Commons Chamber

Friday 13th June 2025

(began 4 months, 2 weeks ago)

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09:34
09:35
09:36
None Portrait Private Members' Bills: Terminally Ill Adults (End of Life) Bill: Remaining Stages
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the orders of the day. Terminally ill adult end-of-life

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bill to be further considered. Now.

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Now. Before we begin I would like to say a few words about today's proceedings. We will begin at the proceedings. We will begin at the point we ended on Friday 16th of May, the decision to be taken after the debate on the first group of the debate on the first group of amendments. I will put the necessary questions without further delay. After that debate, on the second group of new clauses and amendments, I remind the honourable member that the scope of the debate will be the amendments and new clauses in that amendments and new clauses in that group.

We have nearly 60 members who have indicated that they wish to speak in the debate. Not all honourable members will be called. honourable members will be called. It is not customary to impose a speech time limit on Private Members' Bills. But I hope the member in charge of the bill and the speakers after her will restrict themselves in the early part of the debate. Including taking interventions. The Chair will keep it under review as the debate progresses. And I will say now, that if the chair back feels that people are taking advantage of the chamber, a time limit will be imposed.

I hope you don't have to do that. I do not expect to call the front benches to speak until at least 115. I also confirm that I have provisionally selected for separate decisions of all the propositions in the name of Kim Leadbeater, the member in charge of the bill. I've also provisionally selected the following separate decisions on new clauses. Amendments B to new clause 14. New clause 1, two, and 16. I will make further announcements for separate decisions on amendment at an appropriate point.

We will begin with a question that new clause 10 will be added to the bill which was debated on Friday 16th of May. The question is that new clause 10 be added to the bill. As many are of that opinion say, "Aye". And of the contrary, "No". The ayes have it. The ayes have it. We now come to new clause 11 which was debated on Friday 16th of May. It has been selected for separate decision. I call Kim Leadbeater to move formally that new clause 11 be read a second time.



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Moved formally. Coordinating where an unwilling

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doctor is unwilling or unable to act. The question is that new clause 11 be read a second time. As many 11 be read a second time. As many are of that opinion say, "Aye". And of the contrary, "No". The ayes have it. The ayes have it. Question is that new clause 11 be added to the bill. As many are of that opinion say, "Aye". And of the contrary, "No". The ayes have it. The ayes "No". The ayes have it. The ayes have it.

We now continue clause 12 which will be debated. It has been which will be debated. It has been selected for separate decision. I call Kim Leadbeater to move

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formally. Report for assistance not provided because coordinating doctor not satisfied with all relevant

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matters. The question is that new clause to be ready second time. As many are of that opinion say, "Aye". And of of that opinion say, "Aye". And of the contrary, "No". The ayes have it. The ayes have it. The question is new clause be added to the bill. As many are of that opinion say, "Aye". And of the contrary, "No". The ayes have it. The ayes have it.. We come to new clause 13. It will be convenient to consider the other selected new clauses amendment and group two is listed on the selection paper.

I call Kim Leadbeater to move.

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Moved. Thank you Mr Speaker. It is a privilege to open today's
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Kim Leadbeater Portrait Amendment: New Clause 13. Kim Leadbeater MP (Spen Valley, Labour)
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know colleagues wish to speak today I will endeavour to speak with brevity to the new clauses in my name. Starting with new clause 13. This important new clause and related amendments greater regulatory framework and safeguard round the approved substances referred to in the bill. By imposing a duty about regulations, and use in connection with the self administration. Amendment 72 provides that the regulations related to approved substances are subject to the affirmative procedure, meaning they must be laid before Parliament and approved by resolution of both houses.

Providing important pulmonary oversight. These amendments ensure that the substance used in assisted dying are subject

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to appropriate dilatory regime. Patricia Ferguson.

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Patricia Ferguson. Thank you Mrs bigger. I am generally looking for clarification, generally looking for clarification, as a former cabinet minister I guard the devolution settlement. I wonder how the extension of some of these clauses to include Scotland will be clauses to include Scotland will be interpreted? I would like to know what conversations have taken place between the member in charge and Scotland's Lord Advocate and also

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the Scottish Government? I thank her for that intervention. I have taken legal intervention. I have taken legal advice from government officials to ensure that devolution is respected at every stage of the proceeding. When legislation does need to be amended that affects the jurisdictions, those conversations jurisdictions, those conversations have already started and will continue. I will make some progress. In terms of the substances that will be used, they will not be new substances. As we know assisted dying is available in many other jurisdictions, and there are substances which have been used safely, and in some cases, for many years.

Their safety has improved around the world. They do need to be treated differently which the purpose of the new clause. It is most likely that these products are already licensed for other purposes and they could well be regulated through the MHRA and within the regulations for the purpose of the bill. It is important that time is given.

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I thank the honourable lady. As someone with more than 20 years someone with more than 20 years experience as an ATP, I want to emphasise that controlling and administering drugs is an important part of every of care professionals part of every of care professionals practice. Management is front and centre do we do when we are handling centre do we do when we are handling drugs. Does she agree that the safeguards added to the bill along with the existing frameworks are

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with the existing frameworks are more than adequate to deal with this? I thank her for the intervention and sharing her expertise. And along with other colleagues with medical with other colleagues with medical backgrounds on this amendment. I'm backgrounds on this amendment. I'm going to make some progress. Given what the speaker has said. I now what the speaker has said. I now turn to new clause 14. There are a turn to new clause 14. There are a lot of people who want to speak.

And amendment 73. This clause imposes a duty to make regulations prohibiting advertising of services relating to voluntary assisted dying. This issue was discussed at Bill Committee following amendments tabled by the envelope of West Worcestershire. It was proposed that should be no advertising assisted dying services was I agree there was consensus on the Bill Committee. The previous amendment and issues around workability, termite committee return to it at report stage hence this new clause. Amendment 73 provides that new revelations under clause 14 are subject to affirmative procedure providing pulmonary oversight.

I want to thank your member for West Worcestershire.

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Thank you. When it comes to the evidential base, this week 'The evidential base, this week 'The Times' page 15 there is a story of a man who was born in South Africa and man who was born in South Africa and lived in Australia and has come to London today and this week for this particular bill to give his story. His story is he was diagnosed with cancer and only two weeks to live. He lived for three years and one month and is still living.

There's an evidential basis that is going. He said he was never afraid to die but he said he is afraid of the but he said he is afraid of the process of dying. With the process of dying. With the honourable Lady acknowledge the evidential base and the importance of the subject and the evidential base against this bill is growing?

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base against this bill is growing? I thank him I'm not sure it is quite relevant to the advertising in terms of assisted dying services. I'm afraid I'm going to make some progress based on the number people that want to speak today. I want to thank your member for West Worcestershire and a member for Reigate working with me on this amendment. I'm pleased that they are supporting it. Moving onto new clause 15 and amendment 54, these amendments make changes to the courts and Justice act.

Insert a new clause into the act to provide that deaths that occur in accordance with the bill will be certified by an attending practitioner and medical examiner. They will not be subject to an investigation. Currently suspicious deaths investigated by coroners. In situations where the cause of death is unknown. Assisted deaths will not fall into these categories and there will be no need for a default investigation. This ensures avoiding unnecessary delays and distressful bereaved families. These are not unexpected deaths.

They are sadly inevitably going to happen. It is the manner and time of their death and about which the patient will make a legal informed choice having been assessed. As a professor has said, I will not think of any death that will be subject to greater scrutiny than an assisted death. The process far exceeds the level of safeguarding in place for many of the deaths that are at present routinely reviewed by medical examiners and not referred to a coroner. Anyone can report a death, including an assisted death to the coroner or to the police if they have any concerns but it was not carried out in accordance with the act.

If any offences have been committed they will be investigated. Section 2 of new clause 15 requires that the medical certificate of cause of death must state the death as an assisted death, but must also recall the illness or disease which caused the person to be terminally ill. This is important for data collection and monitoring. The jurisdictions with similar legislation, around 70% of patients have some form of cancer, and this amendment will ensure that data was collected not only relation to how many people were accessing assisted dying but the terminal illnesses would make them eligible.

I now come onto new clause 20. Including with onto new clause 20. Including with Right roles and responsibilities sit with the right people. It issues guidance with the Secretary of State and enables Welsh ministers to issue guidance on devolved matters. The Secretary of State must consult medical officers in order to have the benefit of their expertise which is really important. New clause 20 as provision that ensures that the Secretary of State must consult people with learning disabilities and people with protected characteristics which includes disability, race, religion and belief.

They must also consult providers of Health and Care Act services. This includes palliative end-of-life care, and I'm really pleased that hospice UK are supporting this amendment. It is very important that those voices are heard. The Secretary of State can consult anyone they feel to be appropriate, creating a holistic approach. Coming onto devolution, this long overdue reform would apply to England and which share a criminal justice system. Health is devolved and I recognise from the outset that the legislation must respect evolution and I look at the same conventions that the government would if this were government bill.

I've worked with officials to make the right steps are taken by the right people was engaged with colleagues, met with the Welsh minister in Cardiff, and there will be ongoing detailed discussions between the two teams of government officials to ensure work ability of legislation in both jurisdictions in line with the devolution settlement. Moments 92 to 94 also ensure that the devolution settlement is respected and adhered to. I want to thank the honourable members for thank the honourable members for their diligent work on the Bill committee but also for working with me on the amendments in relation to Wales.

And the Welsh government for their guidance and support. I hope colleagues across the house will support these new clauses and amendments. I now turn to new clause 21 which makes provision about the use of the Welsh language. The conversations that happen at the end of a person's life are extremely personal and should be handled with the utmost sensibility. They are conducted in the best interest of the patient and a big part of that is by using clear communication, and in this respect, language matters.

If a patient in Wales has Welsh as their first language or if it should be made to ensure they can communicate with voluntary assisted dying services in Welsh. I commit to this and have made good on that commitment. Coming on to amendment 76 and 77, as with any bill, it is important that we are amending legislation to secure overall coherence with the statute book. As such, the clauses relating to medicines, advertising and employment protections amend or confer power for legislation that currently extends to parts of the UK.

This doesn't mean the provision of assisted dying, but for example, it extends the prohibition on advertising to the whole of the UK and provides the employment protections in this bill to Scotland. This is the guidance I have received from legal experts, and as such, I hope all colleagues can support these amendments. If the bill passes in the same way as I have worked with the Welsh government, I will work with other devolved Administrations to ensure devolution is respected. Mr Speaker, that concludes the explanations for the amendments tabled in my name.

And I know there are many colleagues the decay to speak on the debate today, so I'm not going to comment on all moments in the group, but I will just make two comments on moments that are not in my name, allowing other people plenty of name to speak. Amendment 42 from the member for Newcastle-under-Lyme not only tries to remove the backstop and the provision of assisted dying in England but it creates a number of issues. If Parliament chooses to give this choice are terminally ill people, they cannot be a clause in the bill that would prevent it being available sooner cities safe and practical, that this amendment would remove the four year backstop.

It would also prevent the payment of the voluntary assisted dying Commissioner and create a potential commencement gap between England and. As such, I've been advised that this amendment would create work ability issues, and I are colleagues who want an operable bill to join me in rejecting it. To finish, I am pleased to support amendment 21 from the honourable member for Twickenham and I thank her for her engagement with the bill and this amendment which would require the secretary of state to prepare and publish an assessment of the availability, quality and distribution of palliative and end-of-life care as part of the first report on the implementation of the act, mirroring the assessment required as part of the five year review.

Whilst the bill seeks to address what is a very specific issue in terms of the feelings of the current law, it has become part of a much needed broader conversation about death, dying and end-of-life care. We all have our own experiences of death, loss and grief, and it is something that we don't talk about enough. I am pleased this bill has led to many conversations up and down the country which will be a positive thing. I have had many such conversations over recent months, including the palliative care doctors, nurses, hospice staff, GPs, hospice UK and Marie curie who are supporting this amendment, and I would like to thank them all for their constructive engagement with the bill.

I cannot imagine there is anyone who is not truly grateful for the outstanding work done every day by the wonderful people working in palliative and end-of-life care in every one of our constituencies. Many or most of us will have personal experiences of the kindness and compassion they have shown to our own family and friends but this is not an either or conversation. Palliative and end-of-life care and assisted dying can and do work side-by-side to give terminally ill patients the care and choice they deserve in their final days.

So in the same way that they should not be an either or for dying people, it should also not be an either or for us as legislators to choose between supporting assisted dying or other end-of-life choices, and that is why I am supporting member 21 to assure that we channel our energies in this place to supporting all the options available to terminally ill people, something which I have always committed to do. Thank you.

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Regulation of abused substances and devices.

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and devices. The question as the new clause 13 we read a second time.

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we read a second time. It is a privilege to be called at this stage in the debate. My this stage in the debate. My principal reason for voting against the bill at second reading was my concern that vulnerable people would concern that vulnerable people would be put at risk. I agree to serve on the Bill committee so that I could the Bill committee so that I could allay my concerns about this and address some of the issues raised by address some of the issues raised by others.

I do not think that the revised version of this bill properly or complete reflects the properly or complete reflects the concerns expressed on a multitude of different occasions, and consequently does not fully mitigate the risks to vulnerable groups. We all recognise the decision-making of all recognise the decision-making of any kind is not take place in a vacuum and that in all parts of life, we live in a particular context. The Equality Act 2010 recognises that many people face discrimination or unfair treatment as a result of particular characteristics and that reasonable steps should be taken to eliminate this.

It was very clear from the oral evidence sessions that
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Sarah Olney Portrait Sarah Olney MP (Richmond Park, Liberal Democrat)
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particular care has to be taken to assess the context which people are seeking assisted death. If they suffer from a mental illness or an eating disorder, if they are from a low income or ethnic minority low income or ethnic minority background, if they suffer from a disability or if they are in an abusive relationship. These factors are likely to lead to an increased risk that someone will seek an assisted death which they would not assisted death which they would not have sought if those factors were not present.

The point was made by myself and others during the myself and others during the Committee stage that it would have been desirable to have received an equalities impact assessment before the detailed work of committee the detailed work of committee scrutiny had begun so that the committee members had a sense of how the proposed legislation would impact those groups that we know can impact those groups that we know can suffer a disproportionate level of disadvantage. We were told it wasn't practical to produce it until after the Committee stage because it would be necessary to assess the impact of the assessments majoring committee, so these impact assessments were published five weeks ago and I have to say, I was pretty astounded.

The equality impact assessment makes no recognition of the fact that certain groups in this country may have their lives prematurely shortened as a result of this legislation passing. It concerns itself with the barriers people may face with trying to access assisted dying, and I find this astonishing. The people who draft this not hit the speech from Vauxhall and Camberwell Green when she spoke with passion about the underlying equality of access to healthcare experienced by those from black and minority ethnic backgrounds would be exacerbated if this bill passed and amended.

Today not listen to the oral evidence of Dr Jamila Hosein where she talked about her experience of working with racialised communities in Bradford and their fears of being pushed disproportionately towards an assisted dying pathway, or the testimony on the experience and concerns of disabled people, testimony which has been echoed by Liz car. It is inexplicable to me that the impact on vulnerable people should be framed as removing barriers to accessing assisted dying and not as it should be the increased risk to their health and well-being that the passing of this legislation presents, and I am concerned that we are thinking about the impact on vulnerable people solely with reference to those who are suffering a terminal illness with fewer than six months to live.

We are not thinking about the impact on wider society of introducing a concept of livestock being life worth living and how that might not disproportionately affect vulnerable communities, so my new clause 19 and Amendment 88 seeks to ensure that a comprehensive range of statistics are collected about those who seek and receive an assisted death so that proper and complete monitoring can be carried out. It is absolutely imperative that we get the picture of who is requesting an assisted death so that any patterns of disproportionality can be addressed.



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On the point of disability and those with mental-health issues, those who are anorexic, those who those who are anorexic, those who perhaps need family assurance when it comes to this, what assurances does this bill give to the families of those people? Do we see any

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of those people? Do we see any assurances of those who want to end their lives, whether they suffer from those ailments? I welcome that intervention. I

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I welcome that intervention. I spoke intensively about the impact spoke intensively about the impact on anorexic people of this bill, and I am not satisfied that those concerns have been addressed. I have concerns have been addressed. I have been pleased to support Amendment 21 which has attracted support from across the house and requires the across the house and requires the Sec of state to report upon the impact that this has had on the healthcare available to those with palliative and end-of-life care palliative and end-of-life care needs.

I am really pleased that the member has agreed to accept this. I'm pleased to be supporting the I'm pleased to be supporting the moments of my other constituents from Wimbledon, and moments 103 and 104. These seek to make all Statutory Instrument subject to the affirmative procedure rather than a Negative procedure that is currently provided for. As it currently stands, this act once passed will come into force in four years time with no further scrutiny from MPs, and yet there are a whole host of issues that have been delegated to the Secretary of State or not even considered that will need to be legislated for after this bill has received its Royal assent.

As the bill currently stands, the only way for Parliament to scrutinise these powers article for 90 minute debate on a motion that cannot be amended and will only be voted on if the Leader of the Opposition calls for a boat. Affirmative action means that the Secretary of State can only exercise the powers delegated to them with the approval of Parliament. An issue as sensitive and as profound as assisted dying, I believe that to be an appropriate level of scrutiny. In a similar vein, I will make some progress.

In a similar vein, I plan to support the amendments in the name of the member for Tonbridge which seeks removal Henry VIII powers from the bill and from the moments introduced through spin Valley for I will support those as I do not believe that the use of Henry VIII powers appropriate or necessary. I want to speak against amendment 94 in the name of the member for spin Valley. It appears to be an innocuous amendment but in reality, it reverses the moment which I had accepted in Committee stage.

The bill as originally drafted creates an enormous constitutional minefield. The bill seeks to amend the criminal law of England and switches are reserved matter for the UK Parliament but simultaneously to make provision for healthcare which is a matter devolved to the Senate in Wales. Furthermore, the Senate debates to motion calling on the Welsh government to support the principles of assisted dying, but this was defeated by 19 votes to 26. This was a non-binding motion but it does demonstrate that this bill gives the UK Parliament the power to impose on the Welsh and it and measure that it has expressly said it does not want.

The bill as amended gave the power to the Welsh tenant to decide for itself when it was ready to bring the bill into force. It reverses that provision and deprives the Senate the right to exercise as legitimate powers. It is not just a memo 94 restores the constitutional loophole at the committee had closed, it threatens to create real problems and risks for Welsh citizens. If a Sen fails to enable the act, I urge fellow members to have regard to the committee's decision in this regard I will speak briefly about other amendments.

I remain concerned about a future Secretary of State having the power to change the NHS Act, specifically section 1 which sets out the purposes for which the NHS this. Using regulations rather than an act of Parliament. The power could be used not once but at any time to make fundamental changes to what our NHS is for. I was dismayed to see a change of this magnitude made to the bill in committee and I'll be voting for amendment 12 in the name of the honourable before Mitcham and Morden to reverse it.

Amendment 42 seeks to remove the automatic commencement of this bill after four years. The vast majority of acts of parliament, the Secretary of State decides when to bring the key provisions into force rather than its happening automatically. The effects of the provisions of this bill is even if we have a future covert pandemic or the secretary of state realises that adequate training has not yet been completed, it will still come into force. It is unusual and reckless and for that reason I support amendment 42.

Amendment 13 in the name of the honourable Member for Glasgow West requires the appointment of a new voluntary assisted dying Commissioner to be approved by the health and social care Commissioner. The Commissioner, a role created from scratch, will be high-profile and important. Having a second layer of approval will add more approval to the appointment process and provide transparency in the event of anything that arises. It is vital members of the House of opportunities to scrutinise and debate the new role which is not included in the bill a second reading.

Thank you Mr Speaker.

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Thank you Mr Speaker. For allowing me to write in this debate and speak to new clause 6. This and speak to new clause 6. This clause proposes a special representative for ethnic minorities. I am not white Mr minorities. I am not white Mr Speaker, as some of you may have noticed. The fact that my present in noticed. The fact that my present in this House is unremarkable is in and of itself remarkable. That did not of itself remarkable. That did not happen by chance.

It happens because of those that came before me. The of those that came before me. The mother of this house has spoken powerfully in this debate and I know that my unremarkable presence here that my unremarkable presence here is due to her remarkable achievements. She may not always achievements. She may not always hold the same opinions as me, but we have always shared the same labour values. She will never know how values. She will never know how grateful I am, we all are, for her.

I may be the last generation of MPs that can say this to her while she is in this House, thank you. The member for Vauxhall has spoken powerfully in this debate. The member for Walsall has put this amendment forward. I know I stand on their shoulders too. And I don't doubt their good intentions. But this bill has nothing to do with the this bill has nothing to do with the colour of my skin. New clause 6 proposes a special representative for ethnic minorities.

I disagree with this clause because the colour of my skin has no bearing, no special place in this debate. This act will be reported to the ECHR as set out in clause 51. The Secretary of State can already consult with community representatives. For every person of every skin colour, this person of every skin colour, this bill gives the already dying a choice to end their suffering. choice to end their suffering.
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Jeevun Sandher Portrait Dr Jeevun Sandher MP (Loughborough, Labour)
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We do need to make sure there are times the amendment so it is not just about the generalisation. We

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have gone past that. I think this is more 1/3 reading speed. Mr Speaker, it is to the point of

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Mr Speaker, it is to the point of where we are.

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I made that decision don't

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challenge the chair back. I apologise Mr Speaker. What I meant to say was clauses around special representative around ethnic special representative around ethnic minorities, the point I'm trying to explore is why it is that as ethnic explore is why it is that as ethnic minorities we do not require special representatives. But it is included

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in the act within clause 51. I thank the gentleman for

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I thank the gentleman for giveaway. This is a very sensitive issue. There is data to support the issue. There is data to support the fact that people from minority ethnic groups are less likely to trust their health professionals, while it is 18% among the general public. It is as high as 30% who do not think it is necessary to have this. Thus my honourable friend not think it is necessary to make sure there are additional protections for those who face additional barriers such as those from minority ethnic groups?

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It is a powerful point. Members, has spoken powerfully but the impact of ethnic minorities this bill could of ethnic minorities this bill could have. Does anyone in this house no how many ethnic minorities accessing how many ethnic minorities accessing assisted dying in other nations? I will give way on this point. The will give way on this point. The member for Richmond Park raised it

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earlier. If we don't know, it is probably because they are not collecting the because they are not collecting the data. My position is we should be collecting the data and that is why should vote for my amendment.

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should vote for my amendment. Speaker, we do know. Ethnic minorities are less likely to access minorities are less likely to access assisted dying in jurisdictions in assisted dying in jurisdictions in place. In Oregon, 10% of those using or accessing assisted dying our ethnic minority compared to 40% of the population. In California, 15% of ethnic minorities access this option compared to making up 30% of the population. That is not the the population. That is not the point.

The point of this bill is to give people the choice to end their life regardless of the colour of their skin. There is no special quality about the colour of my skin that affects my access or the need for a special live in this case. A case that is covered by the ECHR, and covered by the Secretary of State. I will give way.

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I thank the member for giveaway for the I'm quite perplexed with his speech. I would like to understand, does he have the data to reflect the actual demographics of those constituencies, of those areas, in constituencies, of those areas, in comparison to the UK? These presented to the House.

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presented to the House. I spend a lot of time around data, and I'm not sure I understand data, and I'm not sure I understand the question being asked. I think I will make a little bit of progress. I know this has been a heated I know this has been a heated debate. I know people feel strongly on each side of this House. I am so grateful for members who have come here before me who made my place impossible, who have spoken so powerfully and so humanly in this debate.

But I do not believe, and the evidence shows, that the colour of my skin does not belong in the discussion of this bill. Thank you

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Mr Speaker. Rebecca Smith.

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Rebecca Smith. Thank you Mr Speaker. I rise today to speak in support of today to speak in support of amendment to new clause 15 which is in my name. I hope honourable in my name. I hope honourable members will feel able to support. Although it seems technical, it is a SIM pool amendment with a significant impact with regards to significant impact with regards to ensuring genuine protection against the use, proper detection of coercion, and effective scrutiny of how the law works in practice.

Simply put, the effect of my amendment is to ensure that deaths amendment is to ensure that deaths from assisted dying under the bill will still fall within the coroner's duty to investigate deaths under section 1 of the Coroners and section 1 of the Coroners and Justice Act 2009. I will explain why it is so important. Like many it is so important. Like many colleagues, I have been deeply concerned from the outset about how this bill is drafted, its work
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Rebecca Smith Portrait Rebecca Smith MP (South West Devon, Conservative)
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ability, its impact on the NHS, and indeed the lives of honourable people up and down the country. To people up and down the country. To be clear, my own view is one unintended death as a result of this bill becoming law is one too many. I would humbly ask colleagues who are still considering that position, or indeed who are minded to support indeed who are minded to support this bill, to consider this point about my amendment very carefully in the round. What is unacceptable the round.

What is unacceptable error rate, given the government figures which underestimate the impact, even a 1% error rate can see impact, even a 1% error rate can see a minimum of 13 wrongful deaths in a minimum of 13 wrongful deaths in year one. With 45 year by year 10. A 45% error rate would see 65 deaths in year 10 foot 10% error rate would see 131 deaths in year one and 455 in year 10. I think these are lowball estimates but they are nevertheless chilling.

If this law is passed it will be exceptionally difficult to say whether or not to happen errors or instances of abuse. Or at the very least any errors which are picked up will be but a fraction of the true picture is tragically those who would testify to this fact would already be dead. My new clause directly addresses this issue. In England and Wales, a coroner will investigate a death when certain legal conditions are met. This duty is primarily governed by section A of the Coroners and Justice Act 2009.

His honour who served as the Chief Coroner of Finland and Wales until 2024 notes that any death was arising as a result of the administration or ingestion of a lethal substance constitute an unnatural death which the local coroner is under a statutory duty to investigate. Clearly assisted dying meets this definition, and it is right that such deaths be afforded the best possible posthumous judicial scrutiny.

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Thank you Mr Speaker. I appreciate the honourable Lady giving way. Does she not feel that giving way. Does she not feel that provisions in the bill already have the safeguarding but also most importantly does she not feel that importantly does she not feel that putting the family through a coronial process and it is an coronial process and it is an expected death is unfair, unjust, and completely beyond the bounds of

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what the coroners are meant to do? On the first point, I don't

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On the first point, I don't believe that the law is strong enough as it stands in terms of this bill. On the second point, we are ready to with the fact that families are not guaranteed the knowledge that their loved one is going to have an assisted death. So I think have an assisted death. So I think the point is not entirely to be the point is not entirely to be considered. As it stands, the bill would disapply the duty of the coroner to investigate in the case of an assisted death that has been carried out in accordance with the bill's provisions.

You clause 15 specifically would amend the Coroners and Justice Act 2009, to clarify an assisted death does not constitute an unnatural death the purposes of the act. I must say it takes an extraordinary leap of imagination not to concede a deliberately administered lethal drug is anything but an unnatural

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death. I support what she's saying. We

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I support what she's saying. We are going through a process will be considered the appalling situation of coercive control in domestic of coercive control in domestic abuse situations. A person who is a victim may not realise they have been a victim until years later. A been a victim until years later. A person who is gone through an assisted death will not have years

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assisted death will not have years later, is this a way of making sure we guard against evil of coercive control? I thank you for the intervention

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I thank you for the intervention I picking agree, this is the sort of safeguards that even the sponsor of the bill is saying should be there. I think this amendment puts it in a much stronger position.

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much stronger position. She is right in what she says

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She is right in what she says because just as those of us who are opposed to the death penalty, we are against it because we do not believe in the infallibility of the state. The state can get things wrong. Officials can get things wrong. And when they do, they should be a proven clear path as to how that wrongdoing can be identified, and try to ensure it does not occur again.

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I thank my little friend for that. The statistics I quoted earlier are pretty clear to the earlier are pretty clear to the point that he is just made. I will point that he is just made. I will make some progress. The work undertaken by the coroner is not a box ticking exercise or a bureaucratic hurdle. In the context bureaucratic hurdle. In the context of assisted dying, it is an extreme and powerful deterrent against abuse and powerful deterrent against abuse or malpractice.

To quote his honour in a letter to 'The Times' on seventh May this year, he said the seventh May this year, he said the removal of any realistic prospect of an effective inquest would magnify rather than diminish the obvious

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risks of deception and undue influence. She is making a powerful speech.

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She is making a powerful speech. She also share my concern is that Royal College pathologists have Royal College pathologists have stated in their statement about the removal of the coroner?

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I thank the member. I will now make some progress. I struggle to see how this works with a commitment see how this works with a commitment to enact legislation with the strongest safeguards in the world. By removing automatic oversight of assisted deaths, Bill sets a lower bar for scrutiny and review and bar for scrutiny and review and create an information deficit. Put another way, we simply don't know another way, we simply don't know what we don't know. Implementing a novel piece of legislation such as this without ensuring the most this without ensuring the most robust possible scrutiny of deaths taking place under the act is astonishing.

Under this bill, assisted deaths would be the outlier, as any other intentionally procured death would automatically be reviewed by a coroner. Why should be reviewed by a coroner. Why should deaths under this act be any deaths under this act be any different? Requiring automatic scrutiny from a coroner for assisted death should not be viewed as an add-on at the end of the process, or perhaps just a safety net, though it is that. I have said I'm not going to take further interventions. Rather it is imperative to consider the whole picture, particularly regarding malpractice or coercion, whether on the part of medical professionals, family, or third parties.

In written evidence to the committee, Dr Rhys Johnson, a legal expert from Essex law school highlighted that in some cultures decision-making as a collective process involving family and community members. This approach combined with the bill's provision for signing by proxy in clause 19 intentionally great opportunities for coercion and abuse particularly where family members have conflicting financial, social, or emotional burdens. Without the coroner's inquest, we would lose the ability to fully and properly investigate the possibility of where coercion or abuse took place.

In such culturally sensitive situations. Investigation of assisted deaths by a coroner is not a luxury but a vital safeguard. Without it people will fall through the cracks. Beyond coercion, automatic inquest provides vital opportunities to identify other critical issues which may not otherwise be picked up. Without the coroner's inquest will be no post- mortem examination. This is not really an academic point. Studies have shown that one in four cases have been misdiagnosed after autopsy. Without this oversight, as the former Chief Coroner notes, there is no certain means of knowing whether the improved substance has led to a quick and painless death or a lingering and distressing one.

And even whether it failed to cause death altogether and the deceased had been dispatched by manual of fixation or some other unlawful means. I'm not sure it could be more clear. In view of the experts of this area, the Royal College pathologists and the Chief Coroner of England and Wales that the proposals are not fit for purpose. I urge Honourable members to support urge Honourable members to support

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I suggest we aim for six minutes informally.

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The amendment in my name strengthens clause 14. White we want to restrict advertising about to restrict advertising about assisted dying? Not just because assisted dying? Not just because such adverts could be seen as crass or insensitive, not just because we worry private companies could worry private companies could profiteer from death but because they influence choices, and the issue of choice, whether informed issue of choice, whether informed choice or coercion or coercive control as all ready mentioned is in control as all ready mentioned is in many ways at the heart of this bill and whether it safeguards are sufficient.

My brother works in sufficient. My brother works in advertising and he knows its power. It is why companies spend billions of pounds on it, why Google is the of pounds on it, why Google is the giant it is, why you will see lots of adverts trying to influence every
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Paul Waugh Portrait Paul Waugh MP (Rochdale, Labour )
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single one of us. It is why X is full of ads. Advertising works because we are suggestible, prone to messaging, to visual cues and hints. Older people are bombarded with adverts from everything from stairlift to care home. One person's advert is another person's public advert is another person's public information campaign. It is not information campaign. It is not possible to imagine a Secretary of State in future who passionately believes in the merits of assisted dying to authorise such a campaign. dying to authorise such a campaign.

It could be a government approved plotline, and add read out by a podcast that sounds like it is a podcast that sounds like it is a news item or their own opinion. Many in this house try to protect teenagers from online harms, but the teenagers from online harms, but the online harm of a website about assisted dying shared on TikTok assisted dying shared on TikTok could be a reality without tighter safeguards.

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I think the honourable gentleman for speaking so clearly about the issue of advertising. Will he issue of advertising. Will he recognise the reason this question recognise the reason this question has banned pharmaceuticals is because we are not in the position we have had in America where people we have had in America where people are popping pills all the time because of that is the reason we are protecting patients and we need to

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protecting patients and we need to do the same with assisted dying. I agree on the dangers of what is done in America, a real lesson for done in America, a real lesson for us here. As the member for Reigate put it, conversations about assisted dying should happen in person, dying should happen in person, between the relevant doctor and the patient. They should not be prompted by a TV ad or something seen on a by a TV ad or something seen on a bus.

The member for Bexleyheath and Crayford also spoke very movingly about the way that IVF surfaces have about the way that IVF surfaces have been commercialised leaving people who are already on their knees and vulnerable to exploitation so that someone else can profit. I'm certain it will be the intention nobody in the house that passing this bill into law should mean the rise of a similarly aggressive market for assisted death, but it is our responsibility to deal not only with intended consequences but the unintended consequences as well, and I think the real risk to the way this has been drafted to allow exceptions that are not specified on the face of the bill.

A future Secretary of State will be empowered to make the necessary regulations and to amend them at any time, and a future Secretary of State who does not share the concerns of this house which have the ability to draw the exception so widely as to make the band worthless. There are a number of similar bands already in place on tobacco, surrogacy, and the latest drugs being marketed to the public. In every case, the legislation sets out the exceptions, leaving no room for doubt as to how Parliament intended that the public should be intended that the public should be intended.

Why should the services of this bill legalise not be subject to that same legal clarity? To people who have less time to live not deserve all the protection we have the power to give them from death they do not truly want? I cannot believe this parliament would be content to have that taken out of its hands and the right of our most vulnerable constituents left for someone else to decide on some other day. My amendment sets out that exemptions to the ban should be limited to cases where a person has requested information and cases where the materials are intended for health professionals and not for patients.

New clause 14 allows for a future secretary of state to make provisions that would have to go through the house and legislation. It is not at all clear why this is needed to introduce a ban on advertising.

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I support the argument and the

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I support the argument and the amendment. This is part of the exemption of promoting a service. exemption of promoting a service. The promotion of a service to doubtful fearful and vulnerable people, and that is precisely what is and addresses.

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I agree with the gentleman, and there is a wider point about the Henry VIII powers that are in this Henry VIII powers that are in this bill. They'll be one third of those added to the bill. This will be the added to the bill. This will be the third power added to this bill, and the stage had none. The Atty Gen the stage had none. The Atty Gen said that reliance on these Henry VIII powers upsets the executive and VIII powers upsets the executive and he is right.

But away from matters of constitutional principle, I am concerned the practical impact of such a power would lower Secretary of State to change the law as set out in the suicide act of 1971. This contains the offence of encouraging or assisting a suicide. Ministers have confirmed that the bill has drafted leaves the event in place except where practitioner once a person to die and a provision of the act. We must not hands the power to future Secretary of State to weaken or abolish that offence without the need for primary legislation.

It specifies that the suicide act cannot be amended in this way. I hope we will recognise that this does not seek to undo or undermine her own amendments but to build on it and to ensure the band she intends to deliver doesn't collapse on the loophole.

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He is making a really powerful point and there is consensus across the house about banning advertising the house about banning advertising for these services. His amendment would be slightly limited and it makes to exceptions that will makes to exceptions that will probably need to be a broad piece of work to be done around that, but I would commit to working with him on

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would commit to working with him on that if he's interested. The point of my amendment is to make sure that a future Secretary of make sure that a future Secretary of State would have to come before this house with primary legislation. The report stage of this bill is not about the principles of this bill. about the principles of this bill. It is not about whether a member may support the idea of assisted dying as we point out to everybody's as we point out to everybody's tracing this amendment.

It is about this bill before us today. We have to ask what will it mean in the real to ask what will it mean in the real world for our very real constituents. Just how strong are the safeguards? We are not the safeguards? We are not commentators but legislators. Our job is to scrutinise and test again the bills that come to this place. I spent 20 years up there in the Press Gallery writing about politics, but the best difference between them is that we have wrote in this place, and with that boat, particularly a Free vote comes responsibility.

There is no greater responsibility than protecting the vulnerable from feeling they have to end their life, and that is why I have tabled this amendment today. I'm not driven by religion although I don't believe that those should be denigrated or patronised if they have been during this bill. It is worth saying that some of those who assessed dying have a faith that their worldview is the right one, and driven instead by my duty as a legislator to get this bill right, and by what I see as my moral duty to protect the most vulnerable in society was my duty is to protect those who don't have celebrity names or campaign groups behind them, the people who don't get heard, who don't want to be a bother, who don't want to make a fuss, who feel that they are a burden on the family but may never say so.

I worry about the unheard, the unseen, the ignored, and the marginalised. Mostly, I worry about the heartbreaking modesty of that phrase you often hear from older people, I don't want to be any trouble. We need for their sakes to make sure the safeguards in this bill are the strongest they can

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possibly be. I only intend to speak quite briefly, but I wanted to start by briefly, but I wanted to start by saying that we have to be really honest about where we are, the current situation, the legal status quo. It is not working. It is quo. It is not working. It is failing terminally ill people who want choice, compassion and control at the end of their lives. Right now, those with the means are travelling abroad to die, often alone, without medical support away from their loved ones, and often at from their loved ones, and often at a time when they can physically make it rather than the time of their choosing, and those without the choosing, and those without the means, any suffering they don't want or they try to take matters into or they try to take matters into their own hands in the UK and safely or illegally.

It is not humane, it or illegally. It is not humane, it is not fair, and it is not sustainable. I spent two years as a minister in the Department of Health minister in the Department of Health and palliative care as part of my portfolio, so this was something that came across my desk on a regular basis and I had a lot of time to think about it, and it is not easy to find an answer and a solution to this, but I think we are to people to try and do that.

That is why I support this bill because it brings this issue out of the shadows and into the framework of regulation, safety, and dignity.

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I don't know if she has had time to read the independent palliative to read the independent palliative care commission's report, but it goes into how pain can be palliate goes into how pain can be palliate it, how symptoms can be palliate it, and ultimately, the problem at the moment we have got is poor care and moment we have got is poor care and the poor provision of specialist palliative care commissions. Will she read that report and understand the difference that palliative the difference that palliative medicine can make for all of those examples of poor care that we have

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heard in these debates? I will read that debate and she makes an excellent point. Palliative care is really important and needs to be improved, and in many cases, it can make such a difference but it is not the solution for everybody and there are cases, the most heartbreaking cases in my own constituency without former palliative care would not have made the difference, and that is why I support this bill, and that begins with new clause 13.

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I wonder if you could assist me. I'm at a loss as to what amendment we are discussing.

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we are discussing. The member gives the moment a moment to address it because she
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Caroline Dinenage Portrait Dame Caroline Dinenage MP (Gosport, Conservative)
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doesn't have long to contribute. Addressing new clause 13. This

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Addressing new clause 13. This provides a strict regulation of life ending substances and self administering devices which means administering devices which means transparency about what substances are used, how they are stored, prescribed, and delivered. We awaited patients, clinicians and the public to ensure that every part of this process is governed by clinical standards and ethical safeguards, and for those physically unable to swallow yourself ingest, this clause also ensures that devices to look itself a ministration can be safely used.

Without that, we risk creating a system that exclude some of the very people it is meant to support. But while we must regulate this properly, we must reject amendments that will undermine or stall bill delivery. Amendment 19 proposes added suicide prevention and liberty safeguards to the code of practice as a minister who put so much of that legislation through, those are really, really important topics, but this is not the legislation to address them. Let's keep the code focused on the bills core function, ensuring a safe, consistent and compassionate assisted dying process.

Amendment 20 would allow nonadherence to the code to be used in civil or criminal proceedings. This is not appropriate for guidance is meant to help professionals navigate difficult decisions, not to become a legal trap. If clinicians act negligently, existing law already applies. We should not be creating new liabilities for those who are acting in good faith in very difficult conditions. I also oppose amendment 97 and 27 which would require MHRA to licence drugs for assisted dying and nice to recommend them.

That would make this bill unworkable.

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To share my concerns that the impact assessment associated with this bill says that the safety and efficacy of those substances used

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efficacy of those substances used for assisted dying is difficult to assess? I'm not entirely sure that I do

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I'm not entirely sure that I do agree with that but I really want to talk about the MHRA because it just talk about the MHRA because it just isn't setup to licence drugs for ending life. Clinical trials to ending life. Clinical trials to support this kind of licence would be requirement, however substances likely to be used already tried and tested in other jurisdictions and are MHRA approved for other are MHRA approved for other purposes, so new clause 13 will provide strict regulations we need without putting prohibitive hurdles without putting prohibitive hurdles along the path to a compassionate and painless death, and finally, on amendment 42, it would remove the amendment 42, it would remove the backstop date imp imitation, giving the government discretion over when or whether to put this law into effect.

But copyright. If Parliament passes this bill, there must be a reasonable timeframe for implantation. The four-year backstop already gives the government more than enough time to put this right, This is a moment to show we can be compassionate and confidence. We can replace the status quo with a system that is fair and accountable. Let's support new clause 13, let's reject amendments, and that show dying people that we are ready to treat

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them with dignity and trust that they deserve. Thank you Madam Deputy Speaker.

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Thank you Madam Deputy Speaker. Before entering this place last July as an member for North Somerset, I had been a pharmacist for nearly 20 years. Pharmacists have a unique role to play in our healthcare role to play in our healthcare system and, as a group of health professionals specialising in drug usage and safety, that is where I usage and safety, that is where I wish to focus my thoughts today. And for the house my expertise. Throughout the passage of this bill, Throughout the passage of this bill, we have had a great benefit of learning from a number of learning from a number of international examples.

In Australia we have seen a carefully designed countrywide pharmacy system that has delivered self administration, assisted dying. Their evidence is
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Sadik Al-Hassan Portrait Sadik Al-Hassan MP (North Somerset, Labour)
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assisted dying. Their evidence is reassuring. Even in cases where the drug is not fully ingested, every patient can die peacefully and without convocation. Not a single complaint has been received from any of the families involved. In Switzerland, we have learned from their decades of practice where they have refined the substances and processes involved the point where complications are now nearly unheard of. Their approach demonstrates that, with care and rigourous regulation, drugs can offer an effective and compassionate route to end one's life.

This brings me to new clause 13. Introduced by the member for Spen Valley. This clause outlines a comprehensive framework for the oversight and safety of substances involved in assisted dying. As is only right for life ending drugs, the public expects the highest standards of transparency and standards from manufacturing to dispensing. As someone involved in every facet of pharmacy in the past 20 years, I believe this clause meets all of our expectations. By strengthening safeguards and enhancing the workability of this bill, you clause 13 ensures healthcare professionals can act with clarity and confidence.

Amendment 72 is similarly important and I believe it will provide much assurance to those in this place who were uncertain about whether or not they feel they can support this bill. By ensuring that all regulations made by the Secretary of State under new clause 13 are subject to the draft affirmative procedure, this will ensure this place continues to play a central role. Overseeing the safe and effective implementation of this legislation for years to come. Through our collective continued scrutiny, offer the opportunity for many millions of constituents who have contacted us on this issue the chance to continue having their

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voices heard and their concerns answered. Harriett Baldwin.

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Harriett Baldwin. Thank you Madam Deputy Speaker. I rise to speak to new clause 14 and rise to speak to new clause 14 and amendment 14B and 14A. I was honoured to follow the speech from the men before Rochdale but also want to thank the member for Spen want to thank the member for Spen Valley for working closely on this Valley for working closely on this issue of banning advertising because issue of banning advertising because whatever your views are in terms of assisting terminally ill adults to end their lives, I remain implacably against the potential harms that against the potential harms that arise when our society and imperfect state is given permission to help state is given permission to help kill themselves.

Have to acknowledge there was a majority at second reading in favour of this bill, and a majority in terms of closing down the debate the last time we had the report stage. Thinking ahead to the possibility that this bill might go
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Harriett Baldwin Portrait Dame Harriett Baldwin MP (West Worcestershire, Conservative)
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on the statute books, I hope everybody participating in this debate will recognise that we should debate will recognise that we should not allow the services of the organisations that will arise to organisations that will arise to provide this service, to advertise on television, online, on posters, on television, online, on posters, on TikTok, on any platform that our on TikTok, on any platform that our constituents may be seeing. I think we can all imagine a scenario where, we can all imagine a scenario where, if this bill passes and the House does not agree to new clause 14 a, does not agree to new clause 14 a, that the independent contractors, the not-for-profit firms, perhaps even the NHS itself, will be able to even the NHS itself, will be able to advertise to potential customers, for example on afternoon for example on afternoon television,.

Can you imagine the situation you are sitting watching a repeat episode of One Can you imagine the situation you are sitting watching a repeat episode of 1 Foot In The Grave, as an advert runs for a funeral plan company and it is followed by an organisation that is offering to provide the services to make it easier for you to have an assisted death. You may think that I am painting a situation that is only hypothetical but in fact we have seen in Belgium that the government itself is running online adverts featuring young healthy women at a yoga class talking about how they are worried about granny's situation, and asking if they have considered telling her about the option of assisted dying.

So I am very grateful to the honourable Lady for tabling her new clause 14. I don't think it is perfect that she and I had a lot of discussion about the wording. And I do also support the intention behind amendment A and B to new clause 14 because I think it is important. We have heard ministers confirm that encouraging assisted dying under this bill remains a crime under section two of the Suicide Act. However, it does require showing intent to encourage, whereas adverts themselves might be framed so they are not so intended.

So it is right that there is a specific provision on advertising needed in this legislation. I am also concerned in the unamended new clause 14 about the scope of some of the exceptions. I am grateful that for example in subclause two does not refer to potential service users. There is nothing that prevents the Secretary of State with the Henry VIII powers from exercising the power to exempt them. Doing so would negate the point of the prohibition. I would be grateful if the Minister confirm that the power will not be exercised great exceptions for adverts that are targeted at potential service users.

It is absolutely the case that, as the men before Rochdale mentioned, there are a number of advert bands already in existence on the face of legislation. For example the cancer act, the surrogacy act and the tobacco advertising and promotion act. They are set out clearly on the face of the bill. So I hope this can be resolved. I hope the House today will support at a minimum the new clause 14 proposed by the proposal of the bill. I hope that the House will also support the strengthening amendment which I endorse.

And I hope that ministers will confirm that these powers will never be used to create an exemption to section two of the Suicide Act in order to partially allow encouragement of assisted dying, I

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think it would defeat the whole point of the provision. Alison Hume all. Thank you Madam Deputy Speaker. I

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Thank you Madam Deputy Speaker. I rise today to speak in favour of new clause 15 which clarifies that an clause 15 which clarifies that an assisted death would not be classified as an unnatural death, classified as an unnatural death, and a full coroners inquest would not normally be required. My constituent in Scarborough and constituent in Scarborough and Whitby lived with motor neurone disease for six long years. As his condition worsened, as options condition worsened, as options narrowed until there was only one choice that preserved his dignity, autonomy, and peace.

To travel to
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Alison Hume Portrait Alison Hume MP (Scarborough and Whitby, Labour)
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autonomy, and peace. To travel to Dignitas in Switzerland and end his suffering on his own terms. Louisa, as his wife of 25 years, as someone who had known him since the age of 18, did what any loving partner would do. She stood by him. She helped him onto that plane. She held his hand through the most difficult decision of their lives, and now, for that act of love, she is under police investigation. That is precisely why we need new clause 15.

If the bill is passed, assisted dying would be a legal strictly regulated and monitored choice made by the individual concerned.

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Thank you. And I recognise the situation of your constituent is awful. But we are here to balance today the choices of people who may not be loved as dearly as him. Our concerns here would be about the fact that many of these killings fact that many of these killings could be mercy killings. If there isn't that recourse to the coroner, isn't that recourse to the coroner, then some people may be taking their lives under coercion and pressure.

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lives under coercion and pressure. They may never be discovered because it won't be given the full law. I thank my honourable friend for

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I thank my honourable friend for her intervention was to new clause 15 is particularly addressing the 15 is particularly addressing the role of coroners and coroners investigates deaths where there is a reasonable suspicion that the reasonable suspicion that the deceased has died a violent or natural death. Where the cause of death is unknown or there is detention but this is not the case with an assisted death. There would already be strong safeguards in place including multiple layers of oversight or assessment.

The process is cautious, thorough, and heavily safeguarded. There is no need to investigate an assisted death as it is not unnatural. In this country, it is still a crime to help someone die peacefully with dignity. Even when they are suffering unbearably from a terminal illness. I will make progress. Even when they are of sound mind, even when it is there deeply considered wish. Anthony wanted a good stare. He wanted to die peacefully with grace, without pain, and without profound suffering.

He got that in a foreign country far from home, far from family, because our laws force people like Anthony to make that desperate journey abroad. This is why I support this bill, and in particular, new clause 15, as there is no need for coroners to

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investigate assisted death. I thank my honourable friend for giving way. One of my constituents giving way. One of my constituents told me of her mother's pain in her last few months of suffering. So painful that she could not bear to painful that she could not bear to be touched by my constituent or her brother. Now both my constituent and her brother are facing post- her brother are facing post- traumatic stress disorder because of the difficult situation they witnessed while their mum was dying.

witnessed while their mum was dying. Does my honourable friend agree with me that if they had helped her to me that if they had helped her to die in the way that this bill allows, that they should not then be subject to a coroner's subject to a coroner's investigation? Isn't going to help them and it isn't going to help their mother.

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their mother. I thank my honour friend for giving way. She makes a powerful case on behalf of the constituent. This is a compassionate and practical clause. It ensures the bill but only works for the individual making the choice but also for the families they leave behind. Let us not turn our backs on people like Anthony and Louisa. Let us not make criminals out of the compassionate, the death of a loved one is always difficult. When someone has gone to the legal and safeguarding process of assisted dying, it isn't right that the family should face an unnecessary and potentially lengthy and distressing coroner's investigation.

I'm coming to my conclusion for the new clause 15 protects bereaved families like that in my constituent Anthony, and therefore I urge on all

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members to support it. As the speaker has mentioned, for

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As the speaker has mentioned, for everyone to get in, we need speeches to be shy of six minutes and interventions to be sure.

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interventions to be sure. Thank you Madam Deputy Speaker. I'm conscious of those comments and I'm conscious of those comments and I will try and limit my comments to new clause 13 and some of the new clause 13 and some of the amendments to it. The Royal College of Physicians, the Royal College of of Physicians, the Royal College of Psychiatrists, the Royal College of pathologists, the Association of Palliative Medicine, the British geriatrics Society, all have several problems with this bill. I've heard problems with this bill.

I've heard nothing from that move of the bill despite trying to intervene on her a number of times as to what she has number of times as to what she has done to ensure that their concerns have been addressed. This brings us have been addressed. This brings us directly to a fundamental concern, namely the means by which assisted death would be carried out, through new clause 13. The impact assessment to this bill recognises " The safety and the of those substances used for assisted dying is currently difficult to assess.

" No safeguards can...

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I am very grateful to my honourable Member friend for taking intervention. Would he agree that the things we are considering our conventional agents? They have been used in anaesthesia because of loss of conscience and suppression of respiration for generations will

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respiration for generations will stop these are not novel substances. I obviously respect the honourable Member giving his medical
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Gregory Stafford Portrait Gregory Stafford MP (Farnham and Bordon, Conservative)
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honourable Member giving his medical background as far as I am aware they have not yet been used for murdering people which is what we are going to do here. That is the thing. It leads me neatly on, no safeguards can prevent compilations from taking medicines. I'm sure the honourable member knows there are always going to be obligations potentially. In this case, including regurgitation of the drugs, regaining consciousness and seizures. Can I finish this point. In the 27 years the law in Oregon has been in place, data is only available for about 36% of cases.

Within that, 59 instances of regurgitation are known to have occurred. Nine are known to have regained consciousness, and different drug protocols have been used in those 27 years. The efficacy and safety of the drugs are unknown with a time range between ingesting drugs and death ranging from one drugs and death ranging from one The lack of defined protocols in the administration of this is precisely why I have tabled my amendment see to the member for new clause 13.



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Does he agree with me that the M Archer Ray would insist with any Archer Ray would insist with any substance used in medicine is approved for a specific cause and you can't translate that to a you can't translate that to a completely different because with a reason for doing this, and would he further agree with me that the way to deal with this is to have this

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properly regulated through the MHRA? I agree with my friend, and there are some amendments made by my are some amendments made by my honourable friend behind me. My amendment would require the Secretary of State to prohibit the use of medical devices designed to use of medical devices designed to induce death by the ministration of gas such as the suicide part which has been in the press recently. This device bypasses medical oversight entirely and presents an ethical rupture in our framework.

If this bill proceeds without safeguarding against such measures, we risk opening the door to a deeply troubling precedent, one that would erode accountability and compromise the integrity of end-of-life care.

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I thank them for giving way. I would like to share with the would like to share with the honourable member my expertise as a pharmacist that drugs can be used pharmacist that drugs can be used for many indications and are quite for many indications and are quite commonly used in unlicensed situations where there would be less situations where there would be less evidence to support them and in the situation which we are coming and discussing today with new clause 13, an idea that is incredibly well researched and practised and evidenced in multiple countries.



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I thank the gentleman for his intervention and I don't disagree that drugs are used for different that drugs are used for different things. What I am saying is that the medicines that we potentially, the drugs that we will use in this situation, where they have been used, they have had unintended consequences and side effects, and if this bill passes, we need to make sure they are effective in what they are intended to carry out, namely

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the end-of-life of the individuals. The reason that is so important is because it is yet another safeguard, particularly given that we learn through analysis from the we learn through analysis from the impact assessment that much of this is part of the organisation. That

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is part of the organisation. That needs to be regulated in the way that he describes. I thank my friend for his

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I thank my friend for his intervention. The Royal College of intervention. The Royal College of physicians has said that medicines prescribed and administered in assisted dying must be regulated for assisted dying must be regulated for safety and efficacy for this use, and if it is good enough, it is something that we in this house something that we in this house should see on the face of this bill. I draw the marks on this bill but I would like to say that I do also share my support for amendment 99 which I think will require a report on the drug effects before Parliament approves regulation, and a number of the other amendments which would hopefully remove the wide-ranging Henry VIII powers that this bill currently has.

In light of all of this, I remain deeply sceptical of this bill and that it doesn't have the required things that the government deserves.

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I'm grateful to you for calling me to speak on this most important me to speak on this most important me to speak on this most important of issues in this chamber, and as I of issues in this chamber, and as I do, I think of all of those who were killed in the horrendous plane crash killed in the horrendous plane crash in India yesterday, and I think of their families, friends and the lives they have left behind.

I rise to speak to amendment 42, tabled in my names and 60 colleagues my names and 60 colleagues represented in this house, and amendment 42 takes the entire assisted dying process which has to commence automatically in England commence automatically in England four years after the act is passed. And notwithstanding some of the comments we have heard earlier on, that would be regardless of how far along the plans and preparations are all the manufacturing and supply to end the life of anyone who chooses this death.

The training of those on the panel, the impact of the NHS in England and, the budgets and the rest. Colleagues will know that the first draft of this bill, this
10:52
Adam Jogee Portrait Adam Jogee MP (Newcastle-under-Lyme, Labour)
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process was due to commence two years after any such act was passed into law. I welcome the fact that my into law. I welcome the fact that my honourable friend amended the first eight of this bill from two years to 4. It was a welcome involvement to such a serious inconsequential change to every aspect of our country from healthcare system to country from healthcare system to legal system which should not, must not and cannot be rushed. And therein lies the basis of my therein lies the basis of my amendment.

If this change is going to happen, let's do it properly. Let's not impose a timeframe that Let's not impose a timeframe that puts us in a binder means we are driven by timing and pressures which come with a ticking clock, rather come with a ticking clock, rather than by doing it properly. People than by doing it properly. People living in Newcastle to Pembrokeshire by counting on us parliamentarians, by counting on us parliamentarians, both of us who are concerned about assisted dying and those who are in passionate support of it.

This bill has won everything vote on the floor of the house, apart from on this issue of the committee. People are counting on us to make sure that this bill passes and that it is a success, that it will be consistent and that it will be safe. If this bill passes, it will introduce assisted dying and the biggest jurisdiction yet by population. These are uncharted waters. It will not be like anything else. The last thing we should be doing is rushing this process.

At Committee stage, the table amendment passes the commencement deadline for Wales. Her amendment made provisions that assisted dying could only be rolled out once Welsh ministers deemed everything was ready for a safe rollout. The committee voted by majority to give this extra safeguard to the people of Wales. It feels good now for the people of Wales at Committee stage, it is good enough for the people of England today. In other words, we face a situation where assisted dying may proceed in England months or even years before Wales.

The provisions in the systems may look different, the process of organising the English system to meet the arbitrary deadline would almost certainly lead to rushed decision-making. My honourable friend from Spring Valley has sought to fix this disparity, but it isn't fixed on safeguards but the members she appointed to my constituents in England who know that the remedy is to allow auto commencement to happen in Wales as well, removing a safeguard at the bill committee voted for. The answer to this is not to fast track assisted dying in both England and, potentially putting lives of some of the most vulnerable at greater risk through decisions.

I haven't been on these benches very long but I have been for the auto commencement generally which is unusual. The legislation of this magnitude is reckless. Reinstating an auto rollout on Wales when the committee expressly voted against it borders on the undemocratic.

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I met the sponsor of bill in the Isle of Man. I took three years to get to this point and the sponsor of get to this point and the sponsor of the bill will take at least five years to implement it in the Isle of Man, a much smaller jurisdiction.

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Man, a much smaller jurisdiction. My friend makes a good point.

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My friend makes a good point. He is fast becoming my favourite on the benches opposite among many on the benches opposite among many competitors. But the point that he competitors. But the point that he makes his fundamental because if we are going to do this right, we have to do it thoroughly and by to do it thoroughly and by independent analysis. Had the honourable lady had the kind of free honourable lady had the kind of free letter to scrutiny and analysis before the bill, we may have had I

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before the bill, we may have had I end these matters out in the first place. I think the gentleman for his intention which teaches me not to take them. Thanks for helping the street cred this morning. He raises an important point. Members of this house have been told that this bill we are voting on today and not the principal was rigorously tested and refined in committee. But we have now seen efforts to undermine that same committee. Amendments 94 and 95 set a single purpose of undoing the amendment introduced in Committee stage to improve this bill to make it a safer, more conventional piece of legislation.

The invitations of these amendments go beyond justice. They also challenge the basic tenants of our democracy. One of the key roles at the heart of our democratic system is the role of the Minister of Crown foot of the ministers who prepare the groundwork for legislation to be done successfully, and these would do away with this commonest function. They would see the responsibility for ensuring the rollout of assisted dying in Wales, the power we entrust to our ministers and democracy to take away from us.

Conscious of your cough, I shall quickly move towards the end of my remarks. Ministers should be able to lead the roll-out of assisted dying in Wales, just as they should in Wales. It is ministers who should be responsible for delivering the seismic changes to health and legal systems and is only right that they decide when provisions become important a put England back on an even footing with Wales. Getting this right is a matter of life-and-death it makes sense to avoid and decision-making.

It makes sense with the usual constitutional powers. One death because of a rash decision will be one too many, and it should give us all food for thought. Our collective sticking to an arbitrary deadline led to deaths that may otherwise not have taken place. We must recognise that we can prevent this, and we prevent our votes today. To do this we must uphold it in Wales, and I asked to vote against amendments 94 and 95.



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M3 is in my name which is the
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Tom Gordon Portrait Tom Gordon MP (Harrogate and Knaresborough, Liberal Democrat)
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M3 is in my name which is the exact opposite of the member for Newcastle-under-Lyme. It would see Newcastle-under-Lyme. It would see the commencement to be going down to 3. This is truly had that initial conversation which took them two years to full. I was the only person to speak against it. What frustrates me about the situation that we are now in is that we are acknowledging that we are doing this because the status quo is not acceptable. People are pushed taking decisions that they shouldn't be, having to go to foreign countries for that opportunity overseas.

And those of us who support this bill on those principles, what frustrates me about this four-year period is a number of things, principally than the people who are in office today wouldn't necessarily be had to be implement in it, and I am really hesitant about supporting a bill that we wouldn't know who would be seen through those details. So the amendment, reducing the threshold down to 3 years would still be more than most jurisdictions around the world. This has gone down to a shorter six months and 18 months, so three years would still be a substantial increase on other countries.

We are not innovators or leaders in this field. There is no reason that we can't take best practice and speak to colleagues around the world. I believe this does have the stronger safeguards of any which is why an implantation

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requirements. I want to put on record my
10:59
Tony Vaughan Portrait Tony Vaughan KC MP (Folkestone and Hythe, Labour)
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I want to put on record my sincere thanks to the member from spent valet for the way she has approached this and listen to concerns across the house which has been evidenced in the clause put forward the names of members for Reigate and West Worcestershire, testament to how we could work together. I rise today to speak in favour of N C-14 but against N C-14 B. I understand the intent behind this amendment in the name of the member for Rochdale.

Nobody in this house wants to see voluntary assisted dying services being advertised in a way that is insensitive, inappropriate, or exploitative. We all want to protect individuals, particularly those who may be vulnerable or more easily influenced, and I fully share that concern, but why respect the principle behind the amendment, I do not believe it offers the right solution. The underlying clause brightly prohibits advertising voluntary assisted dying services to the public while giving ministers tightly defined powers to create appropriate exceptions through regulations.

That is important because in a healthcare system as complex as ours, we must be able to draw the line between unethical promotion and responsible The original clause gets the balance right. What the amendment does is two things which in my view are both problematic. First it tries to define on the face of the bill narrow exceptions to the advertising ban. Just two. Replying to individual requests and professional commune occasions of patients that they are unlikely to see. As we had from legal experts, writing into primary legislation removes essential flexibility which may even hamper implementation.

Ministers will not be able to respond to future development or clarify borderline scenarios without coming back to this house with further primary legislation. It can also limit the ability of future ministers to clarify how this will work in the real world and evolving work in the real world and evolving situations. Good regulation should be responsive and proportionate and not fixed to a point in time. Second, this amendment attempts to limit the scope of further regulation by barring any changes to the Suicide Act 1961.

But that is already covered. 14 already present changes to this bill is the original clause is not only duplicate, but it closes off any future clarity that might be needed in the Suicide Act such as to ensure offences around coercion or fraudulent practice are dealt with. This amendment does not add clarity, it risks confusion. It does not strengthen the advertising ban, it introduces constraints that

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can make provision harder to enforce in an evolving practice. There is a key question here,

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There is a key question here, quite simple, does advertisement quite simple, does advertisement include a leaflet on a GPs surgery table or on the door going into a table or on the door going into a GP? To me it seems very unclear what is information on what is advertisement.

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advertisement. That will have to be worked. I don't have the answer on that my don't have the answer on that my fingertips but maybe others do. fingertips but maybe others do. Further to what I said, I was pleased to hear the honourable member for Spen Valley say earlier that she is open to working with the that she is open to working with the honourable member for Rochdale and others to find a workable way forward on all of these issues including that one.

I hope he is including that one. I hope he is able to take up on that offer. This is obviously an area where constructive cross-party work can ensure that the strong safeguards are achieved without unintended consequences. For now, I urge members to reject this amendment in its current form because we oppose its aims but because we can and must

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find a better way to achieve it. Thank you Madam Deputy Speaker. I am grateful for the first opportunity to contribute on this opportunity to contribute on this bill. It would not be appropriate for me to dilate on my profound
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John Glen Portrait Rt Hon John Glen MP (Salisbury, Conservative)
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for me to dilate on my profound anxieties and concerns about this. But I do approach the amendments that I rise to move today in the spirit of constructive engagement with the bill and what has come before it. I rise to move amendments 82, 83, 84, 85, and 86. These amendments will strengthen the panel by giving it some of the features of the High Court safeguards. This has regrettably been removed. We have heard from the bill's sponsor that it will be stronger because it includes a broader range of expertise.

The argument against that is that the High Court has stronger safeguards because it is the powers of the court and the independence of the judiciary. My amendments would mean we don't have to choose between the two. The power is now part of the bill but we can have a better bill if we give it some of the features of the High Court, namely the independence, the calibre of its judges, and its powers as a court. Amendment 82 would require all panel members to be appointed by the judicial appointments commission which nominates judges in England and Wales.

Currently the selection of panel members is wholly down to the voluntary assisted dying Commissioner. Schedule 2 Mac says the Commissioner must make a list of persons eligible to sit as members of panel. I have no doubt that the commission will be someone of great integrity and experience. But he or she will certainly be a strong advocate of assisted dying. And so will those who put themselves forward for panels. That may create an impression that the VAD commission is a self-selecting group with a particular set of institutional views.

I believe that if this system is to command public confidence, then the appointments would be best administered by some external body. And the judicial appointments commission is the obvious choice. In this country, I hope we trust the judiciary partly because we know they represent no set of opinions, just the commitment.

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I'm grateful to him for his amendments. He is right that this is amendments. He is right that this is something that the house was enthusiastic about the High Court state will stop and reintroducing state will stop and reintroducing proper judicial scrutiny would revert the bill back to something that the House voted for a second reading.

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reading. It won't surprise into note that I agree wholeheartedly with him. I recognise, and that was a major recognise, and that was a major reason that many colleagues gave an earlier point in the discussion. I would be very happy to give way.

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would be very happy to give way. I thank him for his constructive engagement. Would he agree that it engagement. Would he agree that it did not vote for the bill the inclusion of the High Court Judgements and now he is trying to Judgements and now he is trying to reintroduce the High Court Judge,, is there some sort of bill he would

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vote for other than a judge or retired judge someone on the panel who is a legal expert? I have been clear. I'm coaching

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I have been clear. I'm coaching my contribution with these my contribution with these amendments in a constructive way to try and bring together the will that she has expressed but also recognise she has expressed but also recognise I believe the meaningful dilutions in the authority of this process and what can reasonably be amended to what can reasonably be amended to invigorate it along with principles that was intended at the outset. If I just revert to the point I was making about the judiciary, they just have a commitment to uphold the just have a commitment to uphold the law.

I think that should be the standard that we should be looking for when it comes to matters of life or death. The judicial appointments commission already conducts commission already conducts appointments for all tribunal's including lay members of tribunal. The government impact assessment compared to the panel to the Mental Health Tribunal. Appointments to the Mental Health Tribunal including the nonlegal members are done by the judicial appointments commission. So this would not be a novel function for them. Let me move on to amendment 85.

This ensures that all members of the panel have to take the judicial oath if they have not already if other amendments passes would only be necessary for the nonlegal members was that is crucial for public confidence that the judicial oath is taken. Amendment 83 and 84 seek to preserve an important element of the bill is originally presented to the House. They ensure the most senior decision-making figure, the chair of the panel, be a High Court judge with all the experience and professionalism that this implies.

Under these amendments, all High Court judges would be eligible, they must either would be eligible, they must either be currently serving or below a certain age and it must be a judge of the highest authority and not a deputy judge. Members of this House and the public were originally told that this would be a safe bill slightly because it would have a High Court Judgement top that was a persuasive promise. I think there is a way to honour it even in the new version of the bill.

I would also like to briefly mention the retirement age if I could, because it is important, it used to be 70 it is now that judges can continue until 75. With the panel, there is no age limit. If we are saying that 10 If we are saying that 1018 year old retired judge is still able to decide on matters of life-and-death, then why are they saying they are too old to help clear the backlog of criminal cases? This seems a meaningful anomaly.

Madame Deputy Speaker, in the interest of time I think I have made clear the purpose of these amendments. I bring them to the House today in a spirit of

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trying to bring and strengthen the bill back to where it was intended, and meet expectations of so many who supported it. Thank you Madam Deputy Speaker. I

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Thank you Madam Deputy Speaker. I rise to support a number of new clauses amendments to this bill. Common thread is to address the gaps in terms of safeguards and oversight in terms of safeguards and oversight that the current form of the bill lacks. Should this will pass and to make sure it is improved has better make sure it is improved has better protection than it currently does, and remove some of the risks it contains. New clause 4 requires monitoring by the Chief Medical monitoring by the Chief Medical Officer, and alongside the Officer, and alongside the requirement for a High Court judge, and oversight from the CMO was removed at the Committee stage this means the commission would essentially mark your own homework.

And independent oversight was highly
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Allison Gardner Portrait Dr Allison Gardner MP (Stoke-on-Trent South, Labour)
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And independent oversight was highly sensible given significant concerns expressed by this bill from many experts and organisations, often neutral in principle but concerned on this bill. This includes the Royal College of Psychiatrists, British and geriatric Society, the Royal College of Physicians, and many experts such as Professor Jay and Munton Smith, Baroness Finlay, parliament's leading expert on palliative care, and Professor, sorry, the former head of the British Medical Association. And many more. They have expressed concerns even when you trot the principle of advocacy of this bill.

principle of advocacy of this bill. And an the need for people who have protected characteristics and other descriptions, and I fervently hope it includes domestic violence victims. Amendment 13 sensibly as a requirement that the Commissioner appointment is not the sole remit of whoever is the Prime Minister by requiring the consent of the health and social care Select Committee. This provides a safeguard against ideological and politically motivated appointments. I would be concerned why anyone would prevent this.

Amendment 15 addresses concerns of involvement of private for-profit providers of assisted dying. There are concerns of gaming of the system, when there is a commercial relationship to providers, meaning the relationship of the coordinating doctor and independent doctor risks being compromised. Likewise assistance of set providers does not lay the consent of Dr shopping has raised the previous debate. Amendment 15 will provide providers to be transparent and provide reports on service numbers and cost and revenue. In previous debate in the public discourse I found it disconcerting that in response to legitimate concerns, or we have been offered as we have seen today are some promise unspecified future regulations that will fix the gap.



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I thank her full stop she is making a powerful suite. Does she share my concern that most of these share my concern that most of these discussions were having have been thrashed out at Committee stage and thrashed out at Committee stage and now we are being told we will leave them to the Lords if we can't fix them here. That is a flawed process.

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I entirely agree my honourable friend. Expect MPs to improve this bill without clarity as to what these regulations are all will be, how the service will be delivered, and without rigourous regulatory and without rigourous regulatory oversight is fundamentally wrong. In light of this, the fact that implementation of this bill would be implementation of this bill would be automatic in 2029, a general election year automatically, is not realistic when we look at the areas realistic when we look at the areas where we lack details to I'm supporting amendment 42 proposed by my neighbour, which allows the my neighbour, which allows the Secretary of State to determine the appropriate date for the bill to implement it.

This will allow time to the NHS to be fit for purpose. Palliative care to be strengthened and adequate regulations to be drafted and scrutinised by Parliament without being rushed. Similarly, but fundamentally to the society we live in and for our most important institutions, member 12 protects the fundamental status of the NHS. The current bill provides Henry VIII powers to amend the NHS act without limit which could include the specification of charges. If, as Labour MPs, are committed to protecting the NHS, being free at the point-of-care, then amendment 12 is vital.

This amendment will require any changes to the NHS 2006 act to be made via an act of Parliament. The future is uncertain. We must build in safeguards on the face of the bill that fundamentally alters the fabric of our society. There are many others I will mention, briefly amendment 27 requires the licensing of drugs used for assisted dying by the MHRA. Research has shown that painful and protracted deaths via drugs are not uncommon with death ranging from three minutes via drugs are not uncommon with death ranging from 12:57 hundred and 37 hours, nearly a week, with up to eight hours to lose consciousness and serious side effects.

Disproportionately affecting younger people. Amendment 27 will help ensure the safety and efficacy of the substances. I will close with quoting Sir David Haslam in response to some of the divisional stories on both sides of the debate, and how we balance these with the good of society. As you know, NICE has to make the decision to approve or not approve medications and treatments based on the cost and clinical effectiveness model. They are experienced in weighing up societal goods versus the needs and wishes of individuals.

The David states, " From individual perspectives, assisted dying he is a logical development. But from the aspects of society it is likely to have profoundly different impact with a legion of unintended consequences. Once we blur the boundaries, there is no going back on the elasticity with how assisted dying has been applied in other countries should serve as a warning that such legislation is unstable. " In closing, even if we apply all the safeguarding amendments put forward, this bill will still not be fit for purpose.

The Renter's Rights Bill contains 191 pages was not the end of life bill consists of just 43. Should it pass, let us try we insert a level of safeguarding as some, I urge all honourable members to support the new clause and I have not had time to address other not had time to address other

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Let me begin by laying my cards on the table. I am a liberal and have always supported the right of individuals to freely choose when they want to end their life. I have
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Paul Kohler Portrait Mr Paul Kohler MP (Wimbledon, Liberal Democrat)
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they want to end their life. I have no religious or philosophical objection to dying and the debate, it was assumed I would vote in favour. But as the debate in this chamber on the second reading progressed and particularly as a result of the compelling speech the member for Vauxhall and Camberwell Green, the city of Durham, and in particular the mother of the house, the member for Hackney in Stoke Newington, I came to the reluctant decision that the state of palliative care in this country, the safeguards are against coercion in all its forms were not sufficient to vote in favour of this bill.

Despite the changes that Committee stage my mind has not changed. I will again be voting against the bill. However, it can equally be clear that amendments one and three and 104 in my name and to which I will now speak on not amendments but critical to ensure there is proper scrutiny if this bill becomes law.

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The issue of palliative care has been raised across this house and we have been repeatedly told that this have been repeatedly told that this is not an either or choice but does the member agree with me that without world-class palliative care, that full force some patients down

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that full force some patients down the assisted dying route were otherwise they would have chosen better care? I agree entirely. It is not a

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I agree entirely. It is not a free choice with the standard of

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palliative care. I thank the member for giving way

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I thank the member for giving way and I share with him concerns about and I share with him concerns about the level and quality of palliative care in this country. However, I do not agree that giving people the choice to end their life if they are terminally ill and have a diagnosis that they are going to die shortly in anyway undermines our ability as a house to insist on an improvement of palliative care. What's more, statistics from other jurisdictions show that once given that choice,

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people often turn to palliative care. It is giving people a choice when

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It is giving people a choice when they look on the internet and see how awful the death might be because of the shocking state of palliative of the shocking state of palliative care which is not a free choice. This is an extraordinary bill with 45 clauses in 38 regulations of which five are Henry VIII powers, powers to modify primary powers to modify primary legislation. The nonpartisan society are absolutely neutral on assisted dying made clear that there is lots of powers in this bill conferred on ministers.

Why is this a problem? ministers. Why is this a problem? The Atty Gen puts the point as follows, the clauses upset the follows, the clauses upset the proper balance between Parliament and the executive. It is not only a strike to the rule of law but strike to the rule of law but accessibility and legal 17. This bill is an example of such reliance. There is a major problem because in large parts, the safeguards are left and decided by regulations. What level of, location all the doctors need to have? How well TBS? Who can be a proxy? What happens at the self ministration drugs go wrong? When pressed on the key safeguards and key issues, support the bill say there are problems which can be approved later.

The same goes for how this will actually be delivered. Will it be the NHS, and if so, how? Will providers be commissioned and how, by whom, and on what terms? Will profit providers be allowed? These questions are unanswered by the bill that was introduced in the house. I had hoped they could be answered in committee but a not. Instead, we got even more reliance on delegated powers. It means that MPs cannot make a judgement about assisted dying and how it will actually work in practice.

Take training for example. MPs might assume that training provided will be a robust two week course on coercive control. There is no such requirement in the bill and indeed, the impact assessment suggests it will be a short course. Secondly, regulations cannot override the substitute, so it will have to be taken into account how depression can impair decision-making because does not change the fact that impaired judgement does not mean someone lacks capacity. As the Royal quite societies told us.

In those matters with guidance and regulations place them outside the democratic control of MPs. With exceptions, they will not get a vote on those that have no input directly or indirectly and formulating them. The case for defence might be the reliance on that to build this complexity. The experience of other jurisdictions suggest this is not the case. In Victoria, the first Australian state to legalise dying means there are only 20 pages of regulations as they have included much more within the act, necessary longer than what we have got today for that is a good thing there is more parliamentary scrutiny.

I hope we understand why it is not possible for spin ballet to draft the bill as detailed to anyone before second reading but with the help of government resources, those gaps will be filled during the course of the committee and report. Sadly, it is not the case. I had much more to speak about but heeding the Deputy Speakers cough, all I would say is that I will be voting against this bill, but even if you disagree with

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amendments. I want to begin by thanking my honourable friend force Ben Bradley honourable friend force Ben Bradley who has exemplified the integrity in who has exemplified the integrity in public service. I wish to speak public service. I wish to speak today to amendments 82, 83, 84, 85 and 86 as mentioned earlier by the and 86 as mentioned earlier by the honourable member for Salisbury. As a former lawyer, these amendments do a former lawyer, these amendments do concern me.

In committee, the concern me. In committee, the Minister for courts was clear that the panel's decisions will be subject to public law principles. subject to public law principles. This will include propriety and absence of bias, including the absence of bias, including the appearance of bias. My concern is designed to be inquisitorial, to collect information, not meant to be adversarial like a court. Requiring
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Rachel Taylor Portrait Rachel Taylor MP (North Warwickshire and Bedworth, Labour)
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a judicial oath I will make some progress. Requiring a judicial oath progress. Requiring a judicial oath would be inappropriate because this panel is not performing a judicial panel is not performing a judicial function. It is a special administrative panel. His first priority must be focused on priority must be focused on safeguarding and the review of evidence. Disqualifying deputy judges would only shrink the call of judges would only shrink the call of experienced candidates. And I do not believe these changes would make the process safer, more effective, or process safer, more effective, or better.

Instead, it would make it better. Instead, it would make it more difficult to appoint experts to allow the panel to function as the necessary safeguard that it needs to do. Finally, I returned the most important aspect of this bill, those who are affected directly. Opponents present hypotheticals but I have heard real stories from my constituents who support this bill. One constituent told me about her husband who died of metastatic prostate cancer. He wanted to die at home despite the efforts of a dedicated palliative care team, his final month was marked by excruciating pain.

Our constituents deserve better. They deserve the choice to say goodbye in peace, surrounded by loved ones without unbearable pain. For me, this debate is about the status quo and after hearing the stories, listening to lawyers and doctors, it is clear that it is not. And if we vote in favour of it, it must be a bill that our constituents will expect to come forward and be brought into law quickly, so I'm therefore opposing amendment 42.

The British public overwhelmingly supports this bill. They are looking to this house for current and leadership, and that is why I will vote for this bill with the amendments that strengthen it. Let's bring dignity, peace and choice to those facing the end of their lives in difficulty and pain.

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Before I come to the substantive part of my speech, I would like to part of my speech, I would like to pick up on the speech to Beds. I pick up on the speech to Beds. I have signed the amendments to Salisbury because I support him and think the panel does need strengthening. It is not the case strengthening. It is not the case that courts have to be adversarial. Tribunals are set up to be inquisitive and the mental health tribunal is setup to be inquisitive, tribunal is setup to be inquisitive, and that is why I take commitments to this bill to make a tribunal to this bill to make a tribunal panel as the mechanism in terms of scrutinising decision-making.

It has been a pleasure to listen to this
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Ben Spencer Portrait Dr Ben Spencer MP (Runnymede and Weybridge, Conservative)
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been a pleasure to listen to this debate this morning because on this area relating to the prohibition of advertising, the debate started to move to focus on issues around suicide promotion and suicide prevention. This is something that I have been quite concerned with and has been part of what we have been talking about. I think it is a real blind spot, the interaction with duties to prevent suicide, be that doctors duties under article 2 of the convention, around the prevention of suicide clinical duties and the operation of the mental health act with this bill.

And the reason hasn't been focused on up until now is because of the framing of the bill as the assisted dying Bill as opposed to a suicide bill, and in a way, I started calling physicians assisted suicide. I started using the term because it was in common parlance that everyone was using, but I think the problem is that it frames it as something else. It frames it as reducing dying process as opposed to an act to end someone's life, which is why I have tabled amendments similar in how this is conceptual.



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I would just like to take issue with some of the language being used. We have heard the word murder, killing, suicide. 23 years ago next killing, suicide. 23 years ago next week, my husband died of terminal week, my husband died of terminal cancer. He was in extreme pain and was given morphine to relieve his pain and as the pain got worse, he was given morphine so that he could die gently and not in complete die gently and not in complete agony.

This is about helping people agony. This is about helping people die in a civilised way, helping die in a civilised way, helping their families not go through a horrendous experience of watching a horrendous experience of watching a loved one die in agony, and call it murder and killing is so wrong and I think we have a duty to mind our language about this bill. It is about helping people die quickly and about helping people die quickly and with dignity.

It is assisted dying.

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It has been a very well tempered debate. Let's keep it so. We know

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constituents are watching. I thank her for her intervention and of course, there are situations and of course, there are situations in which it is perfectly understandable. I spent my career understandable. I spent my career looking after people, many of whom looking after people, many of whom present to me their thoughts about wanting to end one's life. Many of them had mental illness, some have had terminal illness. The fundamental problem with this bill fundamental problem with this bill is that it turns a complete blind spot to these people who are highly spot to these people who are highly vulnerable.

It is absolutely scandalous that we have got to this point and we are still having this debate around the core concept which is why this bill should have been dealt with from the start with the Royal Commission to review so we don't have the situation where, at report stage, we are still debating report stage, we are still debating This is why I have tried to table amendments to help get to a point where we make sure that the most vulnerable are protected.

If it becomes, my amendments 19 and 20 work to edit the code of practice to this bill to make sure that there is clear guidance with regards to doctors duties, suicide prevention, to protect human life, their interaction with the Mental Health Act because the bill is currently blind on what you do if people are detained in hospital, what you do with patients resenting with suicidal thoughts, I have great concerns that there will be many people who are quite unwell psychologically, you start presenting to services seeking an assisted death rather than

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presenting with suicidal ideation. I can't be the only person in space was lost someone they love to space was lost someone they love to suicide and as I look to the Royal College of psychiatrists, who, the College of psychiatrists, who, the penny drops but for many with a penny drops but for many with a diagnosis, they have dental health issues which of course come with them, how does he think we distinguish between a person who distinguish between a person who chooses to end their own life because of a mental health issue because of despair, because they have an illness and someone who wants to end their life because of despair because of something else.

despair because of something else. Doesn't this deserve -- impair.

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These are going to be difficult

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These are going to be difficult things to eat and he would say, you get in front of a psychiatrist, you get in front of a clinical nurse specialist was working in specialist was working in psychiatry, this is what psychiatry does, this is what it is about which is why the amendments I put down, to is why the amendments I put down, to ensure that you get in front of a psychiatrist as part of this process. To ensure... My amendment process. To ensure...

My amendment will make sure the code of practice clarifies this interaction with clarifies this interaction with services. I think I am pushing it. I tried to intervene on the Member for spend valley earlier to try to ask spend valley earlier to try to ask this question about what do you think about this, she is welcome to intervene now she has further points intervene now she has further points to add, otherwise, I will ask the Minister if he and his winding up could address these particular could address these particular points.

Thank you.

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points. Thank you. I rise to speak to amendment 27 which would require the doses and types of lethal drugs to be properly licensed by the NHS RA. It is important to place on record that I do not think that this bill is safe and does not provide adequate safeguards and most importantly, it will deepen and exacerbate inequalities. On that point, I know I speak for tens of thousands of disabled people who rightly say, we need assistance to live and not die.

Throughout the passage of this bill, members from across the House have received many letters and briefings from leading experts including this week, a letter from over 1,000 doctors from across all areas of medical practice, expressing the
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Marsha De Cordova Portrait Marsha De Cordova MP (Battersea, Labour)
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clear view that the bill does not provide answers to how we improve provide answers to how we improve management of end of people's lives. They made the point that the drugs They made the point that the drugs expected to be used in assisted death should go undergo rigourous death should go undergo rigourous testing and approval as required by any other prescribed medication. Those requirements are missing from Those requirements are missing from this bill, indeed, there is nothing in the bill requiring lethal drugs in the bill requiring lethal drugs to be regulated by the medicines and healthcare regulatory authority.

And healthcare regulatory authority. And this is contrary to good medical this is contrary to good medical practice. Many of us will have heard that complications of drug use for that complications of drug use for assisted dying occurred in around 7% after and included vomiting, seizures, and prolonged debts of up to 137 hours. Where is the requirement in this bill to inform patients about how these risks including prolonged dying might be managed? Where is the plan to identify the most acceptable medications? I want to urge members to, if they have not already done so, to consider this letter signed by many leading experts, as if we do not listen to them, the very people who would have to implement this bill, who will be listened to? I would like to make a further comment, it is clear that the bill does not protect honourable patients from coercion.

I am not taking any interventions. In 2021, the UN human rights experts raised expert -- concerns that even when restricted to those with terminal illness, disabled and older people may feel pressurised to end their lives due to social attitudes and lack of appropriate services and support. I know across the House we know the support for disabled and older people is inadequate. We know that disabled people continue to face disproportionate levels of poverty, isolation, and hardship, and until that changes, I urge every member to

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think and not vote for this bill. I rise to speak in support of new

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I rise to speak in support of new clauses 13, 14, and 15, tabled by my honourable friend, to support amendments 94 and 95, and to oppose amendments 94 and 95, and to oppose amendment 42 and I would like to pay tribute to the compassionate leadership and immense heartbreak of leadership and immense heartbreak of the honourable member. And also, to the honourable member. And also, to the very thoughtful and very hard work done by members of all views who participated in the Bill who participated in the Bill committee, those who have worked behind-the-scenes to scrutinise this behind-the-scenes to scrutinise this and to contribute to the debate.

I would also like to thank all of the constituents who have been in touch
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Ellie Chowns Portrait Ellie Chowns MP (North Herefordshire, Green Party)
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constituents who have been in touch with all of us and I am sure like me, you have all reflected carefully on the contributions made by constituents and taken them into account. It is clear though, that the status quo is not acceptable and that is why it is right that we have this legislation before us and why it is right that we are scrutinising it so carefully and looking at it in such immense detail. Turning to new clause 13 regarding the regulation of substances for use in assisted dying, they obviously have to be properly regulated although it is equally obvious that they can't be subject to conventional clinical trials in the same way as other medicines and that is why the proposal about making this go through the MHRA is not appropriate but the regulations set out, provided for, will ensure that this critical part of the process is carried out with the highest possible level of scrutiny and harm prevention.

It is essential that there is transparency and assurance of the process from manufacture all the way to administration and that

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is what MC 13 does. I am interested in what she is

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I am interested in what she is talking about in terms of the safety of these drugs. And ask whether there is any adverse event data there is any adverse event data existing globally to quantify how much harm and suffering could be much harm and suffering could be caused while inducing the dying process.

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This gives me the opportunity to speak about the very detailed speak about the very detailed evidence given by my constituent who I spoke with at length yesterday about precisely this detail and I about precisely this detail and I have reviewed of any substance, but have reviewed of any substance, but the reality is that the comments made in this chamber today have indicated that these substances are indicated that these substances are being held to a far higher standard than substances routinely used in palliative care and so, we have to recognise that in fact, in assisted dying, the substances that are talked about, there is a huge amount of evidence about the efficacy of those substances, there is a huge amount published, peer-reviewed evidence about the efficacy of those substances and the reality is that, people like my constituent who is 40 S experience, a global expert in this area, point out that, we know how to assist people to have a peaceful, compassionate death effectively, and this is what this is about.

It is about people who are terminally, helping them to die with dignity, to face those final moments with the support and love and care of their family around them, to face them not in agony, but in whatever degree of peace is possible. When you are facing death. Turning briefly to amendment new clause 14 related to advertising, this, as the honourable member spoke about, this has been developed in consultation, as a result of concerns raised by opponents to the bill, to try to ensure that crucial thing that, assisted dying is not an advertised service.

There is a crucial distinction between advertising and information, so this clause ensures that the assisted dying remains a careful clinical process and not something that would be promoted commercially. It is a balanced cross-party Safeguard supported by people from all sides of this debate. I am very short of time, I think I had better continue. Turning to clause 15 in relation to the coroner. This bill is passed, assisted dying would be a very strictly regulated process. The choice of an individual, not a death cause that the hand of others, but by the individual themselves, as has been pointed out, this would be the most scrutinised type of death at all in the country, and therefore it makes no sense to require another legal process at the end of that legal process at the end of that when they have already had multiple agents -- layers of scrutiny before their death.

I am sorry, we are short of time. This is a compassionately thought I would safeguards in place, it would go against the spirit of the compassionate should be driving all of us to require a coroner's inquest. I will briefly pass to amendment 42, from the honourable member, which would renew the amendment leaving it in the hands of the Secretary of State as to when or if this becomes into effect. This would go against the will of the House.

If the House passes this bill, it is perfectly reasonable and perfectly workable within the next four years, for the detail of it to be worked out. We have already dealt with the length of time allowed for that to happen, this is effectively a amendment that seeks to kick the bill into the... That would be its effect. To conclude, I want to briefly address the misconception that seems to have informed some of the comments that I have heard in the debate today.

I.e., that the assumption, that families would be wanting to pressure family members to die quicker. My mum is a social worker, she is a specialist palliative care social work and she has told me and he has a practice she has never experienced that happening, it is the other way round, family members... I am sorry, I am concluding. We are each speaking from our own experience and from the heart. The evidence is that it is dying people

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She has made it clear, she is not taking interventions. It is dying people themselves facing the end-of-life who wish to have the choice, only small numbers of them take this choice but it is crucial, humane, compassionate, for crucial, humane, compassionate, for us to offer them that choice. Assisted dying is comp entry to palliative care, it is not palliative care, it is not contradictory. This bill has been through a huge amount of scrutiny, through a huge amount of scrutiny, far more than any other bill this session.

Therefore, I deeply hope that the House will pass this compassionate, humane, and clearly compassionate, humane, and clearly drafted, tightly structured bill to drafted, tightly structured bill to offer a dignified death to those who are facing death. are facing death.

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Thank you. I rise to speak to my amendment number 13 which concerns the appointment of the voluntary the appointment of the voluntary assisted dying Commissioner. During the committee stage of the bill, it was decided that the Prime Minister was decided that the Prime Minister would point the voluntary assisted dying Commissioner and he would serve five years and be responsible serve five years and be responsible for appointing the assisted dying. The Commissioner would oversee the The Commissioner would oversee the training of panel members, give them guidance on the procedures to be used, and crucially, decide when a
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Patricia Ferguson Portrait Patricia Ferguson MP (Glasgow West, Labour)
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used, and crucially, decide when a case that the panel has refused should be referred to another panel for reconsideration. The Commissioner will not, according to the bill, be acting as a judge but must be a current or former senior judge of the Supreme Court, Court of Appeal, or High Court. But is not required to have any expertise in medicine or in healthcare. And importantly, following committee stage, the bill no longer requires that the Chief Medical Officer be responsible for monitoring whether or not the assisted dying regime complies with the law.

That responsibility has now been transferred to the voluntary assisted dying Commissioner. So the person who is in charge of making the process, the person who is in charge of creating the panels, will also be the person who decides whether or not the act is being administered correctly in that administered correctly in that

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Given the scandals in infected blood, to things that happened at a mid star. Having that robust mid star. Having that robust oversight for the Chief Medical Officer officer is a good way

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forward. I thank the member of his

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I thank the member of his intervention. I think he does make a very valid point. The point of my amendment, I will come to this. We amendment, I will come to this. We need to ensure there is much scrutiny as possible in this regard. scrutiny as possible in this regard. Clearly, from what I have outlined this is an exceptionally important post and one which carries a great post and one which carries a great responsibility and significant responsibility and significant power.

Indeed it seems to me that post-order will require the judgement of Solomon to be able to judgement of Solomon to be able to fulfil their role. It is surprised that as the bill stands there is no requirement for pre-scrutiny of the appointment by the relevant Select Committee. Despite the profile of the poster and the controversy I think it will inevitably attract. Considering that such pre- appointment scrutiny is required, for the chain of the Competition and Markets Authority, for the chain of the BBC, the chair of the Charity Commission, the Information Commissioner, the chair of the Care Quality Commission, the Health Service Commissioner of England, the chair of the judicial appointments commission and the chair of the UK statistics authority.

The omission of such scrutiny, in this case is clearly a serious oversight, which my amendment seeks to remedy by ensuring that the correct Select Committee does have that power of scrutiny, over the spill. Chris Raqqa over this bill.

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In my view, we need to guard the rights and privileges of Parliament rights and privileges of Parliament very jealously. We need to ensure very jealously. We need to ensure that this Parliament is involved in the scrutiny of this bill going forward as a much as it possibly can forward as a much as it possibly can be. And the bill itself requires to be as rigorous and transparent as is be as rigorous and transparent as is possible. No matter what side of the debate you are on it is important and we owe it to the people who sent us here.

The people who have been us here. The people who have been writing to us in such great numbers, to make sure that this bill is as strong and as good as it possibly strong and as good as it possibly can be. And my amendment seeks to make sure that in that regard, regarding the voluntary assisted dying commissioner, it is a

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stronger. Thank you. I refer to honourable members to my register of interest, a consultant paediatrician. The debate so far has primarily focused on ethical consideration and legal frameworks, who will be eligible for Doctor Who though, the when and the why. I want to focus on the House. As a doctor, I know that there is a drugs in different combinations can be fatal. In other words there is more than one way to kill people. But which would be the best to do.

Which would be most comfortable and how do we know. For example some forms of assisted dying use blockades and in common parlance that means they paralyse you. Imagine a situation where you are in a lot of pain and someone gives you such a drug, to the outside you look relaxed and peaceful as your muscles relax, but inside you could be in a lot of pain and unable to express that to anybody else. Do we want people to be comfortable and know they are comfortable, or only appear comfortable to us.

Clearly want them in comfortable as well for stop we need it properly regulated for this purpose. Assisted dying is often portrayed as a safe, peaceful and controlled. The reality in countries where it has been legalised is more complicated. Technical difficulties frequently arise and complications causing a greater suffering, requiring intervention and leading to a prolonged painful death. I quote in the medical journal, a
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Caroline Johnson Portrait Dr Caroline Johnson MP (Sleaford and North Hykeham, Conservative)
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pathologist, works in the same trust as I do says there is lack of reliable data on the safety of drugs reliable data on the safety of drugs use. Largely due to inconsistent reporting in jurisdictions where reporting in jurisdictions where such dying is legal. In Belgium it is estimated over 52% of euthanasia cases are reported to federal cases are reported to federal euthanasia and the evaluation committee for stop during a Select committee for stop during a Select Committee visit to Oregon, to discuss assisted dying, in the last Parliament, which I went to and to honourable members from the other honourable members from the other ventures went as well.

We heard ventures went as well. We heard about the complications being known in 71% of cases. No healthcare professional present when the drugs professional present when the drugs were given, so we couldn't know. We do not know of the drugs been taken in some cases. When we did we found in some cases. When we did we found a history of seizures, vomiting and of prolonged deaths. In nine cases in Oregon in 2023, there was a case, nine patients of having reawakened, being given these drugs.

in Washington in 2018 report, 31% of patients took more than 90 minutes to die. I would also remember and remind honourable members in the absence of evidence that things are going well, is not the absence of

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things going wrong. I thank the honourable lady for giving way and for so eloquently giving way and for so eloquently describing some of the variation in the use of drugs, in the case of Me Me that Me that in Me that in a Me that in a normal Me that in a normal practice Me that in a normal practice that Me that in a normal practice that we have the Yellow Card Scheme which allows for any adverse events from ingestion of prescribed medication to be reported.

Is it her understanding that under the current proposals of this will not happen at assisted dying? If you also aware of the review that shows other great the review that shows other great variation in the range of drugs are used and the dosage.

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used and the dosage. I thank the honourable lady for the intervention. One of the key problems compared to others is that problems compared to others is that we cannot ask the patient afterwards how that felt, we cannot get their feedback, because they are dead. If we are going to give them things like this, we may not be able to tell. There are physiological ways you can monitor patients and get some idea, perhaps heart rate or temperature. We are not meant to be doing that.

That is one of the reasons why it had put forward the amendments today, to ensure that the drugs are properly regulated by the authorities we know that the drugs been tested for the purpose for which they are being used. I have not got very much time. Another return of the cot. One examines the litigations, it makes troubling reading. It is often an ad hoc cocktail including highly toxic agents, muscle blockers and others. There is no drug regime agreed.

Oregon, Canada and the Netherlands use combinations of opiates. All drug combinations have shown long and medium term debt. As it stands in this bill doctors will have to consider prescribing untested drugs or drug combinations which could potentially breach the GMC prescribing guidelines. To address some of these concerns I have tabled several amendments. Amendments 96, 97 in ensure that no drug can be approved under this act unless there is scientific consensus it is effective and does not cause undue pain or side effects.

It has been licensed for that purpose by the MHRA. I cannot understand why anyone would disagree with that. 98 clarifies the secretary of state is not compelled to approve any drug, after consultations no drug is safe and offer standard. At 99 alongside 100 mandate that the regulations are And it must be provided. This report must include time to death, possible complications including pain and any likely side effect of the post substances. I cannot see where that would be controversial. Surely we want everybody to be informed and make informed decisions.

These are part of making an informed decision. A new clause 13 B requires medical devices for self administration agreed by the MHA. The secretary of state regulations. This is a basic safeguard we would expect and it should be nonnegotiable as a condition here. Amendment 42 will move the time limit and pressure on the Secretary of State. I understand concerns about this. There is often a narrative that this will lead to patients being able to die at a time and place of their choosing.

The regulations in this bill require the doctor to stay with the patient from the moment they take it when they die. This could take some time to stop do we have enough doctors to do this, at a time of their choosing? At the moment I do not think we do. I do not see how in a short period of time that would be achievable either.

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Thank you. I stand in support of new clauses 20 and 21, with new clauses 20 and 21, with amendments 89, 90, 92, 93, 94 and 95 in the member of Spen Valley. I will in the member of Spen Valley. I will not speak toward them. Colleagues fear not. Given some of the fear not. Given some of the discussion I want to focus on a discussion I want to focus on a couple of aspects given I am a proud Welsh MP.

A lot of the debate today
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Alex Barros-Curtis Portrait Mr Alex Barros-Curtis MP (Cardiff West, Labour)
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Welsh MP. A lot of the debate today has centred on differences, or perhaps confusion about the distinction between devolution, and aspects of this bill. Firstly I'd like to thank a subclause 21 (Consequential Amendments) 90. I contribute my honourable friend about the Member for the work that I know they have done, together on this. Two ensure the people in Wales can assess the assisted dying process, in the Welsh language if process, in the Welsh language if that is the preference.

Some of included medical professionals and palliative care consultants, their overarching concern was the fear that the barrier of language may be inadvertently impacting the ability of the relevant person, in Wales to access and understand the assisted dying processes. I'm grateful to them including Dr Sue Seaman and Mark Talbot. New clause 21 Emma Ma 90 seek to replace a law 47 and provide a form of the first or second reparation, the report about the first or second assessment of a person, or the final statement, must make provision for it to be in Welsh.

It stipulates that the where and when and informs the dying Commissioner that they wish to communicate in Welsh. The Reasonable steps to make sure that wishes respected that communications by relevant assisted dying a new panel are in Welsh. These important amendments, as they are about accessibility and respect and ensuring that language is never a barrier to compassionate end-of-life care. They uphold a principle of linguistic equality, which is a well est and public services in Wales and I trust that this should not be controversial to colleagues, when this comes to a vote.

As a Welsh MP and pleased to see the inclusion of the moments 92, 93, 94 and 95, whilst the may appear small amendments, they are important. Because of their respect, fully, as my honourable friend said, they respectfully the devolution settlement, by ensuring Welsh Ministers have the necessary powers, about devolved aspects of the bill, health, whilst retaining the powers of UK Ministers, over those aspects, that are not devolved. Something that I think got slightly misunderstood by some in this debate, earlier.

Taken together, they provide clarity and legal certainty and they offer reassurance to patients, clinicians and government agencies, in Wales. That principle should be uncontroversial. I know from my own discussions, with the Welsh Government and the Welsh health Minister, that he is extremely grateful, for the interactions he has had with the honourable member and that he is confident that this is a workable, from the perspective of Wales. In from the perspective of Wales. In This is seeks to mandate the Secretary of State must within six months publish a report, setting out the impact of this legislation, and the civil procedure rules and probate proceedings.

I do not recall, during this debate, and during the streams of evidence we have heard, there was a suggestion that this bill is necessarily likely to result in any serious changes to those specifically reference matters. On the contrary, England at CNO, Professor Chris Whitty warned against a bureaucratic thicket and saying that best safeguards of the simplest. Let's keep that in mind when we are considering this legislation and avoid inserting no doubt well-intentioned but inserting amendments that will create such tickets. I would like to conclude by tickets.

I would like to conclude by showing one story from a constituent of mine that was focused very much on safeguards, which has been the debate about all of these amendments and all other new clauses. I want to finish up, I appreciate his forbearance. That constituent was Claire O'Shea. She was originally diagnosed with IBS. It was only much later they realised that she had a stage IV cancer. Within an hour of this, passing at second bill, clear message me to say, what a powerful debate today.

It is hard to say I am pleased as it is a terrible issue to have to contemplate. It is such a relief to know the next stage is open and hopefully allays the fears of those, talking about safeguards. Claire lost her battle with cancer last month. I'm pleased that we are here again, discussing the specifics of this bill and talking about amendments in good faith that either side thinks will enhance it safeguards. In honour of Claire and of all those like her, I urge colleagues to vote to support the clauses, amendments and new clauses of outlined and to support the bill itself.



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I rise to speak to a moment 70 in my name. I also refer to my register my name. I also refer to my register of interest in regards to the Royal College of Psychiatrists. New clause 13 is, we are told a replacement for clause 34 and I would hope members have taken the time actually to have taken the time actually to compare the two. Because a new clause 13 contains even more powers, than clause 34. It follows the trend of this bill, where instead of more of this bill, where instead of more detailed elements in the bill, more powers added.

And it seems to be the powers added. And it seems to be the line is that there are some issues which we will sort out later. It seems to be that this place would be seems to be that this place would be It seems there is no explicit limit or principle by which they are to be exercised. Nor do we have the benefit of a policy paper by the Secretary of State actually saying how he intends to exercise those powers. Nor how has its successors
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Robin Swann Portrait Robin Swann MP (South Antrim, Ulster Unionist Party)
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will either. Relating to the will either. Relating to the approved substances clawed 25 in approved substances clawed 25 in face a problem. As a barrister and pharmacist told the committee and written evidence, the substances intended to end life are not medicinal products. Actually within medicinal products. Actually within the meaning of the human medicines regulation 2012. And that is a definition which itself derives definition which itself derives itself from EU law and it states itself from EU law and it states that, that term, must be interpreted as not covering substances whose effects merely modify psychological effects merely modify psychological functions and which are not such as to entail immediate or long-term beneficial effects for human health.

beneficial effects for human health. That creates the real problem. If it is not a medicinal product, then why does the bill provide that pharmacists are to be involved in the preparation of it and why are doctors supplying it? I will make a bit of progress. Because you clause 13 you clause 1360 get around this problem by giving power to the Secretary of State to amend the human medicines regulation 2012, actually to make them fit in. So the impact assessment tells us that the government has no plans to conduct or rely on the sort of scientific studies that normally come for drug

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approvals. I would like to thank the honourable member for giving way. As honourable member for giving way. As a pharmacist as you know, there are drugs that are going to be used for drugs that are going to be used for assisted dying, that are commonly used in pharmacy now. It would be obvious for pharmacy is to supply in some way shape or form, those drugs. some way shape or form, those drugs. And I accept his point about medicines being used, but he must medicines being used, but he must accept my point I hope, that, how would the same studies that are used to prove treatments, be used to to prove treatments, be used to prove the useful death?

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prove the useful death? I think the member said in another intervention, the members would used with licence and the risk would used with licence and the risk of prescribing them as for the person using them as well, so that is where the risk was back on the individual rather than what is covered in this bill, because that is where it comes. I do not understand the need to treat them as medicinal products, but if it is the will of this House to change the law here, what I cannot understand is why this law now changes that for the rest of the United Kingdom and indeed, that is the base of my amendment because this House is not voting for assisted dying in Northern Ireland.

So it has no locus in changing the definition of a medicinal product in Northern Ireland in order to accommodate this bill which after all we have been told, applies only to England and Wales unless it is the intent of the bill sponsor or those behind it at a later date to extend to Northern Ireland using some of the Henry the eight regulations. There is a further issue in Northern Ireland, we are still subject to EU and on this point I would be interested to know where the government has considered this aspect in that regard.

Can the Minister really change EU law in Northern Ireland with regards to the use of these substances? If so, why has it not been granted for such power in other areas of significance to Northern Ireland? Why only this? Why have so much government time previously spent working in medicine regulation and supply for Northern Ireland or why did the right honourable member when he was the Minister of State for health, and I have the Minister of health Northern Ireland, spent so much time on it.

To that extent, can I ask, what engagement there has been with the Department of Health or the Minister of health Northern Ireland, or indeed, the chief pharmaceutical officer in Northern Ireland, or is this another section of the bill which has been put in without any background or any engagement, just to meet the sponsor needs? In that regard, in conclusion, the application of those provisions to Northern Ireland also has implications on the protection, because if as a result of these regulations are made under these provisions, pharmacists and Northern Ireland are required to be involved in the manufacture or preparation of those substances and they will not have the benefit of the clause, as that clause has not been extended to Northern Ireland in this bill.

I therefore oppose the extension of this to Northern Ireland and Scotland and I will oppose amendment 77 and ask members to support the amendment in my name.

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I rise to speak in support of amendment number 15 in my name and I will minimise my comments and maximise others time in this debate. maximise others time in this debate. Because of the widespread unease from NHS practitioners, because of the growing number of voices of concern about the shortcomings of concern about the shortcomings of this bill, it seems that if this legislation is passed and I still hope that it won't be, but if it hope that it won't be, but if it does get passed by this House, it is likely that assisted deaths will take place away from the public sector.

Indeed, this bill does not prevent assisted deaths from being outsourced to private companies. outsourced to private companies. There is no definition of what reasonable renumeration means in reasonable renumeration means in return for helping to end someone's life. My amendment seeks to ensure life. My amendment seeks to ensure that providers publish on an annual basis, the numbers they provide those services to, the costs of doing so, and the revenues received in return. I know that many will be guided in this debate by their religion when they vote in these issues, and though I respect that deeply, I am not a person of faith.

If there is a booming baritone voice appealing to my conscience, it is not God but of the concerns about the commodification of care. In his time, the worry was about the role of the market and extending life, today my concern is about the role of the potential role of the market in ending it. Throughout the passage of this bill, we have discussed coercion of different kinds by
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Blair McDougall Portrait Blair McDougall MP (East Renfrewshire, Labour)
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individuals and the lives of people individuals and the lives of people who are entrusted to us. As a Labour MP, I do not think we can have this debate without addressing the economic coercion experienced by the economic coercion experienced by the vulnerable in our society. I understand, I genuinely understand understand, I genuinely understand as someone who was sat at a bed and pray for mercy, I understand the pray for mercy, I understand the attraction of the arguments around choice, but for me, as a Labour MP, choice, but for me, as a Labour MP, arguing for freedom of choice is a fundamental principle in isolation fundamental principle in isolation without also acknowledging the economic social, and cultural context that people make those choices in is not for me, it seems a

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Labour approach to this. With the honourable member agree with me that no matter how many clauses or bills we put through, we cannot mitigate for the fact that people are vulnerable and particularly financially vulnerable, according to the charity mind, many people consider suicide in this country because of financial

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hardship. How would we mitigate for that? He makes an important point, one that we have to consider today. We that we have to consider today. We must recognise the choices, as the honourable gentleman says that people may, limited by the unfair destruction of wealth, the injustices that disabled people face injustices that disabled people face throughout their lives, or the attitudes of the powerful in society attitudes of the powerful in society towards those who are less fortunate.

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fortunate. A very short comment, thank you for giving way, if you look at the statistics, it is usually the more statistics, it is usually the more well off in society that choose assisted dying, not the less well off.

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off. I will come to that point shortly, as it happens. But I think shortly, as it happens. But I think we have a duty to ask, will the poorest and most vulnerable he coerced into choosing a sister dying over palliative care through economic disadvantage? Will they be exploited by those with a financial interest in them choosing to end their life? And will their death become a commodity? And if we are really going to pass legislation that allows someone's death to become a matter of business, we must have full transparency on those financial motivations.

It is not that carers in the private sector about people any more than people working directly within the NHS, but private healthcare operates in a context. The evidence that profit influences on the moral choices made across the care and treatment already provided in this country is overwhelming. This is not a hypothetical concern. For example, a systematic review published by the BMJ found that private equity ownership of healthcare is associated with lower standards of care. Around the wonderful miracle of IVF, we have an industry profiting from desperation as people start life rather than end life.

And already today, and this relates to the point from my honourable friend in front of me, already, at the end-of-life, choice and palliative care is limited by economic status with the wealthy more likely to die a good death than the poor. This amendment seeks to address the fundamental question of whether free choice really is free, by bringing into daylight the financial motivations of those involved in

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decisions. I thank the honourable gentleman for giving way that point and he makes a strong argument about why we should be excluding private for profit providers from registration. profit providers from registration. I made an amendment specifically to limit the provision of assisted dying to charities but unfortunately, the amendment was rejected. Would he be able to clarify where and how he thinks assisted dying should be and what his understanding is on the basis of his understanding is on the basis of this bill and the lack of clarification we have had.



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I think she makes an important point. I think this amendment seeks to recognise that there is a difference in where the income stream comes from and there are stream comes from and there are moral issues raised by that. I don't wish to exacerbate the bronchitis so wish to exacerbate the bronchitis so I am going to continue. This amendment touches on that fundamental point at the heart of the debate. Disabled people in every aspect of their life, have to fight every day for resources from a state, a market, and a society that views them as a drain on finances.

Do we honestly believe that at the moment, when the most vulnerable are the least able to argue for themselves, at the moment when they are under the most intense societal and cultural pressure, at the moment where they are at their most expensive, that that same public and private sector will succeed in making a choice for them when it has failed to do so throughout the rest of their lives. Even if we can convince ourselves that will be true in the state sector, can we say it will be true from the market? I do not believe this bill should be passed if it is, let's not make it worse by allowing an scrutinised profit from the loss of human beings.



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I rise to support new clause 14B, new clause 1, two, 16, 15 a, and 14 new clause 1, two, 16, 15 a, and 14 A. I make two observations, I do so A. I make two observations, I do so as a Welshman representing an English constituency, I checked the English constituency, I checked the Northern Ireland Affairs Committee and I chair the constitutional and I chair the constitutional affairs. I remain to be convinced that the confidence expressed by the proposal of this bill, that it honours, in the spirit and the letter, the devolution of letter, the devolution of settlement, is true.

And she has been able to see the accession on the face of her honourable friend, I the face of her honourable friend, I do not believe the honourable lady believes it honours the devolution settlement has far as Scotland is settlement has far as Scotland is concerned either. And I make this point and I know how easy it is, because I know this is a trap I have fallen into, we are here to make law which has to stand the test of time. The honourable lady, she was not the only one, but she assured a heartfelt anecdote of a conversation with her mother as a result of her mother's professional work.

We should not and cannot particularly on an issue as a motive and as life changing literally, as this bill, we should not base our decision on anecdote, but on cold analysis of what is before us. It has been almost 6 months to the day since this bill was introduced and still, I think it is best described as being skeleton. We have been told time and time again by the honourable lady and the Minister how busy officials have been looking at the practicalities of the bill and how to operationalise it and to make it workable.

And yet, this House is kept in the dark on what Ministers intend. Indeed, the honourable gentleman, said in his earlier contribution, that his understanding was that the honourable lady was still prepared to work with colleagues to perfect the bill. We are on the second day of report stage, we could easily forward to third reading today, the time for that evolutionary conversation as long passed. The time for detailed clarification is now. The bill The most common phrase in the government's impact assessment, not
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Simon Hoare Portrait Simon Hoare MP (North Dorset, Conservative)
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known, but unknown. They are thinking of outsourcing the lives of the terminally ill to private contractors are no for profit basis. The honourable gentleman he spoke The honourable gentleman he spoke before referenced someone spinning before referenced someone spinning in his grave at the thought of that. in his grave at the thought of that. Constraining the powers to be given to Ministers, even more Henry VIII powers have been added. Henry VIII powers which were not in the powers which were not in the original bill.

We were told and I know full well that many honourable know full well that many honourable and Right Honourable members bought this, that the role of the committee this, that the role of the committee and further stages of this bill would provide all of the answers,. All the eyes come across all the teas, provide the full clarification that that is not happened. This House rightly bridles that Ministers of the Crown bring forward legislation which has an unhealthy reliance on Henry VIII powers.

If we do it on other legislation we certainly shouldn't for this. It is beginning to feel as if this were a deliberate tactic. Keep things vague. Do not make anything too real or tangible. Do not confront what this will mean, day to day. Let's just keep it light, let's keep it airy fairy. Let's keep it in the cloud of the principal and somehow or another, through benign intervention, good will accrue. I think that this is too serious an issue to place that faith, because placing their faith could be misplaced.

It relies on us as members of Parliament to not care. To switch off, when we hear the words secondary legislation. Something which we know can often take place in five or 10 minutes, in a committee room of a 14 or 20 people, selected by the Whips, no debate on the Floor of the House. It is not a niche issue for the Hansard Society or the Delegated Powers and Regulatory Reform Committee and it would be a shame and a stain on this House, in this parliament, if we just nod through a bill, which gives us this idea that Henry VIII is the way to go.



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I won't, I am very conscious of time. Madam Deputy Speaker, of itself, the fact that many Right itself, the fact that many Right honourable members have been constrained, in the length of their interventions, because of your persistent cough, I say that not as persistent cough, I say that not as a criticism. When it next week we have a lot of online Whips and the following week we have exactly the following week we have exactly the same, more time really should be given to this.

I do wish the government to take this on, not as a government to take this on, not as a government bill, but had found committee and report stage time, on committee and report stage time, on the floor of the House, in government time. This is too serious an issue to have as many gaps that an issue to have as many gaps that this bill has. The founding fathers this bill has. The founding fathers of the US worked on the basis that the vague generalities of the Constitution would always be adhered to and that men and women of good will would adhere to it.

They are now beginning, I'm sure, posthumously in the current iteration to wonder if that is true. We should not leave it up to Ministers to define and decide how regulations come forward. We have bills which have page after page after page which when people think to themselves what is this all about, actually about very little. The amendments which have been tabled which I support have been tabled in good faith. But I am afraid to say I think in terms of trying to improve this bill it is trying to make a silk purse out of a

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sows ear. I rise to support MC 20, empty 21, as well as a moment 70, 71, 92 to 95. They are all about the right, to 95. They are all about the right, they are all about the right people, having the right powers, at the right time and in terms of the right time and in terms of the amendments, respecting the devolution settlement for Wales. I will not take interventions, I'm will not take interventions, I'm really sorry to honourable members.

really sorry to honourable members. An extremely to the Member for Spen Valley who engage so meaningfully and strongly with the Welsh Government. Including going to
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Catherine Fookes Portrait Catherine Fookes MP (Monmouthshire, Labour)
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Government. Including going to Welsh health Ministers and officials to ensure they are continually consulted during this process. So starting with the new clause 20, it ensures that it is the Secretary of State, not the Chief Medical Officer was responsible for issuing guidance on the operation of the bill. It enhances oversight and accountability, by placing this responsibility, for the Secretary of State. The scrutiny and accountability over how this law will be implemented in practice and will be implemented in practice and put in the right place.

It is a normal practice that officials whose roles and responsibilities may alter, over time are not named in primary legislation. It is important to note however that the Chief Medical Officer is definitely not been cut out of the process. The chief medical officers for England and Wales must be consulted. The amendments also allow persons with learning disabilities and other protected characteristics as well as providers of palliative care services to contribute to the process of provisioning guidance. So it is a simple but important amendment that ensures the right level of ministerial oversight.

And I urge colleagues to support it. Moving on now to new clause 21. As my honourable friend the Cardiff West has already explained. It is important to urge people to support this part of the amendment, because it ensures that people in Wales are able to access the assisted dying process, in the Welsh language if that is their preference. Almost 30% of the population in Wales speaks Welsh and it is so important that they can access this service, in their language, should they wish to.

It is a small change, but it will make a huge difference to patients, families and conditions in Wales. Moving on to amendment 70 and 71. They simply provide provisions around the use of interpreters. Requiring the Secretary of State to publish a code of practice, on this matter. Interpreters are essential to ensure fair and equal access to the assisted dying process. Those whose first language is not English or Wales. On amendments and 92 and 93 they provide greater detail on the Welsh Government's responsibilities in delivering assisted dying services in Wales.

Some honourable members seem to be confused about what is and isn't devolved. As a Welsh MP, I wholeheartedly support this amendment, which 100% respects devolution. It ensures that Welsh Ministers have all the powers that they need, with regard to the devolved aspects of the bill. The health provisions, while retaining the powers of UK Ministers, over those aspects that are not devolved. The criminal justice provisions. Including crucially changes to the Finally, Finally, on Finally, on the Finally, on the amendments, Finally, on the amendments, Madam Deputy Speaker, I support amendments 90, 94 and 95.

Which clarify how and when provisions, relating to voluntary assisted dying will come into force, in Wales. These do not infringe on the devolution settlement, but simply provide clarity and legal certainty. All of these amendments would help our constituent knower, a 19-year-old , who knows what he wants, if his pain becomes unbearable. This bill is about giving people, like knower, the choice, control and compassion they deserve at the end of life. And who are we to deny that choice. In conclusion, I want to pay tribute, once again so my honourable friend the Member for Spen Valley who working closely with officials, in both Wales and in this place as a craft, what could be the strongest and most safeguarded assisted dying legislation anywhere in the world.

It is the bill designed to protect everyone, including my constituents in Monmouthshire and people across Wales. Thanks to the careful considered amendments, including the ones I rise to support today. Not only respects the devolution settlement, it ensures the right people hold the right powers, at the right time, to deliver this safely. I urge other members to join me as we legislate to protect the plights of the terminally ill, in their final months, to legislate for compassion, for choice and for dignity.



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I rise to speak in relation to the members at 39, 40 and 41, in my name. With regard to the clause of name. With regard to the clause of 47 and information, we should also read clause 21, which has been made read clause 21, which has been made up by the sponsor for this bill. The issues here, we have touched on, issues here, we have touched on, others have touched on Welsh devolution. I want to touch on the devolution.

I want to touch on the settlement in Wales. What we are talking about is something quite conventional in the sense of written conventional in the sense of written Welsh being available for forms and Welsh being available for forms and guidance, that way, way more significant is the availability of the people who wish to use Welsh, Welsh may well be the first
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Liz Saville Roberts Portrait Rt Hon Liz Saville Roberts MP (Dwyfor Meirionnydd, Plaid Cymru)
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Welsh may well be the first language, in dealing with the stages of this, the provisions provided by this bill. We have the all reasonable steps in relation to be able to find a coordinating doctor and an independent doctor. I would like to say, I would like more than a reasonable, reasonable steps, but the reality is we have to deal with the staff who are available and the the staff who are available and the language that they have. A third stage, I'm very glad, I am appreciative of the honourable member for Spen Valley, also appreciating this in her new clause is it is really, really important for a Welsh speaking individual to be able to communicate in the language in which the best express themselves, when it comes to the assisted dying review panel.

Because this is the final stage which we will recognise whether there is a question of coercion, whether there is a question over capacity. I must also welcome the fact that there are different clinical specialists. I believe this improves that the identification potential of questions of coercion and capacity, by having an expert, psychiatrist and a social worker, different I must take a step back to the reality of how Welsh language speakers can use Welsh, with injustice, which of course is aware the aspect of the assisted dying review panel comes in.

In justice, you have an individual and an individual has the right to speak Welsh. If they use Welsh in a court, then an interpreter will be used to interpret their words to the people to whom they are speaking. That is not acceptable, in this context. This is of the most serious, the most desperately difficult conversations that people will have. They must be able to, not just to speak Welsh, but to be heard as well, in their own language, if all Is that.

I would like to say I'm withdrawing my amendments at 39, 40 and 41 and supporting a new clause 21, wholeheartedly. I want to turn to the Senedd powers, particularly clause 54. Firstly, I welcome the clarity of responsibility, as regards to Ministers and Welsh Government, UK Government, in clause 20. There are two issues here. There is clarity of powers, but there is also respect across the legislative I have concerns, and 94, 95, to the amendments made by the honourable member for Richmond Park, in committee.

What did those amendments in committee do. They ensured a vote in the Senedd, to decide when the act would come into force, in its entirety, in Wales. Now in Scotland they passed stage II of the assisted dying for Terminally Ill Adults Bill, 13 May. Such a bill that could not be brought forward, in Wales because Wales has no powers over criminal law. This bill that we are discussing here today could not be rolled forward, in Wales. Although I appreciate what the honourable member for Cardiff West Monmouthshire said about the devolution settlement.

I'm glad we have clarity. There is also a question of respect for decisions already made in the Senedd. As things stand, what does the Senedd have to do for will be required to pass a legislative consent motion, as required by the sea well convention, that can be ignored. -- Sewel Convention. This effect actually Wales and consumer action This is calling therefore for a vote, for the second thing that could happen in the Senedd. You will be expected as in those areas where there is the power of the Senedd.

Commencement, a decision is required on the provisions of the bill, which have devolved confidences. Specifically the NHS in Wales. Reminded if this is refused, in Wales. That means that this bill, if enacted can only be brought in, into the private sector. That decision lies with the Senedd. The critical point that none of us have raised is a decision, debate on 23 October, last year, when the Senedd debated, in principle the question of the assisted dying. And the Senedd voted against this.

Professor Emyr Lewis of a whiz with the University believe this and I agree with him to be highly significant. That vote included the First Minister and the health Minister of Wales who voted against the principle we are against the principle we are , , which , which allows , which allows the , which allows the Senate , which allows the Senate to , which allows the Senate to have , which allows the Senate to have a vote on the commencement of this bill when it is enacted, is highly significant and although I support very much of this bill, in principle and in broad detail, I cannot

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support amendments 9495 because they rollback on that. I would like to move amendment 12

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I would like to move amendment 12 in my name. I want to be clear, a decision on amendment 12 is not a vote for against assisted dying, it is about preventing any government is about preventing any government of any political persuasion from of any political persuasion from rewriting the very purpose using a small group of MPs in a committee small group of MPs in a committee room rather than on the floor. My amendment seeks to protect the amendment seeks to protect the foundational document of our NHS and ensure that any changes to it are ensure that any changes to it are properly debated in open Parliament as the public should expect.

Let me as the public should expect. Let me explain why this matters. At committee stage, clause 38 was added to this bill. This clause gives a future Secretary of State sweeping powers to amend existing health law through delegated legislation. Subsection 4 of clause 38 allows a future government to change the very purpose of the NHS by amending purpose of the NHS by amending section 1 of NHS act 2006. section 1 of NHS act 2006.
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Siobhain McDonagh Portrait Dame Siobhain McDonagh MP (Mitcham and Morden, Labour)
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I thank the honourable lady for giving way, she is setting out her concerns eloquently. What concerns does my honourable friend have that this bill writes a blank cheque for a future Health Secretary to change the nature of NHS without parliamentary scrutiny.

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That is the whole purpose of my amendment and my speech. Section 1 amendment and my speech. Section 1 is the legal foundation on which every NHS duty rest, guaranteeing every NHS duty rest, guaranteeing our NHS will serve everyone, always. This section has remained virtually This section has remained virtually unchanged since 1946 because it unchanged since 1946 because it expresses a promise, a comprehensive health service designed to secure improvement in the physical and mental path of the people of mental path of the people of England.

Those words commerce broken and enshrined in law, set the and enshrined in law, set the purpose of NHS. A National Health Service, free at the point of delivery.

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Can I put on the record, members should not be wandering into the chamber and then very quickly making an intervention, lots of members are an intervention, lots of members are waiting to speak and make interventions, if that is the case, have you been in the chamber for a while?

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while? I had to use the facilities, I apologise for that. I am a gentleman apologise for that. I am a gentleman apologise for that. I am a gentleman of an age. I apologise, and I thank my honourable friend for taking the intervention, we are about to reach the 80th anniversary of the the 80th anniversary of the landslide 1945 Labour government landslide 1945 Labour government trail of NHS, and fundamental to that is the point you make about the NHS being free at the point of need, NHS being free at the point of need, about care, compassion, and life.

What assessment has she made about What assessment has she made about how this bill, if it goes through unamended, will fundamentally challenge that great victory and

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legacy we cherish. The power to be able to alter the

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The power to be able to alter the intentions as mentioned by the honourable member, was not in the bill we voted for in November. And bill we voted for in November. And that is why I have tabled my amendment. To prevent anyone from amendment. To prevent anyone from tampering with NHS as founded by our tampering with NHS as founded by our forefathers. Because let's be clear about what clause 38 of this bill would allow. It would allow a Minister, through delegated legislation, to rewrite the very purpose of our NHS.

It would let purpose of our NHS. It would let them do so without the full scrutiny that primary legislation demands. And it would mean Parliament could be denied any real chance to amend be denied any real chance to amend or reject that change. These are not abstract constitutional concerns, this is about whether the founding promise of the NHS can be quietly rewritten. Not through open debate, not by an acts of Parliament, but by a handful of MPs behind closed doors in a committee room.

And once the pass is sold, there is no telling what future governments might do. This is why this matters so deeply, because the NHS is not just a set of services, it is a promise, a promise made right here in this House nearly ATS ago during the second reading of I think it is important for her to be able to explain in detail what these philosophical and institutional implications are but fundamentally for ordinary patients, what does my honourable friend think this bill will do about changing the relationship between the patient and

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the doctor? The potential is to alter everything in a very undemocratic everything in a very undemocratic manner. In this very chamber, we were told that the NHS would lift were told that the NHS would lift the shadow from millions of homes, keep very many people alive who might otherwise be dead, relieve suffering, produce high standards suffering, produce high standards for the medical profession, and be a great contribution towards the well-being of the common people. We well-being of the common people.

We have a duty in this place to defend that promise. We cannot allow the promise to be reworded without the promise to be reworded without the full voice of Parliament. We await to the public, to patients, and to to the public, to patients, and to NHS staff who dedicate their lives to this service, to stand firm and protect what is sacred. The amendment is simple, but its impact is profound. It ensures that any future changes to the call principles of the NHS must be debated openly, transparently, and with the full consent of every member.

No shortcuts, no sidestepping, no ministerial overreach. I urge colleagues across the House to support amendment 12 to stand with our NHS, to stand with the people it serves. And I urge my side, the Labour side, not to allow the assisted dying Bill to be the Trojan horse that breaks the NHS. The proudest of institutions, the proudest measure introduced by our

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party in 120 years. I rise to speak in support of amendments 21, 103, 104, and 42 amendments 21, 103, 104, and 42 amendments 21, 103, 104, and 42 tabled by my honourable friend. As other members of said, this is a deeply consequential bill. I want to deeply consequential bill. I want to record my thanks to the honourable member, to all members of the Bill committee, and to all those who have committee, and to all those who have contributed to the careful scrutiny of this bill, to the tabling of amendments and debates over them.

This bill is about the end-of-life, it is an emotive and sometimes it is an emotive and sometimes painful topic. I am grateful to my many constituents who have generously shared with me, their experiences and opinions. I have experiences and opinions. I have also taken some time to consult palliative care practitioners including those providing hospice care in my constituency. Those care in my constituency. Those conversations reinforced the all and admiration I have for these caring professionals. Their expertise and deep commitment is always impressive. Contrary to the points made earlier by the honourable member, they are adamant that they can provide sufficient pain relief to the vast majority of those receiving end-of-life care.

The issue is not about the efficacy of treatment, it is about access to it. And in this, I echo the powerful points of the member on the present inequality of access to palliative care. Amendment 21 would ensure that the availability and quality and distribution of palliative end-of- life care is published within one year of the act being passed. When assessing the provision of end-of- life care, it is critical that this House and the public can see how palliative care is being delivered.

I strongly believe that for the measures in this bill to provide a genuine choice to those that end- of-life, palliative care must be much more widely available. The honourable member argues that there should be no false choice between
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Calum Miller Portrait Calum Miller MP (Bicester and Woodstock, Liberal Democrat)
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palliative care and assisted dying. Yet she and health Ministers no that there is a choice since resources there is a choice since resources are limited. When so many hospices have closed beds due to funding shortages and receive more than 70% shortages and receive more than 70% of their funding from donations, I am concerned that we may see significant expenditures on a new regime for assisted dying funded by regime for assisted dying funded by the state as a health treatment while the palliative care sector and while the palliative care sector and hospices in particular remain chronically underfunded.

Only by having the assessment of the having the assessment of the palliative care system, can we be confident of knowing whether access confident of knowing whether access to palliative care sufficient. If we are to provide a true choice at are to provide a true choice at end-of-life, this is critical. I also stand in support of amendments 103 and 104 and 42, 103 and 104 would give this House assay of the key decisions that still remain to be taken about the implementation of this bill.

Given the significance of the bill and the importance of the many questions still to be resolved, these amendments are critical. Amendment 42 would ensure that we do not career towards the enactment of this bill in four years, whether or not the system is ready to operate safely and fairly. Taken together with amendments 21, 103 and 104, this would ensure that this House has the chance to consider whether those at end-of-life can access the full range of support, advice, and protections intended by the bill.

And that they deserve palliative care services across the country. Like so many in this House, I have direct personal experience on the issues addressed by this bill. My father was diagnosed with stage IV cancer in May 2002. Over the next seven weeks, he and my family benefited from the incredible care of our local hospice. Sharing his life, care, and death has shaped me so I fully understand why so many of my constituents have asked me to vote on this legislation in light of their and their loved ones experience.

Yet, our task here is to legislate for a new system that will affect thousands of people and society as a whole. I firmly believe that however this House votes on this bill, debates must result in a new focus on the provision of palliative care so that all people at end-of-life truly have options in the management of their care and

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death. I rise to support the amendments

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I rise to support the amendments of my right honourable friend who of my right honourable friend who sadly can't be here today, as group 2 amendments 34, 35, 36, and you close six, they are on ethnicity, it close six, they are on ethnicity, it is a health inequality that shape life expectancy and outcomes and COVID debts illuminated this but it is absent from this bill. A young me would have been 100 % behind this would have been 100 % behind this bill, I am for autonomy, but in 10 years of being an MP I have been years of being an MP I have been exposed to coercion, duress, the billionaire price of London property and elder abuse and it is no coincidence that the majority of London MPs and the majority of BME MPs oppose this.

As do I. Let's look at amendment 34. The experience of my age parents, now no longer with
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Rupa Huq Portrait Dr Rupa Huq MP (Ealing Central and Acton, Labour)
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us, opened my eyes to a world of pills, incontinence pads, power of pills, incontinence pads, power of eternity, carer worries, and I saw how non-native English-speaking pensioners, and I am not talking about Welsh speakers, have their about Welsh speakers, have their agency denied by health professionals may be unconsciously professionals may be unconsciously as it is, so my mum's GP who had as it is, so my mum's GP who had contempt for her accented words, said one question only at every said one question only at every appointment and by the time she made it to hospital, freelancers and the power of speech, reverting to her power of speech, reverting to her power of speech, reverting to her mother tongue, they saw her as an annoyance, a time waster, bed blocker, similarly, the way that the disabled are often written off, disabled are often written off, people cannot see beyond the non- verbal.

And so, this amendment 34, would place a duty on the Chief Medical Officer to provide information at every step of the way. Do I get more time?

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I recognise the time constraint.

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I recognise the time constraint. On the issue of vulnerable groups, you may know that there has been a you may know that there has been a letter sent and the spokesperson for the bill sponsor dismissed this, saying concerns were old news, do you agree that there is a problem you agree that there is a problem with the way that this bill is, so with the way that this bill is, so that often concerns with groups with concerns have been dismissed?

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concerns have been dismissed? We know Esther Rantzen wants this, we know many want this, but our bill is to be the voice of the our bill is to be the voice of the voiceless as well, so I totally agree with her. As opposed to the agree with her. As opposed to the sort of vague, ever changing qualifying criteria that get held up a safeguard, lease these amendments would put ethnic minority people on the board, if they are on the board, they should be on the board as well.

It seems neglected altogether. This would provide real protections and we know that in a cost of living crisis the system of assisted dying could be quite attractive, we know that these communities have lower disposable household income than standard household and you can imagine relatives in a cost of living crisis, a housing crisis, wanting to speed up grandad's probate to get a foot on the ladder or granny or anyone, convincing herself... I will. -- won't. Convincing themselves that, they would be better off out of the way given the cost of living crisis and getting the younger generation on the ladder for someone to disallow, we know it will be broadened, depressed people in Holland can get this, we know the need to fix positive cable lesson, what about suicide prevention week? We know the public opinion is for this.

Public public opinion is for this. Public I've had people pointing out the unfairness of the cost of Dignitas, 10k. Yes, we know the status quo isn't perfect, but let's not remedy it was something that will make things worse. We need to get this 100% right if we are going to do it. This bill while well intended has too much room for error, manipulation, miscalculation and unintended consequences. Six months to live is impossible to predict. It is too late to change your mind, once the letters happened.

A thousand doctors have argued it will widen inequalities and is simply not safe. These amendments strengthen the bill by taking minorities into account, they have been completely and acknowledged, by it. They must be incorporated into any assisted dying, but best of all being not to run down this route. Not to rush down this road in the first place.

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So littered with obstacles. I rise to support new clauses 13,

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I rise to support new clauses 13, 15 and to oppose them and 42 and to commend the honourable member for commend the honourable member for Spen Valley, for the way she has Spen Valley, for the way she has navigated this incredibly difficult and sensitive process. In considering these clauses and the passage of this bill, I have kept in passage of this bill, I have kept in mind the simple but difficult word pain. Because this actually is about pain. Because this actually is about those who face a certain death, in unimaginable pain.

And its relationship with palliative care relationship with palliative care and the word choice. I won't actually, because so many people actually, because so many people want to speak. I think we are lucky
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Richard Tice Portrait Richard Tice MP (Boston and Skegness, Reform UK)
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want to speak. I think we are lucky enough in this country to know we have some of the finest palliative care, in the world. It is a noble aspiration to want to improve that, to want to be the best in the world but nevertheless, not many of us will Ospina love ones, family and friends suffer huge pain, in the finest palliative care and the trauma that that leaves on those left behind can be so painful and enduring. And I think that is why we are where we are.

For me, I think it is unfair there are so many to speak. For me in considering this I think that yes let's improve palliative care but let's remove choice when faced with certain unimaginable pain is actually the

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right thing to do. That is what I will be supporting with this bill. Thank you. I hope that members

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Thank you. I hope that members will understand that I have in my thirteenth hour of trying to speak thirteenth hour of trying to speak on this topic will not take any interventions. I rise to support new interventions. I rise to support new clause 4. A moment 14B, my clause 4. A moment 14B, my honourable friend from Rochdale and honourable friend from Rochdale and moment 13 from my honourable friend from Glasgow West. The suffering and ending suffering. Let me start by saying that ending suffering is a saying that ending suffering is a shared goal by all across this House.

No one has a monopoly on House. No one has a monopoly on wanting to end suffering. The question is about how we best do this. As a former aid worker and this. As a former aid worker and someone who has risked my own life, in order to alleviate the suffering of total strangers, in war zones, I promise you that I am motivated to
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Melanie Ward Portrait Melanie Ward MP (Cowdenbeath and Kirkcaldy, Labour)
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end suffering, at least as much as end suffering, at least as much as the next member. It is worth the the next member. It is worth the House knowing to that my darling dad died of terminal cancer, in a hospice run and funded by charity, because of the NHS doesn't cover because of the NHS doesn't cover that provision. New clause of all matters. We do not live in an equal society, although many of us, society, although many of us, particularly on these benches seek to bring one about.

This is a deeply flawed bill and the truth is that in flawed bill and the truth is that in seeking to give a choice at a summit risks causing a new harm to much larger vulnerable groups of larger vulnerable groups of citizens. It safeguards water down in committee stage will not prevent this. Indeed, a letter from over a thousand doctors in this week said that they will widen inequalities and it is simply not safe. We heard earlier from the honourable member for Rochdale about the impact of advertising on the most vulnerable.

A new clause 4 increases data about the impact on the most vulnerable and brings proper oversight from the Chief Medical Officer, including in relation to (Protected Characteristics). Last time we debated this bill we heard from my honourable friend the Member for Exley Heath and Clifford. We were in a shared situation of having a dearly loved family members who have complex disabilities. My honourable friend and families both know how it is to have to struggle, to fight every week, for the access to basic state services that our love one is entitled to but cannot access.

Services and patient state resources that would increase the quality and ability to live well but we are stretched beyond breaking point by successive Tory governments. It is that experience and that brought me into politics and into the Labour Party and still come into this day away from my day job as a member of this House have to fight a behalf of my love one who has significant physical impairments as well as learning difficulties, to access of the health care and support that they desperately need.

Vulnerable people do not always make decisions in their own best interests and I know two from my family experience at the vulnerable people can be highly susceptible to pressure from others who do not have their best interests at heart. That is why the transparency of new clause 4 matters. Have described the safeguards in this bill as inadequate. And in Washington state, almost 2/3 of them who asked to have an assisted death in the gear of data is available for stop cited fear of being a burden on their family, friends as their reason for doing so.

I do not want that to happen. Over 350 disability rights organisations oppose this bill as it stands. One of my constituents told me this bill contributes to a sense amongst disabled people that we are disposable. A moment 13 a new clause of four make important changes to the voluntary's assisted dying Commissioner. My honourable friend on the Labour benches have requested them wisdom of the Prime Minister himself, having to personally appoint the death Star as the media has christened that role, shortly Finally earlier this week I heard of honourable members saying that he believes this bill is flawed, but plans to vote for it anyway, so that it becomes a law and we would have to sort out the problems later.

We have heard more of that today. He did not specify how we thought this would happen, or when. He is right that the bill is flawed. He is wrong that we can ignore those problems. To do so would be to fail in our job as legislators. Being in favour of these amendments and against this bill does not mean accepting the status quo as some have tried to suggest. It means that we choose, instead, to protect the NHS, to work, to fight, to battle palliative care system that is worthy of those we represent.

Rather than diverting time and energy into people helping to kill themselves. to kill themselves. Whilst I am not opposed to the principle of assisted dying, I have a number of deep concerns about the content of this bill. The process by which we are legislating for such a monumental change and importantly, the context in which it would be enacted, given the numerous challenges facing our health and care services. And that is why I have tabled an amendment 21, in my name, relating to palliative care and end-of-life need, which has attracted cross-party support.

I am also grateful to the honourable member for Spen Valley, for supporting this amendment and I would like to pay tribute to her today, for kickstarting the debate about dying well and in particular palliative care. A topic which for far too long has been neglected by many of us, myself included. Amendment 21 requires the Secretary of State to lay a report before
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Munira Wilson Portrait Munira Wilson MP (Twickenham, Liberal Democrat)
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care, do not receive it and people who are who are poorer, less educated and nonwhite are even less educated and nonwhite are even less likely to receive it. So Madam Deputy Speaker, I was horrified, if Deputy Speaker, I was horrified, if I'm honest, by the speech, made by the honourable member for Loughborough, earlier today, because Loughborough, earlier today, because all of the data shows us that actually people, from minority ethnic communities are less likely ethnic communities are less likely to access the healthcare services to access the healthcare services they deserve stop in particular palliative care.

There is a deep distrust of health services and those who are in this place, during the Covid pandemic saw that played out, in real time, in hospitals and care settings, up and down the country. Far more people from minority ethnic communities lost their lives, former health care professionals with ethnic characteristics were not protected in the way that they should have been. If as a result of this bill passing those people are less likely to access palliative care, I will give Wayne a moment.

If those people from minority ethnic communities and disadvantaged communities are less likely to access palliative care, as a result of the fear of this bill being passed, my fear is that actually, contrary to what is said by supporters of the bill, that more people will die a terrible, horrendous, traumatic and painful death, rather than fewer and they will be disproportionately from She She raises She raises a She raises a really She raises a really powerful She raises a really powerful and excellent point about the ethnic minorities that died during Covid.

The access to healthcare. As you understand that is something of deep importance to myself as well. She is right about the need for greater palliative care. I am glad that this is a discussion that we are now having. I think we look at assisted dying around the world. I think there is concern around ethnic minorities being more likely to access it as they are less likely to access it. That is neither here nor there point. The question is that given the safeguarding places the processes working well, that is where the stats are going forward.

I

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do say I take good faith that she raises it. I hope the honourable member and thank him for his intervention. The thank him for his intervention. The statistics undermine his own statistics undermine his own argument. All of the data shows us that they are less likely to access the healthcare services they need. Therefore they are less likely to end up accessing assisted dying. And actually the honourable member for Stroud the game away. He is Stroud the game away. He is acknowledging it now.

It tends to be the wealthier people who access assisted dying. Because they are the assisted dying. Because they are the ones who have the choice. They have the services to have a meaningful the services to have a meaningful choice. These inequalities deeply, choice. These inequalities deeply, deeply concern me. And I my grave concerns about this bill becoming concerns about this bill becoming law is that it, they are the ones who do not have the loudest voices, or well funded campaigns to support them.

And I think this whole debate about inequality and access to palliative care should be actually the top of the debate on a separate day. I hope we have a chance to have that, Madam Deputy Speaker. Marie Curie also warns there is no Curie also warns there is no The scale of the challenge and that the whole system is in a perilous state, due to a lack of sustainable funding and limited privatisation of end-of-life care. A survey of Integrated Care Boards in 2023 found that half, half had no plans to invest in capital and palliative care services and 14% admitted that their services were inadequate for the needs of the population.

Whilst 21 would not had a duty on the Secretary of State to put forward a plan to address the variable provision of care as that that is outside the scope of this bill, the proposed report would at least shine a much-needed spotlight and I hope, I very much hope that it provides a catalyst for change. If this bill passes, we will be in a position where assisted death is available, universally, on the NHS, to those identified in this bill, the access to good palliative care is not.

That, Madam Deputy Speaker is not giving people a genuine choice at the end of their lives and passing this amendment will not change that. In my view it is a bare minimum first step to analyse and expose the gaps, which needs to go hand in hand with urgent action. That is why today I have also been persuaded to support amendment 42, in order that the parlous state of palliative care can start to be meaningfully addressed, before this bill comes into force.

And if it isn't in a better state, then this bill should better state, then this bill should

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I hear the arguments that palliative care is not as we should palliative care is not as we should expect right now, but what I expect from members opposed to the bill, what level of palliative care do we need to have in this country so that need to have in this country so that assisted dying can go hand-in-hand

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as a genuine option? I met with the care committee and honourable member opposite and they honourable member opposite and they have undertaken a commission and reporting to this and they will advise us. I am aware I need to sit advise us. I am aware I need to sit down, I will end by saying that I would like honourable members to support my honourable friends in their amendments to ensure that we their amendments to ensure that we are not allowing Henry the eight are not allowing Henry the eight sweeping powers in this bill which is so sensitive and important, new is so sensitive and important, new schedule to collect data on how this bill any assisted dying debt service will operate.

We need transparency.

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I rise to speak in support of new clause 15 and Amendment 50 for and against new clause 5. As members and against new clause 5. As members and right honourable members will no doubt be aware, new clause 15 would doubt be aware, new clause 15 would not classify a death as suspicious or unexpected and a full coroners inquest would therefore not be inquest would therefore not be needed. If this bill becomes law, assisted dying would be illegal, assisted dying would be illegal, strictly regulated, and a well monitored choice made freely by the monitored choice made freely by the individual concerned.

To be abundantly clear to members here today, it is not assisted suicide. This piece of legislation concerns This piece of legislation concerns people who want to live, but who are faced with an inevitable, reversible faced with an inevitable, reversible terminal diagnosis, and one choice over the manner of their death. It over the manner of their death. It is an important choice that removes some of the trauma and anxiety, not only for the patients themselves but also for their families and loved ones. New clause 50 and its consequential amendment number 54 will ensure that families naturally grieving the loss of their loved ones are not subject to an invasive coroner's investigation completely needlessly.
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Lloyd Hatton Portrait Lloyd Hatton MP (South Dorset, Labour)
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I have been trying to intervene throughout the debate. It is important to realise that if there is any suspicion around the assisted death, a coroner can still be involved. It does not exclude that but it stops the automatic referral

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to a coroner. I share the sentiment put forward by my honourable friends. I firmly believe that we should protect bereaved families against such a bereaved families against such a distressing ordeal being automatically put into place, particularly when the process as set out in this bill would already be out in this bill would already be out in this bill would already be both legal and transparent. I would like to make progress if I may. With this in mind, it makes sense to this in mind, it makes sense to support new clause 15.

If we pass legislation to permit assisted dying with the full weight of the law with the full weight of the law behind it we must also respect that choice in the way that we classify and record such debts. These deaths and record such debts. These deaths would not be in anyway unexpected or suspicious so to classify them as suspicious so to classify them as such would simply be inaccurate. And it has already been touched on in great detail during today's debate, if passed, this bill would implement the most robust assisted dying framework anywhere in the world.

The bill already includes multiple layers of oversight. In my view, it is cautious, thorough, and robustly safeguarded. A retrospective investigation would be to duplicate the process and risks suggesting

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wrongdoing when none has occurred. I wondered what the honourable members view was of the opinion of the Royal College of pathologists responsible for medical examiners who say that debts following assisted dying should be notified to the coroner just as other debts the coroner just as other debts following the administration of drugs provided must be.

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drugs provided must be. I respectfully disagree, I

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I respectfully disagree, I believe that already, the layers of safeguarding already exist as safeguarding already exist as legislation. New clause 50 is a compassionate and practical clause which will ensure that the law not only works for the individual making only works for the individual making the choice but also for the family that they leave behind. Moving to speak briefly on new clause 5, I speak briefly on new clause 5, I would strongly encourage other members to vote against this clause today. Table by my right honourable today.

Table by my right honourable friend, this amendment requires the government to publish a report on any impact this bill might have on civil procedure rules and probate proceedings. On this issue, the chief medical issue as has already been pointed out, has warned that we are at serious risk of creating a bureaucratic. New clause 4 would do just that if passed. Requiring that the government publish such a report would create unnecessary bureaucracy and divert resources without adding any material value. As many members I am sure are aware, the government has already published an impact assessment on the relevant impact that they deem this bill could have.

There is nothing in the bill that is likely to result in any changes to civil procedure rules so there is no obvious justification for producing a formal report on this issue. It is important that we remain focused on practical and meaningful safeguards rather than procedural requirements that are based on immaterial impacts. Introducing extra reporting requirements based on speculative impacts risks creating unnecessary red tape without delivering any practical benefits. Therefore I urge members to reject this clause and accept no additional reporting in this area is needed.

As we rightly scrutinise this bill today, line by line, including nearly 97 hours of scrutiny so far, which I notice more than many many government bills, we must keep dying people at the centre of this debate. I speak today in support of new clause 15, its consequential amendment 54, and speaking opposition to new clause 5, exactly for this reason. So that we can keep terminally people at the centre of this discussion and at the centre of this piece of legislation. No matter where you stand on this pressing matter, whether you support this bill or even if you have some reservations, it is crucial that we collectively ensure this bill is workable, compassionate, and truly centred on the dying person.

As legislators, this must always be our chief concern. Thank you.

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I rise to support, to speak briefly to amendment a, 77, tabled briefly to amendment a, 77, tabled by my honourable friends, but I will by my honourable friends, but I will also speak to new clause 13 and Amendment 96 and other amendment if Amendment 96 and other amendment if time permits. I begin by saying I time permits. I begin by saying I was confused when I looked at the amendment paper a few days ago I noticed that amendments which were directly impacting on Northern Ireland had been tabled.

When I last Ireland had been tabled. When I last checked the bill as a whole, it extends only to end in an wail so I find amendment 76 and 77 perplexing. find amendment 76 and 77 perplexing. To be clear, criminal justice are devolved matters, the people of Northern Ireland select their own Northern Ireland select their own assembly to make precisely these sensitive decisions. That includes whether or not to legislate for whether or not to legislate for assisted suicide and issue a profound moral weight and consequence.
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Carla Lockhart Portrait Carla Lockhart MP (Upper Bann, Democratic Unionist Party)
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My colleague is right to pursue this and the honourable member across the way said earlier, the NHS was for the Labour Party and this amendment ensures that they can overrule assembly members, the secretary of state can overrule,

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surely that must be wrong and is in the face of the democratic process that we are here to uphold. My honourable friend is right.

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My honourable friend is right. The constitutional basis alone of 77 is necessary and I hope my honourable members will be in honourable members will be in support of it. Moving on to beyond the constitutional concern, I am concerned there is a danger, an absence of regulatory framework under the bill. This gives the under the bill. This gives the Secretary of State powers to approve legal drugs while clause 34 and the legal drugs while clause 34 and the Secretary of State to make provision of prescribing, storage, handling, just -- handling as well as just -- handling as well as enforcement.

The fundamental issue of how these approved substances are of how these approved substances are actually approved remains alarmingly weak. The bill defines approved substances simply as a drug or other substance specified by the Secretary of State by regulations. There is no express requirement for the substances to undergo specific rigourous testing for their use in assisted dying. When this issue was debated in committee, I was disappointed to see good-faith amendments being dismissed, such as amendment 143 which sought to mandate that the substances be approved through the medicines and healthcare products regulatory agency and either the National Inst for clinical excellence or the group strategy processes and I support amendment 96 tabled by the honourable member Wychwood and I quote, ensure that drugs can only be approved if the Secretary of State is reasonably of the opinion that there is a specific consensus that the drug is effective and can end someone's life without causing pain or adverse side-effects.

This is a common sense approach which should attract support from the House. More than 1,000 doctors what a powerful letter to MPs to outline any concerns about this bill, calling it a real threat to both patients and medical workforce. I strongly urge this House and colleagues to read this letter before third reading. Indeed, the government own impact assessment does not provide any comfort with regards to the use of legal drugs under the terms of the bill which bloggers -- doctors letter picks up on and to undergo testing and rigourous approval that would be aided of any other medication or to be regulated by the regular tree agency.

They go on to say that this is contrary to all good medical practice and this matter is not just for regulation but also with regards to patient safety and complications, there is no requirement in this bill as drafted to inform patients about how the risk can be prolonged rather than a peaceful dignified death will be managed. Complications do occur and this is not just scaremongering, when complications have been reported, patients have experienced difficulty swallowing, drug regurgitation, seizures, and have even been unconscious as Canadian associations, patients have experienced regurgitation, burning, and vomiting, I also wish to draw members attention to the written evidence submitted to the bill committee by a group of experts, senior pharmacists, and pharmacologists in their submission, they want that the approach of this bill as drafted puts the cart before the horse, specifically they caution against proceeding without a comprehensive evidence for efficacy and safety and note that this review should be scrutinised by MPs before consideration of legalising assisted suicide.

These are not small details of incidental matters, even at the late stage in the bill passage through the Commons, we are still being asked to pass legislation without satisfactory answers to without satisfactory answers to basic questions from experts in the field. If something is not good enough. I am grateful to have the opportunity to speak and will close by saying whatever mitigating amendments maybe pass by this bill, this bill remains morally and ethically wrong and is flawed and

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should not be passed. I rise to speak to amendments

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I rise to speak to amendments eight, 30, 85, 86, but let me turn to amendment 77 which extend some of the privileges of the bill to Scotland. My overview of the bills in Scotland and England suggest to
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John Grady Portrait John Grady MP (Glasgow East, Labour)
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in Scotland and England suggest to me that if someone moved from Glasgow to Bradford or Newcastle, they would lose their right to an assisted death in Scotland and would have to wait one year to acquire their right to an assisted death in England. Imagine the heartbreak if you were diagnosed as terminally six months into your permanent move to Newcastle and as a natural consequence of the law of habitual residence, a matter that has not been addressed satisfactorily as how the relationship between Scots and English role in the Scottish and English law bill will be worked out.

That is something that I suspect will require further primary legislation in this place and in Holyrood if both bills pass. I turned to the remainder of the amendments. Amendment 13 are sensible, it introduces much-needed scrutiny and oversight to the appointment of a commissioner. My right honourable friend, the member for Salisbury has set out in detail the very sensible reasons for the introduction of his suite of amendments. Amendment 86 is particular important because the panel faces real difficulties and compelling people to come before it if they have relevant evidence and it seems to me reasonable that the panel should hear from people who have relevant evidence.

I am also concerned that the panel process does not provide a clear role for people who love and care for the person seeking an assisted death. And amendment eight requires the panel to actively consider hearing from such people. This addresses a from such people. This addresses a It is important to place the process in its proper context. I recognise that there is an important cluster of intrinsic values around their right to self-determination and autonomy and the right to be treated with dignity.

And the justification for assisted dying, for many is of the people should we able to exercise this right. And I have some sympathy with those arguments. However, there is a further very, very important question, will everybody who requests assisted death be doing so on the basis of a true exercise of autonomy and a true exercise of self-determination. People across our family of nations cannot access a good help. Good treatment can help people with mental health issues have a fulfilling life, even at the end of their life.

And I speak of this through personal experience myself, with various family members. We all agree that palliative care and end- of-life care is not available to many people and Britain has entrenched poverty and people worry terribly about money at the end of their lives. It is important to understand that the panel and the Commissioner do not ventilate or investigate these matters at all, because they are looking at pressure from other people and this terrible societal pressure. Faced with those

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terrible... Does my honourable friend agree with me that across all aspects of with me that across all aspects of this bill, we cannot legislate, only for those with good mental health, those that are loved, protected, we those that are loved, protected, we must have at the heart of this the most vulnerable, those without a voice, those without loved ones, voice, those without loved ones, with their best interests at heart and ensure that those people are protected. protected.



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protected. That is precisely why I draw on a 16-year-old. Some will seek assisted 16-year-old. Some will seek assisted death. I find it very hard to accept that these would be truly autonomous that these would be truly autonomous choices. We must be clear that the very same circumstances that have denied people self dignity and autonomy, throughout their lives will drive them to an assisted death. I find this deeply troubling and I worry that we are placing too much confidence in the concepts of capacity, autonomy and self- determination.

Everyone accepts that coercive control is common. It is incredibly common, as is a domestic abuse and elder abuse. There are very clear risks of coercion and I recognise that the supporters of the bill have sought to improve protections, to protect people, in these types of circumstances. I have anxiously scrutinised these protections and I do not believe they will achieve their aim, which is why the amendments are so

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important. However, we must... Thank you. Last weekend the bill

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Thank you. Last weekend the bill sponsor posted on X, to people who wanted to die together and wanted. wanted to die together and wanted. To dishonour for the assisted death. To dishonour for the assisted death. Are you concerned that this may see a surge in suicide pacts. Given that there are, as we know mercy killings, which are unfortunately killings, which are unfortunately actual deaths. Do you share the fears of the government's suicide adviser that this bill will undermine suicide prevention efforts.

efforts.

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efforts. On that, I think everyone comes to this House debating this in good to this House debating this in good faith. And in the courts, there is a general view that we should be reluctant to attack otherwise. I'm sure that question was meant on that basis. I do think however that one must not lose sight of the fundamental point that for detections in this bill will not address the profound societal pressures that people face. And I think one must not lose sight of whatever protections are included in this bill, it will not protect people against coercion.



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Thank you. It was said that bad laws of the worst tyranny. And I see laws of the worst tyranny. And I see many imperfect measures before this House. The government persuaded by the way. Usually, through scrutiny the way. Usually, through scrutiny they are improved. And that is because process works when there is because process works when there is time available and in particular, time available and in particular, where this pre-legislative scrutiny, independent analysis, far out thinking about the consequences of thinking about the consequences of what we debate here.

That could have happened, regarding this important happened, regarding this important matter, but it hasn't, because it has been shoehorned into a process has been shoehorned into a process ill fitted, for its purpose. Now the ill fitted, for its purpose. Now the amendments that we relate today are a late attempt to improve the bill and I particularly recommend, in the name of my honourable friend, Roman Weybridge, made an excellent contribution. The right honourable member, my right honourable friend, I should say, for Salisbury and the honourable member for Rochdale, why do I support those amendments, because critically it is important that the safeguards in this bill are not only maintained, but improved, enhanced, for all the reasons that have been advanced by members across this House about coercion and vulnerable.

The member from North Herefordshire, said she never encountered coercion. There must be a wonderful place where people wear hearts, but in the rest of the kingdom I am certain, the rest of the world, there are many wicked people doing very bad things. We must never allow those wicked people to have rain and power over those who will be, inevitably, because their circumstances are at risk if this bill is not improved. I will this bill is not improved. I will give way as I cited the honourable lady, to her.
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John Hayes Portrait Rt Hon Sir John Hayes MP (South Holland and The Deepings, Conservative)
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I am afraid he has misrepresented what I said. I was contributing an observation from someone who has been deeply involved in palliative care practice. He reports that it is a far more frequent that the dying person wishes to die. It is their family pressuring them, encouraging them to stay alive as long as possible. So the point being made about coercion, the fears about coercion appear to be, worrying about something that is not actually

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the case, in the cases of dying people. I am afraid I disagree. I think there are numerous cases where people would be encouraged. Perhaps people would be encouraged. Perhaps even forced to make a decision when they are at their most vulnerable, when they are frightened, when they when they are frightened, when they are doubtful, when they are coping with illness, when you're distressed, when they may be distressed, when they may be unbalanced. Of course we have to protect against that eventuality, if protect against that eventuality, if this bill is to be passed.

I will give way. Very briefly.

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give way. Very briefly. The evidence suggests, it shows that in the exit interviews in that in the exit interviews in Canada and 35% in Canada, 47% in Oregon listed the reason for doing so, they felt a burden to their

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family. The honourable gentleman, the right honourable gentleman was anticipating what I was going to say. I'm citing that exact evidence many times. We do need to look at the experience of elsewhere to inform what we do here. We always do that. When we pass in this place. There is worse in news than that. Rather than being improved during this passage, this bill is in many ways got worse. In particular, by giving additional powers to Ministers, to so-called Henry VIII powers.

Delegated legislation are mentioned, in this place, you should always be fearful. When there was a ministerial discretion are used, BW fearful. And I say that, looking directly at the Frontbench opposite. Looking at my own Frontbench. What this bill does is to give permissive powers to government. And I just want to offer some of them, to illustrate my point. This bill empowers Ministers. To amend a Suicide Act, including the offence of encouraging suicide. To re-write section 1 of the NHS Act, to re- section 1 of the NHS Act, to re- secure improvements, in mental health, in England and Wales and N lives of the terminally ill.

They can amend the NHS Act to specify the service is not free of charge. This act only proves to the section of the act services is provided free of charge, when charging isn't expressly provided for. They can amend the definition of a medical practitioner, so it is not a doctor carrying out the assessments, etc., etc.. That is where the amendment in the name of the honourable lady, is so vitally important. And the speech she gave was amongst the best speech is not heard in this house, the passion she feels vulnerable people and the difference the NHS makes to them.

It not only fell on that side of the chamber, with regards to theatre. We all come to this place to ensure that the least fortunate of being voiced. Those with less power are given a little more power, and advocacy. I so do the honourable value for Spen Valley, in conclusion, that there has never been any doubt about the death of propriety. Let us now be sure about the breadth of her mind. If she really wants, in this bill, to be passed in a way that is palatable, then she must surely accept the amendments that I have supported and highlighted in this brief, all too

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brief contribution. Members need to be aware that I will be starting a Frontbench will be starting a Frontbench speeches at 1:30 PM. The final speech.

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speech. I roasted move my Amendment 27.

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I roasted move my Amendment 27. The insufficiencies of clause 20 -- I rise to be my Amendment 27 and clause 20. It defies a process. I have taken extensive research, have taken extensive research, including academics, anaesthetists and others to understand the safety concerns of the pharmacology concerns of the pharmacology describing and dispensing. Normally the MHRA would undertake research and trials to secure safety, quality and licensing. BNF focusing on dosage and side effects. NICE, the
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Rachael Maskell Portrait Rachael Maskell MP (York Central, Labour )
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dosage and side effects. NICE, the Orwell's strategy group showing the drug works and is cost-effective. This underpins the reputation of UK pharmacology. Can the House assure itself that without due process, some will have a safe and peaceful death. Let us look at the evidence. First the data is poor. The health Select Committee is from Oregon. We know there is variant types in which people can die, up to 137 hours. Nausea and vomiting in 10% of cases, seizure or muscular burning. Regurgitation and regaining Regurgitation and regaining consciousness.

There are, there is a lack, no time. There is a lack of consistency of approach and data across jurisdictions, the substance to be used. How they are to be titrated. Dosages. Ingestion can be a factor, absorption there is frailty, metabolism and drug reactions. Pharmacokinetics and Farmaajo code dynamics are complex. It is been my discussions with the tops, curious which have been most alarming. -- Toxicologist. 80% of cases on death row, using pentobarbital have a flash oedema.

This drug disintegrates and the membranes, in the long tissue, filling them with fluid, causing shortness of breath and a sense of drowning. As a clinician I have supported many with this in ITU, with such a diagnosis. So high concentrations of this drug will cause acute assault to the cardiopulmonary function and if paralysed and conscious, a patient may look peaceful, but is anything but. So such physiological distress needs research. It is unclear how government will identify data process and safety.

The risk to those handling the toxic substance, also needs examining and in the light of the government's identity identifying there is a pregnant, an assisted death, this needs examination. There is no safe , if it is to be used, as in Australia, the government's impact assessment did not examine this, so needs revision. Also the drug is not an approved substance for humans in the UK. Licence, or unlicensed. IMHO way and NICE have a role to play and as we are hearing, increasingly, from professional bodies, they are withdrawing their support from the bill, because they know that the regime is set out in this bill adjusts not slaves and that is our duty.

It's all examine the evidence.

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-- Not slaves. By offering the condolences of his Majesty's opposition for all his Majesty's opposition for all those who were in the India pain crash, the families of British citizens who sadly lost their lives. Our thoughts are with all of them. Telling to the bill before us today. As is well understood the opposition As is well understood the opposition race neutral on the issue of assisted dying to be introduced. I assisted dying to be introduced. I do want to raise two important matters, firstly on the question of time.

All of us understand suitable challenges in balancing the desire of colleagues to speak on this matter with the limited time available for Private Members' Bill. I know Mr Speaker is doing his best to strike the right balance. The number of members appointed in the timing given to this bill a timing given to this bill a significant and more than that, normally allocated to quite
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Kieran Mullan Portrait Dr Kieran Mullan MP (Bexhill and Battle, Conservative)
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substantial so government bills. I think it is right to acknowledge that this is far from an ordinary bill. It is hard to think of a more bill. It is hard to think of a more deeply consequential, highly contentious piece of legislation for contentious piece of legislation for At previous sittings, a number of members have been unable to speak. Speaking time has had an informal time limits, and interventions have time limits, and interventions have been limited as a result. Debating this house is not just important in this house is not just important in helping us decide how we vote but is used by the courts to help interpret legislation and more limited debate legislation and more limited debate limits the scope to this.

A minister would have significant time at the would have significant time at the end of the report stage to deal with amendments, provide clarification, and explain intention in a way that and explain intention in a way that members of the bill will not. A majority of members may be satisfied with this, but many are not. While the business of this house, what we decide is determined by majority vote, how we reach a decision, and how we allow alternative views to be explored matters.

We should all consider whether we want debate of such importance to be curtailed in a manner that it has been. So, I would ask the government to consider whether it could assist the speaker by making more time available for us to ensure, as we come to the third reading, that we could have the fullest possible debate and every member has a reasonable opportunity to speak and take interventions in the way they would like to. Secondly, members will be aware that the bill before us is extensive but not the full picture.

Add as have highlighted, elements of how it will operate will be determined by future delegated legislation. The government delegated powers memo contains delegated powers including Henry VIII powers, and more powers are contained with amendments tabled for decision today. They include matters such as the content and thoroughness of doctors report, regulations for replacing a coordinating doctors who are unable to continue, and specifying who will be notified of the panel's decision which has been raised as a potential safeguard. These are not trivial matters.

These pieces of legislation cannot be amended. MPs can only vote yes or no and certainly not on the floor of the house. It is important for members to fully understand that. MPs often have to weigh up the consequences of which I stay legislation because it could leave a void. Members are well within their rights to be content regardless, and certainly, a majority of the committee have presented a bill to the house with the composition as described. That is the legitimate choice for members to make, and we have had debate today about amendments to curtail these powers and members will need to decide their views on that, but I would urge the government, in the interest of supporting members, to have the clearest possible idea of how a scheme they are asking to operate to try and provide as much detail going forward as to what these future regulations might consist of.

While we won't be able to have all the answers, most members will agree that we vote with more detail not less. Even if members are satisfied to support assisted dying in principle. This is something that only the government can do and I asked the Minister reflects on this challenge alongside giving the government's response to those asking for more government time to be given to allow wider debate with more members able to speak. Opposition remains neutral on the matter of whether we should introduce assisted dying, but it is incumbent on us to draw attention to mask the procedure that can primarily be addressed by the government.

I look forward to the Minister addressing those concerns that I have reflected on my remarks today.
13:35
Stephen Kinnock Portrait Stephen Kinnock MP, Minister of State (Department of Health and Social Care) (Aberafan Maesteg, Labour)
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I would like to associate the government with the words of the opposition spokesman regarding the tragic incident in India. As members will know, the government remains neutral on the passage of this bill and on the principle of assisted dying. We have always been clear that this is decision for Parliament. However, the government is responsible for ensuring that the bill if past is effective, legally robust and workable. I would like to start with a brief observation about process and the time made available to Parliament to scrutinise the spell.

This bill has received over 90 hours of Parliamentary time which is more than most bills. Also more than 500 amendments were tabled and considered in the Commons committee. I therefore thanked members on all sides of the debate for their contributions during the extensive consideration and scrutiny that this bill has received. Turning now to the amendments given the time afforded, I will confine my remarks to those on which the government has significant legal or operational concerns and those amendments tabled to address significant work ability.

I would also like to remind the house that a full list of amendments tabled by the member which the government deems essential or highly likely to contribute to the work ability of the bill can be found in the letter sent to all members by myself and my honourable friend from Finchley and Golders Green on 15 May. Turning 1st to amendments tabled by the member. New clause 13 tabled by the member. New clause 13 and Amendment 69, 53 and 72 allow the government to create or change legislation to set out the end-to- end process in relation to approved substances to be used for assisted dying.

These amendments allow for monitoring and for regulatory regimes to be designed which will offer robust oversight of approved substances and the devices used to administer them, specifically in the context of assisted dying. Amendment 50 for a new clause 15 replace clause 35 which is currently unworkable in the legal context. They align with scrutiny and certification with the existing process for deaths which are not process for deaths which are not deemed unnatural. This means that assisted death will be scrutinised by medical examiner, rather than a coroner, and less reported to the coroner by anyone who has concerns about the death.

Amendments 92 to 94 ensure that the Secretary of State and Welsh ministers have powers to make necessary regulations to approve assisted dying services in Wales. In the mid 95 brings the Welsh commencement powers in line with the devolution settlement and removes the requirement of clause 54 for Welsh ministers to lay commencement regulations before the Senate for approval, to align with usual procedure. I now turn to amendments tabled by other members which the government assesses as creating potentially work ability challenges.

Amendment 97 would require the MHRA to license the approved substances to be used in assisted dying. This may present work ability challenges as licensing is not possible if the approved substances do not meet the definition of medicinal product under the current relevant legislation. Furthermore, licensing is reliant on the manufacturer applying for a marketing authorisation. For that indication and providing the necessary understanding of support. Should the bill passed, the government would work to put in place an appropriate regulatory regime for the approval of substances.

It may be helpful to note that the member for Valley has tabled new clause 13 which recognises the need for robust rig later frameworks to be in place and provides the powers needed to introduce such a framework. Amendments 105 to 107 to clauses 13 and 18 would reflect the scope of powers to make provision about assisted dying services. They further restrict the use of powers in relation to the regulatory framework for abuse substances and the advices used, and the prohibition of advertising for I would point towards the memorandum which has been published by the government setting out our consideration of the Henry VIII powers in the bill.

As with legislation more broadly, the government recognises the need in appropriate cases for amendment by Henry VIII powers. Members will be aware that the delegated powers and regulatory committee will issue its own consideration of the bill which will of course be made available to all parliamentarians. Amendment 36 to shorten the commencement to 3 years. Should this bill pass, a new service with robust safeguards and protections would need to be carefully developed and tested with input from a range of delivery partners.

The government's view is that the bill as amended during committee with a four year backstop for commencement would be more likely to provide for safe and

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effective implantation. On that point, one of the key thing said by the lead member thing said by the lead member throughout this is that for years and this bill as it currently is would be a backstop. Is that the

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would be a backstop. Is that the case if he is saying he would take a requirement of four years and it couldn't be sooner? It is absolutely the policy and

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It is absolutely the policy and intent of the sponsor for this to be a backstop and the government is working on that basis to ensure it working on that basis to ensure it is about. And not a target. is about. And not a target. Amendment 42 seeks to remove the four year backstop. Whilst this is a matter for members to decide, we would note that if both this would note that if both this amendment and amendment 94 from the amendment and amendment 94 from the member for spend Valley are accepted, nobody would have the power to commence reserve provisions

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power to commence reserve provisions in Wales. This would create major work ability concerns for the service in Wales. One of the advocates of this bill talk about the point of choice and autonomy in deciding when and where that person will die. They can minister confirmed to be have enough doctors to provide an at-home

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service for people to die at home at the time of their choosing? I thank her for that

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I thank her for that intervention. I would refer her to the impact assessment which is a set of scenarios and in that impact of scenarios and in that impact assessment, detail is given on expected numbers and also capacity expected numbers and also capacity of the system to deal with the of the system to deal with the service. Amendments 13 and 82 to 85 relates to the appointment of the voluntary assisted dying Commissioner. These amendments would Commissioner. These amendments would put the process for these appointments out of kilter with standard practice for non-judicial appointments and can significantly limit the pool of individuals limit the pool of individuals available.

A moment 86 would give the panel the same powers, privileges and authority as the High privileges and authority as the High Court which are significant in scope and are set out across different court rules and legislation. It is unclear how this would apply to panels in practice and it may be unworkable given the panel is not designed to be a court. New clause 4 and amendment 28 would put various responsibilities in the Chief Medical Officers for England and, imposing duties on primary legislation on individual civil service may cause difficulties in the future if the role does not exist or the title changes.

It is usual practice in primary legislation to be conferred on the secretary of state who may go to the Chief Medical Officer. There were number of questions directly asked of the government which I would like to briefly respond to the member for South Antrim asked about medicine regulation in Northern Ireland. These amendments will not affect the application of EU law. They will ensure coherence between the different legislative frameworks, and the sponsor with the devolved government supported by officials. The member for Richmond Park asked about the equality impact assessment.

The EQ IA considers the characteristics alongside socio- economic background, geography and mental health. The member for West Worcestershire asked about the suicide act and about advertising. I can confirm that encouraging or facilitating suicide will remain a crime under the suicide act, and on advertising, new clause 14 of past would oblige the secretary of state to make regulations prohibiting certain forms of advertising which promote voluntary assisted dying services. The exemptions to this which may be provided under subsection 2 will not cut across the criminal offences elsewhere in this bill or in the suicide act.

I hope these observations were helpful to members and their consideration of the technical work ability of the amendments that we have debated today. Thank you.

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I beg to me that the question now be put.

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be put. As many of that opinion, say I I
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None Portrait Division
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None Portrait Division: New Clause 14: AMDT.(b).
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The The question The question is The question is as The question is as on The question is as on the The question is as on the Order Paper as many are of that opinion say, "Aye". And of the contrary, "No". Tellers for the ayes Patricia Ferguson Ruth Jones. Tellers for the

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Order. Order. Order.

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Order. Order.

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Order. Order. The ayes to the right 233. The

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The ayes to the right 233. The The ayes to the right 233. The The ayes to the right 233. The noes to the left 254. The noes have it. to the left 254. The noes have it. to the left 254. The noes have it. The noes have it.. Unlock. We now come to the question that new clause come to the question that new clause 14 be added to the bill. The question is that new clause 14 be added to the bill.

As many are of that opinion say, "Aye". And of the contrary, "No". The ayes have it. contrary, "No". The ayes have it. We now come to new clause 15 which has been selected by a separate decision.

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Moved formally. Investigation of deaths et cetera. The question is that new clause

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The question is that new clause 15 we read a second time. I think 15 we read a second time. I think the aye have it. The question is the aye have it. The question is that new clause 15 be added to the bill. As many RF that opinion say bill. As many RF that opinion say aye. I think the eyes have it. We aye. I think the eyes have it. We now come to new clause 20 which has been selected for a separate decision.



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Moved formally. Diligence about operation of act. The question is that new close 20

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The question is that new close 20 be read a second time. The eyes have it. The question is the new clause 20 be added to the bill. As many that are of that opinion, say aye. I think the eyes have it. We now come to new clause 21 which has been

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selected for a separate decision. Moved formally.

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Moved formally. Provision about the Welsh language.

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language. The question is that new clause 20 1B read a second time. I think 20 1B read a second time. I think the eyes have it. The question is the new clause 21 be added to the the new clause 21 be added to the bill. As many the tariff that opinion, say aye. I think the eyes opinion, say aye. I think the eyes opinion, say aye. I think the eyes have it. We now come to new clause 1 which has been selected for a

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separate decision. Moved formally. No health professional should

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No health professional should raise assisted dying first. The question is that new clause 1 is that new clause 1B read a second is that new clause 1B read a second
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Christine Jardine Portrait Points of Order Christine Jardine MP (Edinburgh West, Liberal Democrat)
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Thank you very much. I don't think it matters how one is going to vote on this issue. A lot of us are finding it very frustrating that some members seem to be deliberately hanging about in the lobby to delay the process. Can something be done to appeal to their better natures that, in order to get this through and for the public to see that we are respecting their wishes, it really looks petty and childish and could they please abstain from doing

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it the next time? I thank the honourable member for her point of order. You will have her point of order. You will have seen that I did send in the sergeant

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to investigate the delay. Access to Telecommunications Objection Objection taken, Objection taken, second Objection taken, second reading, Objection taken, second reading, Electric vehicle charging point bill, second reading.

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Objection taken, second reading,

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Objection taken, second reading, Objection taken, second reading,

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Objection taken, second reading, what day? Friday, 20 June. Support for infants and children

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inflammation bill, Lord's. Objection taken, second reading,

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Objection taken, second reading, what day? Fourth of July.

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what day? Fourth of July. Building works consumer protection Bill, second reading.

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Second reading, what day?

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4 July. Meet information of information of killing Bill. Objection taken, second reading,

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what day? Friday, 20 June.

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Friday, 20 June. Objection for value-added tack in

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Objection for value-added tack in Objection taken, second reading,

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what day? Friday, 20 June. Exemptions for value-added tack miscellaneous provisions bill. what day?

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Friday, 20 June.

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Motorhomes bill. Second reading.

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what day? Friday, 20 June. Arms, legs, bodies review bill. Objection taken, second reading, what day?

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Friday, 20 June. Public-health control of disease act 1984 amendment bill, second

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reading. Objection to the taken, second reading, what day? Friday, 20 June. Time at statutory information act 1946 amendments Bill.

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1946 amendments Bill. Objection taken, second reading,

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what day? Friday, 20 June. Dangerous Dogs Act 1991 amendment

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bill, second reading. Second reading, what day?

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Friday, 20 June. Domestic Energy Bill, second

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Domestic Energy Bill, second reading. Objection taken, second

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reading, what day? Friday, 20 June. BBC licence fee non-payment

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decriminalisation for over 75 spell. Objection taken, second reading,

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what day? Friday, 20 June. Opened vaccine damage payments

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bill, second reading. Objection taken, second reading,

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what day? Friday, 20 June. Anonymity of suspects bill, second reading.

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Objection taken, second reading, what day? Friday, 20 June.

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what day? Friday, 20 June. Children's clothing value-added tax bill, second reading. Objection taken, second reading,

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Objection taken, second reading, what day? Friday, 20 June.$$NEWLINE

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what day? Friday, 20 June.$$NEWLINE Highway amendment Bill, second reading. Objection taken, second reading,

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what day? Friday, 20 June. British Broadcasting Corporation

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privatisation bill, second reading. Objection taken, second reading,

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what day? Friday, 20 June. The legal immigration offences

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Bill, second reading. Objection taken, second reading, what day?

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Friday, 20 June. Votes and damage payments bill

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second reading. Objection taken, second reading,

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what day? Friday, 20 June. NHS England treatment bill, second reading.

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second reading. Second reading, what day? Friday, 20 June.

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20 June. COVID-19 vaccine damage damage bill, second reading.

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bill, second reading. Objection taken, second reading,

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what day? Friday, 20 June. Mobile homes at 1983 amendment bill, second reading. Objection taken, second reading, what day?

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Friday, 20 June. Arm's-length body accountability bill, second reading. Objection taken, second reading,

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what day? Friday, 20 June. Bailiffs, warrants of possession

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Bailiffs, warrants of possession bill, second reading. Objection

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taken, second reading, what day? Friday, 20 June. National health funding and

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copayment bill, second reading. Objection taken, second reading what day? Friday, 20 June.

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what day? Friday, 20 June. Interpersonal abuse and violence men and boys strategy bill, second reading. Objection taken, second reading,

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what day? Friday, 20 June.

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Friday, 20 June. Pets microchip bill, second reading. Objection taken, second reading, what day? Friday, 20 June.

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what day? Friday, 20 June. Terminal illness relief of pain bill, second reading. Objection taken, second reading

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Objection taken, second reading what day? Friday, 20 June.

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what day? Friday, 20 June. Immigration and visas bill, second reading. Objection taken, second reading

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Objection taken, second reading

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what day? Friday, 20 June. British Indian Ocean Territory sovereignty and constitutional

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arrangements bill, second reading. Objection taken, second reading what day?
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Jeremy Corbyn Portrait Points of Order Rt Hon Jeremy Corbyn MP (Islington North, Independent)
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him how to pursue this matter further. Point of order.$$NEWLINE Further to the point of order raised Further to the point of order raised by my friend, the member for Hayes and Harlington, I wish to also play some record my thanks to our solicitor Martin Howell and many others who work very hard on this case because the implications are obviously very serious. If there are elements in the police and possibly in Crown Prosecution Service that once Members of Parliament Bill held to a different standard of account than the general public, that removes us from the normality of law in this country and I think that would be a very, very bad step indeed.

And I will take your advice of course and follow the advice that you have just given me to take this up with the clerks because as being held to a different standard would be a very bad thing. We have to all, all of us, have the right to take part in public protest about human rights abuse, about war, about peace, about anything else. That is what democracy is about, and I saw this whole effort as being a means to try and silence the democratic rights of everybody in our society by picking on us as Members of Parliament and I am grateful to the decision that's been made today, but like the member for Hayes and Harlington, I don't intend to let it rest just there.



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I'm grateful to the member for

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I'm grateful to the member for giving the point of order, and as he knows, this is not a matter for the chair, but he has put his point on
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Caroline Johnson Portrait Dr Caroline Johnson MP (Sleaford and North Hykeham, Conservative)
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more volatile, greater pressures have started to affect our natural resources will stop the county has suffered from flooding caused by overwhelmed drainage systems as well as flooding caused by excessive river levels. The effects and people are magnified. Some people whose are magnified. Some people whose homes were flooded, they lost the homes were flooded, they lost the ability to live in their home for quite long periods of time. Last week, I had the pleasure of visiting an academy as it reopened formally following significant flood damage following significant flood damage this past year.

The children there had to be bussed to different schools around the county, in the schools around the county, in the trust, and measures had to be taken to restore the school. I want to give thanks to everyone involved in give thanks to everyone involved in that. The community really pulled together for those children, and the Department as well, the Department for education and DEFRA worked very closely together not just to ensure the school was repaired but measures were put in place to stop this happening again.

The school has now got flood doors in place, to prevent flooding coming in. And they are having some work done over the summer this year in preparation for the autumn rain, to protect the outside environment. And the playing field and a special garden at the back of the school, and the higher ground which will seek to absorb some of the water if the rain over tops the back again. At the same time, unfortunately the new councillors and directors of Reform have chosen to abolish those dedicated to managing flood risk.

I want to make a simple point, my constituents deserve to live in safety, to go about their work and education without severe disruption from climate events. We have to make sure getting everything to protect their rights and livelihoods. We need to make sure that recommendations are being followed up and maintenance work is being done on time. We also need to listen to local experience and expertise, and not undo the good work started under the previous government was fostering collaboration between fostering collaboration between agencies and local people.

Many communities across my constituency have been affected by flooding in recent times, and they deserve to have their experiences shared. In one area, residents faced huge disruption in 2024 when heavy rainfall onto existing wet ground caused flooding. The local authority report on this event found that poor maintenance of the local water courses had contributed to funding, as the problems with the drainage systems and surface. As I saw when I visited the area, cooperation amongst different agencies is key in tackling these events.

Lincolnshire County Council are responsible for cleaning rallies and maintaining drainage. Another organisation is responsible of T4 maintenance. And local groups contributed valuable local knowledge and experience. The Environment Agency have responsible these as set out in the report, and have engaged local committee by providing maintenance updates. They spent £271,000 in 2023/24. Since the Spending Review revealed a cut of over the review period, can the Minister assure my constituents that there will still be the money to continue to maintain these dikes going forward? What will the Minister do to ensure transparency from councils? Updates from EA are simple to access, but the website simply lists actions following each flood report is on going but we need more clarity.

In Sleaford, residents faced similar problems. In drainage systems becoming overwhelmed. I welcome the work the EA have done. The business case for a major capital scheme recently approved on 2 June. This means that the project is expected to deliver £188 million in economic damage avoided, £74 million in people -related benefits and will protect 604 properties from flood damage. In another area, more work needs to be done. Residents suffered flooding twice in quick succession including in the school. In October 2023 and again in January 2024.

An agricultural ditches over tops the capacity. The councils recommended that the EA and the county council should work together to carry out assessments. With the results to be reported back to the Lincolnshire flood risk and water management partnership. These inspections have not yet happened. We know as reports into historic flooding are calling for closer collaboration, the Reform council run doing a successful partnership already established. Lincolnshire flood and water management committee do work in bringing together key agencies. The environment agency, the Internal Drainage Boards, Anglian Water, district councils, and other key experts.

As of three weeks ago, Reform abolish this weeks ago, Reform abolish this committee. They have a generalist environmental committee which does not have the same specialist remit to cover most important complexity to cover most important complexity use in the county. So rejecting the Baleba contribution of the IDBs and local experts, they are saying they know better than local people. All the main parties have opposed the committee abolition and seen it for what it is. If the government sees this reckless action is being brought on local communities and elsewhere, what can they do to ensure that councils uphold their responsibilities to residents? Instead of cancelling initiatives we should be creating new ones.

I was very encouraged by the excellent work under the previous government, the maintenance pilot, a scheme designed to foster collaboration between farmers and the NFU, local drainage boards, and Enivornment Agency. This scheme enables greater coordination and commonsense flexibility in the management of waterways, for example by training local landowners of how to manage courses and netting them to carry out their own channel clearance themselves. This avoids ludicrous situation where you see local people who can see a problem with the local water, they are a wearable flood their farm, they are aware it will flood the land, they have the equipment and know-how to do something about it, but the law prevents them from doing so.

It is illogical. Public sector operational agreements do exist as to how to streamline these schemes stop of the great local successes was the 2018 dredging of eight-foot strain. A farmland drainage channel dating from the 17th century. And the drainage board and the environment agency working together. Why are the lessons of these schemes not been learnt more widely? Since the last election scheme right and considers the has ground to a halt. With this have gone the benefits that were already accruing.

With a minute to commit to supporting these schemes and encourage the rollout. As she looks to have budgets, it is worth recognising that it is much cheaper for the IDB to clear drains and ditches then it is the EA, whose procurement processes are so cumbersome and have become significant more expensive. One of the things that frustrates many local people in the constituency is that they can do the job and get it done much quicker and they are waiting in places of flooding but it is not getting done.

Another thing that the Minister discussed with the Treasury is that the IDB is prevented from using red diesel its pumps. One of the things they tell me is a problem with that is that pumps are placed in isolated places, and people are going and stealing it because it is expensive. The IDB feel that if it was red diesel in those pumps that would be much less likely to occur. In another area, a number of houses have flooded, and we have had a less than promising update from the environment agency in that respect who are saying that they are expected to receive a model of this river system in summer 2025.

I don't know if the Minister has an update. We are expecting the plan in the spring and it has been and gone. So we greater she could help us. There is some concern of the overall cost of that in terms of the number of houses was the I encourage the Minister to remember that all the people who live in rural areas may live in less densely population areas but they have the same right as others. I could give more examples of communities in my constituency will suffer the impacts of flooding and you are crying out for a joined up approach will protect them from the future.

A familiar story happened in recent floods, with drainage, excessive water run-off, and communities left to suffer. While the EA have carried out some channel clearance, flood reports have said response ability for the central agents, county council, landowners and stakeholders like Anglian Water. It is vital that "Location is at the heart of the strategy. And politically motivated meddling is not allowed to get in the way. And I took the chair of the EA and the Minister to visit this when it was full.

The prioritisation from EA had been to protect the school, and not clearing the vegetation. Of course once the floods came, it was a problem. It would have been much better for the creatures and for the environment and for the wider countryside if those dikes had been cleared properly in the first place. There were literally trees growing there. There are two final community is facing specific threats. In one, resident in Stuart flooding in 2023, 24. I understand the Enivornment Agency have been conducting debris removal, they are investigating a capital program for defence under the next five years.

Any scheme will need to be economically viable and the cost benefits defined. This is despite future house putting plans which will see more land covered, and more demand on drainage systems. As of December 2024, and the government's key targets, central inkjet partnership now faces a housebuilding target of 1552 per year, an increase in 47% on the previous target. Can the Minister shall be that the cost benefit analysis deciding the fate of future flood defence schemes will take account of the government plans? Will he account for all the ways flooding impacts community life, from work hours lost, home damage, to watercourse repairs and drainage.

Finally, another area was impacted the flooding when the River Slea faced higher water levels. There faced higher water levels. There have been efforts to manage this. Residents in September 2024, saw a sewage processing plant flood which caused discharge and polluting smells. I met with Anglian Water to discuss the concerns. The bigger concerns they now have is about a biogas jester that may be built next door. It is vital lessons are learnt and we avoid repeating mistakes that will lead to more destruction for local people.

Addressing these risks requires careful allocation of the money. A glance at the most recent funding allocations under the coastal risk management scheme shows that many dozens of projects appear in the bidding process and yet receive no funding. The allocation data for the Internal Drainage data for the Internal Drainage Boards shows 15 intended projects listed for completion. But none have any funding allocated this year. Lincolnshire County Council are due to receive crowdfunding 2025/26, you one of the property flood resilience project.

An two smaller projects will receive a total of 52,500. 19 other projects will receive no The government has made much of the funding for flood defence since February. As I said before, it is about making choices. Can the government clarify how we are expected to prioritise funding for projects that need support, especially in light of the budget. How much money is spent on developing scenes that do not come to fruition and what is the estimated cost in household damage on those who decide not to act? As I mentioned earlier, the hard workers in my constituency do so much for local and national economy and it is vital that we remember them as well.

I asked the government what will come of productivity in areas left with flood defences? What will happen for food security when some of our best agricultural land is lost, and how are farmers meant to prepare for that uncertainty in practical terms when they already face threats to their livelihood? Just as farmers have been left facing farm tax of the party opposite and suffer the sudden loss of sustainable centres, they also face the threat of flooding without the help and support they need in the long-term interests of rural communities.

We have reached the time for action on flood present in and resilience. The way to manage these risks is knowledge, strategies and proper funding. Essentially with basic common sense. On the first point, we must keep local people within decision-making systems. We must give them the tools and authority to manage their own environments. We must build project such as the water maintenance pilot. Long-term planning and working. We can do more. The creation of the authority for example will provide a structured platform for long-term planning which can be tailored to the needs of local people, rather than the nationwide frameworks.

Finally, we must ensure that vital projects receive necessary funding without being held up by cost benefit frameworks. Local authority should hold power is less decision- making power to make sure that interventions are made when they need them most in a timely and efficient way. We can make sure that local people have control of the local environment and give the tools they need to prevent the devastating

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impact of flooding. Can I begin by congratulating the

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Can I begin by congratulating the honourable member for calling this debate and raising these very debate and raising these very important issues which I will endeavour to answer in the time remaining. Protecting communities homes as this is an farmland from flooding is a priority for this government, and I'm delighted to hear that the Academy students are hear that the Academy students are now safely back at school. I'm sure now safely back at school. I'm sure they had a very disruptive time, especially those taking public exams, and I am grateful for her generous comments about the generous comments about the Department for Education and DEFRA and EA officials working at pace to and EA officials working at pace to minimise the impact, and I pay tribute to all of the people impact on that, not least the parents and on that, not least the parents and the students themselves.

I'm very pleased here that there are flood resilient repairs, and I'm very interested to think about ways in which NATO-based planting around the school can potentially help with some of that flood mitigation in the future. Can I also say how incredibly disappointed I am to hear that the new reformed county council in Lincolnshire have taken the frankly very shortsighted and unwelcome decision to abolish the Flood Re and French protection committee for this shows the danger of pandering to reactionary rhetoric and then leaving local homes, local communities unprotected, and I should be watching very closely to make sure that they are fulfilling their duties under the flood and water management act 2010.

I am aware obviously that her constituency has been badly affected
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Mary Creagh Portrait Mary Creagh MP, The Parliamentary Under-Secretary of State for Environment, Food and Rural Affairs (Coventry East, Labour)
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by flooding from storms. More were flooded this January after heavy flooded this January after heavy rainfall, and my thoughts are with rainfall, and my thoughts are with those affected as the former MP. I had a thousand flooded into thousand seven, the psychological impact on seven, the psychological impact on residents is very long lasting. I totally understand her desire to totally understand her desire to raise these matters on behalf of her constituents, and the local communities that she serves.

Engagement and collaboration are a key component of managing and key component of managing and mitigation flood rest, and I'm pleased to hear that she is in contact with the Environment Agency contact with the Environment Agency on these matters. I can confirm that her constituency is receiving £9.3 million from the government's flood investment programme this financial year, which is funding the repair and maintenance of a number of crucial flood defences. But I would also just say that the section 19 reports, because she mentioned the county council reports, I believe that they have been completed and any decisions arising from those reports will take place in future funding years.

So, work has started this month on phase 1 of the flood resilience project which will support embankment assets. Phase II of the project which is planned will bring further investment in sustaining legacy assets while implementation adaptation measures to improve resilience of the area to flooding. The EA is working with partners to build an up-to-date model of the lower rhythm to be completed this financial year which will be used to test future adaptive approaches and accurately assess flood rest.

And I will ask my honourable friend the Minister for water and flooding to write to her if there are anything we can't get through in the time available. The reversely project is talking about a new sustainable future to management in Sleaford for top engagement has been undertaken with organisations and other stakeholders on this project, and Ruskin 10 is also being considered for a flood resilience project. Asset out by the Chancellor this week, to support the government's growth mission and plan for change, we are investing a record two point £2.4 billion to build new and maintain and repair existing flood defences across the country.

That is 1.4 early in pounds each year. This is a 5% increase into our annual average investment compared to the existing spend of 2.65 billion over the last two years, 24/5 and 25/6. Our current investment process is supporting projects which will help 52,000 homes and businesses and through essential maintenance which will have their expected level of protection or restored. This is a total of many properties that will benefit. Helping to deliver growth and help against economic damage.

We have also unlocked £140 million from this investment to get 29 checks moving. These were targeted at schemes that were ready to go so that this can be delivered faster for those who need it the most. The government inherited flood assets after years of underinvestment leaving 3000 of the key defence asset below the condition required. This government is taking decisive action to fix the foundations giving communities confidence that flood defences will protect them. We are prioritising over these current spending years from 24 /5 to 25/6, £108 million in repairing and restoring those critical assets.

£36 million last year focused on damage from recent storms and flooding, a further £72 million this year to make defences are resilient, reliant and ready. In addition, Environmental Land Management Schemes present a valuable opportunity for supporting flooding and coastal erosion risk management through direct funding of actions, providing a revenue scheme to support landowners working with capital schemes and indirect actions which will lead to reduced watercourse maintenance requirements, increasing the lifespan of our assets. She mentioned red diesel and I just wanted to say quick point on that.

The previous government removed most red diesel entitlements from April 2022, but there are some exceptions, and Risk Management Authority's which includes internal drainage boards may use red diesel for drainage, ditch clearance including work-related agriculture, horticulture and forestry, so I hope that is a useful clarification. Watercourse management faucet different bodies, repairing landowners that join the course such as the draining picture required to keep those watercourses clear of anything which could be an obstruction. The Environment Agency has permissive powers to work on main rivers and Lead Local Flood Authority's or internal drainage boards have permissive powers from ordinary watercourses, so EA focuses on those activities which will achieve the greatest benefit in terms of protecting people and property from flooding.

This can include dredging and clearing channels, and often in Lincolnshire, this involved the Yukon ID ds. The agency spends an average of £40 million on these in around 3000 commenters have main rivers. The need for dredging is assessed on location by location basis and the Environment Agency will work with local communities, IDPs and through public sector cooperation agreements to assess whether dredging is technically achievable and cost- effective. Ensuring that it doesn't significantly increase flood risked downstream and that it is environmentally acceptable.

She asked about future funding reforms. The current approach to funding introduced by previous government in 2011 neglects more innovative approaches, so to address this, we have reviewed our approach, and last week we launched a consultation on proposals to reform the way we allocate funding to flood schemes. Our proposals will make it simpler for all Risk Management Authority to calculate their funding, benefiting all councils, including those that have less resource to commit to the application process. This should speed up delivery of vital schemes and ensure money is distributed more effectively across the country, including for rural and coastal communities and poorer communities who have previously struggled to secure funding.

We will make it easier to invest in natural flood management schemes that also give benefits for nature, water resources, and the fight against climate change. We are considering how communities can make better use of property flood resilience measures and changes to the current approach which will be launched in time for the investment programme which will start in April 2026 the consultation is open to all and we encourage anyone with an issue to respond for flood funding. We do however have this at the very top of the Secretary of State's priorities which is why we set up a flood resilient task force to provide oversight of national local flood resilience and preparedness.

This is a new approach and it brings together representatives from national regional and local government, devolved Administration's, the emergency services charities and environmental interest rates. We need to know what works and we are learning where we need to make changes. We have established action groups led by members to deliver progress on areas including flood warnings, awareness of recovery, and insurance schemes. This government fully supports the vital role of internal drainage boards play in managing risk, protecting the environment, and we are providing that we announced

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yesterday. When I went around the

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When I went around the constituency, I got a consistent message at that time that the EA had not performed as well as the IDB and not performed as well as the IDB and it was costing more money per activity for them to do it, so I went if the minister in her final went if the minister in her final few minutes will be able to touch on how the IDPs can do more of the work

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how the IDPs can do more of the work and can engage more local people in doing it for themselves. I'm happy to say that, in March, we announced an additional. The previous government setup and previous the allocate £75 million to previous the allocate £75 million to the IDB fund. We announced in March and additional £16 million boost to and additional £16 million boost to the IDB fund so that creates a total the IDB fund so that creates a total of £91 million.

That should enable IDPs to modernise and upgrade their assets and waterways to ensure they are fit for future, improving water management for more than 400,000 ha of agricultural land and 91,000 Blacks loose, and two other areas. Which have received government funding of around £10.4 million in grants from the IDB fund since 2024/25, to help with pumping station repairs and water banquet repairs as well. I am in my final minute, so I will just say if I encourage her constituents to sign up for flood warnings on gov.uk, it is vital that communities are aware and in the communications chain to beware of flood events especially because we have some very heavy weather intense rainfall planned for this evening.

But any other issues,

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I will endeavour to write to her on issues you may have. The question is this house do now

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The question is this house do now adjourn. As many are of that opinion say, "Aye". The ayes have it. Order.
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This debate has concluded
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