to people who are terminally ill. Is he really saying, therefore, that he doesn't want a new clause which says doesn't want a new clause which says that, which rules out from assisted death people who feel they are a death people who feel they are a burden on others, people with disability? Is he really saying disability? Is he really saying that? His argument is exactly the argument that led to the expansion argument that led to the expansion of X -- assisted death to just those

**** Possible New Speaker ****

kinds of people. I'm grateful for that intervention because it allows me to intervention because it allows me to continue addressing those points. Substantial motivation is vague and legally imprecise. It is an attempt legally imprecise. It is an attempt to shut the door on entire groups of people seeking to access assisted people seeking to access assisted death. How do you establish a substantial motivating factor? Now motivation exists and packing. Feeling about and can coexist with physical deterioration and untreatable pain.

Secondly, if suicidal ideation is to think about dying by taking one's own life, would that not encompass everyone seeking assisted dying?

**** Possible New Speaker ****

I thank him for giving way. I think today of Norman Ward who in think today of Norman Ward who in 2020 shut himself because of the terrible pain he faced. With my friend agree that this clause or friend agree that this clause or amendment would mean that Norman amendment would mean that Norman Ward would be unable to access the

**** Possible New Speaker ****

Ward would be unable to access the choice that would end his suffering? I do agree. Similarly, I cannot support amendment 102 which requires Doctor to ensure there are no Doctor to ensure there are no irremediable suicide risk factors. irremediable suicide risk factors. There is no clear legal clinical There is no clear legal clinical definition of this. The bill already includes multiple checks on mental capacity and mental illness, including by independent doctors and a specialist panel. The vagueness of this amendment risks wrecking this much needed.

I emailed Karen much needed. I emailed Karen yesterday to ask if I could refer to her. Her father-in-law had sadly her. Her father-in-law had sadly died during the time between our exchanges. Karen hopes his story could make some small contribution to changing the law. They don't need to be more people in this position. They can have a choice at the end of life. Are brilliant palliative care workforce like Karen can have choice on the kind of care they provide.

I must make progress, I'm afraid. I hope that members across the house will join in support of new clause 10 to strengthen the bill and enforce the choice for patients and practitioners is at the heart of this legislation and oppose amendments and clauses that would

**** Possible New Speaker ****

wreck the bill and put that choice at risk. Before I called the next speaker, after his comments, I will be asking after his comments, I will be asking members to limit their comment to no longer than eight minutes. I called

**** Possible New Speaker ****

Tom Garden. I'd like to start by thanking the

**** Possible New Speaker ****

I'd like to start by thanking the honourable member for Spen Valley for bringing this bill forward and

11:23

Tom Gordon MP (Harrogate and Knaresborough, Liberal Democrat)

- -

11:32

Florence Eshalomi MP (Vauxhall and Camberwell Green, Labour )

- -

Thank you. I will be mindful of time and allow other colleagues to speak, so I have carefully made sure that my speech is short, so I will not be taking any intervention. I voted against this bill at second reading on the grounds of inadequate safeguards against the coercion of minority communities. This was based on my belief that if we are to legislate for something serious as the end of someone's life, then the borough should reach should be deemed safe and needs to be much deemed safe and needs to be much higher than in other areas.

In the time since I have closely followed the scrutiny that this bill has received at committee and report stage. I hope that my concerns would be addressed but I am sad to say I am even more worried now than I was then. Before we get into the important new clauses and the amendments that provide important safeguards, I want to state again that I do not think this bill is the appropriate mechanism for a national decision of this magnitude to be made. And, ultimately, any decision on it should be led by the Government and the clear will of this House, not on promises made to people without an elected mandate.

I want to pay tribute to the work of tireless campaigners on a number of important issues in relation to the scrutiny of this hill since second reading. This has resulted in many amendments and new clauses being tabled by numbers from across the House aimed at strengthening the House aimed at strengthening the protections for at-risk groups. As I alluded to, I certainly do not have enough time to speak to all that I support, but I am grateful for the many efforts of the many who have spoken today.

I will speak to amendment 16 which is tabled in my name. The amendment to clause 28 makes it explicit that there would be no obligation for any care home or hospice to provide assisted dying on their premises, if they are regulated by the Care Quality Commission and the Care Inspectorate. I understand that numbers have table the new clause 10, ensuring there is no obligation on anyone to provide assistance. Whilst I welcome the expansion this provides to individual practitioners, we do not wish to provide assistance.

I do not believe that this is comprehensive. Dr Jamilla Hussain, a palliative care consultant working dominantly with ethnic minority communities in Bradford give more evidence at the bill committee. She said, and I quote, I have gone into those committees and I have spoken to them around this bill. What they say, overwhelmingly, to me, yes we are scared. We are fearful that this is going to result in a disproportionate impact on our community. We have seen this and we are scared. Heartbreakingly, she also said almost every week one of the first things I have to reassure patients about is that I cannot legally do anything to shorten their life.

This is front and centre for those patients and we see it all the time. This is not an academic or theoretical risk. Are we really prepared to sideline those unheard voices and risk further inequalities in healthcare as we legislate? We are all elected to this place, to elevate the voices of those who feel the furthest away from power. And if we are to achieve this, we must make decisions to honour their experiences and to legislate to protect them, but if hospices are unable to opt out and provide assisted dying as a collective policy, then the people who already feel ignored by the healthcare systems are more likely they are and access in the care that they need in their lives.

This would further create unnecessary suffering, something I know that we are all united in wanting to avoid. And it is on this theme that I will close. I do not doubt the good intentions of any members choosing to support this bill today and I thank the many constituents that have contacted me on both sides of this. But as politicians we have to be clear that members with valid concerns about this bill are not raising it because of some ideology or religious belief. It is because we recognise that if this bill passes it may impact everyone, not just those who may choose to wish to die.

It is not wrong or scaremongering to consider the wider family life relationships, feelings of burden or coercion, including vulnerable women and people from the BMT community at the end of their life. It is not scaremongering for us as politicians as we continue to receive the response from our constituents about the broken state of our NHS and the social care and for us to think carefully about a bill that may alter the very relationship between doctors and their patients. And this is frankly insulting to disabled people, hard-working professionals, up and down the country, who have raised many valid concerns about this bill.

To have it dismissed as religious belief. But I have sadly come to the conclusion that instead of being given that universal right to this, it will come and it will reinforce the health inequalities that deprive so many from our vulnerable communities that dignity in a new life. I urge members to keep this at the forefront as we vote today and to reject this.

**** Possible New Speaker ****

Thank you. I am grateful to be able to speak in this debate today and will be focusing on three particular areas. New clause 9, particular areas. New clause 9, amendment 51, and amendment 38, and I will not take intervention so that other members may speak. New clause 9, in my name, essentially establishes the standard of proof, establishes the standard of proof, namely the level of certainty and the amount of evidence required in the decision-making under this bill. Now, to put this into context remembers, there are various remembers, there are various standards of proof that are used in law.

The very lowest is reasonable law. The very lowest is reasonable belief, which means that a belief might be held by an ordinary person might be held by an ordinary person in the same circumstances. Then, there is a civil standard of proof, known as the balance of probabilities. This is sometimes probabilities. This is sometimes known as the 50% plus one rule, or, more likely than not. Finally, we have the most serious, which is the have the most serious, which is the beyond reasonable doubt test which applies for criminal.

This goes further than the balance of probabilities, and requires the probabilities, and requires the person to be sure. Now, given the lack of clarity and confusion as lack of clarity and confusion as Committee stage as to whether the test doctors should be reasonable belief or the balance of probabilities, I have proposed this new clause. As you will see, it has three parts, subclause one relates to the assessment by the coordinating and independent doctor. And here I argue that the balance of probabilities test should be used because it feels perhaps overly punitive to exclude someone from the process at the initial stage if it is more than likely than not they will meet the test but there are some doubts.

However, some clause 2, the assisted dying, to my mind, must make their assessment beyond reasonable doubt. Given that they will have all of the reports of the doctors and professionals, if, at this stage, they are not sure beyond reasonable doubt, then the application should not be approved. This is an essential safeguard. The final components of close three released are the moments of supplying illegal drugs. The doctor is required to satisfy themselves that the person has capacity and clear, settled, and informed wish to end their life and is not be coerced.

At this point, the balance on probabilities test does not suffice. It must be beyond reasonable doubt. This is life and

11:42

Sarah Bool MP (South Northamptonshire, Conservative)

- -

death. All Honourable Members need to ask themselves if they are happy to ask themselves if they are happy without this amendment, that someone be provided little drugs to end their life by our NHS in their life by our NHS in circumstances where we are not absolutely certain. I acknowledge absolutely certain. I acknowledge for the record there has been an objection to the use of beyond reasonable doubt by numbers the Solihull on the grounds of whether it is right to apply a criminal it is right to apply a criminal standard of proof with a civil standard which may be flexible enough.

However, I would note that enough. However, I would note that in the House of Lords case 3B into thousand, Baroness Hale put it, thousand, Baroness Hale put it, there are some proceedings whose there are some proceedings whose nature is such that it is appropriate to apply the criminal standard of proof, and a subsequent 2012 case affirmed this. Now, if we stay silent and let the assisted dying review panel and the courts dying review panel and the courts try to work out whether this is a term that should satisfy to mean civil or the criminal standard it would merely result in numerous battles.

On a matter so serious as death, we, as parliament, must provide the clarity needed. Without this, the bill is simply not safe. My second area today is on informed consent and amendment 51 to clause 11 of this bill. This amendment would impose a duty on assessing doctors to inform individuals seeking elicited death any reasonable or scientific opinion indicating the prescribed services that carry risk of complications including pain. And this clause 11 currently requires doctors to describe how they are to bring about death and to discuss with the individual bottle to be done in the event of complications.

However, it omits a critical element identified by the General Counsel in the guidance of consent. Namely, the obligation to communicate no risks of harm and the uncertainty surrounding those risks. A patient cannot be said to give informed consent if they are not made aware of the full range of potential complications, including pain, distress, and the possibility that the drug may not act as expected. The state of Oregon's most recent data shows that competitions were reported in the early 23% of cases in 2023, but historic data shows a competition rate of 11%.

Now, since the introduction of the law, there have been nine more incidents of patients regaining consciousness after ingesting the prescribed substances, and time to death has ranged from three to death has ranged from 12:57 hundred and 37 hours. That is more than 5 1/2 days. No, Canadian studies indicate there are around 5% of foreign assisted death resulting in a distressing process. In some instances, medical intervention is required. Now, evidence also suggests that young adults, particularly those aged 18 to 24 are more likely to experience extended and unpredictable deaths.

Furthermore, not all complications may be outwardly evident. High doses of barbiturates compared may result in what outwardly appears to be calm and peace of death but in fact may conceal considerable psychological suffering. The member talks about offering choice, but a choice made in the absence of information is not true autonomy. It is application. And meaningful decisions require that the individual is aware not only of what is intended to happen but also what may possibly go wrong.

If they exquisitely require that patients be informed of any known risks associated with the medications administered, so why would we adopt a lesser standard here. This amendment simply calls for honesty. And, finally, but very briefly, I also want to add my support to amendment 38, which clarifies that an individual who is not already terminally ill under the definition of close to subsection 1 cannot qualify by refusing the standard treatment or the terminal conviction. Someone living with type I diabetes which, for the record, is a progressive illness that cannot be reversed by treatment.

And knowing that this condition is solely managed by the individual, or not, in cases of extreme stress, this is an incredibly important protection. Alongside the multiple daily injections, 24 seven monitoring of everything you do, a diabetic could be at risk of suffering with diabetic distress, or even This could prove fatal if standard treatments are not accepted. They should never be offered assisted suicide. They could recover with the right support. The member for Spen Valley knows I've spoken to her about my concerns.

This amendment would be a step to protect those who may be unable to protect themselves using the standard means. Diabetes and anorexia have been a reason for assisted suicide in Oregon, so please be aware of what could happen. Madam Deputy Speaker on a personal note, not long after I was diagnosed as a type I diabetic eye suffered diabetic distress. I didn't know how I could continue with this condition and I convinced every single person at my workplace I was absolutely fine.

It was only that my parents caught that but I would be in this position today here to get the support. So please think seriously about the unintended to protect your honourable people -- to protect vulnerable people like myself.

**** Possible New Speaker ****

At the second reading my decision to support this bill was one of the hardest I however had to make. One hardest I however had to make. One which required to go to very depths of myself and draw on my experience as a child in excruciating pain. Along with the extensive poignant Along with the extensive poignant experiences shared with me by my eight runs. As I said then, my support was conditional upon support was conditional upon specific changes at committee stage.

I'm pleased to say all these changes I'm pleased to say all these changes have been made. As a member of that committee, it was the most committee, it was the most extraordinary cross-party deliberative process I have ever deliberative process I have ever witnessed in my 20 years of analysing legislation as an academic

11:47

Dr Marie Tidball MP (Penistone and Stocksbridge, Labour)

- -

and policy researcher working in disability law and policy. On the committee, I worked to strengthen the voices of disabled people and their protection under the bill's provisions. I moved amendments to introduce clause 20 on independent advocates, and clause 44, creating a disability advisory board. These are augmented today by amendments 75 and 91, brought by the Member c.... Four qualifying person engaging in the bill for them to effectively understand their options around end-of-life care. Empowering disabled people to be treated with the dignity and respect that we deserve.

These independent advocates would be required to undertake specialist training and would be available regardless of whether the individual is ultimately found to be eligible to request an assisted death. This clause, I will make progress. I'm respectful to all those on both sides of the House who wish to speak in full. The cause flow from evidence we have heard including leading experts, in conjunction with amendment 75 before us today, those with autism, along with a learning disability or a mental disorder, as defined under the Mental Health Act, 1983, will all qualify for an independent advocate.

Amendment 75 which defines learning disability will apply to clause 7 which applies for specific up-to-date training on reasonable adjustments and safeguards for autistic people and people with a learning difficulty for registered practitioners. At committee, I was grateful for the support of the member for Barking Heath, and to my delight, the honourable member for Neath culture, for these independent roles, along with unanimous support of the committee for the introduction of clause 44, which sets up the disability advisory board.

This advisory board introduce the voices of disabled people in this bill to embed a long-term and iterative structure to report on its implementation and impact disabled people to the secretary of state. Crucially, this board must consist of disabled people and representatives from Disabled People's Organisations. Building on these clauses, amendment 91 before us today expands the duty to collect additional information about whether immediately before death, the person seeking assistance had a disability within the meaning of section 6 of the Equality Act 2010, other than a disability amounting to terminal illness within the meaning of this bill.

So often, controllers taken away from disabled people in all sorts of circumstances. I passionately believe in inclusive healthcare for disabled people. Taken together, all of these measures will create a solid foundation to enable disabled people to have a strong voice in advocating for themselves in their choices for the end-of-life care and importantly, AC to table in shaping the monitoring of the bill providing continued scrutiny and accountability. In conclusion, there were many, many moments during the committee stage when I reflected on how I would want to live a good death.

The most poignant was when the death of a terminally ill husband was described who sought husband was described who sought assistance to die in Spain. His wife said, he had always been a bit of a cowboy and said he wanted to die with his boots on. I'm proud to say that that is what he did. At the end, we were holding hands and I said to him, don't be afraid. He said, I'm not afraid. And he winked at me, just before he closed his eyes.

May we all have the opportunity to be able to choose a good death, wearing our cowboy boots with the love of our lives by our sides.

**** Possible New Speaker ****

Liz Jarvis. I'm grateful for the opportunity to contribute to this vital vote. It is absolutely imperative that we get

11:52

Liz Jarvis MP (Eastleigh, Liberal Democrat)

- -

is absolutely imperative that we get this bill right. And that protectors and procedures are watertight. I thank my constituents who have written to me on both sides. Today I'm supporting amendment four, tabled by my honourable friends M-4 Harrogate and Knaresborough. Which would allow those with to Jennifer would allow those with to Jennifer -- Nigel Hartley told me positive care and assisted dying are not and should not be at odds with each other. Palliative care can provide incredible support.

And I'm very glad that this debate has reopened the national conversation about issues of funding for palliative care. However, as I know from my personal experience with my mum, who died last March after a seven-year struggle without Symons, palliative care can sometimes only go so far. Amendment four Greg Knight is that those with neurogenic -- neurodegenerative illnesses deserve compassion at the end of their lives and extending the time for 12 months will give them more control over their ultimate decision.

It also support new clause 10 which would extend the right for any professional involved to opt out from providing assistance under the bill, and extends productions to professionals who may be involved. I support amendment 59 and Amendment 62, which relate to training on domestic abuse. These amendments are critical to ensure the coordinating doctor can identify where there may be signs of domestic abuse. The inclusion of this training enhances the bill's protected framework as no medical professional without specific and up-to-date training on domestic abuse will be able to serve as a coordinating doctor.

Importantly, amendment 74 defines domestic abuse using the language of Domestic Abuse Act 2021, explicitly including coercive, controlling an economic abuse. Amendment 63 removes any ambiguity about the scope of eligibility, making clear that only terminal illness qualifies under this legislation. This clarity is essential to maintaining public trust and ensuring that the bill is not open to interpretation or misuse. It can be incredibly difficult for people with disabilities and their families and carers to get their concerns across and they can often feel unseen and unheard, so this amendment is vital.

Finally, I would like to contribute by paying tribute to the honourable member. For her work on this bill and Hershman discourage, determination and willingness to engage. As other mums have said, the decision before us is fundamentally about whether we believe on an individual's right to have choice at the end of their life. I know what my mum would have said -- -- as other members have said.

11:55

Rachael Maskell MP (York Central, Labour )

- -

Briefly on amendment 26, hospice care is not a formulation of care but a clinical setting where palliative care is delivered, so I trust the House will accept amendment for accuracy. Let me turn to amendment 45 and consequential amendment 46. The literature points to a complex, clinical decision- making of which this is, being safer if made in the context of multidisciplinary team, advocated for by the professional bodies at the very start of the process. It screens out unconscious bias and provides clinical about ability with robust interdependency, demands a deliberative process and safeguard clinicians and patients with more secure outcomes.

I have talked extensively to the professional bodies, clinicians and read the academic evidence on this and in drawing up best practice this amendment will provide search safeguards, ensuring that the patient is at the heart. Members will know that this initial assessment is the most important part of the process and clinicians and professional bodies do not understand why psychiatrists and social workers are placing a quasi judicial role rather than using their expertise. The process makes the wrong assumptions without this change.

As a predication towards an assisted death rather than recognising the insecure position that someone with a terminal illness finds themselves having, and the safeguards that are required. There are many reasons for suicide advocacy and they should be explored, in clinical practice, should someone determine they want to end their life, for whatever reason, a clinician would seek to ensure that right professionals were involved in the care of the person with exploration diagnosis and where necessary, therapeutic farmer logical interventions. I will not.

Doctor Lady Smith, the president of the Royal College psychiatrists, could not have been clearer, academic research is the same, when someone is in receipt of a terminal diagnosis there is frequently an episode of depressive disorder. The doctor presented evidence that those who had a wish to hasten death were 18 times more likely to feel suicidal stop they say mental disorders are treatable. suicidal ideation is higher in the months following the diagnosis of terminal illness.

People change their mind, no longer wanting to die. The fear of central control is why somebody may decide to want to and alive, and this can be treated palliative. Often no psychological after-care, people failed, yet this should not be a reason to die. So I asked the panel, a panel with a social worker to assess the psychological needs of a patient, experts being able to detect coercion, intrinsic and extrinsic, understanding people when they are at their most vulnerable, and diffusion of complex emotions, anxiety and fear.

Solutions can be found by them. Then, a psychiatrist. Depression, anxiety and fear unnatural responses to trauma. However, can be treated with the right interventions. It detects at point somebody expresses a wish to die than a person can have a wish to live. The travesty of getting this wrong is unconscionable. Then a palliative care consultant registered on the GMC specialist register, understanding the very actions that can alleviate somebody's suffering. Evidence at the bill committee from Sue Ryder showed how poor provision led to somebody's consideration of an assisted death cap while, the president of the Association of medicine set out " we know that effective palliative care can change a terminal ill person 's point of view from wanting to die to wanting to live ".

The point I've heard from all leaders of palliative care. These are the specialists who know how to palliate, physical, psych logical and social and spiritual needs of the patient and they have such techniques which many people have not had access to because of poor vision. In our palliative care commission which reports on Tuesday, please read the evidence which report, we reported accidents in end-of-life provision is achievable, Tim and people I was not getting access. Without this, I feel the bill not only leaves the patient down en route, that to die, and this is not choice.

It's a path to an assisted death. And I asked for two doctors, a generalist and specialist, one of which is the coordinating doctor. Yesterday the Royal College of Physicians stated that there is inadequate protections of patients and professionals in the bill and I quote " the proposed mechanism of the decision-making are not in line with good clinical and professional practice. Parliament must address these critical issues in the legislation or risk failing to protect vulnerable patients and uphold the integrity of clinical practice".

This week, the chair of Royal College of GPs has said they have got real concerns about the practical and legal implications within this bill. And IC to address that assessment process with my that assessment process with my But I must quickly say to the Minister if you think just two days of training for a doctor is sufficient, I will tell him they will not have the necessary competencies, but it even suggests impact assessment it will just be 90 minutes on line for 60 minutes interactive training.

That is simply not good enough. Poor Millicent makes assumptions. And this bill certainly does it, assume someone once to die, however it is a clinician is duty to have an open and enquiring mind to seek out reason not to assume for a Government suicide prevention strategy recognises as such. It is only through examination that we can establish why someone once to die and the aid for palliative care commission reports that 24% of the population know very little and have not heard of palliative care as set out by the King's College study.

This only presumes persistent death, not choice. Finally, how to do this. Separate or joint assessments. And then a panel meeting to deliberate. So, not a cause I traditional and So, not a cause I traditional and evidence led assessment where real choice is offered. Listen to the choice is offered. Listen to the experts, hear their collective voice. This bill is unsafe, which is why the professional bodies are speaking out against this bill. My amendment would nudge it into a safe place. The scale of concern for place.

The scale of concern for exceeds this. Colleagues, we must follow the experts evidence. follow the experts evidence.

12:03

Rt Hon Sir Jeremy Wright KC MP (Kenilworth and Southam, Conservative)

- -

12:17

Points of Order

Point of order, Simon Hoare. from a former Attorney General on some key legal points there. This is still a private members proposal. Is it in order, or how can the support of the bill, the member for Spen Valley, respond to whether or not to accept amendments to have proposed legislation, if she's not in the chamber to hear the arguments? Is it not discourtesy to the House and those who have spent some considerable time working on amendments on both sides of the argument, for her not to be here to hear what they are advocating?

12:18

Kevin Bonavia MP (Stevenage, Labour)

- -

And I thank the member for his point of order. He will know that is not a matter for the chair. Can I remind members that whilst there is no formal time-limit, there are many members who wish to contribute in a very important debate and it will be very helpful if members can keep their remarks to within the eight Bonavia.

**** Possible New Speaker ****

At second reading of the bill, I voted in favour. Partly because I believed in the principle of it believed in the principle of it because I do believe in the right choice and the right not to choose, but also because I believe that we but also because I believe that we needed to have a way of checking somebody's clear intention. At the somebody's clear intention. At the moment, there are horrible deaths moment, there are horrible deaths that are going on and there are no such checks in place.

So I was key such checks in place. So I was key to see how this House could come up with a system that will not be perfect, but better, than a terrible state, the terrible status quo that we have now. And in the bill, at we have now. And in the bill, at that stage, we had to checks by medical practitioners and then 1/3 layer, the involvement of a High layer, the involvement of a High Court judge. And although I was pleased with the third layer, I was not convinced that that third layer not convinced that that third layer was the right way to deal with that matter.

So I was pleased that the committee has now proposed a panel now of experts to make those checks. And the previous member has our belief rightly looked at some of those points. But for me, having that panel in place is very important and it's our job today to see how we can strengthen that I want to speak to amendments 78 and 79. And I think the improvement in amendment 78 there is to make sure that we have that unanimous decision, and that includes a decision in favour of a stiffer cut of eligibility, and I think that is better than was previously in the draft.

And certainly better than a High Court judge. And amendment 79, setting out those written reasons, because there will be scrutiny of those decisions. And we do need to have those proper written reasons. So my plea to members. I do appreciate that everybody who is here today and has taken part in this process has come with the best of intentions. It is not easy stoppages very difficult. And we have our constituents, any of them from both sides, giving us examples.

We are doing the best that we can, certainly to alleviate people's suffering. That, I hope, is the common intention of this House.

**** Possible New Speaker ****

I thank him for giving way. Like my honourable friend, deciding to vote in support of the bill at the second reading was a difficult second reading was a difficult choice for money but it was to improve the current situation that exists, to have dignity in dying stop does my honourable friend degree that to impose significant degree that to impose significant restrictions to a bill, we should not render it ineffective, if the bill is passed.

**** Possible New Speaker ****

bill is passed. Today... My honourable friend is

**** Possible New Speaker ****

Today... My honourable friend is right to think about the impact of instruction. We are all trying to instruction. We are all trying to improve the bill, whether we believe it in principle or not. I believe that the amendments that I'm talking to do improve that bill. I should end by saying this. For all of us,

12:22

Rt Hon Damian Hinds MP (East Hampshire, Conservative)

- -

end by saying this. For all of us, who are thinking carefully about the bill, and all the different parts of it, ask yourselves this question. Does it make it better than the status quo? I believe it does. I believe that there will be fewer more horrible, painful deaths out there and that is why, I've been able to help in that direction, and I remain in support of this bill and I asked other members to think very

**** Possible New Speaker ****

carefully, too. I'm going to speak only about

**** Possible New Speaker ****

I'm going to speak only about amendments 101 East specifically on adults with Down's syndrome or learning difficulty although that amendment does have direct relevance to new clause 1 that the from to new clause 1 that the from Hackney has spoken about earlier. This amendment would disallow medical practitioners from initiating a conversation about assisted dying with the person who assisted dying with the person who has Down's syndrome or a learning disability. And I speak primarily disability. And I speak primarily from my experience with others in the All-Party Group on Down Syndrome and what we have heard from members of that community, people with Down Syndrome, their families, and professionals specialising in the condition.

There are many many condition. There are many many strong and deeply heartfelt arguments that have been put by colleagues and indeed to all avast, by our constituents, by people in favour of the bill, including favour of the bill, including families, in the very most difficult circumstances to imagine, sometimes unimaginable circumstances. And nobody could question the conclusions that they have come to individually as a result of those circumstances. There are also equally deeply held and heartfelt points that are made to us by people from the other side, from the other perspective.

Actually, also, informed by their car sometimes unimaginable own family circumstances. Of the arguments put against, I am basically drawn to those around coercion. But I think it is important remember that coercion is itself not entirely a black-and-white matter, obviously there are, there is the very sharpest end of cases where an individual will directly ring pressure to bear on another for their own ends. But there are also other relations below that and pressure can be felt very differently by different people -- gradations below.

They be felt by people who feel they are a burden which can be a burden on family, on caregivers, on the National Health Service or more broadly on society, and once assisted dying is an available option, I worry over and above the question of pressure from others about the effect of pressure from. The builder stipulated in clause 36 that the Secretary of State will issue guidance, code of practice, make sure that the practitioner establishes there's a clear and settled intention for the person to end their own life, including assessing that person has a capacity to make such a decision.

That will of course have a very material challenges of its own, in terms of this amendment, I'm talking about the initiation or suggestion, or raising of the matter, specifically than individual who has a learning disability...

**** Possible New Speaker ****

The thing about the right honourable friend's amendment is that they put it in the face of the that they put it in the face of the bill, he is right that the code of practice and statutory guidance can practice and statutory guidance can be of value but was on the face of the bill seems to be fundamentally important, in particular respected as described, in terms of coercion.

**** Possible New Speaker ****

as described, in terms of coercion. Is right, and we talk about

**** Possible New Speaker ****

Is right, and we talk about there's going to be secondary legislation, guidance, code of practice. We can only ever take that on trust. And the subject we are on trust. And the subject we are debating again today is of such debating again today is of such moments but what is in the face of the bill is that much more important. And given the scale of important. And given the scale of the decision that people could be making as a result of this legislation, I think it is right that an additional layer of caution is applied by legislators.

Obviously is applied by legislators. Obviously it's important not to generalise, and every single individual is an individual. But it is the case that individual. But it is the case that people with Down Syndrome may indeed, often do, exhibit distinct social characteristics, including great sociability, empathy, a strong desire to please others and seek positive social feedback, while also being particularly sensitive in many cases to criticism or perceived failure, and this of course can compound the issues around communication and compared. And you don't need to term what can result as coercion to worry about what might happen as a result in that context.

So I repeat, this in terms of my amendment 101 East and also new clause 1, -- amendment 101 East. It's about initiating the conversation and make sure there are safeguards. I urge the House to apply caution commensurate with the apply caution commensurate with the gravity of the path that could be embarked upon.

12:27

Cat Eccles MP (Stourbridge, Labour)

- -

I rise to speak against amendments 102, 85, new clause 16, 38 and new clause 9. In my varied NHS career I have seen all aspects of death and disease. And as healthcare professionals we commit to do first no harm, and as medicine advances at breakneck speed, able to preserve life far beyond what could have been possible in the past. However, I have seen many times when I feel that preserving life can be harmful.

Lifelong treatments do not always improve policy of life and patients suffer pain and discomfort as well as mental distress. Friends and family have to watch their loved ones go through these difficult experiences. And I believe patients should have a choice to end their life with dignity when faced with a terminal illness. Safeguards within this bill have been significantly strengthened at committee and amendment seeking to further delay the process are simply unnecessary. Oral evidence was given by multiple experts including Professor Chris Whitty about we must be mindful not to overcomplicate the process to appoint that no one can access an assisted death.

Amendment 86 to impose an unnecessary restriction by requiring the terminal illness to cause severe pain and discomfort that cannot be relieved by palliative treatment will stop the bill already requires that symptoms cannot reasonably be relieved and it is important to remember that terminal illness is more than just pain alone. Amendment 102 states that remedial suicide risk factors be addressed, before any preliminary discussion. Again this is covered in the bill, with multiple checks on mental capacity and mental illness.

Suicide risk is complex and fluid and as I know myself from my own struggles as possible to feel suicidal but not to want to die. This is another fake an unnecessary barrier without clear legal or clinical definition. New clause 9 a new clause 16 and amendment five or six undermine multiple layers of assessment, independent oversight and professional accountability where safeguards are already strong and multifaceted. Amendment 38. Patients to only qualify if they have not received further treat or taken life short link steps.

It is morally wrong to force anyone to accept medical treat and they do not wish to have. This bill is about choice and autonomy and this amendment undermines freedom to make deeply personal decisions about one's care. This is not a one-size- fits-all approach and must always be a patient centred approach. My constituent mark share the story of his sister who sadly died from a rare form of terminal cancer two years ago and despite receiving the very best palliative care her pain could not be relieved and she begged her relatives to help her and her life, which obviously they could not And the father suffered a long and painful death as his body give out to the point he could not even swallow.

This was not how he would have chosen to end his days, and his family had to share his suffering as there was no other offering. The current system is clearly inadequate, unsafe, and lacks any compassionate and dignified options for end-of-life patients. I do not wish to consider assisted dying to be any alternative to end-of-life care, and I come and I know many others in this House, will continue to campaign for better funding and resources in palliative care hospices. And I believe that the two must go hand-in-hand.

I will keep going because of the time. Other countries which have implemented the assisted dying law have, increased funding and palliative care significantly, ensuring fairer, more equitable range of options for patients. I believe the safeguards within this bill are more than adequate and it is important to remember that doctors healthcare professionals, are constantly looking out for consent, competence, and possible coercion within medical and social care settings. I am almost done, so I will keep going. Around 20 people per day die in

12:33

Siân Berry MP (Brighton Pavilion, Green Party)

- -

excruciating pain, discomfort, in spite of palliative care. And I spite of palliative care. And I believe that we, as lawmakers, oh it to those people and their families and the thousands more who will die and the thousands more who will die in the meantime to continue this in the meantime to continue this Thank you. I will speak very briefly Thank you. I will speak very briefly as I spoke in favour of the bill at second reading in November as well.

My name is on it and I have supported the campaigns that want to supported the campaigns that want to see a change in the law, including the dying UK of which I declare I am the dying UK of which I declare I am a member. Since the second reading I have met with and listened to a range of professionals and range of professionals and individuals, mainly people who have individuals, mainly people who have concerns and those who want to see further changes made. In Brighton, this has regularly included constituents in my surgery as well constituents in my surgery as well as local faith groups and charities and those that support groups for disabled people.

Today, we debate around half, more than 100 opposed amendments. Led by several from the honourable member who has set out so well how she has put them together based on her own very detailed work and listening to opponents as well. I cannot commend her work in the committee more. The new amendment for the proposal include welcome changes to transparency rules and processes and decisions made and we also have many carefully drafted, clear proposals from other avenues also.

On eligibility, I continue to support with slowly progressing diseases like motor neurone disease, as reflected in amendment for which I have signed and which was argued so well by the honourable member for Harrogate. Today, I do not want to list those amendments. I do want to briefly set out the approach I will take to the amendments being debated today, while listening to the rest of the debate and deciding how to vote because I believe that we must end up with the strongest, clearest, and fairest process for making decisions, safeguarding against abuse, scrutinising the use of the policy after it becomes law, providing the very best and most appropriate help to people who want the choice at the end of their lives.

I aim to strongly recommend that we demand greater reporting and recording of the decisions made for transparency, including financial transparency, demographic data, and other statistics for those who are supervising decisions, providing the new service, including the new supervising Commissioner. The ability to monitor the implementation of this policy, ensure it is working as intended to detect any problems immediately. I would also changes in the process that ask for more training, for those taking part in decisions and to ensure fair and effective communication includingwhich requirements.

However, I am not currently able to support the amendments that are placing undue compulsory additional burdens and hurdles in traditions or demands on those people that apply for those people to make this choice beyond what is in the current bill because I know from what I have heard from the experience with those in Britain heavily and that the people asking for this choice will, by definition, be at the end of a horrible disease. Very often terminal cancer, which they have fought and fought with their doctors for a long time, and that they will now be facing their final months any situation with potentially huge suffering over which they have no control and fear greatly.

We must all remember that only dying people are eligible and the vast majority of these cases the persons eligibility, capacity and reasons will be more than clear to the decision makers. And I believe that we must look at these risk cases to be approved in a respectful, caring and compassionate way and as swiftly as the current bill process allows. In other cases where things are less clear, I agree. Many questions have been asked and I believe the professionals currently tasked in this rigorous process under the Bill's proposals would be very well posed to judge where the consultation and investigation would be necessary.

The current rules along with the members I support mean that they will also have to account very clearly for what they ask and what they decide under effective scrutiny, therefore I cannot support some of the proposals that were made and subject to additional steps, interrogation, somebody appointed to argue against the extra processes and compulsory psychological investigation, to me, these are intrusive. They are effectively arias. I am on my last paragraph, really sorry. In helping eligible people to make their own choice for when and how to die at the end of what they have already suffered, I truly believe we must not make the process any harder or dramatic than we need to, and while I am listening hard, quite a few of the amendment being proposed today do cross this line for me.

These momentous decisions must be led by momentous decisions must be led by compassion, and not be made to seem yet another battle to face by people yet another battle to face by people who have already given their all to staying alive. staying alive.

12:38

Naz Shah MP (Bradford West, Labour)

- -

Can I thank all members for supporting my amendment 14 and 18 and can I also to those that said there happy to accept my amendment this morning. This increases my concern. Insofar as the honourable member has also indicated that there might be the need to change some of the wording for it to be accepted. In that vein, given that I have not seen the wording of this new amendment, or proposal of this new amendment, I cannot accept it in its current form until I actually see it in writing and unable to scrutinise that and then make an informed choice.

In addition to that, this also raises the further question and that question is this was only told to me this morning at 930 on the House. This was not discussed with me, this has not been, and I unnatural whether this, whether the sponsors have discussed the Minister, because this very argument has been hashed out in the committee where many of us spent weeks and weeks scrutinising line by line. And, indeed, the Honourable Members amendment 181 attempted maturing Bill committee, to strengthen that particular clause that we are talking about in this amendment.

And at that point the Ministers on their feet during the Bill committee outlining their neutrality did not given opinion that this would not be workable, so those amendments that were tabled then, that many of those colleagues argued then, the Minister said were not workable in the government's opinion, so I also want to understand what is it in the government's opinion that has now changed? Have those assessments been made by the honourable member that these amendments could now accepted? Watch this speaks to, and I really, really want to emphasise this to all members listening, and the public at home, is that this process is flawed.

Fundamentally flawed. This is not how we make the gestation. I take my responsibility, as I am sure everybody in this House does, extremely, extremely seriously. This is, literally, a matter of life and death. If this bill passes, and does not have the safeguards, then there is no coming back from those decisions, so let's go back. Happy decisions, so let's go back. Happy The committee with me, I had that same advice from the Ministers and they disagreed with the wording of the amendment, yet they were accepted by the Bill's sponsor, accepted by the committee, and now sit in the wording on the face of the bill, so we are going to, the bill sponsors, the position of this House will now be, that those amendment are not in line with the

**** Possible New Speaker ****

government's position. What is her view on that? That we are going to be asked. I thank my honourable friend for that intervention because I think it that intervention because I think it is absolutely right. That is the problem with this bill in this problem with this bill in this process and how we are taught, we are given things on the face of this. Happy to give way.

**** Possible New Speaker ****

this. Happy to give way. Thank you for giving way and I think her for her passionate contribution. This is exactly how we contribution. This is exactly how we make law. We take evidence. We take

**** Possible New Speaker ****

make law. We take evidence. We take evidence. We have discussions. Could I respectfully remind Honourable Members that we are here Honourable Members that we are here for the report stage to debate the amendments to this legislation. Not amendments to this legislation. Not to discuss how the process of the law is being made. law is being made.

**** Possible New Speaker ****

law is being made. Thank you very much, Madam Deputy Speaker. This is about my amendment, because amendment 18 is very much about anorexia. This amendment was debated. It has been hashed out time debated. It has been hashed out time and time again, and today whilst in this seat I am told the member is mounted to accepted, that any discussion. I do not know what risk assessment or assessment Government has made. So, how can I speak to that amendment when I do not have those details? I can turn to this House that Chelsea Roff was the expert on anorexia, give evidence to the committee.

I can talk about how other clinicians of every single charity, the major charities on each disorder have made it really, really clear that in this bill, if it goes through, it is not fit for purpose. People will for through that loophole. Because I do not have that information in front of me, I cannot speak to it. Sorry, I will make one more point. I will make some progress now. So, I sincerely appreciate the guidance from the Madam Deputy Speaker and the Speaker and all across this House.

The cloaks have been really helpful. But coming back to the amendments, what I will say is this: in Oregon, in the states, 60 women, 60 women were given assisted death. All, everything one of them, 100 % of them were told they had the capacity. We have an issue in this country were we have 11 cases that have gone to court of protection. 10 of them, my understanding is, nine of them, sorry, have all been told they do not have the capacity.

But the doctors have been given the permission to not continue to treat them. That is an issue.. There is an issue when it comes to this. There is a second issue in relation to the Second Amendment that I tabled. And, again I am speaking to that because we cannot accept and even if the member does accepted, the entirety, would forward come of my first amendment, we do not hold the loophole with the Second Amendment. And the Second Amendment that I have tabled which I am speaking to is amendment 38.

So, if we have diabetes and the honourable member spoke very passionately about diabetes and I know the XP was because I have been additionally diabetic and three occasions. I pursued the risk of being diabetic as well. If somebody decides not to take insulin, if somebody decides they do not want to take, not want to have dialysis, they would ring themselves within the scope of this bill as it is written. That is a fact. It is a fact that as this bill is written, it does not, contrary to many people who have been on the radio or been on the radio stations, it takes people from mental health, it does not say on the basis of this bill, that mental health is excluded.

It does not say that. excluded. It does not say that. Sorry. It does not say that. No, I will not wear because I will make progress. I am very conscious that there are lots of colleagues sitting here, then 100 of them, who did not get to sit and speak yesterday the first time it was her, and many people who might not get to speak today, so I am trying to speak. But I am feeling really disheartened and the reason I feel disheartened is we have spent, like other numbers have pointed out on this committee, time, so much time, rehashing these arguments, haven't we? And then there is opportunities.

There are opportunities to fix the bill rather than be having to put the amendment done and others having to put the amendment down and take the opportunities and not give the floor the opportunity to speak. So, in relation and back to my amendment, I have lost track of time. It needs finishing. I will come to my I have spoken to parents, I have spoken to parents of a girl who had diabetes and complexities of Al- Aqsa, -- anorexia.

They said that the law that help them because the daughter wanted to go to Dignitas but it would have been illegal and this is the lobby are trying to change. It will be a young woman like Jessica who dies if this fails. It will be parents like Leslie and Neil who lose a child. That is a terrible tragedy, no family should ever have to endure and no one in this House will be able to say truthfully that we did not know or didn't see this coming.

That is not compassion. That is abandonment. I will not be complicit in that and I hope this House will not be either. That is why we must act now. Amendment 14 and amendment 38, each of those throws are different and dangerous loophole. Loophole one, without the other is not enough. If we are serious about protecting vulnerable people, this House must support both amendments. Thank you.

12:47

Rt Hon Kit Malthouse MP (North West Hampshire, Conservative)

- -

Members will be aware there are still many wishing to contribute. Could I ask about contributions are kept to 5 minutes.

**** Possible New Speaker ****

I am grateful to the sponsoring Minister for having put me on the bill committee, were in my view we did some excellent work, and will be have heard a lot of claims about the process today I think anybody process today I think anybody objective who reach the bill that is now being reported to the House will recognise it is a strong piece of work that is measured in 6 to strike a balance in what is a difficult a balance in what is a difficult area of complexity and humanity and compassion, and morality.

Before I compassion, and morality. Before I move on to just discussing three or four of the amendments, I wanted to bring the House back to what we are bring the House back to what we are trying to deal with here. We are dealing with a set of people who have been told that their struggle have been told that their struggle with disease is over. That they are heading towards a navigable death. heading towards a navigable death. It's nothing more that medical science can do for them.

And what we science can do for them. And what we are trying to do today is to give them the chance to face to on their them the chance to face to on their own terms. That is the simple mission the House has been set. The second thing I wanted members to contemplate as they look at this slew of amendments is while it is easy to look at each amendment individually and see its merits or demerits, have to bear in mind the machine we are building as a whole.

And the fact that we are putting those people through this process at a time when they are facing the end of that struggle, they are thinking about the nature of their death is going to be like, they are talking to their friends and family, putting their affairs in order and being concerned about when that awful day is going to come. And we have to have some compassion in the process as well as compassion in the purpose. And so when you consider some of the amendments, which I'm going to highlight a moment, please have in your mind this idea that we have to put these people through a possibly two-month process, at a moment when they are severely time- limited, very often less than six months.

So for example, new clause 7, my honourable friend, which seeks to restrict the number of patients that doctors can deal with in a 12 month period, this will severely restrict access and may mean that patients were part way through the process have to suddenly change because the doctor is time-limited and pushed out. That is notwithstanding the multiple safeguards that are already in the process. Similarly, and my honourable friend from, were in southern gave an interesting speech about 40 47.

-- About 47. He is creating another step, another delay, another set of problems for the dying person to overcome, or issues for them to address. In his amendment, I'm sure he's a lie there may but he was effectively creating an exhaustive list of individuals who could be called upon in any circumstances might be 'is properly interested in the welfare of that individual. To me the person who should be most interested in the future is the person themselves. Any step that we take that cuts across their privacy, autonomously and alacrity with which they can seek the solution to the impending perceived agony seems to me a step too far.

I don't understand how practically the commission is supposed to ascertain, is it neighbours, friends, just family? What is the definition of family? We need to... In a moment. We need to put out contemplation and how they want to handle their death squarely

**** Possible New Speaker ****

in the hands of the dying person. Thank you for letting me raise

**** Possible New Speaker ****

Thank you for letting me raise intervention. You mentioned that the person is autonomous and should be protected from enquiries around protected from enquiries around them. But what of that person is not autonomous, because they are being coercively controlled by partner? coercively controlled by partner? And what if that partner has prevented them from reaching out to their family to let them know about their family to let them know about the fact that going to take an assisted death? Would it not be a great safeguard to make sure that the panel and all of those doctors around them had ascertained that the

**** Possible New Speaker ****

family had been told? The honourable lady makes a good point and it was a compelling point point and it was a compelling point made at committee, and certainly one made at committee, and certainly one we recognise. And that is why her amendments that were table at committee were adopted, specifically on training, for everybody involved in the process that should be in the process that should be sensitised to detecting that, and also that any doctor in the process and indeed the panel might want to know my family are not being informed.

The specifically white social worker is put on the panel, to understand the psychosocial environment to which the person is taking that decision. Fundamentally, in the end, if I am facing a death, in a matter of weeks, and I decide in my capacity that I don't want it for my family, that is my choice. That is my decision. I may have to explain why to doctors about... On that point can I remind members that we really are short of time.

**** Possible New Speaker ****

I am grateful. I will be swift. That is my choice and this bill is rooted in giving autonomy to those who have had capacity and those who who have had capacity and those who are facing death and we must take care to tread carefully upon that right. And then finally, two amendments by my honourable friend amendments by my honourable friend for Reigate, first of all, new for Reigate, first of all, new clause 16, which is saying that somebody has to be substantially motivated, or can't be substantially motivated, or can't be substantially to motivated by certain to motivated by certain considerations.

I don't understand what substantially motivated is meant to mean. To me this misunderstands the capacity of what misunderstands the capacity of what it must be like to be told you are dying. The things that might run through your head, the affairs you might have to deal with, the news might have to deal with, the news you have to break with your family, the impact it is going to have on the impact it is going to have on your possibly small children, all of these form a cocktail of motivations but the one thing that I have learned over the last 10 years of campaigning and spending lots of time with dying and bereaved people is that towards the end of life they have a clarity about what they want.

Absolute clarity. Because it has come clear to them towards the end what they do this going to be like. And at the very least, they want to have the card in their back pocket to play if they require it. Remember these are people who are facing death who are struggling with death, and we have to give them the power to advance it and then finally, I'm just conscious of time, finally the amendment A2 new clause 10, I think we might be facing a division this afternoon, this is a difficult amendment, we debated it, similar amendment at committee.

We are very clear that there should be a conscientious objection clause that is strengthened by new clause 10 to allow individuals to opt out. But allowing an employer, any employer, to say that any employee in the employment cannot then participate, they decide not to, seems a step too far and could prove to have unintended first of all, every healthcare trust in the country, the board of what will become a battle for control, for those who oppose and those who don't.

We might find that in care homes, as the honourable gentleman for Gainsborough said, in care homes people may suddenly find they have to grit themselves after years of living there to relocate to get the living there to relocate to get the kind of death that they want. And in effect, what this does is prioritise the rights of somebody who is providing accommodation over the providing accommodation over the rights of the dying, and as I said at second reading, in my view as they face the end, should prioritise the rights of the dying.

the rights of the dying.

12:55

Lizzi Collinge MP (Morecambe and Lunesdale, Labour)

- -

It would be unprecedented to put a formal time-limit on. Please can members listen to the structure that

**** Possible New Speaker ****

we are very short of time. I was writing to speak to new clauses 1 and 10 but I will restrict myself to new clause 1 for the sake myself to new clause 1 for the sake of time. New clause one says that no health professionals should raise assisted dying first unless the assisted dying first unless the patient has already raised it. If the patient doesn't mention the issue, doesn't specifically ask for issue, doesn't specifically ask for it, the doctor would be entirely it, the doctor would be entirely prohibited from even mentioning it.

This is problematic for many different reasons. It goes against good medical practice and is good medical practice and is actively opposed by the British Medical Association. This undermines the hard-won rights of people to be fully informed of their medical options. And would make the application of the bill unfair and unequal to the detriment particularly of marginalised people. New clause one would have... I will

**** Possible New Speaker ****

give way. I thank her for giving way. Just

**** Possible New Speaker ****

I thank her for giving way. Just this week on health and social care Select Committee, have heard from vulnerable service users and they vulnerable service users and they talked about white coat syndrome, that people who when given options, faced with medical nationals, are more likely to be pushed into doing it. And that is the concern here and it. And that is the concern here and that is what this amendment is here, and I don't how I will vote but I minded to support this amendment

**** Possible New Speaker ****

because of what I have heard from people from vulnerable communities. Amendments need to be brief as well. I thank him for his intervention.

**** Possible New Speaker ****

I thank him for his intervention.

**** Possible New Speaker ****

I thank him for his intervention. I will expand on this more. That is exactly why all options need to be on the table. That's exactly why good medical practice has to have good medical practice has to have all options on the table because patients should not be being influenced by the opinions of influenced by the opinions of whether philosophical or medical or a doctor, what they should be influenced by is by full and informed consent. And I believe you informed consent. And I believe you because one would chill those discussions.

It would limit the discussions. It would limit the options of assisted death to those already in the know, those who are most decreased literate. Those who most decreased literate. Those who are most, who are best off and least marginalised in society. It would marginalised in society. It would result in unequal access to legal process. Flies in the face of good medical practice. Good medical practice has moved away from this paternalistic idea that harms patients and tackle the individual control, -- and took away individual control.

After many years of fight, mainly by women and marginalised communities, it established good healthcare practice means patients having full information in order to make the decisions. I'm mindful of time so I'll continue. Why now as a chamber would we choose to give To hide information from patients, on the options? So many years people have been put through this. Informed consent to treatment including end- of-life care is only informed when it includes all options. There is also the practical element. What would count as a patient raising it first? Would they have to specific statement, you specific language? It would make a legal and medical minefield for doctors and patients.

I would like to finish. I'm mindful of time. Colleagues may wish to look at the NHS Constitution. It says, you have the right to be involved in planning and making decisions about your health and care with your care provider or providers including your end-of-life care. And to be given information and support to enable you to do this. That is only the case if people are in fact given that full information. All people should have access to full information on matters of care.

To do otherwise is to deny people their decision. It is paternalistic and we should be moving away from that model, and people have fought so hard for that. We have a chance today, colleagues, to make sure this legislation is the best it can possibly be and it has been a pleasure to listen to the contributions from across the chamber. When third reading arrives, I am minded to call the amended bill because the current situation for terminally ill people, the current situation, with no safeguards, no production, and with no choice, is production, and with no choice, is

13:00

Dr Ben Spencer MP (Runnymede and Weybridge, Conservative)

- -

I beg to movement 18, 31, 17 and 32 in my name. I will start with amendment 18. There have been many more arguments put forward for the needs of the bill, both for debate inside and outside this place. In the vast majority have focused on prevention of suffering there is also the desire for control for end-of-life or irreversible suffering has dominated. The principle of bodily autonomy, for which I strongly support, in the context of full decision-making capacity of certain reported caveat is used to justify the rights in which this bill will grant.

However, putting aside the debate surrounding the bill and focusing on the text itself which is the task we face at report stage, the provisions of this bill are silent on suffering, silent control and on a terminal illness with fewer than six months prognosis. If the principal is it must prevent irreversible suffering, then all of those suffering irreversibly should be able to seek positions for assisted suicide. If the principle is that we give people control another level of bodily autonomy than all adults who truly and freely consent to informed decision-making capacity should be able to seek physician -assisted suicide.

In these principles if they are circumscribed into an arbitrary definition of terminal, the conclusions must be that either their suffering or autonomy is more important than others. More or less value. And we have seen that certainly imported into this debate. When requesting an assisted death is not framed as suicide but is understandable. The underlining argument made if you are terminally ill that is understandable. We must ensure that we do not by accident or otherwise enshrine value judgements on the worth of the lives of the terminally ill, or the protections they should enjoy, like everyone else.

So, I have tabled my amendment 18 to expand the scope of the bill as much as I can to reduce that discrimination inherited. The maximum I can go to is to remove the six-month restriction. I wish the amendment could go further. I know some amendments will wince at this provision, but if they do, I asked members to ask themselves what do they think the principles and values within this bill are? How are they being applied? And are they being applied equally? It is why, I believe, this bill is incoherent.

My amendment introduces more clarity into the bill and if we do not, the courts will. Moving to amendment 30 and 31, if we are to rely on the principle of autonomy to authorise assisted suicide with terminal L, then the express choice must be true and free. Autonomy needs helping. A true and free choice is performed, a true and free choice cannot be made with the coercion and true and free choice these decision-making capacity. I believe to rely on the principle of autonomy for the most grave decisions, there needs to actually be a choice.

In the absence of relevant and available to palliative care option, there needs to be choice. How can we rely on autonomy in the absence of choice? The prospect of people choosing physician -assisted suicide, not because it meets their needs, but because their needs are met due to a failure of provision of palliative care is moral outrage. My amendments would make sure that does not happen. I really cannot, I am sorry, given the time restrictions. But I now come on to amendment 18 pertaining to the test of capacity making itself, so in English law we use the Mental Capacity Act to define capacity and I believe it is right, the function of the test capacity used in this bill we have common law test capacity in some circumstances which arose before we have the Mental Capacity Act, however the decision such as this and the decision to end one's own life, this is not a decision that was omitted in the early case law leading up to the Mental Capacity Act of 2005.

There is no background or jurisprudence. These tests have not been done before. This test needs a bit more of a framework of support, this lizard minimum information that needs to be understood as part of the test of functional capacity. Critically, this includes the current treatment options in proceeding in the act and also medically about the physician -assisted suicide is not a medical treatment. It is a personal choice about life and death. Without my amendment 17, this bill will fundamentally undermine doctor- patient relationships.

Doctors do not prescribe death. This bill must make that clear. I now finally moved to my amendment 32. There has been some discussion about the inadequacies of the decision-making capacity test in itself as gatekeeper. In effect that there may be circumstances in which despite having it, the person is otherwise recognised as vulnerable, and of course this is how our courts operate. The impact of depression or personality disorder on the decision-making capacity can be subtle and pain, I know, I used to be a consultant as a psychiatrist and did research in the area of this.

This is tricky stuff to do, especially in the context of a request for an intervention, rather than a refusal, so we have trained psychiatrist at an early stage of setting capacity. They are experts at picking up these subtle cues. And all the other stuff that is going on. The request for a physician for assisted suicide is not taken in isolation and this needs to be understood and supported. And we need someone that knows how to reduce the Mental Health Act because you are doing this as a doctor.

Doing this assessment. You have a patient in front of you. And if you have a mental disorder and their expressing desire to end their life, you need to make sure that they get the right and appropriate treatment and that may well be using the Mental Health Act. We need to make sure that this happens and would happen as part of the process as usual but there is no safeguard within this bill to make sure it happens. Psychiatrist turning up at the panel at the end is not good enough.

They need to be there from the start. Finally, there are broader issues about this interaction with protections to save life article 2 and doctors duties. And I will cover these in the grouping and it is incredibly important, this interaction with suicide prevention strategy.

**** Possible New Speaker ****

Daniel Francis. Thank you, Madam Deputy Speaker. Undergrads to speak to amendment 24 Undergrads to speak to amendment 24 in my name. I would like to start by thanking the Member for inviting me thanking the Member for inviting me to be a member of the committee. I accept the principle that someone given six months left to live should given six months left to live should be able to choose the moment that they die with their loved ones around them. This is not a vote on around them.

This is not a vote on the principle we are not being asked to make an arbitrary use of trust, to make an arbitrary use of trust, for we are legislators. And my experience in the bill committee tells me that this bill, as in Britain, still requires additional safeguards also to address the concerns so many people in this

13:08

Daniel Francis MP (Bexleyheath and Crayford, Labour)

- -

concerns so many people in this country have. For me, it was death. And my thoughts and concerns about what happens when I die that drew me to it.

**** Possible New Speaker ****

I will not because the time is short, I am sorry. It like a small number of members in this House, I know that the concerns when you are know that the concerns when you are a parent of a child with complex disabilities including a learning disabilities including a learning disability. That concern lives with you every single day of your life. you every single day of your life. That concern about what will happen to your child when you are gone.

About who will assist your child because of the help they require due because of the help they require due to their development all capacity, due to the difficulties they have communicating, and the difficulties they have interpreting the information, the concern that wants information, the concern that wants me every single day is who will make and how will they make those decisions to support my daughter when my wife and I are gone. That concern which is shared by thousands of others, that the Mental Capacity Act was not through the scenario.

Act was not through the scenario. When you are the parent of someone with a learning disability, you become accustomed to supporting them in their decision-making. You understand their site and communication. You understand their language needed to help them make a decision. The Mental Capacity Act rightly has a low bar to allow individuals to live a fulfilling life. Because we want individuals to have their capacity assessed, to purchase money from the bank. I have read countless times this issue and it has never been challenged, in fact it has been accepted, that this would be, the following scenario, it would be absolutely possible to occur.

And an adult with a learning disability discovers have less than six months to live. They have a mental capacity that allows them to make many decisions in life. They have enough capacity to understand they could be a burden on their parents and their elderly parents might take the view that they require support to make the most complex of decisions. Yet their son or daughter, because they would be assumed to have capacity, have the principle of the Mental Capacity Act, could go through the entirety of this process and the first time their parents would be aware is when they have been informed that their child has been assisted to die.

It is for that reason that I also support amendment eight, 10, and 33, in the names of my Honourable Friends relating to family members being aware of the process. Furthermore, because rentable two of the Mental Capacity Act states that a person is not to be treated as unable to make a decision unless all article steps to help them have been taken without success. It is again accepted during the committee process that doctors would have to assist individuals in this scenario to make that decision about assisted living.

And provide lived experience I would agree how some experts of the Mental Capacity Act are currently being carried out given I often have to talk to professionals to do my job as my daughter has less or more capacity than she actually has. I have accepted she would not have enough capacity to go through the process, but the vast majority of people with learning this abilities in this country, are not in the same position and could not apply for assisted death. The bill committee heard from many people, Doctor Rachel Clark raised her concerns my Baroness Falkner give evidence in the human rights commission and said that capacity was a very serious consideration and Dr Jamilla Hussain gave evidence of one palliative care team deeming her capacity while another team in the same person did another.

We have Professor raising his concerns. Dr Price raising her concerns. And in the last week we have seen the Law Society say that Parliament should fully consider how the Mental Capacity Act would operate before any legislation is passed. The Royal College of Psychiatrists saying they do oppose this legislation as it stands and they oppose it particularly on mental capacity aspects because it does not correlate with the Mental Health Act under this legislation as it should and Royal, physicians coming out in the last few days to support it.

Now, I conclude by saying that I have heard a lot in this debate in the last six months about choice, compassion, and dignity. But what about the choice, compassion and dignity of the people I described? I fundamentally believe it is my job, that it is all our jobs, to protect the most vulnerable. And I believe that this Bill as it stands out to do that. I have every sympathy for somebody at the end of their life, as I have said.

I believe that they should have the right to go on their own terms, in their own time. But are there sufficient safeguards to ensure a response to those? Two the Parliament. To make their voices heard. That we do not fully consider every scenario to safeguard those that do not have those links and do not have a voice? If that choice comes at the price of one person in a borderline capacity decision, presumed to have capacity, it will be one death too many. That is my view that this is not a price worth paying stop and, for that reason, I implore colleagues to support my amendment.

**** Possible New Speaker ****

Can I urge the last few remaining members who are going to get in to keep their remarks brief, please.

**** Possible New Speaker ****

Carla Lockhart. I come to do, what more can I say than what I said in the previous than what I said in the previous debate? The effort is much lower because as the committee has because as the committee has progressed, the bill and the intentions of the bill have been exposed over and over again. exposed over and over again. Amendment safeguards and words Amendment safeguards and words championed in this place has been set aside and this place we were told that the committee considering the bill would balance, get the make-up did not reflect intentions.

make-up did not reflect intentions. 55% of MPs will for 61% of the committee supported it. The mask has slipped time and time again, with one of the biggest blows to the bill one of the biggest blows to the bill that the public need-to-know listening to this debate today that in the previous debate it was Labour in the previous debate it was Labour for approval via High Court judges as being the strongest safeguard, yet this safeguard has been removed with the panel of psychiatrists now being legislated for, so the voluntary panel at that, so it has been replaced, judges who have an impartial responsibility have been replaced by a voluntary panel, which could well leave enthusiasts for assisted dying, and with the Royal College of Psychiatrists now having said there is not even enough sufficient supply for such panels, so I want to be absolutely clear this bill is immoral.

If it is passed at a future date, it will create a publicly funded, goldplated assisted suicide service which gives the ability to give a legal drug by the state to end one's life. It goes against my strong question and that of my constituents and across the While I note the intentions of new clause 10, for the many healthcare professionals who wish to pay no part, it does not go far enough. Members across this House have regularly remarked that in his conscience vote for money, parties, and we must respect one another's views but if we are committed to allowing conscience right in this place we must also ensure conscience is protected outside this House.

My deep concern with new clause 10 which has been portrayed by the sponsor of the bill as a safeguard does not replace or disapply amendment 341 past at committee stage which while removing any duty of referral for healthcare professionals still requires healthcare professionals to point people in the direction of where they can obtain information, and have a preliminary discussion about assisted suicide. Not only does it repeat this requirement it reinforces it by insisting that new clause would not affect any duty relating the requirement to provide information.

This concern of conscience was raised earlier this week by the Royal College of Psychiatrists in its press release. Announcing its opposition to the bill, setting out its concerns that

13:18

Carla Lockhart MP (Upper Bann, Democratic Unionist Party)

- -

clinicians are still required to signpost patients to information on assisted suicide. The Rockwood noted for some psychiatrists who wish to contentiously about, these concerns contentiously about, these concerns will not be allayed by new clause turn when those representing turn when those representing clinicians express such concerns we clinicians express such concerns we ought to listen to them. Listen to the professionals. And I encourage members to listen to the Royal College and also listen to the 250 College and also listen to the 250 GPs who are opposed to it.

Moving to amendment 100 and, and a word to the Down Syndrome unity, the Down Down Syndrome unity, the Down Syndrome research foundation said we are deeply concerned that the risk are deeply concerned that the risk of coercion and undue influence, in particular with Down Syndrome and particular with Down Syndrome and intellectual disabilities, but a significant risk of coercion and undue influence, because of their native trust and reliance on caregivers and professionals. I cannot comprehend why the lady cannot comprehend why the lady declined to accept an amendment at committee which would have provided explicit protections for people with Down's syndrome.

Again highlighting the flows and the risk of coercion. The reality is that vulnerable and cannot be fixed. It is weaker than before the committee began and I would encourage all those concerned, members that recognise that this bill is flawed and that no amendments, no tightening up will ever make it right to legislate to ever make it right to legislate to end one's life with illegal drug. -- With a legal drug.

13:19

Points of Order Dame Meg Hillier MP (Hackney South and Shoreditch, Labour )

- -

Point of order.

**** Possible New Speaker ****

We appreciate the huge challenge for you and the speakers office for you and the speakers office chairing this debate. This normal for private members bills that the debate continues on an orderly and debate continues on an orderly and proper fashion so everyone can have their say. We appreciate it is more challenging in these circumstances. challenging in these circumstances. We have heard many times running out of time, members not taking interventions because of concerns about time and the informal time limit dropped.

The frontbench still needs to speak and it is in the power of the chair to refuse any suggestion of a Closure motions. I would put, I would like to ask the chair if there was thinking going on about whether this debate can continue. Many movers of amendments continue. Many movers of amendments have not yet been called to speak and I for one would like to hear their points of view.

**** Possible New Speaker ****

their points of view. I thank the for her point of order. I hope she would not wish me to anticipate any decision on a to anticipate any decision on a Closure motions at the current time. She makes a valid point that any members will be disappointed in members will be disappointed in wishing to speak. But she will also know that there will be further debate on the second grouping on this bill.

**** Possible New Speaker ****

Point of order. This is the last debate on these amendments and that is my concern. amendments and that is my concern. And it is in the control of the Speaker whether or not to grant a photo on a Closure motions. I simply

**** Possible New Speaker ****

make that point. Can I reassure the that I have

**** Possible New Speaker ****

Can I reassure the that I have heard her point and I repeat I am not going to make a pre-decision on not going to make a pre-decision on any Closure motions that has not yet any Closure motions that has not yet any Closure motions that has not yet I will be very clear because I'm aware we are trying to fit in as many people as possible. Can I address a few issues around the assessment of capacity under an C9. assessment of capacity under an C9.

And I would point out that this whole bill, one of the key things whole bill, one of the key things about assessing capacity is, in most cases of capacity, as addressing as cases of capacity, as addressing as a doctor, it is very clear-cut. You either have capacity or you don't

13:21

Dr Simon Opher MP (Stroud, Labour)

- -

either have capacity or you don't and that is quite easy to establish. There is a small number of patients where it is more difficult. And by amendment to this act through the committee we now must refer that person to a consultant psychiatrist for an assessment by a specialist. And so they then are in the best position to assess both very difficult points of capacity. That very much strengthens this bill as to what it was. I would also like to very briefly talk about new clause 1, particularly.

As doctors, we must under our ethical obligations give options to patients and if we are absolutely forbidden from doing this, and this will make it a crime to do this so you could be convicted of doing this, this totally wrecks the doctor-patient replacement, it's unprecedented and unworkable. No, I can't give way. I'm going to quickly go through this. That is why the BMA are against that new clause and there is also no duty for doctors to raise this issue either but they shouldn't be any ban on them doing so either.

And as I have already pointed out, they did introduce the so-called gagging clause in Victoria as part of the legislation. However, after five years that has now been removed-independent review because it caused confusion and it harmed patient care. So what I would say is patient care. So what I would say is that... I urge colleagues, you must vote against new clause 1. Let us respect the patient right to information and not restrict it. It has to ensure that no patient is

**** Possible New Speaker ****

left suffering simple because they didn't know what to ask and that no doctor is punished for trying to help. Many thanks for giving way. On that point I have particular concerns... Can I just clarify whether the jab was giving way.

**** Possible New Speaker ****

Sarah Russell.

**** Possible New Speaker ****

Sarah Russell. Thank you for giving way. Does he agree with my concerns about new clause to which although I know genuinely are well intended is in danger of being read together with new clause 1 to indicate that new clause 1 to indicate that children, that there should be not be discussed with children at all,

**** Possible New Speaker ****

be discussed with children at all, even if they raised it first because of the difference between the wording of the two clauses. Sorry, I agree, any restriction around the doctor-patient relationship will harm patients, so Thank Thank you. Thank you. I Thank you. I rise Thank you. I rise to

13:25

Sarah Olney MP (Richmond Park, Liberal Democrat)

- -

Thank you. I rise to speak Thank you. I rise to speak in support of Amendment 87 in my name, and in support of various amendments in the names of other members which I have signed. Try to this I have signed. Try to this legislation being laid before the House I had not held strong feelings about the issue of assisted dying. I listened carefully to the arguments on both sides, including those of on both sides, including those of the many constituents who wrote to me on the issue, before deciding to vote against a second reading.

I made my mind up late in the day, I made my mind up late in the day, I continue to be appreciative and respectful of the reasons why people are in favour but for me, the fundamental question was whether a not we were putting vulnerable not we were putting vulnerable people at risk of -- by passing this legislation and I resolved that on balance we were. The memo was keen to affect the balance of opinion across the House as well as in across the House as well as in parties and the make-up of the bill of the committee and I was happy to volunteer as the only LibDem Novotel, as a service to my party Novotel, as a service to my party and House.

It was a privilege to serve on the committee and I wish to put on record my admiration to all those members, ministers, chairs and house staff, and my thanks to the house staff, and my thanks to the many witnesses who gave evidence. I regret to say that the experience has hardened my opposition to the bill, my position is not rooted in the fundamental objection to the principle of assisted dying but in the approach taken to framing this particular piece of legislation. Amendment 8760 not the arrangement around the first declaration to rule around the first declaration to rule out the possibility of Doctor shopping.

We heard from the Chief Medical Officer during the oral evidence sessions, that a diagnosis of terminal illness and a prognosis of life expectancy cannot always be made with a high degree of accuracy and that a degree of professional judgement is required on behalf of the coordinating doctor. This can Of diagnosis and prognosis and this is backed up by the Royal College of physicians this week, the spokesperson was quoted in the time saying it's extremely hard to tell if someone only has six months left to live.

So my amendment seeks to establish whether the patient has already sought and been refused permission to see an assisted death so the coordinated doctor can consider reasons for the first refusals and whether the patient circumstances have materially changed since that time. This will help to inform the clinical judgement needed to be made in each visual case and discourage patients from applying to multiple doctors for an assessment. I'm proud to support amendment 24 and the name of the men before Bexleyheath and Crayford which disapply is the presumption in the Mental Capacity Act that a person has capacity unless the opposite is established.

There was a great deal of debate at committee about the efficacy of the Mental Capacity Act and whether it's provisions were sufficient to establish capacity to make an informed decision about whether or not to seek an assisted death, the member for Bexleyheath spoke compellingly about his own experiences of how the Mental Capacity Act is not applied effectively always and I'm glad the House has had an opportunity to hear him. The Royal College of Psychiatrists cited the insufficiency of the Mental Capacity Act is one of the nine reasons for opposing this bill earlier in the week.

They said capacity act was created to safeguard and support people who do not have the capacity to make decisions about their care or treatment or dislike finances. Should the bill become law in England and Wales imprecations for both the Mental Capacity Act and Mental Health Act need to be considered. I am also supporting new clauses 1 and two in the name of the member for Hackney South and Shoreditch which prohibits health professionals from raising the subject of assisted dying. It is my personal belief that people's rights to pain relief and palliative care towards a natural and should be prioritised above and assisted dying pathway that young people under the age of 18 should not be thinking about assisted dying as an alternative to continued treatment of palliative care.

I was disappointed my post amendments to safeguard people suffering from eating disorders were rejected. Eating disorders are primarily a mental health condition but have an obvious physical impact. There's a severe risk the physical impact of an eating disorder can be diagnosed as a terminal illness when in fact eating disorders are always treatable. We cannot allow vulnerable suffers eating disorders to elect for assisted death when there remains a possibility of a full recovery and the chance of a happy and fulfilling future, and that is why I supported amendment 14 in the name of the member for Bradford West he was such an ticket member of the Bill committee.

I was glad to hear from the lead member she's going to adopt that amendment and I look forward to seeing the further drafting. Supporting amendment 16 in the name of the member for Vauxhall and Camberwell Green. I welcome the new clause 10, that extends the right to refuse to Dying to any person but it's important the right is extended to all organisations such as hospices and car homes. Assisted dying undermines the mission and purpose of these institutions and they should have the right to refuse to provide on their premises if they do not wish to participate.

We shall speak in favour of amendment 22 in the name of the member for Shipley. There is insufficient provision to identify and seek to ameliorate mental health conditions or other factors that may seek... May seek people to seek a premature end to their lives. I believe every time a person seeks to end their life prematurely is deeply regrettable and we have a duty to explore whether there are preventable factors that can be addressed before a request for assisted dying is granted.

**** Possible New Speaker ****

As been the case throughout the consideration of the bill, the consideration of the bill, the opposition have not taken the position on the principle of the bill and not take a position on any

13:29

Dr Kieran Mullan MP (Bexhill and Battle, Conservative)

- -

13:42

Division

motion, I will decide whether to accept it. The fact there are many amendments to have been spoken to, that is not unusual and that is why it is not a normal procedure. This is going on further days to discuss that further dates, and of course,

**** Possible New Speaker ****

later today. I would like to thank members across the house for their excellent contributions to this debate. As contributions to this debate. As members will say, this is sponsored members will say, this is sponsored by the member for Spring Valley. On the principle of assisted dying the principle of assisted dying which we have always decided is a decision for Parliament, I want to

13:43

Stephen Kinnock MP, Minister of State (Department of Health and Social Care) (Aberafan Maesteg, Labour)

- -

13:58

Points of Order

Point of order.

**** Possible New Speaker ****

I beg to move that the question now be put. The question is that the question

**** Possible New Speaker ****

The question is that the question now be put. As many are of that opinion say, "Aye", and of the opinion say, "Aye", and of the contrary, "No". Division, clear the Order. The question Order. The question is Order. The question is the Order. The question is the question now be put. As many are of that opinion say, "Aye", and of the

14:00

Closure Motion: Division

opinion say, "Aye", and of the contrary, "No". The tellers for the Ayes, the tellers for the Noes,

**** Possible New Speaker ****

Locked Locked the Locked the doors. There There is There is a There is a delay There is a delay in There is a delay in the There is a delay in the lobby. There is a delay in the lobby. Will

**** Possible New Speaker ****

The The eyes The eyes to The eyes to the The eyes to the right, The eyes to the right, 288,

**** Possible New Speaker ****

The eyes to the right, 288, the nose to the left, 239.

**** Possible New Speaker ****

nose to the left, 239. Thank you. The eyes to the right,

**** Possible New Speaker ****

Thank you. The eyes to the right, 288, the nose to the left, 239. The 288, the nose to the left, 239. The eyes have it. Unlock. The question eyes have it. Unlock. The question is that new clause 10 be read a second time. As many of that second time. As many of that opinion, say I the contrary, no. I think the eyes have it. We now come to question new clause 10 read a to question new clause 10 read a second time.

Sorry, I've just done that. We now come to amendment that. We now come to amendment eight. We now come to amendment eight and new clause 10 which has just been debated, has been selected for a separate decision.

**** Possible New Speaker ****

Move formally. The question is that amendment 10

**** Possible New Speaker ****

The question is that amendment 10

14:16

New clause 10-Amendment(a): Division

14:38

Adjournment: Condition of Stockport railway station

**** Possible New Speaker ****

reading. Objection taken, second reading,

**** Possible New Speaker ****

Objection taken, second reading, what day? Friday, 13 June. I beg to

**** Possible New Speaker ****

what day? Friday, 13 June. I beg to move that this house does now adjourn. The questionnaires of this house do now adjourn.

**** Possible New Speaker ****

do now adjourn. Thank you. I welcome the opportunity to start this debate on the commission of stop railway station and I want to thank you and Mr Speaker for granting time for Mr Speaker for granting time for this. I also want to refer the house to my register of interest, in particular from stock point particular from stock point constituency. I also thing the first point to mention this debate would point to mention this debate would be to thank all the staff at Stockport station, including the cleaners, security staff, the cleaners, security staff, the engineers, the ticket office staff members, platform safety staff and everyone else in the retail outlets

14:38

Navendu Mishra MP (Stockport, Labour)

- -

14:57

Simon Lightwood MP, Parliamentary Under-Secretary (Department for Transport) (Wakefield and Rothwell, Labour )

- -

**** Possible New Speaker ****

calculations the Treasury does. Obviously we want to see growth at every corner of the country and at every corner of the country and I'm sure we will be waiting as everybody else the Spending Review outcomes. We are aware our partners will have their own priorities for the future of railway in the areas and we are open to engaging directly with them on their plans, the core aim of the Stockport station redevelopment scheme is to support future increases in rail patron edge and green travel and drive clean and sustainable income growth.

It will improve the accessibility, attractiveness and usability of Stockport station and reduced town centre severance. There is an opportunity to leveraged package of works through the greater Manchester authority sustainable transport authority sustainable transport settlement funding for delivery by March for delivery by March 2027. Which would include a refurbishment of platform buildings with a focus on platforms one and two. Stockport Council, network Rail and Avante are meeting today to further go about this work was the Avanti West Coast have funds available for the current financial year to undertake works that will focus on staff facilities that need upgrading and also accessibility enhancements at the station and will share further information as these plans are developed.

I thank the Member for Hazel Grove for his intervention touching on passenger assistance, Avante has seen a significant increase in passenger assistance over the last 12 months, now reviewing the passenger assist process so they can meet the needs of passengers on that service.

**** Possible New Speaker ****

I thank him for making that point and I had a conversation with Avante recently about passenger scheme. The recently about passenger scheme. The West Coast Mainline and service is a major network in this country and I think we should welcome, Bunty should welcome more disabled people should welcome more disabled people want to use the services and I'm told by members of staff at the station that one member of staff at the station with 3.8 million entrances and exits on the part-time entrances and exits on the part-time basis of passenger assistance I'm sure he will grieve me that's not

**** Possible New Speaker ****

good enough under vanity need to do -- of 'Love Nwantiti' to do a lot better. Wants the railway that is

**** Possible New Speaker ****

Wants the railway that is accessible to everyone. I want sea transport system that is accessible to everyone and I'm sure we will to everyone and I'm sure we will take away his comments on this individual case and discuss it further with the rail minister. I also thank the member who discussed the accessibility challenges that she has raised can I also found she has raised can I also found looking forward to meeting with the Nathaniel Yates who my honourable friend rightly highlighted for his work on accessibility.

I will talk a little bit about some of the other major works carried out by network Rail in and around Stockport full stop is currently delivering a £20 million project to rebuild the Greeks great bridge which carries a major road junction over the Manchester spur of the West Coast Mainline and in Stockport throughout the work network Rail has kept the community informed with regular drop-in events there been well attended and received no complaints since the closure of the road. The project team have excellent presence on site regularly checking in to reduce the impact on the works as soon as possible.

**** Possible New Speaker ****

He is being extremely generous as I mentioned in my speech I welcome the £20 million investment at the Greek Street bridge, I also welcome the £1.1 million investment to clean the £1.1 million investment to clean the viaducts, but if we are being honest the Greek Street bridge and the viaduct are not part of Stockport state station, they're an essential part of the railway essential part of the railway network that I want to see real investment at Stockport station for passengers and staff member so I hope network rail watching this and hope network rail watching this and

**** Possible New Speaker ****

hope network rail watching this and I hear what you are saying. It is important that we look at the important that we look at the system, including the £1.1 million to refurbish the viaduct hilt in to refurbish the viaduct hilt in 1840. Let's move on to the issue of 1840. Let's move on to the issue of step free access at Heaton Chapel because I know my honourable friend is interested in that. Since its launch, the access programme has delivered step free access at more than 260 stations across Great Britain.

Only around half of great British stations have step free access, and in between platforms, however, there was 50% in 2005. My honourable friend engages with Northern trains to propose that Bridlington, Heaton Chapel and Redditch South are priority in future rounds of funding as none of the stations were nominated to the last round of funding. In the meantime, the Department will seek further opportunities to improve rail accessibility and if the industry installs replace infrastructure at the stations, this will need to comply with the current accessibility standards.

On the issue of services provided at Redditch South, the Department expects operators to match capacity and frequency of their services to demand. These must also be operationally sustainable and deliver value for taxpayers. We know partnerships as we managed the contract with northern trains which serves Redditch South and well served business cases put forward. This was bound for social benefits of any enhancement with the performance of existing services and the financial impact on taxpayer subsidy. Moving onto the direct service into Manchester airport, an issue I know my noble friend is keen on.

The Sheffield Manchester airport service was withdrawn in December 2022 as part of the timetable developed by the Manchester task force includes DfT, the trade operators Network Rail, transport for Greater Manchester and transport for the North. We see improved connectivity as an important factor in growing the national economy and we hope that new infrastructure will allow services from stop port to the airport. Though I must stress that there could be other towns and cities making a case for their pre- 2022 direct connections to be restored.

I want to thank my friend again for this debate at which we have discussed a number of important issues affecting rail services in these constituencies. I visited not once but twice to his constituency, and I hope it doesn't take it personally that it was a sitting dear. I will do my best to return to Stockport as long as the member can

**** Possible New Speaker ****

guarantee that the sun is shining. The question is that this has to now adjourn. As many that opinion now adjourn. As many that opinion say I the eyes have it. Order,

Feed Live - Click to view video

Return to start of debate - Return to top of page