Lords Chamber

Friday 21st November 2025

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10:06
10:07
Lord Trees Portrait Lord Trees (Crossbench)
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Moving Moving Non-commercially Moving Non-commercially into Moving Non-commercially into the Moving Non-commercially into the UK Moving Non-commercially into the UK. Moving Non-commercially into the UK. By 2024, there were 368,000 dogs moving. These were not my Lord's day trippers. Many were one way trippers, illegally imported dogs, many poorly bred, poorly kept unsocialised vulnerable to ill health.

In 2025, the PDSA estimated that 21,000 dogs were imported with cropped ears, a mutilation illegal in this country in 2023. The Cats Protection estimated that 65,000 cats had been imported, many of which had been declawed. Another illegal process in the UK. So this bill, my Lords, will bring these practices to an end. It closes a loophole in pet travel rules that have been exploited for profit, and introduces a proportionate limit on the number of pets that can be brought in in a single, non-commercial movement.

It makes it harder for unscrupulous individuals to abuse the system. The bill also grants the government powers to introduce secondary legislation to restrict low welfare welfare imports, by prohibiting the import of puppies and kittens, for example, under six months of age, restricting the import of heavily pregnant animals and of pets that have been subject to mutilation, like ear cropping and like declawing in cats. I welcome the government's assurances that they intend to work with stakeholders to consider appropriate exemptions to these restrictions, as these regulations are further developed.

I echo the government's words of caution that any exemptions must be extremely selective and must not allow loopholes to be created that could be exploited. This bill, my knowledge, is a testament to what we can achieve when we work together across this House. I know noble Lords will support its passage and help us to take this important step forward to ending pet smuggling and improving the welfare of pets brought into the

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United Kingdom. My Lords, I beg to move. The question is that this bill do now pass.

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do now pass. We can be proud that we are a nation that truly loves our pets nation that truly loves our pets and legislates for them. To dogs, cats and ferrets. Who will in the future be protected by this new law? And that is a tribute to all those And that is a tribute to all those vets, owners and rescue charities who have dealt with these terrible cruelties and campaigned for change. I congratulate my Liberal Democrat I congratulate my Liberal Democrat colleague and vet doctor, Danny Chambers, who has made this a law Chambers, who has made this a law so soon after becoming an MP.

Heartfelt thanks. Also go to the Heartfelt thanks. Also go to the noble Lord Trees and to the Baroness Hayman, the Minister, for all the work that they have done to all the work that they have done to deliver this, but also my thanks to every parliamentarian and it is every parliamentarian and it is wonderful to see so many here today to mark this moment. Every
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Earl of Effingham Portrait The Earl of Effingham (Conservative)
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dogs and ferrets currently suffer through the smuggling trade. There will be a great many animal lovers across the whole of the United Kingdom, who will be incredibly grateful to the noble Lord Lord Trees today, and we thank him for pursuing this with a laser focus which will now be enshrined in law.

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My noble friend from the front bench finally responds. I ought to say the spirit of this morning, that there is a four legged member of this House here, this side, who would like to thank everyone involved on behalf of his species.

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involved on behalf of his species. Well done. My Lords. I'm very, very pleased

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My Lords. I'm very, very pleased to be able to speak at the Third Reading of this private member's bill. Ending puppy smuggling was a bill. Ending puppy smuggling was a government manifesto commitment, and we've been really delighted to support the this animal Welfare support the this animal Welfare Bill through both houses of Parliament. So I'd like to thank Parliament. So I'd like to thank again, my noble friend, and I will call him my noble friend, the Lord Trees, for his excellent stewardship of the Bill through stewardship of the Bill through this House, and also thank Doctor Danny Chambers, MP, for so carefully guiding this bill through carefully guiding this bill through the other place and for working so constructively with us in constructively with us in government.

And my partner, my department is now going to be taking forward that crucial task of implementing the measures that have been set out by Lord Trees just now,
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Baroness Hayman of Ullock Portrait Baroness Hayman of Ullock, The Parliamentary Under-Secretary of State for Environment, Food and Rural Affairs (Labour)
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My Lords, I beg to move that

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this bill do now pass. The question. Is that this bill do now pass, as many of that opinion will say, content, not content. The contents have it.

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have it. My Lords, before we move on to the second day of Committee of the the second day of Committee of the Terminally Ill Adults Bill. I'll make a statement about proceedings, as I did last week. I hope this as I did last week. I hope this will again help with planning, and it is in line with how business it is in line with how business proceeded last Friday. Firstly, I would like to again thank on behalf of all members, the staff and the public Bill office.

Yeah, who have again had to work late into the evening, well beyond anything that evening, well beyond anything that is reasonable to deal with. The over 1000 amendments to this bill. over 1000 amendments to this bill. I also want to thank, on behalf of the whole House, the clerks Doorkeepers attendants, Hansard Doorkeepers attendants, Hansard staff, the broadcasting unit, catering staff, school staff and police who have supported the preparation for this important second day committee and are delivering for the House today. delivering for the House today.

Here, the Government Whips Office circulated the updated grouping circulated the updated grouping list yesterday. My noble friend, Lord Falconer of Thoroton has proposed a target for today's debate, as was the case last week. I would expect the House to rise at
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None Portrait Business of the House
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a convenient point around 3 p.m. in line with usual procedures and in line with the companion, we line with the companion, we maintain the typical flexibility to rise slightly before or slightly beyond this point in order to conclude the group being debated. Ultimately, this remains in the Ultimately, this remains in the hands of the House. I will return to Dispatch Box this afternoon to further advise the House if I think further advise the House if I think there will be useful.

There are, though, a few other points I wish to make before we begin today's Committee stage. It is important to remind ourselves that this is remind ourselves that this is Committee stage. A noble Lords should address their remarks to the amendments under consideration and amendments under consideration and not make long Second Reading speeches going way beyond the substance. The amendments being substance. The amendments being debated. The Second Reading of this bill has passed. It lasted two long days. I expect, as I believe all noble Lords do, that despite sincerely held views and differences of opinion, we will at all times conduct ourselves with courtesy and respect for each other and show the public watching our and show the public watching our debates.

The House of Lords, in the best possible light. So please refrain from doing anything that will bring that into question. The acoustics are excellent in this chamber, and the microphones are very sensitive. A noble Lord should not be holding conversations in the chamber or making remarks. They would not like to be broadcast live. If you wish to speak to other noble Lords, please retire to the Prince's Chamber. The royal gallery. The peers lobby or the Long Room and return when your conversation has ended.

Several noble Lords contacted me last Friday after after the last debate, to express their frustration with other noble Lords who spent large parts of the debate talking to others around them and causing annoyance and inconvenience. Please do not do this, my Lords. I wish to reiterate again that the bill before us today is a private member's bill, and the noble Lord in charge of the bill is my noble friend, Lord Falconer of Thoroton, and not the Ministers on the front bench.

This is not a government bill. It will not become a government bill. The government remains neutral on the bill. That position is not going to change. Having made those opening remarks, which are said to assist the House,

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I think we should now move on to debate the issues of substance before us. Yeah.

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Yeah. It has to be again in committee on the terminally ill adults end of life bill. Lord Falconer of life bill. Lord Falconer of Thoroton. My Lords, I beg to move that the House do now resolve itself into a committee upon the itself into a committee upon the bill. The question is that the House do now resolve itself into a committee upon the bill, as many of that opinion will say, content. Contrary, not content. The contents Contrary, not content.

The contents have it. In clause one. Amendment

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three Baroness Finlay of Llandaff. My Lords. We come to a key concern in this

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We come to a key concern in this bill the very real risks of coercion and pressure to seek an coercion and pressure to seek an assisted death. While the bill acknowledges coercion. It does not fully address the dynamics of fully address the dynamics of domestic abuse at the end of life, nor the intersectional risks faced by women, by those who are disabled, by women, by those who are disabled, whether long term or through illness or from ethnic minority illness or from ethnic minority backgrounds.

ONS data showed that in the year from March 20th 23 to
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Baroness Finlay of Llandaff Portrait Baroness Finlay of Llandaff (Crossbench)
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the Covid 19 pandemic. Reported incidences of domestic abuse to third sector and statutory agencies third sector and statutory agencies have increased by over 60%. A systematic review by Michelle Mitchell and colleagues, covering years 2000 to 2021, found the years 2000 to 2021, found the incidence of abuse increased in terminal illness, and these results resonated with Jamila Hussain's resonated with Jamila Hussain's findings in Bradford. People with life limiting illness experience a life limiting illness experience a range of abusive behaviours in three broad categories.

Coercive three broad categories. Coercive and controlling behaviour, emotional and physical abuse and neglect and financial abuse. Financial abuse is particularly rife in its many forms. Take the rife in its many forms. Take the relative who goes to the cash machine for their relative, who is ill, and quietly pockets some of ill, and quietly pockets some of the cash, or quietly steals valuables, or the family keen for their relative to die before a fixed term life insurance runs out. fixed term life insurance runs out.

Yes, my Lords, I've seen it. They wanted a new car. Emotional abuse wanted a new car. Emotional abuse includes telling the person that they were a burden, either directly or indirectly, through conversations designed to be overheard by the person who is ill. And some are told they're not dying fast enough. Abuse affects treatment decisions and can lead to people missing out on curative treatment through making adverse decisions about their care. For some women, death is the only way out that they can see from their situation.

It reflects the national data where suicide is now the commonest cause of domestic abuse related deaths. The Oregon data shows that feeling a burden to family or carers has been stated as an end of life concern by over 47% of people having an assisted death. This was higher than the under 30% who cited inadequate pain control or concern about it as a reason. After the noble Lord, Lord Faulkner's evidence to the Select Committee, I did recheck the official reports.

Oregon does not collect data to understand if there have been problems with coercion, nor does it report on those turned down for lethal drugs. This bill has been publicised as being about pain, but does not mention pain at all. Specialist palliative care can deal with pain, detecting the coercive threats, humiliation and intimidation, which are usually subtle and consistently maintained out of sight of anyone in authority, is far harder. It is the complaints about the heating bills, family carers being fed up at having to prepare drinks and food, groaning when asked for something.

So many ways to give the message that you're a nuisance and would be better off. Dead abuse impacts patients mental health and wellbeing leads to feelings of loss of control, entrapment, powerlessness and depression. But health and care professionals lack confidence in identifying abuse. It is rarely detected by doctors. Why? Because dependence limits disclosure. Illness increases women's dependence on the on the perpetrators, making disclosure harder in the last months, weeks, and days of life. Even when patients when professionals ask directly.

Disclosure requires time to build trust with the same professional who understands how abuse presents. At the end of life, in different cultural contexts, and who can offer practical support such as safe housing, financial help and, if needed, support for dependents. Without this, disclosure is too risky. Most women in Doctor Hussain's group said they would not dare to disclose abuse during an assisted dying assessment. As currently set out. They felt the process was too brief, too medicalised and too uncertain to guarantee their safety.

I recall a patient whose pain was not controlled on 1000mg of morphine a day. After a few days in our hospice, she disclosed to a care assistant at night the years of worsening abuse that she had endured, total distress from hidden abuse had given her total pain. Social work intervention and safeguarding in place was the solution and she went out to a new home, needing only 60mg a day. Disclosure is more likely in a trusted relationship with someone they can know, can look in the eye and know will work hard to improve their situation.

In today's NHS, continuity of care is not the norm. It is fragmented with inadequate transfer of information between sectors. Patients do not see the same person time and time again, whether doctor, nurse or other professional. That is why it's essential that information is sought from police callouts to a domestic disturbance. Local authority records to reveal any safeguarding issues in the household. Clinical teams who have been involved, social care, community carers and family members who may well be aware of abuse but had not known how to disclose it.

My Lords, let me come on to another type of subtle subliminal pressure also addressed in this group of amendments that, arising from whatever the doctor suggests under the Montgomery and McCulloch rulings, patients must be informed of all possible treatments appropriate to that condition. And if a doctor says and there is the option of an assisted death, the patient will hear that I know what lies ahead for you, and you should consider ending it now. A Canadian lawyer told me of his friend who had a stroke, and on being taken out of the ambulance, was asked whether he wanted treatment or made medical aid in dying.

Their term for assisted death and of patients repeatedly asked by different doctors in the hospital time and again about made and the corrosive effect that that has. So the amendment in the name of the of Baroness Fox of Buckley and others is particularly important. It does not prevent conversations, but it would stop subtle, coercive influences from doctors who may be under pressure, who may feel that they have to raise this. Just as the problems of DNR orders arose during Covid, or with some of the abuses of medical power and inappropriate surgery that was in the headlines not that long ago.

My Lords, I beg to move.

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Amendment proposed clause one, page one, line four. Leave out a

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page one, line four. Leave out a and insert an independent. Element in this group. My amendment 118 introduces an independent financial review background check on close relatives background check on close relatives for eligibility can proceed, and it aims to block eligibility where there is known financial abuse risk. there is known financial abuse risk. My amendment 462 aims to make coercion and financial abuse coercion and financial abuse checking a statutory duty of both the Commissioner and the Multidisciplinary Review Panel.

My Multidisciplinary Review Panel. My Lords, the noble Baroness, Lady Finlay has really set out some of Finlay has really set out some of the issues, concerns about coercion and I do not need to repeat it. I am a long standing supporter of am a long standing supporter of hourglass, an amazing organisation devoted to combating abuse of older devoted to combating abuse of older people. They are neutral, of course, on the bill. But their chief executive, in evidence to the House executive, in evidence to the House of Commons, wrote there is an epidemic of abuse directed against older people at the moment.

Some of older people at the moment. Some of it is due to the economic climate we are in with people just wanting to have their inheritance now, and to have their inheritance now, and some of it is due to the fact that older people feel like a burden.
10:29
Lord Hunt of Kings Heath Portrait Lord Hunt of Kings Heath (Labour)
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Evidence also given at that time by the Royal College of Psychiatrists stated that except with overt direct coercion, coercion can be very, very difficult to detect, as very, very difficult to detect, as evidenced by anyone, including doctors. Subtle and unintended coercion can also occur within a therapeutic relationship. As noble Baroness Lady Finlay so well pointed out between clinicians and patients, and evidence from Alan Thomas, professor of old age psychiatry from Newcastle psychiatry from Newcastle University for the Association for Palliative Medicine, said in my clinical work, I have had many clinical work, I have had many encounters with vulnerable older people who are being coerced into making decisions.

The fundamental making decisions. The fundamental problem with the bill here is the assumption that such coercion can assumption that such coercion can be detected by 1 or 2 clinical assessments carried out by the coordinating doctor and the assessing doctor. This is a seriously inadequate approach. My Lords, I recognise the Bill already accepts the risk of financial benefit by prohibiting anyone who is a beneficiary under a will, or is a beneficiary under a will, or may otherwise benefit financially or materially from the death, from or materially from the death, from serving as an assessing doctor or witness.

But I doubt that sufficient, even with the mandatory training that is already also encompassed within the bill. It is not clear how a doctor, even with financial abuse training is required, is meant to carry out this investigation. Given especially the cannot audit a patient or be expected to have accounting knowledge. Similarly, my amendments, first of all, propose an independent financial review and background check on close relatives before eligibility can proceed. It aims to block eligibility where this is known.

Financial abuse risk if noble Lords are concerned about the practical implications of this. I would just point out that we already have legislation in relation to live organ donation, providing a precedent to the human tissue. Authority must ensure that there has been no reward or offered for organ donation, and that there is valid consent in place for the removal and use of an organ. And my Lords, it embraced within. That is an independent review process with both the donor and the recipient.

So we do have a precedent in law at the moment as to how a review could be undertaken, checking if a close relative has a history of financial crime serves as a necessary preventative safeguard by identifying individuals most likely to engage in financial exploitation, regardless of whether they are listed as a beneficiary in the current will. And my Lords, I believe that some kind of proactive check in the way I've suggested has to be brought in and goes and needs to go beyond merely addressing overt coercion.

My Lords, my amendment 62 aims to bring coercion and financial abuse checking as a shared statutory duty of both the Commissioner and the Multidisciplinary Review Panel from older people, perhaps from disabled people's perspective. These amendments are critical because many disabled individuals rely on family or carers for financial, personal and social support, making them of course, much more potential to potentially at risk of coercion or financial pressure. My Lords, so what I'm proposing, and I hope that the noble Lord, Lord Faulkner, when he winds up, will be able to respond positively to these suggestions is that we introduce a proactive, evidence based method for detecting potential coercion before any reversible action is taken.

And I also believe, my Lord, that by involving formally, the Voluntary Assisted Dying Commissioner and the panel in reviewing these financial safeguards, it does ensure the oversight and accountability which I believe is missing from the current bill.

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My Lords, I. Support of Lord Hunt of Kings

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Support of Lord Hunt of Kings Heath amendment. In fact, I'm introducing amendments 118 and 118B, which follow his amendment 118. I'm also in support of amendments 45, 46, 47, 49 and 58. First, I would 46, 47, 49 and 58. First, I would just like to say this is an atheist bill that assumes there is nothing after death, which is not a neutral, after death, which is not a neutral, but an ideological position to those without an active belief that there is something after death, I there is something after death, I would say, how can you be so sure? What makes the point that it is an What makes the point that it is an atheist Bill? Because it decentralises death and by so doing decentralises death and by so doing it opens the door to very many evils, including coercion and pressure.

The subject of this group, pressure. The subject of this group, this bill itself, in a way, is coercive. It gives oxygen to dark coercive. It gives oxygen to dark thoughts, which can loom especially large when our best days seem to lie behind us, when we are no longer contributing to family and society in the way we once did, society in the way we once did, culturally and societally. It encourages and influences them as
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Lord Farmer Portrait Lord Farmer (Conservative)
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much as any person referred to in amendments 45 and 46, two of my friends with terminal conditions friends with terminal conditions both followed earlier stages of this bill in the other place, and told me the subject very airing told me the subject very airing made them feel that they were a burden. The message, legislation burden. The message, legislation and policy should be amplifying is you will not walk the valley of the shadow of death on your own. We should be encouraging people to make and keep those relationships make and keep those relationships that will carry them through life and through that dark valley.

Others might also have dug out the words of the Times columnist Matthew Parris, quoted in a debate on assisted suicide in the Other Place in April 2004. He said that although your time is up will never be in order to the elderly, disabled, severely ill and the others to whom assisted suicide others to whom assisted suicide will inevitably be extended will inevitably be extended eventually it May 1st day be the kind of unspoken hint that everybody understands. And that's a everybody understands.

And that's a good thing, as the right hon. Stephen Timms said in that debate, I cannot see that that would be a good thing. It seems to me that legalising assisted dying would impose a terrible dilemma on frail people, elderly people and others when they are at their most vulnerable point in their lives, especially on conscientious, frail people who do not want to die but also do not want to be a burden. I do not think there is any way to avoid imposing that dilemma, unquote.

We've heard from Baroness Finlay about the data from Oregon that over half have applied for assisted dying since 2017, not because they want to die, but because they feel they're a burden. Baroness Coffey amendment 47 guards against this internal coercion to use the Royal College of Psychiatrists phrase further, her amendment 49 includes body, corporate, institution or organisation alongside a person, which of course catches the government itself tragically, and I declare my interest as a Hampshire farmer.

There are farmers who have committed suicide ahead of the imposition of the family farm tax, choosing to die early so their land is passed on intact. Law and policy starkly influence personal decisions. Hence our responsibility as lawmakers to take these unforeseen consequences into account and not brush them aside. Turning to amendment 58, Baroness Grey-Thompson is absolutely right to focus on lack of care as a disadvantage that pressurises if death. If death looks as if it might be painful and protracted, then going through it alone, unnoticed and uncared for is too terrible to contemplate.

But surely we can do better than help someone act on that dread thought that no one would miss me. No one cares. Amendments 118A and 118B. My amendments to my and Lord Vallance amendment 118 would ensure wills are scrutinised and the backgrounds of friends as well as family are not overlooked. If sinister motives suggesting financial abuse are not assumed but at least considered. Legislating for motivation is notoriously difficult because motives are private, subjective, easy to disguise, instead, assisted dying legislation must use clear, objective safeguards to remove the possibility of improper motives influencing the process.

As an aside, I'm not sure this bill prevents any doctors involved from profiting from early death, but Doctor Harold Shipman did, of course, inveigle himself into wills of some of his victims. And that would also be a red flag if found in the commissioner's check on wills. So may I ask the noble and learned Lord, Lord Falconer, why this bill does not do more to exclude anyone with a financial or personal interest, and by extension, anyone who might have been under their influence.

We cannot draft either for compassion or for malice, but we can protect applicants by making it clear from the outset that if anyone with suspect motives has any involvement, their

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application will fall. My Lords, by contrast, I rise as

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My Lords, by contrast, I rise as an atheist and humanist, but I mainly rise to move my amendment 45 mainly rise to move my amendment 45 to add the word encouraged after coerced. I support the general theme of the amendments in this theme of the amendments in this group, which largely tackle the need to strengthen safeguards against patients being indirectly influenced into opting for assisted death, often coercive in all but death, often coercive in all but name, all of these loopholes undermine any certainty that the choice, in inverted commas, is autonomously made.

My amendment, supported by the noble Lord, Lord supported by the noble Lord, Lord Goodman of Wickham, may appear to be a small change, just adding one be a small change, just adding one word. But before anyone concludes that I'm trivially tabling amendments to waste time, I'd note amendments to waste time, I'd note that when we're dealing with a fundamental change in the state's relationship with its citizens, the NHS, relationship with patients, and life and death decisions, the specificity and appropriateness of
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Baroness Fox of Buckley Portrait Baroness Fox of Buckley (Non-affiliated)
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specificity and appropriateness of the words in the law change matter. At present, in the bill, doctors are only required to ascertain coercion or pressure. They're the only two words given in clause one, but there's no duty to even probe or ask broader questions about more subtle, insidious influences that could affect a person's decisions. Just to note, the concept of encouragement is not an arbitrary word. The encouragement of assistance in a suicide is illegal under the suicide act, but not in this bill.

Indeed, CPS policy guidance in relation to prosecuting those who've assisted suicide acknowledges that encouraging that word the victim as is a factor in favour of prosecution. It is also criminal to encourage a person to commit an offence under the Serious Crime Act. So the question is less why I'm bothering to move an amendment. Just to add in one word. Now the question is why did the sponsors of this bill leave that word out? That word encouragement. Adding the word encouragement allows a shift in perspective, in perception, in what undue influence can look like.

Even though there are real problems with spotting coercion or pressure. And we've heard many examples of that, the concepts at least have a hard edge. That is an overt sense in everyday parlance, at least, that you're talking about people doing something that they didn't really want to do. You don't say, oh, I had a really lovely day today. My husband coerced and pressurised me into doing dot, dot, dot, but there's a grey area of much more subtle intervention.

An individual could motivate, lead on, nudge someone into opting for an assisted death rather than being made aware of all the ways that that person might live out their limited time in as comfortable a way as possible. And it's that sort of encouragement that this amendment is trying to get at. My Lords, as I explained at Second Reading, one of my big dreads is that once assisted dying is normalised as a positive treatment option, that vibe shift won't be confined to medical scenarios.

It can and will mean it's popularised as a go to option in broader society. Consider this scenario you've just got the news that you have a terminal diagnosis about six months to live. You're frightened, you're shocked, you're seeking reassurance. It's a bleak time and you're depressed. Well, because you don't want to die. But then a third party family carer friend says, and I ascribe no motivation here, by the way, they say, have you thought about asking your GP for assisted death? I mean, I've been reading about it all over the place.

You can do that now, and at least that way you'd be able to have dignity in dying. And you know how much you hate hospitals and all those doctors fussing about you. Oh, and we all know you aren't good with pain, are you? And how will the kids cope with running around having to visit you if you're in and out of hospital? And wouldn't it be so lovely if you could choose when you go? Then we could all be with you at the end.

And all this is said in soothing, kind tones, and therefore you think, well, I really don't want to die. My instincts are to rage. Rage against the dying of the light. But I really don't want to be a nuisance either. And they know me so well. They know what I'm like, that I won't cope. They have my best interests at heart, so I suppose. Dot dot dot. It doesn't sound exploitative or coercive, but it's an iron fist in a velvet glove. And we have some cultural reference points here when we discuss how the Online Safety Act will tackle suicide sites, there's consensus about the problems of online influencers, encouraging vulnerable people into believing that suicide is a positive way out of their suffering.

There's widespread revulsion at those cajoling, siren voices, encouraging death as an attractive option. And in that context, none of us conclude that this encouragement isn't problematic because it isn't explicitly coercive. What this amendment seeks to do, then, is to get on to the fate of the bill, a duty to consider these more insidious forms of intervention that can have lethal consequences, and that compromise. One of the core justifications for this bill autonomy. If a patient has been encouraged in a way that shapes a decision against their instincts, this corrupts the notion of a decision freely made.

Protecting autonomy is something that should unite all of us here. Supporters and opponents of the Bill. Indeed, the central purpose of the eligibility criteria and the whole process from the first declaration is to ensure the patient is acting autonomously and has not been coerced or pressurised by any other person into making the decision to request assistance in their own death. I, like so many others from charities, royal societies, disabled and domestic abuse campaigns remain worried about the limited mechanisms in the bill to spot anything but the most overt direct coercion.

And we've already heard some brilliant speeches explaining the difficulties there. But if the patient was encouraged, that is even more of a threat to our assuredness that assisted death is a choice freely made autonomously. I'm therefore hoping that the noble and learned Lord, Lord Faulkner, will enthusiastically support my attempt at strengthening the language in the Bill that will emphasise this autonomy. I was, I have to confess, slightly aghast about the Committee stage. In the other place where MPs tabled a number of amendments to ensure much more explicit protections were included on the face of the bill.

Safeguards for individuals who might be vulnerable to coercion in all its forms, and more subtle interventions that could be characterised as encouragement. Yet amendment after amendment along these lines were rejected. So I'm hoping that this House will adopt a different approach and tighten up the drafting of the bill precisely so that autonomy is meaningful and not just a slogan.

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My Lords, supporting the amendments in this section in this amendments in this section in this group to clause one, I rise in particular to speak to amendment 48 particular to speak to amendment 48 in my name. This amendment seeks to in my name. This amendment seeks to strengthen the safeguards against someone being coerced into an someone being coerced into an assisted death. It removes the words by any other person from clause one, subsection two, subsection B, and extends the notion of coercion to recognise notion of coercion to recognise that coercion or pressure can come from a multitude of places an from a multitude of places an institution, a circumstance, or institution, a circumstance, or another individual.

And I'm sure, my Lords, that there is agreement across your Lordships' House that across your Lordships' House that nobody should feel obliged to opt for an assisted death. And so this for an assisted death. And so this amendment aims to strengthen and clarify the eligibility criteria in clarify the eligibility criteria in the bill, in recognition that this is perhaps its most important is perhaps its most important safeguard. I have, as many of us do, have deep concerns about how we protect vulnerable people from unnecessary, unwanted death, and I am especially anxious that we should be aware of the risk of coercion in all its forms, an issue I raised during Second Reading.

And this includes my Lords, where somebody feels coerced through the lack of real choice. For example, the National Audit Office recent report into the state of the palliative and end of life care sector is stark. As we know, funding is stretched and provision is desperate. As things stand, there is a lack of real choice for many people about the end of life. The the knowledge of this could easily be internalised by people leaving terminally ill patients in certain regions, or who are part of particularly vulnerable, marginalised populations, feeling that they have no choice but assisted dying.

Whether or not another person is explicitly pushing them to do so. So therefore, my amendment 48 seeks to ensure such cases are not left out of the bill's definition of coercion. And I would ask my noble and learned friend Lord Faulkner, in his summing up to give consideration to summing up to give consideration to this, so that it remains possible this, so that it remains possible to detect and prevent any death chosen. chosen.
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Baroness Butler-Sloss Portrait Baroness Butler-Sloss (Crossbench)
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became law. And there are various reasons why it would be a good thing to enlarge it. For example, it seems to me bitterly unfair that those with locked in syndromes like motor neurone disease would be extremely unlikely to benefit from this bill in the last six months, because many those I have known have been unable to do anything in the last six months to do it themselves. So the word encouragement is absolutely crucial. It doesn't have to be coercion.

It doesn't have to be abuse. It could be nice people listening to a loved one and realising that they're saying I ought to die, consequently saying yes, why not? And that would be extremely unjust. There's a.

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Profound irony in this group of amendments, because the bill amendments, because the bill introduces far greater protection for vulnerable patients than exist for vulnerable patients than exist under current law. Terminally ill people are currently vulnerable to people are currently vulnerable to all sorts of pressures from family members, from others who may have their own agendas. In seeking to persuade the patient not to continue with their treatment, to die, or just to give up on life. die, or just to give up on life.

And what this bill does is to And what this bill does is to introduce in statutory form, a whole range of new statutory whole range of new statutory protections that simply do not exist in the standard cases of exist in the standard cases of vulnerable people being encouraged not to continue with their with not to continue with their with their treatment. And we see that in clause one, subsection two, which
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Lord Pannick Portrait Lord Pannick (Crossbench)
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clause one, subsection two, which summarises what the act provides in some detail, steps are to be taken and they are taken under the Bill to establish that the person concerned, I quote, has a clear, settled and informed wish to end their own life and has made the decision they wish to end their own life voluntarily and has not been coerced, has not been pressured by any other person into making it. Now, those seem to me to be very strong and very appropriate protections.

The idea that we should proscribe encouragement will inevitably lead to the family members and the friends of the person concerned, the person in the terminally ill condition being worried that if they discuss this difficult, important subject with their loved one, with their friend, they are vulnerable to all sorts of sanctions under the law. And that, I would have thought, is the last thing that we want. Now. The application of these principles, and they're the right principles in clause 1 to 2, will inevitably depend on the facts and the circumstances of the individual case.

So I, for my part, do not see the need for any of these

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amendments here. I am not a lawyer, and it is

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I am not a lawyer, and it is dangerous to follow the noble Lord Lord Pannick. But I think on this Lord Pannick. But I think on this occasion he is mistaken. The fact occasion he is mistaken. The fact that this kind of protection is not there until this bill doesn't actually mean anything. Perhaps it actually mean anything. Perhaps it should have been there in any case. But if we're going to have this But if we're going to have this protection, it needs to be proper protection.

And I do say to those who, at least today, live a who, at least today, live a privileged life that they ought to remember that there are many people remember that there are many people in this country who, for the first time are within touching of large time are within touching of large sums of money, because the housing situation means that there are many situation means that there are many old people who do have values old people who do have values valued houses, which those families
10:56
Lord Deben Portrait Lord Deben (Conservative)
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have never seen ever, ever before. Grandma 200,000. And I just say to Lord Pannick, somebody who was a member of Parliament for 40 years and works now in a community, this is a very, very real fact. And we just have to accept that some people in this House are a long way away from those people. I was brought up in a slum parish by a clergyman. I've spent my life trying to deal with the very people we're talking about.

I think these amendments are crucially important because we are talking about circumstances which we are about deeply to change. The fact is, this bill itself changes the way in which we think about old age and infirmity. I desperately want people to know that they're always valuable, that they've always got something to give, even at the end of life. This bill removes that. If we're going to have it, which I hope we won't.

But if we're going to have it, we must make sure that it is not just that people are protected from coercion, but they are protected from encouragement, which I am afraid is sometimes driven by a sort of misunderstanding of what we can give. I can see people who will say, you know that your grandson is in some real difficulty. You have a last opportunity to do something worthwhile. If you die now, then his house, your house will save.

His marriage will save. His firm will look after his future. That is what will happen. And we who are in happier circumstances should just remember we have a deep responsibility for those people.

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Yeah. These amendments seek to prevent and or identify coercion and pressure which may fall short. Of coercive behaviour and pressures coercive behaviour and pressures which may fall short of coercion, and situations in which vulnerable people may be encouraged to make people may be encouraged to make what is actually an involuntary decision to end their own life, which they would not otherwise have which they would not otherwise have made. My Lords, there is no definition of coercion or pressure in the Bill, although new offences in the Bill, although new offences are created by 34.

I think that's unfortunate and arrangements made unfortunate and arrangements made did not enable the taking of evidence from those with disabilities until the recent Select committee on the bill, Liz Carr said in evidence to that committee that the absence of our involvement has led to disability rights organisations making a formal complaint to the UN convention on the Rights of Persons convention on the Rights of Persons with disabilities. That's very serious, my Lords. We know that 40% serious, my Lords. We know that 40% of those who die by assisted dying in Canada have lived with disabilities.

We also know of the disabilities. We also know of the very real fear which has been articulated in so many meetings by those who live with disability.
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Baroness O'Loan Portrait Baroness O'Loan (Crossbench)
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those who live with disability. Miss Carr spoke about systemic pressures of living with disability, and of what duress actually feels like with great clarity. She said this do you know what? Everything is so difficult. I cannot get a care package, so I can't get out of bed. I'm sitting in wetness, I'm sitting in nappies, and I shouldn't have to live like this. I want to die because the support is not there for me to live. That is duress. And again, I feel I'm a burden on my loved ones.

I want them to have a life. There are no amendments that said that to feel a burden is problematic. We seem okay that people might feel that they're like a burden, that is oppression, that is duress. And the worst is when people will believe it about themselves. And that is a fear with the bill, that people will choose it because there is no choice, because they believe they cannot have alternatives. That is terminal illness, that is terminal illness and disability.

So she spoke of people dying on corridors, dying because they don't get drugs, because nice hasn't approved them, dying because there is not the right support and funding into palliative care, she said. That is suffering and coercion. None of these situations are provided for in the bill. Very subtle pressures, negative comments about what the future holds, comments about the cost of care, etc. can work upon a person's mind until they begin to lose the ability to think clearly about their situation and feel that they are a burden to others.

And this is one of the most common reasons for seeking assisted death in other countries. Another increasing cause for accepting assisted death was revealed in the American Journal of Transplantation, which reported that increasingly, people are doing so to enable them to donate organs to others. Imagine the situation in which someone facing long term disability, or even the death of a loved one who needs a transplant and can't find a donor. What pressure might there be on a person who's terminally ill to give up their life that another might live? This bill gives rise to the possibility that this will happen as it has in other countries.

And yet such a decision really is not a decision made freely. And in many circumstances, my expectation would be that it will not be revealed as a reason why somebody wants to do it until the moment of death, and then there'll be all sorts of complications and concerns, because the purpose of assisted dying is to die. The purpose of organ transplantation is to keep the body in a place in which the organs can survive until they're transplanted, and regular carers support their report, their exhaustion, their sense they can't cope, that it's all too much, and comments like this can be made maliciously to coerce the person into assisted dying and cases of repeated or continuous coercive and controlling behaviour in intimate and family relations have been very well dealt with today, and particularly where financial interests are at stake.

Amendment 52 would protect against these situations when medical professionals who suggested do not resuscitate order because they don't understand the value of someone's life, and who make judgements about the quality of that life, may cause people to think that they should die. They may plant the seed, that death is the only real alternative. A person in hospital or receiving care may be subject to pressure through the communication. The fact that the person is, for example, blocking a bed because no suitable care package can be provided for reasons entirely outside the control of the terminally ill individual.

Just as DNR notices were used during Covid and continued to be encouraged simply because of age or disability, a person in such a situation is doubly vulnerable when somebody else refers to the fact that life is so very difficult for the person they may be. Appreciate that it might be better if they died. The Pathfinders Neuromuscular Alliance spoke recently of the difficulties faced by their members endless battles to gain access to housing, equipment, housing and equipment to funding for care.

The ongoing widespread failure to provide proper support gives rise to feelings of depression, isolation and a diminished quality of life. Actually, in so many circumstances, proper care and support could enable people to have a content and fulfilled life. My Lords, these amendments provide for independent decision making, uninfluenced, not encouraged, not pressurised to make a decision whether that pressure comes from individuals or from an organisation or an institution. This is particularly important as the Bill does not contain any provision requiring the doctor who may be involved in an end of life decision with the bill to become law, to ask the person seeking to end their own life why they wish to do so, or what pressures they have been subjected to.

Moreover, doctors have reported how difficult it is to detect coercion, encouragement, undue influence. Just asking a person whether they're subject to undue influence or coercion is not enough. Noble Baroness Baroness Finlay has dealt with it. They may be afraid to say who they say they are. My Lords, one of the greatest difficulties is identifying where there has been. Doctors are generally not trained to do this, yet they are the ones in this bill who have to make a decision without any context or any supplementary information, that a

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person is free from such pressures. To speak to amendment 48, to which I've added my name, and to which I've added my name, and to move amendment 846, which is in my name, dealing briefly with amendment 48, I added my name to amendment 48, I added my name to explore the the issue as to whether pressure in the in this bill can emanate from a non-human and non-corporate source. As I non-corporate source. As I mentioned at Second Reading, so much pressure nowadays, particularly for young people, comes from the internet, video comes from the internet, video games, social networking, TikTok and influencers.

It is not only the and influencers. It is not only the use by people of online devices as a mechanism to pressure another person, it can be from algorithms person, it can be from algorithms themselves without any other human intervening. In addition to the two intervening. In addition to the two prosecutions of OpenAI for ChatGPT allegedly encouraging children to take their own lives, those with chronic illnesses have testified to me that when, for instance, Facebook realises from Facebook realises from conversations that you've got a chronic illness, it changes your feed from promotion of group chats
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Baroness Berridge Portrait Baroness Berridge (Conservative)
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feed from promotion of group chats and adverts that are positive to negative about your treatments, whether you can live with it and even suggesting going to Switzerland. Is it the bill sponsors intention that when the medical practitioner is verifying in clause ten two eight that it is not this type of pressure? Are the internet service providers covered by clause one? As there's no definition of person in the bill? As I said at Committee stage, this bill is designed for an analogue age or and not one on the cusp of AI, but dealing with statutory guidance.

The amendment 846 this is the next question, not who puts on pressure, but what do we mean by pressure? So the former chief coroner, Thomas Tay, came to our select committee and we asked him, do we need to define pressure? He said if it forms part of the ingredients of a statutory offence, then it might be necessary. Frankly, I'm not sure that it would, because for such a common word in the English language, the fundamental principle lawyers apply is to take the dictionary definition.

So last night I looked in the dictionary Collins English Dictionary. Someone is trying to persuade or force someone to do something. Someone is trying to persuade. What a low bar. What a low bar that has to be detected. And I have to say, I think it's a good job that the law will not be retrospective and that there is parliamentary privilege. Otherwise, I think the noble Lord, Lord Faulkner's attempts to try and persuade us of the merits of the assisted dying Bill might actually be covered by his own bill.

And I ask the noble and learned Lord in select committee whether when a new concept is introduced into the criminal law, whether consultation is necessary. His reply sometimes yes, sometimes no. I think catching mere persuasion means that this is a sometimes yes moment, particularly as has been outlined by the noble Lady, lady alone, that this creates the basis as well for a criminal offence in clause 34, which can mean imprisonment for life. And the noble and learned law will not be surprised to know that we are going to return to his evidence of the Select Committee in relation to clause 34 later on in committee.

So in committee we asked various professionals what they thought pressure meant. So the pathologists, the Royal Colleges are opposed to this bill. Doctor Suzy Lishman, she said I would understand pressure to mean encouragement, to go down a particular route and coercion to involve some force or threat. I have had no training whatsoever in either of these. The Royal College of Psychiatrists Doctor Annabel Price, says it would need to be differentiated from coercion. She said in terms of definition, coercion would be the application of force, threat or.



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Task. The noble Lady, whether the select committee asked anybody the select committee asked anybody who is terminally ill what they thought persuasion or coercion might mean. Yeah.

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might mean. Yeah. So we we did cover that matter in committee on on the first day.

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So pressure has a broader definition. The noble Lady is not answering my question. The truth is, of course, that the committee didn't ask anybody who's terminally ill

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ask anybody who's terminally ill what their view was about any of this. This reply to the noble Lady, then that actually within the bill, then that actually within the bill, that's not necessary as I've outlined clause ten. This applies to the people in the who are to the people in the who are verifying in the process, not to the individual. And it was not in the motion that your Lordships' House approved that that evidence should be taken. So repeating Doctor Annabel Price, she says pressure has the broader definition pressure has the broader definition of perhaps strong encouragement, expectation or the worry of letting someone down.

The noble Lord Lord Patel joined in this mini focus group and he asked if I used the word pressure. What and if I were word pressure. What and if I were to use the word coercion? How would you interpret the two? Professor Mumtaz Patel, who's from the Royal College of Physicians, again opposed to this bill. He said it is grey. So amendment 846 reflects the view also of the Law Society, who are neutral on the bill on assisted dying but opposed the bill.

Kirsty Stewart said I think it is really difficult because there is not a definition at the moment in the bill and that's why amendment 846 is based on the statutory guidance principle from the Offence of coercion and the Serious Crime Act. And I just note that the Home Office have recently had to issue 91 pages of statutory guidance on that offence. It seems the courts are struggling with it. So even if Thomas Teague is right that you look at the dictionary, are we talking about economic pressure, emotional pressure, financial pressure, spiritual pressure, reputational pressure, internalised externalised pressure of circumstances.

For instance, no one provides you with a hospice bed. As Doctor Suzanne Kite said from the Association of Palliative Care Medicine, we know that there are these pressures of can we afford the electricity for the oxygen supply? Yes. These are issues that people face on a daily basis. The bill is silent as to what kind of pressure is meant. But if we move from individual sources of pressure, there can be group sources of pressure. Alastair Henderson, from the Equality and Human Rights Commission, stated to us at select committee as following the wider issue of coercion or pressure at a societal level or an attitudinal level, the broader trends or cultural issues.

Pressure is not always directly applied by an individual, but can result from attitudinal barriers, particularly around disability and the lack of services and some support in a society as a whole. So could it be that pressure comes from nice refusing you the drug that you think will wipe out your metastasised cancer on a value for money grounds? So actually the pressure could indeed emanate from the Chancellor of the Exchequer in her budget, or the Secretary of State for Health and Social Care to encourage vulnerable people to take assisted dying, a matter I did put to the government.

Minister Stephen Kinnock. Caroline Abrahams, of Age UK, said the context again for this is a system in which adult safeguarding is under acute pressure because local government is under such acute pressure. The British Association of Social Workers also said unless those services statutory services are adequately resourced, that may bend people's decision in a certain way. Much of the social care is self-funded. Now. If you are poor and you cannot have access to those personal resources, even more pressure is applied to you.

How does a medical practitioner looking at the noble Lord Lord Pannick? How does a medical practitioner sign to say that this kind of pressure from culture, society or attitudes or lack of statutory services is not being put on the individual? But, my Lords, there was unanimity at select committee when we then started asking all the professionals about training. I asked, I said, you know, the word is not defined in the bill, so I am afraid I cannot help you.

We have no definition in the bill. You're going to need training, though in pressure. Has any of you received training like that? Professor Nicola Ranger from the Royal College of Nursing? No. Professor Mumtaz Patel of the Royal College of Physicians. No. Doctor Michael Mulholland from the Royal College of GPS. No. So we've got other additional costs now added to the bill because we have to devise training in pressure and deliver it to a whole raft of professionals, care staff, etc. so that they understand, particularly bearing in mind the vulnerability to criminal prosecution that exists in the bill in clause 34.

So I have to say that I am going to give this opportunity that the noble Lord, Lord Faulkner, to perhaps shorten Committee stage proceedings. I do think that just deleting the word pressure from this bill, when it has not been consulted on it, has not been subject to pre-legislative scrutiny, would aid this House in evaluating this bill.

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Hold on. Like this, which has so many. Conceptual.

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Conceptual. Linguistic and semantic alternatives on offer, it is very difficult to see how Committee difficult to see how Committee stage like this is really going to help very much in determining a help very much in determining a final solution in relation to the matters under consideration, and therefore it could become very therefore it could become very tempting to enter into the nice and tempting to enter into the nice and easy solution suggested by my noble friend Lord Pannick to the effect friend Lord Pannick to the effect that the bill is quite enough.

It provides sufficient protection, and it is right to say that the bill certainly seeks to provide sufficient protection, and I do not in any way attribute anything other in any way attribute anything other than good motives to those who are sponsoring this bill, and particularly the noble and learned Lord, Lord Faulkner. But I would say to my noble friend that I think say to my noble friend that I think he's underestimating the step change that this bill makes, which change that this bill makes, which is what is the whole difference.

This bill allows someone else to
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Lord Carlile of Berriew Portrait Lord Carlile of Berriew (Crossbench)
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This bill allows someone else to play a part in intentionally ending another person's life, something that is unknown and not part of our law. Unless this bill is passed. And that is why I would say to my noble friend who's a fantastic lawyer and a good friend, that I think he's underestimating the importance of what one might describe as the emotional reaction to this bill. But I think actually is much more like what was described so skilfully by the noble Lord Lord Deben earlier.

And I think he and my noble friend Baroness O'Loan put their finger on the reason why we have to find something to strengthen the bill in relation to these issues, and indeed, I think that the my noble friend Lord panic showed a surprisingly and esoteric confidence in human nature, which I don't share, but I'm the nasty sort of lawyer who has been going round the criminal courts for over half a century. And what I've always said to young people who I suppose the posh word for it is mentored.

Never be surprised by anything you hear in a courtroom, because to quote a newspaper that now no longer exists, all human life is there. And some of it is, I'm afraid, very bad. And I'll just give your lordship very quickly, because I don't want to make a long speech on, at least at this stage. Very quickly, I will give your lordships a couple of examples which don't relate to assisted dying, but they're very analogous. There's a practice called cuckooing.

It happened in my own family on one occasion, and it's a practice whereby those with a malevolent, devious and oblique motive enter into someone's life as a do gooders, and they take over that person's life, and that person is completely taken in by the motivation they appear to show. And in one example, which I know, the detail of a man of 43 with a brilliant intellect but with personal problems, was persuaded to transfer his house to the cuckoo's in a solicitor's office with a solicitor preparing the conveyance, and with a solicitor asserting that it was a fair transaction.

And when that 43 year old man died, a remarkable solicitor called Mr. Nelson in Birkenhead took hold of the case, and eventually, through his skill, the house was transferred back to the estate and was inherited by the only child of the man who died. That's just a real example that you come across in a courtroom or in a family. And another example, which is very much from my own experience of many years ago. I prosecuted the case, a residential home.

I think the term used in those days was matron in a very nice town, in a very nice home, in a very nice place in lovely North Wales. Inherited what then was a huge sum of £80,000 by fraudulently, fraudulently persuading one of her residents to change his will, her will. And that was done by, in inverted commas, kindness. And what we are dealing with here, my Lords, is something that is actually very difficult to detect. But for every case that goes into a criminal or civil court, that kind of kindness in inverted commas has been done 20, 30, 100 times, which are not detected.

And that's why we need the language in this bill to ensure that it can be detected, particularly because of the step change the relationship to death that this bill brings about. But as I've said, I don't think we're going to solve this problem by going through a 30 odd amendments in our Committee stage. And what I would say to the noble and learned Lord is, let's have a let's have a debate about whether words are needed. I think it's absolutely clear that the great majority of members taking part in these debates believe some words are needed.

And then let's not develop that debate. For too long. We spent three hours a week ago talking about the difference between ability and capacity. I was so depressed that eventually I had to go out for a coffee break. And and I think that we need to avoid that sort of elongated and depressing debate. But I would encourage the noble and learned Lord to say early in this debate, we've done it for nearly an hour already, that he is prepared to sit down after this Committee stage with others, with the intention, the purpose of adding the appropriate words to this bill with the assistance that he has been lucky enough to have.

We've had wonderful assistance from the public Bill office. He's had much more assistance from more, even more official channels. We can sit down, we can find the words, we can try and agree on it. And I think, I hope that noble colleagues in this House would absolutely undertake to act in good faith, to try and find those words and to ensure that at Report stage they were included. But let's not have another three hour debate in which we feel as though the pin on which we're dancing is melting underneath us.



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50 in my name, supported by my noble friend Lord Goodman. And it's noble friend Lord Goodman. And it's a pleasure to follow the noble Lord Carlile. And I wouldn't describe you as a nasty lawyer at all. The you as a nasty lawyer at all. The noble Lords, a Burnley fan, and I don't know any nasty Burnley fans, don't know any nasty Burnley fans, but I do know a lot of Arsenal fans. but I do know a lot of Arsenal fans.

Lord Hannett. There is, there is one. One thing I would say about Lord Carlile in some phraseology used early on in your speech, you used the word Final solution. I used the word Final solution. I would encourage the noble Lord to think of another phraseology to to think of another phraseology to to describe that. I agree with a lot of what the noble Lord Lord Carlile say, and I'm grateful to Lord B Lord Deben for following Lord Lord Pannick, because I too am not a Pannick, because I too am not a lawyer.

But like Lord Deben, as a former member of Parliament, I experienced lots of constituents experienced lots of constituents that were under coercive behaviour and lots of MPs do surgeries for
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Lord Evans of Rainow Portrait Lord Evans of Rainow (Conservative)
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their communities and take on these cases. And not a lawyer as a as a lay person trying to fathom out about coercive behaviour is notoriously difficult. And that's why I've come up with amendment 50. My Lords, the existing language limits the coercion pressure bar to cases where it causes the person to make a decision which creates evidential difficulties. This amendment excludes all cases of coercion and pressure without requiring finding out if it is that causes the person to make the decision to end their own life.

My Lords, it is easier to see if someone is being coerced or pressured than to know if the coercion or pressure actually is the cause that leads a person into making the decision. A doctor shall exclude all cases where a person is being coerced and pressured to make a declaration. Rather than engage in causation analysis, similar offences ought to be focussed on the wrongful act of coercing or pressurising, regardless of the outcome. At trial, the Crown, with plenty of resources, would have trouble proving coercion or pressure was resulting in someone making the decision.

How was a doctor on their own supposed to find out? Asking a patient is no help, given that the frail or vulnerable person may not even know that they are pressurised, or being intimidated by coercion, doctors can see pressure from, say, the person accompanying the patient, but not read the patient's minds. This amendment stops doctors from being required to be detectives. The closest analogy to this rule against coercion or pressure to do a potentially fatal action in existing existing law are.

Suicide Act 1961. Criminal criminal liability for complicity in another's suicide do not require any actual attempt of suicide, or even a decision to commit suicide. Section 2nd May commit an offence under this section, whether or not a suicide or an attempt suicide occurs. The Online Safety Act 2023, section 184 offence of encouraging or assisting serious self-harm. Section one 84th May commit an offence under this section, whether or not serious harm occurs. Compare also the Serious Crime Act 2007, section 65, which refers to pressurising someone to commit an offence and does not require the outcome be causative.

In recent years, the Crown Prosecution Service has pursued manslaughter charges against men who subject women to domestic abuse, which is believed to have driven their suicide. These are criminal offences where there is a much higher bar to action, given a person's liberty is at stake. However, clause one is addressing when civil authorities and doctors should draw the line at a patient's autonomy. Why does the bill have a higher standard? There is no statutory precedent for pressured into making it.

The government has claimed that the Online Safety Act 2023 and the Serious Crime Act 2007 are analogous, but the distinction is making the pressure is all that's needed for an offence. Meanwhile, the threshold for excluding a person in clause one requires more than is necessary for a criminal offence. Under these acts. Without this amendment, it would be lawful to progress a person towards an assisted death, even though the person is living in a household where family members are actively making it difficult to live.

All that is needed is to see that the person is not pressured, coerced into making the specific decision. The leading cause of death in domestic abuse victims is now suicide. We work to stop this, but this bill is opening a door to help perpetrators. We estimate three women a week taking their own lives. The government views this as a priority to address, and the CPS will now prosecute for manslaughter. Men who abuse whose abuse is seen to have contributed to the suicide of a woman.

These men have not had to directly coerce their partners into death. The facts of the abuse are sufficient pressure, but assisted deaths. These will be no coroner's inquest to address foul play. Finally, my Lords, the UK leads the world in now recognising coercive control in law. But a regime of total control is poorly understood and insidious as standing together against domestic abuse. Cheryl Henry Leach told the Lords committee coercion is an incredibly complex phenomenon and by its very nature it is difficult to identify and respond to.

A perpetrator of coercion will ensure that a person is dependent on them by isolating them from support, exploiting them and depriving them of their independence and autonomy to make decisions freely. As a result of this, we are extremely concerned. When I think about pressure, I am also mindful of the pattern of coercive control that can be insidious and subversive. Pressure can be a tactic by a perpetrator to enforce a regime of coercive control. That is very complex, and I get that.

But it is important to be mindful that pressure can be tool that indicates a pattern of coercive control. My Lords, studied neglect and coercion is naturally notoriously difficult to detect. And it stands now. And as it stands now, this bill is a suicide charter. My amendment is

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intended to improve this. This bill as it stands now. My Lord, my Lord, my Lord.

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My Lord, my Lord, my Lord. In this group and I have added my name to other amendments. I wanted to start by adding my support to the amendment 460 tabled support to the amendment 460 tabled by my noble friend Baroness Finlay. My Lords, safeguarding measures are My Lords, safeguarding measures are not optional. They are essential to ensure that each individual requesting assisted dying is requesting assisted dying is properly safeguarded. It's essential that all relevant information is gathered so that a information is gathered so that a full and thorough picture of their circumstances can be formed.

We know that poor mental health, know that poor mental health, inadequate care, support or unaddressed social vulnerabilities can profoundly affect a person's decision making and ultimately their capacity and understanding of assisted death. When safeguarding assisted death. When safeguarding is insufficient or overlooked. The risks of coercion, of subtle pressure or abuse increase, and pressure or abuse increase, and these are risks that may be difficult to detect or are deliberately concealed, and this deliberately concealed, and this amendment seeks to ensure that such dangers are neither underestimated dangers are neither underestimated nor ignored.

My amendment 222.
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Baroness Hollins Portrait Baroness Hollins (Crossbench)
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Protects. It takes note of the fact that it's. There's a long waiting list to get psychological therapies when you're distressed in some way, when you're distressed in some way, and you need help to sort out relationships or life circumstances. The decision to request an assisted death is taken at a time of profound vulnerability, often profound vulnerability, often shaped by physical suffering, but also often impacted by fear and anxiety, and by offering timely access to specialist psychological assessment and support.

People, I suggest, would have the space, expertise and stability necessary expertise and stability necessary to make decisions free from mental distress, distress or coercion, as well as identifying treatable well as identifying treatable conditions such as depression that can interfere with capacities, decision making and yet can be difficult to recognise. I'm also suggesting that offering bereavement support to families and bereavement support to families and carers before an assisted death would help to prepare them for the emotional impact of assisted dying emotional impact of assisted dying and ensure that their relatives, their family members decision is understood, respected and ultimately not clouded by unspoken fears or unresolved conflict.

Amendment 612 proposes that assisted death is witnessed and documented to prevent the possibility of coercion or foul play, and this would simultaneously protect professionals involved if any concerns are later raised by distressed family. I'm suggesting a video recording to improve transparency in a tightly regulated environment that can be fraught with high emotion. This may surprise noble Lords. I will explain a little more. I propose that the entire process is video recorded, including confirmation of the person's identity, their wish to die, their capacity to make that decision, clear, evidence that they are acting without any undue influence.

The recording would be submitted to the coroner within 72 hours of the person's death. This approach, my Lords, has precedent in Switzerland, where similar recordings are used by assisted death organisations to support the work of public prosecutors and to reduce the investigative burden on authorities. Concerns were raised during the Select Committee about the pressure these cases might play place on the coronial system, requiring video documentation would both assist coroners in verifying compliance. Hopefully prevent coercion, and reduce the resources required for any further investigation.

Whilst interpersonal and intra familial coercion are important concerns with regard to this bill, I'm actually very worried about systemic and institutional forms of coercion. These operate in more subtle and nuanced ways, and are often harder to detect or observe. How the option of assisted dying is framed or presented within a health or social care system can influence the choices that patients make. We see analogous patterns in other areas of healthcare. A simple example variations in caesarean section rates, where local culture affects where the practitioners steer patients towards one option over another.

A more immediate concern is the widespread, limited availability of high quality, evidence based, specialist palliative care. Inadequate provision can create circumstances in which patients feel they have few viable alternatives, thus making assisted dying appear the only realistic option. We've seen similar processes within mental health services, where insufficient and poorly resourced community provision leads to inappropriate or prolonged use of in-patient detention, simply because no alternative exists. We must avoid replicating this pattern with assisted dying, systemic or institutional pressures, including service gaps and funding constraints, must not result in patients being channelled or coerced, intentionally or otherwise, towards an assisted death, feeling that this is the only viable option for them, that they are a burden, a credible legislative framework must prevent institutional and societal coercion as rigorously as it guards against interpersonal coercion.

The appropriate response to systemic forms of coercion is not the inclusion of particular words or phrases in primary legislation, but the establishment of processes and structures. I suggest that minimise the risk of such pressures arising in the first place. And I think we

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will have an opportunity to discuss better structures later in the debate. Yes.

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Yes. My Lords, my Lords. I rise.

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Oh. I beg your pardon.

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Yes.

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Yes. The House. All right. Before the lady sits down on her video, her lady sits down on her video, her question about video, her amendment about videoing. I think it affects clause 25, which is considerably clause 25, which is considerably later when the actual act is about to happen. I wonder if the noble Baroness would consider, should Baroness would consider, should that actually be done earlier to reduce that? Because by the point reduce that? Because by the point of her own, her amendment, the certificate of eligibility has already been issued.

So I'd be interested to hear her thoughts on interested to hear her thoughts on that and whether it should be considered about the video recording. As pointed out in amendment six, one two should

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amendment six, one two should actually be considered a much earlier stage. I thank the noble Lady. I

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I thank the noble Lady. I thought about that, and I think it could indeed be brought back in a different way later in the debate. different way later in the debate. But I feel that prevention of coercion is really important, and I think thinking about it at this stage is really helpful. Thank.

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Lord Stone.

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Lord Stone. Am I in order? No. My Lords, if I may, if I may forgive me, I just wanted to ask this question if I might of Baroness Hollins. But it applies also, of course, to Baroness Berridge, and that is that does she think she mentioned various things are quoted as causing pressure? Does she not causing pressure? Does she not agree that being in palliative care, palliative care also causes

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pressure? There's no suggestion. Anything

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There's no suggestion. Anything I have said about imposing I have said about imposing palliative care? None at all. But I, I mean, it makes me listening to the debate and I wasn't going to the debate and I wasn't going to speak personally, but I will now, since you've challenged me on that. since you've challenged me on that. My husband was dying with motor neurone disease last year. He felt under immense pressure from this under immense pressure from this debate in the House of Commons.

In the other place, he found it very, very difficult. It made him ask questions about am I entitled still to palliative care? Am I am I really entitled at a time when the NHS is so short of staff? In short of time? He worried about it and I had to offer him a lot of reassurance so that he he could make his own decision. He was not ready to die. And I think that the idea that offering palliative care is a fine pressure is really not to understand the whole nature of the dying process and the way in which, as we come to realise that our life is coming to an end, that we need time to understand, to reflect, to heal, to make sense.

And I think pressure to not be a burden is just huge pressure of not having access to services that are short in

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supply is much worse. Earlier. To extend this conversation. But

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To extend this conversation. But in which case, can she explain why in Australia, for example, where there is very good palliative care, there is very good palliative care, three quarters of the people requesting assisted dying had been requesting assisted dying had been in palliative care at the time of the request. Something like two over 2000 patients in New Zealand,

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over 2000 patients in New Zealand, I'm sorry, in New Zealand. My Lord, are you going to

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My Lord, are you going to address palliative care in a later group in some detail? And we're going to make a distinction between going to make a distinction between palliative care of a general kind of specialist palliative care. And we're going to think also about we're going to think also about specialist palliative care at its best. Again we are hearing day in best. Again we are hearing day in day out about how hospices are closing or having to make staff closing or having to make staff redundant.

I think there's a hospice in Hertfordshire which is just starting its redundancy just starting its redundancy programme this week because it does not have the money to to provide for people's needs. And yet we are for people's needs. And yet we are relying on our hospices to provide that care and it's not sufficiently that care and it's not sufficiently available. My own, my husband's GP actually said when I asked her about who was going to coordinate his care because there were several different teams involved, and she said, oh, it's the hospice nurse will do that.

The hospice nurse, the community nurse who doesn't have access to all of his notes and his records, who who doesn't? I mean, the idea that hospice nurses would take precedence over the GP, the district nurses, yes they did, they were brilliant. But golly,

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were they short staffed? Lord Singh. This has been an extraordinary

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This has been an extraordinary debate and wide ranging. I want to limit myself in a very short speech limit myself in a very short speech to the first, the amendment number three, where we are taking out the indefinite article to replace it indefinite article to replace it with the words an independent. We've heard two polls of the considerations that are facing us. One is the need for autonomy for One is the need for autonomy for the person concerned, the person whose life is in danger and whose whose life is in danger and whose future we are considering autonomy to make a choice with dignity and to make a choice with dignity and independence.

And then the wide ranging ways in which we've discussed coercion and pressure, discussed coercion and pressure, which suggest that autonomy is not a very easy thing to to concentrate a very easy thing to to concentrate on. If there is this range of possible ways of expressing possible ways of expressing coercion or applying pressure or whatever it is, then autonomy must be considered to be quite a difficult thing to achieve. And I honestly believe that. And since honestly believe that. And since the enlightenment, I think I said this the Second Reading since the enlightenment, where we've
11:41
Lord Griffiths of Burry Port Portrait Lord Griffiths of Burry Port (Labour)
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concentrated so heavily on the individual, we do need to rescue from that discussion of the from that discussion of the individual. The fact that we are individuals in community and the individuals in community and the from my own experience as a as a methodist Minister, we're methodist Minister, we're surrounded by people with all kinds of disciplines and experience. And of disciplines and experience. And all I can say is that being with people continuously, from the time the news of an impending death is broken until the funeral, and indeed beyond the funeral, with indeed beyond the funeral, with those who are the clustered around the person who is to die.

As made me aware of all kinds of pressures, me aware of all kinds of pressures, subtle and otherwise. I was taken by the noble Lady. Baroness Finlay by the noble Lady. Baroness Finlay list of possible pressures, the the indirect ones, the unthought of indirect ones, the unthought of ones, the groan, the body language, and so on. What's more, Baroness and so on. What's more, Baroness Thornhill raised the point of whether witnesses were brought who whether witnesses were brought who were themselves facing an imminent death.

I have sat with people facing an imminent death again and again and again, and heard them spell out both their hopes and their fears about their legacy, about someone who's whispering in their ear, about how it'll play out amongst their children, who have quite different views between them. And it's all indirect and it's real and it's contextual. Autonomy is a very difficult thing to conceive of, and all these other indirect things need to be thought of very carefully indeed.

I mean, how many times have I counselled families for whom there was a rogue element, who years ago, for doing something or other that was considered to be very nasty, has fled the family home as to whether they should be brought into the picture about this imminent death, or invited to the funeral or beyond the funeral. Did we do the right thing? How can we live with our conscience? You shouldn't have pushed me to say what I said. All those things are said all the time.

And just one final thing before I sit down. I did promise a short speech that before I sit down, just 16 years ago, I was diagnosed with a very serious cancer bowel cancer, and after having very low blood levels and a total lack of energy, I was immediately rushed into hospital for a serious piece of surgery. And it was a large tumour and I had to face all kinds of things myself. Just as it happens, the letter that spelled out the seriousness and the urgency of the case arrived when my my wife, bless her, was with her mother who was dying up in the Midlands.

And so I received it on my own. I can't tell you what range of things my mind ranged over as I coped with that news. How shall I tell? Who'll want to know? Can I keep it secret? What were the options be for me if I have this serious surgery, will I? Will I have to wear a colostomy bag? Will I have to have invasive and extensive chemotherapy and so on. It was surgery in the end. And mercifully, when we had the tests done and I went back later, they traced not an element of cancer in the rest of my body.

And here I am to bore you with a five minute speech. All these all these years later, it's simply to say that the the indirect, the subtlety, the stuff beyond the stuff, you can be categorical or put a statutory basis on are the things that really come into play when you're talking about an end of life. Now, as somebody, I just wanted to say that John Donne, long before the before the enlightenment did remind us that no man is an island.

Ask not for whom the bell tolls. It tolls for thee. We're all caught up in this together. Somebody in the times picked up a remark I'd made casually describe me. It was that I am now a semicolon. On his way to his full stop.

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support. Of. The amendments. One.

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One. Eight, one, 45. 46, 47, 48, 49.

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58 and 222. And it's a privilege to. Follow both Baroness Hollins and also Lord Griffith. And and thank

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also Lord Griffith. And and thank you for sharing your personal stories. And it is a reminder to us. That this.

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That this. Debate touches some of the deepest things within us. And not only should we be kind to each only should we be kind to each other, but we ought to also be kind to ourselves. I want to declare my to ourselves. I want to declare my interests as set out in the register, but particularly that I am vice president of Exeter Hospice am vice president of Exeter Hospice Care. I'm the chair of the UK Commission on Bereavement and patron of At a Loss.

And your lordships will know that however many amendments there are to this many amendments there are to this Bill, I do not feel the Bill will ever be safe, but I do want to speak on this grouping, because I do believe that these amendments are at the heart of the issue of motivation, and I remain concerned motivation, and I remain concerned at the fact that there is no real current deep investigation of the
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Lord Bishop of London Portrait The Lord Bishop of London (Bishops)
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current deep investigation of the motivation for assisted dying. And amendment 181, I think, is critical for us in terms of monitoring, even if there was no further restriction on what the motivation is for assisted dying, just knowing it and recording it is extremely important because it can give us understanding to know why people choose assisted dying, especially if we are serious about funding properly. The care for people who are dying and the support for them. If we are recording the reason why people choose assisted dying, it means that we can highlight if there are reasons why people choose it that do not fall within the aim of this bill.

So, for example, there is currently no mechanism in the bill to stop someone from receiving an assisted death if they are in pain because they cannot access palliative care. I hope that all of us would believe that if somebody wants to live, that somebody in that stage of their life should have access to palliative care and the social care support that they need, professor Catherine Selman, the associate of the Association of Palliative Medicine and the Royal College of Psychiatrists, highlighted the importance of identifying and addressing unmet need.

And we have already heard the pressure on our palliative care service. We know that only 30% of hospices are funded by the government. We have begun to hear about the beds that are closing and the redundancy programs that are in place. And we also know that if hospices are only 30% funded by through government funding, therefore 70% come through voluntary giving and therefore that is unequal across the country. So therefore palliative care services in hospices are in those areas that are more deprived, are likely not to be as good as in those areas where there is higher social economic activity.

So it is important for us to begin to identify if there are reasons for people accessing assisted dying. That is not within the aim of this bill and therefore asking the question of a person in the preliminary discussion is the bare minimum of what is needed here. Turning then to amendments 45, 46, 47, 48, 49 and 58, they all strike at what many other Lords have spoken to today that pressure, coercion, influence, encouragement, whatever word is most legally appropriate is subtle and is complex.

When asked about the meaning of pressure during the select committee, the Royal College of Psychiatrists said the expectation or the worry of letting someone down, and in a sense, to me that gets to the heart of why it is so important that we define these feelings and decide what we think about them. We've also heard not only how hard it is to define the term that we want to use, but it is also hard to spot it. And we've heard examples of how actually we're not spotting coercion already today.

And we've also heard how hard it is to train. And certainly one of my concerns has been in the discussions so far around this bill that often our focus is on medical staff, but actually people spend much more time with support assistants, with nurses, with occupational therapists, with a whole range of people, not just the medical staff. Often if somebody wants to talk about dying, it is not with the doctor. It is often with the person that has spent more time with them, and that is a whole array of people.

So therefore training is much broader than I think. We often that we often see it. It is also true that I suspect most of us at times feel obliged or a responsibility to or for our family. There will be at some point in our life, whether through illness or otherwise, that we have felt a burden to others. And the reality is our decisions do not live within a vacuum. They are shaped by the many currents of our life, which are different at different stages of our lives.

And I believe that the supporters of this bill have decided that the policy intent of the bill is that even if somebody chooses assisted death to save their family, the money of care costs, that is okay. So as long as it's their decision and free for coercion, I think amendments 47, 48 and 49 and 58 demonstrate why I do not believe that this is okay. They get to the heart of how subtle coercion is. And it's not just personal, as we've already heard, it can be a society wide discrimination in healthcare provision for failing to resource palliative care or adult social care adequately are examples of this.

Indeed, describing indignity as the loss of physical function or of incontinence, or the reliance on care is another societal example of this. We need to remind ourselves that each person person is immeasurable, of immeasurable value, and cannot be diminished by illness, disability, or care costs. I want now finally just to turn to amendment two, two, two, in the name of the noble Baroness, Lady Hollins. Though we have been rightly focusing on the person at the centre of making a choice about their death, as we've heard, death affects so many more people than the person who has died.

The National Bereavement Alliance has said that the needs of the family members, including children, are including children both before and after death, must be considered and met. We know that people who are bereaved, unexpectedly, are more likely to experience complex and prolonged grief, which are associated with worse physical and mental health, including suicidal ideation. The Bereavement Sector Forum, convened by Atlus highlighted the risk of the kind of grief associated with assisted death is very similar.

They warned that the impact of the public purse on failing to address it with the right support will cost not just acute services, not just social care, but also have a cost on individual people. That complex grief is also well documented in Canada. This bill has encouraged helpful conversation about death and dying, but we must make sure that the bill is clear on guidance and support for many families and friends who are involved with somebody who has requested assisted dying.

The work of the UK Bereavement Commission highlighted that people do still do not have access to day to the bereavement support that they need, and there remains a lack of understanding of the cultural and faith considerations that many communities require for death. I hope that the amendment 2 to 2 will be an opportunity for us to make sure that we are proactive about making sure that family and friends and loved ones can access the

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bereavement support that they require. It would be appropriate, Perhaps.

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Perhaps. Of the right reverend. Preferably from somebody who has.

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Preferably from somebody who has. Lord Bridges Lord Hay. I think. It would. Be appropriate for someone who

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Be appropriate for someone who is. Not against the. Bill to speak. We have heard

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Bill to speak. We have heard endless interventions. Lord Griffiths, I'm sure.

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Lord Griffiths, I'm sure. Your side is a member of the Labour Party. I think. It's a I.

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It's a I. I. I want to I. With respect. I want I'd like the house to

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listen the reason that the reason Lord Kakkar. I'm sorry. Do you want to just

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I'm sorry. Do you want to just make one point and then Lord Polak. I'm going to make. One point, which is it would be

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One point, which is it would be very nice if somebody who supports the bill could also have a hearing.

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the bill could also have a hearing. I it's a shame because. I had a particular sort of

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I had a particular sort of important point to raise after Lord Griffiths because, well, I will I Griffiths because, well, I will I was given six months to live 37 years ago. I don't often share this personal issue. I stand here today as living proof that prognosis is not certainty. There are estimates sometimes wrong, sometimes wildly wrong, that experiences experience shapes my approach to this legislation and underlines why safeguards matter so profoundly. When I last spoke in the Second Reading, I made it clear I was against the premise of the bill, and that remains my conviction.

However, if the House decides that the bill should proceed, then it must do so with the strongest
11:56
Lord Polak Portrait Lord Polak (Conservative)
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possible protections, and I support many of the amendments that were many of the amendments that were mentioned, particularly 46 in the name of Baroness Finlay. But in name of Baroness Finlay. But in listening to the debate just now, I particularly was moved by Lord Evans Lord Carlile Lord Deben Baroness Fox in this issue of the Baroness Fox in this issue of the coercion and the encouraging, and I actually want to make a pay tribute actually want to make a pay tribute to Lord Faulkner in, in, in, in this whole issue, which is so this whole issue, which is so difficult and I understand, I think difficult and I understand, I think he's plastering over gaping wounds in this bill.

In fact, I think he must have more plasters than my local pharmacy, and I'll return properly when I have my own amendments. But I'd like to say this, that the this vital piece of legislation is not fit for purpose, no matter how many amendments, no no matter how many amendments, no matter how many plasters. I think we need to look. And if I again and if I end this, just these words, when we debate matters of life and death, and we do so with the utmost seriousness, and I believe that those who have brought forward this bill are acting from the highest motives.

I respect it, but in moments such as these, I know the whole House feels the absence of the wise counsel of the late Lord sacks. He reminded us that purity of motive does not guarantee rightness of outcome. Our responsibility here is is clear to ensure that the law we craft is

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robust. Its precise and overridingly safe. Lord.

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Lord. I think this has been something of an unbalanced debate, so I hope of an unbalanced debate, so I hope it might be possible to hear from someone who supports the bill. And I was particularly anxious. And the reason I wanted to come before the noble Lord Lord Polak, whom he knows. I have a lot of respect, and we agree on many other issues, was to respond very soon after the Right Reverend Bishop of London, Right Reverend Bishop of London, because she was, I think, very honest when she said that she honest when she said that she didn't support the bill and that actually I think she used the word it was unamendable.

And yet here we it was unamendable. And yet here we are discussing amendments. Lord Carlile spoke. Noble Lord Lord Carlile spoke. Noble Lord Lord Carlile spoke earlier, I think, about whether we should discuss whether there is a form of wording whether there is a form of wording that we could all agree, but I think the question then has to be if we can agree a form of wording,
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Baroness Hayter of Kentish Town Portrait Baroness Hayter of Kentish Town (Labour)
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if we can agree a form of wording, would he then support the bill? Yes, because my feeling is that these amendments are not actually about making the bill acceptable, so that those putting them forward could then support it. But actually it's a way of trying to stop our discussion and proper scrutiny, because what they don't want actually is for the bill to go ahead as it is. If I could just finish. It's been a long time to hear someone.

It has been a long time in this debate. I think an hour and I don't know with without hearing nearly two hours without hearing from my side. I want to come on to something, Lord noble Lord Lord Deben said anyway. But you know what we are really talking about in this bill, when these amendments are about coercion or pressure, the situation we have at the moment as the noble Lord, Lord Pannick said, is that people at the moment can go to Dignitas without even proving to a doctor that they're dying without any interruption, any check, whether there's coercion, pressure, whether someone's going to inherit their house or anything else and they can go.

And that's the way they end their life. When they feel it is not worth they choose. It's not worth living any longer. And therefore, I think I have to say to those people about discussing the definition of coercion, are we really content with continuing the status quo where there is absolutely no check whether from a psychiatrist, a social worker, a lawyer, or anyone else, whether they've been coerced, because I think that is the that is the alternative is whether we will allow the status quo to continue with no checks whatsoever.

And therefore, I think that we have to really ask whether these discussions about definition are really about that or actually trying to stop the bill. I would also say, and therefore, maybe we could have a discussion about whether those people who want this wording change will then support the bill, because if they would, let's get down to discuss that. But if they're never going to, I think they're wasting the time of those of us who want the bill to go through.

Could I just finish? It's listened.

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Mr Speaker for. Three minutes one way traffic check.

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check. Thank you. I don't have to give way. I've been speaking for three minutes and I've listened for some minutes and I've listened for some hours. And I'm sure the noble Lord can come back. It's Committee stage so he can speak again. But we've so he can speak again. But we've talked and personal people here. I as a child had to watch both my parents died. People know that one of them very tragically, very suddenly, the other one in enormous suddenly, the other one in enormous pain at the end.

And as a child I'd been through that. So I do understand about bereavement and understand about bereavement and grief and seeing someone die in great pain. So we've all been great pain. So we've all been through that, and some of us come to a different conclusion. We come to a conclusion that actually, no to a conclusion that actually, no matter how we define pressure, coercion, the discussions we're coercion, the discussions we're having, what we want is the ability to move forward and help those who want help to bring things forward.

want help to bring things forward. A few days earlier, it won't be in time. I don't know whether the noble Lord Lord Deben has been noble Lord Lord Deben has been through probate and trying to sell a house, but the idea that you know someone who is already dying, someone who is already dying, please let me finish. Someone who is already dying, maybe a month off, who could be brought forward a month or a couple of weeks earlier would make that much difference. I think we're finding excuses.

I'm sorry not to give way, but I have listened for some hours, and I think it's only appropriate that

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someone who supports the bill also gets a chance to speak today. Yeah. Well done, well done.

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Yeah. Well done, well done. I just ask which amendments she was speaking to because this is was speaking to because this is committee, not Second Reading. And I would also say every amendment I have tabled is designed to make have tabled is designed to make this bill better. And I feel quite concerned to be accused of just concerned to be accused of just time wasting here.

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time wasting here. I was talking to the debate on coercion because at the moment there is no check on coercion. there is no check on coercion. Sorry, not coercion for the existing way of ending one's life existing way of ending one's life early, which is to go to Dignitas. And what I was trying to say was, And what I was trying to say was, if the bill is changed in the way, for example, the noble Lady Lord

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Hollick would like, will she then support the bill? And I think you.

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And I think you. Start there are two separate situations here, it seems to me, and I wonder if.

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and I wonder if. She agrees. One is there are many of us who don't like the bill, but there is a real possibility probability the bill will pass. bill passes, we want it better than it is at the moment. Consequently, we

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are not wasting time. Yeah. Wasting time. I was asking

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Wasting time. I was asking whether, if these changes were agreed, people would then allow the

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agreed, people would then allow the bill to proceed. Before. The noble. No. I have great admiration for

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No. I have great admiration for the noble Lady, but I do, and many others do rather resent her waving
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others do rather resent her waving our hands at us. The reason why we wish to have the sorts of discussions that I was mentioning was so that, believe it or not, we can make a judgement as to whether we're prepared to support the Bill or to be silent on whether we support the bill or to oppose the bill at Third Reading. And it is it is unworthy of the noble Lady to allege that all of us here who are expressing concerns are wasting time because we want to support the bill.

It's not true, and it's what she said.

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I never said about wasting time. The words did not come. I did not The words did not come. I did not say. What I was asking was whether the people who are wanting a better the people who are wanting a better definition will then be able to support the bill. In other words. support the bill. In other words. Well, the bill if we're not. I mean, Well, the bill if we're not. I mean, I hope that the right reverend Prelate is not going to push for a Prelate is not going to push for a vote at Third Reading.

The the the task for this House is scrutiny of the bill, both at this stage and at

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the bill, both at this stage and at report, and I hope that's what we will do. My Lords. I should.

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I should. Not be long. I make I speak to amendment 726,

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I make I speak to amendment 726, which is those of you who actually get that far in the list of attendees will see in the explanatory note. This is one of a number of amendments which I have
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Lord Sandhurst Portrait Lord Sandhurst (Conservative)
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wrong, even where the people concerned were decent, honest concerned were decent, honest professionals. And some of them, of course, were, although professionals were neither decent nor honest. Because I have also sat as a legal assessor for five years as a legal assessor for five years at the General Medical Council, and I appeared as counsel for northeastern NHS trust in a very northeastern NHS trust in a very messy inquiry about 20 years ago, about the the misdoings of a doctor, about the the misdoings of a doctor, Neil, who had featured in the Panorama programme.

Some of you may know about that. So I have seen things go wrong on the ground for things go wrong on the ground for the last 30 or 40 years of my life. It's with that in mind that I've It's with that in mind that I've put down, amongst others, amendment 726 with the support of the Law 726 with the support of the Law Society, it is and I stress here the Law Society is neutral in principle, but has looked at this bill with what can be described as bill with what can be described as lawyers eyes.

And their amendment is designed to make the bill safer and better. In practice. This particular amendment would require not just permit. And that's the difference. It would require the Secretary of State to issue a code of practice in connection with what we are concerned with today, capacity and so on. And the absence of coercion and a code is necessary. And if you look at the the clause in the bill, I think it's 35. Well, there's provision for other codes of practice to be made.

This is simply to add an additional code. And I suggest to you that this is a perfectly safe, non-destructive amendment which will improve the bill in a very important practice, because as we've heard, coercion. And I use that loosely to cover a wide range of subtle pressures, is something which must be addressed. And it should come from the Secretary of State. The sorry, forgive me. The I've forgotten the name. The person who's going to oversee all this.

The panel's. Is concerned. That won't be enough. This must come from government looking at things carefully and putting down a code of practice which says. This is how panels must address this. And we can't have a postcode lottery of a panel in one part of England adopting one approach and another adopting a much tougher approach. We need

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uniformity. Thank you. Well done. I wish to speak in support of

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I wish to speak in support of amendment 48, which stands. In the name of Baroness Richie,

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In the name of Baroness Richie, who seeks to protect individuals from being pressurised into from being pressurised into assisting death. The Lords as the Bill stands, reference to coercion and pressure in clause one are and pressure in clause one are strictly related to coercion and pressure coming from any other pressure coming from any other person. The Lords Amendment 48 removes these three words, which broadens out the whole understanding coercion to include more than just which comes directly more than just which comes directly from other people.

The Lords various forms of pressure and influence can arise very easily influence can arise very easily from various sources, institutions, the media, and of course even oneself. Every week there are new
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Lord Hay of Ballyore Portrait Lord Hay of Ballyore (Democratic Unionist Party)
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oneself. Every week there are new headlines about hospice struggling for funding and the increasing costs of caring for an ageing society. In fact, Pathfinder's New Muscularity Alliance shared a heartbreaking story in their written evidence to the Commons Committee Bill Committee with a patient who was told by their GP and I quote have you got any idea how much it costs the National Health Service? My Lords, what kind of influence will these stories have on someone who is the option of assisted death? There is currently no safeguard that will protect patients from pressure to choose.

And I say choose an assisted death because they feel like a burden on the NHS or their family, or that experiencing loneliness, depression and many other related issues. This isn't just my concern. Caroline Abrahams, age UK, said to the select committee just recently, and I quote, we worry about the lack of choice about whether we are going to get good social care or good end of life care. We worry about a sense that over time, it can be a feeling that older person's lives is not worth as much as a young person's.

How we could ensure that older people, in particular, do not feel under pressure to make a decision that this for this reason, other than the real choice for themselves. Furthermore, I must remind the house of dignity of dying, but pro assisted suicide campaigning material in our tube stations last year in which advertising for assisted dying won't be legal under this bill, promotion of this service by its supporters and its presence in our society, alongside all the problems that are in NHS and hospice, are facing seriously risks sending a message to people at the end of their lives that says our society is better off without you.

And my Lords. If a patient was motivated towards assisted death. For this reason, amendment 48 would ensure that they were not eligible as a result. For my Lord Deben asked those who are supporting the bill, how do you intend to safeguard those who are feeling like a burden or cannot access palliative care, need and feel they have no choice but to pursue an assisting death? And what would we say to Professor Smith, who said in her evidence to the committee, the key question for me is for the person trying to escape the abuse and feelings that they have been to feel a burden, or are they trying to escape the suffering of their illness? And if we cannot answer that question, then we should be very deeply concerned.

My Lords, we start by permitting assisted assisted suicide because people feel like the institutions and the media around them don't want them and leads them down a dark path in their heads that feeds them towards that decision. We would have completely failed those most vulnerable in our community, and I would urge noble Lords to support amendment 48, because today we're

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dealing with life and death situation. These circumstances. I do not think we.

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Can justify more. Than two hours on this group, and I think we should move to the

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wind up on this debate. I. I'd like. To support. The amendments in this group,

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The amendments in this group, and I would I do so I'm a research director at a think tank, which has commissioned a great deal of work from lawyers and academics, including on this subject. But here including on this subject. But here I speak in my own capacity. I'm a historian, and I'd like to associate myself, particularly with associate myself, particularly with the remarks of the Lord. The noble Lord Lord Griffiths of Burry Port Lord Lord Griffiths of Burry Port and the Right reverend, the noble prelate who referred us, who reminded us that we are part of a reminded us that we are part of a whole society and we are not just whole society and we are not just here to, as one man against another or one person against another.

I
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Baroness Lawlor Portrait Baroness Lawlor (Conservative)
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private member's bill and so prevent it being unsafe by prohibiting inducement to assisted prohibiting inducement to assisted suicide by those who, for whatever reason, and we've heard about the reasons, seek to induce, encourage, advise, influence another to take his or her own life. My amendment 57 would prohibit someone from 57 would prohibit someone from planting the idea in the person's head and getting the person to head and getting the person to consider suicide as an acceptable or even necessary course of action, and so being induced to choose an assisted suicide, an option which he or she might otherwise not have considered, given that the planting of such an idea could be done directly or indirectly in a number of ways under the Bill, as it of ways under the Bill, as it stands, and given the gravity of the decision to end your own life the decision to end your own life and its irrevocable character, the safeguard is needed.

Let me illustrate with a possible conversation between someone suffering from cancer whose suffering from cancer whose diagnosis indicates he or she has no more than six months to live, so is in a state of shock and misery at the diagnosis and depressed at the idea that nothing can be done. A conversation with a relative or a friend or a person, such as a doctor, a social care or social services provider, or someone else in a professional position. The person talks about the diagnosis and their feelings to the other party, who might reply, have you considered an assisted death? Or I know someone who didn't want to go through with the whole thing until the bitter end, and the doctor was very supportive, or others find it very helpful to plan an assisted death.

It's straightforward and can all be prepared for, and the family can be with you at the time and you just doze off. None of these possibilities are ruled out by the bill. As it now stands, they would not be.

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In that conversation. And the conversation that happens every day in tragic personal circumstances in tragic personal circumstances where the relative or friend says to the dying person, have you considered giving up your

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chemotherapy? I thank the noble Lord for the intervention, but permit me, if the intervention, but permit me, if the noble Lord would permit me, I'd like to finish, and we can imagine many different sorts of many different sorts of conversations. And if the noble Lords would like to hear many more Lords would like to hear many more examples, and I'm sure noble Lords will ask for them. But I'd like to will ask for them. But I'd like to finish.

None of these possibilities are ruled out by the Bill. As it now reads. They would not be now reads. They would not be considered an instance of coercion or pressure, nor will it be or pressure, nor will it be possible under this bill when it becomes law to investigate with due legal process. If someone else has legal process. If someone else has been instrumental in inducing a person to assisted suicide, person to assisted suicide, provided they are covered by the terms of the bill, the bill outlaws terms of the bill, the bill outlaws only dishonesty, coercion and pressure.

In clause 34 or the pressure. In clause 34 or the falsification or destruction of documentation when it refers to a declaration in clause 35, not other means of inducing someone to opt for assisted dying. Criminal liability for providing assistance will be removed, and the Suicide Act 1961. Under clause 32, civil liability. Also in clause 33, which stipulates that providing assistance to a person to end their own life in accordance with this act, or assisting a person to end their life or performing a function under the act, does not of itself give rise to any civil liability.

Moreover, the Coroners and Justice Act 2009, the duty to investigate certain deaths will be amended so that the reference to unnatural deaths does not include a death caused by the self-administration by the deceased, or an approved substance within the meaning of this bill. Similar changes will be made in respect of arrangements for medical certificates under the new regulations and schedule one on suspension of investigations. These changes mean that there will be no effective way of investigating improper behaviour after an assisted death has taken place.

The Bill already in effect, recognises this problem by making absence of coercion and pressure a condition for eligibility of someone to be given assistance in in suicide. Under its provisions, it opens the possibility to object to an assisted suicide going forward on grounds that the person about to die has been coerced or pressured. Furthermore, clause ten two of the bill gives the first doctor the coordinating doctor, the duty of ascertaining that the person concerned has not been coerced or pressured.

Now we've heard how difficult it is to establish coercion, including from the noble Lady Baroness Finlay and others who have great professional experience in looking after people with terminal and other grave illnesses. And it is very often very difficult to establish coercion. However, it is true that this bill opens the way it wants to establish coercion. Also, it alleges. But as has been argued, the grounds are too narrowly defined. A person in a poor mental state because of their terminal diagnosis is especially likely to be open to suggestions from other people, especially figures of authority such as their doctor, their own family, whom they want to believe is only thinking them.

My Lords, if not, be sure the decision to have assistance to die is genuinely their own. It is not enough just to rule out coercion or pressure. We need also to outlaw subtler, more insidious in indeed but no less effective forms of persuasion. There is a danger, indeed, that if the Bill includes, as it does now, just a prohibition from coercion and pressure, the inference will be drawn that any form of encouragement or inducement, so long as it is not coercion or pressure, is allowed.

Surely that is not what the proponents of this bill would want. The noble Lord, the sponsor and his co-sponsor, are putting forward the bill under the banner of giving dying people more choice over what happens to them, or providing greater freedom. Surely, in your consistency with this underlying purpose, they must be intent on ensuring that the irrevocable choice a person makes to undergo assisted suicide is genuinely that person's free choice and so support the amendment I am proposing and indeed the amendments others are proposing.

And I hope we can go even further. And if my amendment is adopted, a further subsection could be added to clause ten two, making it the duty of the coordinating doctor to ascertain not just that there was not coercion or pressure, but also that the idea assisted of assisted suicide was not suggested to the

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person by another party. My Lords.

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My Lords. Amendments in this group, 5258

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Amendments in this group, 5258 and 181 and they seek to explore coercion and ensure that people are free from undue influence, free from undue influence, including social, economic or care related pressures. Not only active related pressures. Not only active coercion, which is very difficult to prove with. These amendments also seek to try and understand the also seek to try and understand the reasons why someone would choose to end their lives so that we can look at how we might improve further NHS at how we might improve further NHS services, or use that in important debates on reforming the welfare debates on reforming the welfare system.

My Lords, it was raised at the first day of committee. That definition is important, and I do definition is important, and I do believe that much further work needs to be done on the definition
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Baroness Grey-Thompson Portrait Baroness Grey-Thompson (Crossbench)
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of pressure and how it becomes a strict liability. But, my Lords, what we find is it's very hard to gather data. We've been told there is no evidence of coercion in other countries. But Ellen Wiebe et al, in a paper on reasons why people request assisted dying, highlighted some of these very important issues. In 2018, her team looked at 250 deaths in Canada and noted that data was collected differently across different jurisdictions. Of the 250 deaths, six charts no reasons.

56 gave one reason. Some of the charts gave 3 or 4 reasons, but only two reasons were coded, and this doesn't show the whole picture of why people are choosing to end their lives on top of having a terminal condition. If we look to other jurisdictions in Belgium, legal requirements were more frequently not met in unreported cases of assisted dying than in reported cases. And in Belgium, we still don't really know how it's practised in Oregon. The data and the records are destroyed a year after someone has died.

Admitting coercion is highly unlikely to occur. So that's why we need a robust process of identifying it so that can be acted upon. And I look forward to debates in other groups on the role of the coroner in this. My Lords, it is hard to find studies on coercion. I spent a lot of time trying, but it is possible to find a huge number of individual cases in Canada. Lisa Feldstein was with a patient when the patient was pushed towards assisted dying.

The person who suggested it didn't realise that Miss Feldstein was a lawyer. Heather Hancock, a woman with cerebral palsy, was told by medical professionals while she was in hospital that she wasn't living, but merely existing. I wonder how that made her feel again. In Canada, slideshows of made have been shown to healthy patients, which would make you think, as your condition deteriorates that you don't have any other options apart from ending your life. And in Australia in November this year, three people were arrested after a man was found dead with euthanasia drugs in his system and the police believed he was part of a suicide encouragement ring.

Ruth Posner ended a life abroad with her husband. A friend spoke publicly about Ruth's emotionally controlling husband and didn't believe it was a free choice. But my Lords, the difficulty is once you're dead, it is really hard to prove. And as the noble Lady Baroness Berridge raised, this bill doesn't take into account the impact of social media in New Zealand. My Lords, doctors are told to do their best to detect how pressure may be placed on a patient, but it's completely unclear as to their duties and doesn't stand as a safeguard.

This is listed in the review of the End of Life Choice Act 2019. In the report that was published on the 19th of June this year, page 15. In Washington state, physicians are rarely there when lethal drugs are ingested, which makes it nearly impossible to ensure that the patient's decision is free from last minute coercion, impairment or doubt. And in Holland, it was found that GPS, in an interview study felt pressured by emotional blackmail, family influence, time constraints or systematic pressures when processing assisted dying requests.

As mentioned before, real world data from Oregon shows the top reported reasons for assisted death the loss of autonomy, loss of enjoyable activities, loss of dignity and a perceived burden also appears not uncontrolled pain, which is missing from this bill. Now, the Select Committee evidence sessions. The Right Honourable Stephen Kinnock, the Minister for care, was asked about protecting vulnerable people. But the panel has no power to ensure that unmet needs are supported, such as increased care hours, adaptive technology, palliative input and we should ensure that the law does not default to death as a substitute for deficient services, which is an ethical red line repeatedly emphasised by disability advocates and UN experts.

Review and permissive regimes best practice guidance from jurisdictions with assisted dying frameworks highlights the importance of exploring whether enhanced external support might address these factors, and it should be the case that the approval process should check these factors. My Lords, what is presented as a voluntary choice may in fact be a choice made under hidden pressure. And the Australian Care Alliance research shows that the training for voluntariness and assessing absence of coercion was a two minute, ten video with slides that take approximately two minutes 50 to read.

Qualitative reporting in Canada shows disabled applicants citing inadequate housing or lack of care, rather than unimaginable, unmanageable pain. Professor Jane Monckton Smith has warned that coercive control is rarely averted can be financial, emotional or relational, and in the year between April 22nd and 23, there are 242 deaths in domestic abuse cases. Many victims, my Lords, don't see themselves as victim or won't or can't admit to being abused, and autonomy is not exercised in a vacuum. It depends on the protections of those who may be too weary or frightened to speak for themselves.

Doctor Myra Griffiths has stated that many disabled people would opt for this on the basis they're fed up with the struggles they're experiencing. We shouldn't forget that Doctor Griffiths is the disabled academic who recently couldn't get to a debate on assisted dying because the room was inaccessible and the Lords were told all the time, that is not for us. It's not for disabled people. It is so easy for non-disabled people to say that anyone who's terminally ill will by nature be classed as disabled under the Equality Act, and Professor Henry Marsh has said they meaning people with my view, they argue that grannies will be made to commit suicide.

In the Sunday Times in 2017, he said even if a few grannies get bullied into it, isn't that a price worth paying for all the people who could die with dignity? My Lords, grannies are not collateral damage, neither are disabled people. The Committee on the Rights of Persons with Disabilities in March 24th, highlighted the issue that disabled people face in the UK at the moment, and said that the UK demonises disabled people at a time when hospices are being cut, the challenges are more than ever before.

Lords, disabled women are significantly more likely to report experience each form of intimate partner violence measured, which includes rape, sexual violence and rape, physical violence, stalking, psychological aggression and control of reproductive or sexual health. Disabled women are twice as likely to experience abuse than non-disabled women, and disabled people are more likely to experience abuse from an adult family member compared to non-disabled people. Nationally, only 3.9% of referrals were for disabled victims, which would imagine based on per capita population, that will be as high as 16%.

The US National Council on Disability warned that assisted dying regimes risk a double standard in suicide prevention for disabled people, and may channel people towards death rather than supporting them to live. My Lords, if we look at caregivers, 10% of domestic violence abuse cases perpetrated by someone with a care and responsibility and UK carers report from this year says that 53% of carers feel resentment towards those that they care for. At the same time, they're portrayed externally as kind and self-sacrificing.

When a disabled family member with a terminal illness suggests wanting to end their life, a frustrated carer experiencing high levels of resentment and burden may fail to explore alternatives or may subtly communicate that ending the person's life would alleviate their burden. My Lords, is it not time to discuss financial abuse? But 47% of perpetrators were documented or claimed surrogates. That means they have power of attorney, or they were guardians or representative Payees, and many of those were family members. My Lords, I did have one of my amendments ruled out of scope, which was actually trying to strengthen the test on coercion to make it clear about the questions that we should ask when somebody is choosing to end their lives.

My Lords, I believe that we should come back to that at a later stage, because I still don't believe that how the clauses that are trying to assess coercion are going to work properly. My Lords, we should find a way of having a proportionate safeguard that aligns the fundamental principles of self best interest, decision making and suicide prevention, and removing barriers to living well before accepting that a person genuinely

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chooses to end their lives. Hello.

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Hello.

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Hello. Hello my Lord, my Lords. Okay, my Lord. Amendments tabled.

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To speak to. Baroness Anelay to. Go first.

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Go first. Thank you so much, my Lords. I rise. As a nurse and a former president of the Royal College of president of the Royal College of Nursing, and I thank the Right Reverend Prelate, the Bishop of London, for referring to the London, for referring to the broader family of health practitioners who are impacted by this bill. I also note the comments this bill. I also note the comments made by the noble Lady Baroness Berridge about training, and I Berridge about training, and I wondered whether the noble Lady Baroness Berridge was aware of the Baroness Berridge was aware of the current intercollegiate guidance on safeguarding, which covers many of
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Lord Goodman of Wycombe Portrait Lord Goodman of Wycombe (Conservative)
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safeguarding assessment. If I then turn to the British Geriatric Society, they recommended in their evidence to us a requirement for all people requesting an assisted death to undergo a holistic assessment of needs. The next group of witnesses who produced a similar view, were standing together against domestic abuse, who call for a multidisciplinary assessment framework. Now, I could go on, but I would recommend to the noble Lord, Lord Faulkner, when he replies to the debate to take these points on view, because a central question in this debate posed by the noble and learned Lord Lord Pannick has been, are the protections in this bill better than the protections we have at the moment? I want to suggest to the House that is not the question.

The question isn't are the protections better than those we have at the moment? It is. Are they as good as they could be? And I think the answer in many cases is that they're not. And I hope that the noble and learned Lord takes these points on board when he

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replies to the debate. Yes. My Lords. I just want to. Raise one point

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here. We've heard an awful lot. Today. But I'd like to very much support what my noble friend Baroness Berridge and. Baroness Baroness Berridge and. Baroness Rafferty has just said about training. I don't believe a doctor training. I don't believe a doctor or any. Form of medical practitioner can spot coercion,

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practitioner can spot coercion, with one discussion and training in. This area is.

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This area is. Absolutely imperative to have any way of making it work reasonably. And that, my. Lords.

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Lords. Has to be part of the overall solution to this problem. I would solution to this problem. I would just add that whilst I support every one of these amendments, to a greater or lesser extent, I do hope that the noble and learned Lord Woolf Faulkner will really consider
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Baroness Coffey Portrait Baroness Coffey (Conservative)
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Addressing some of the concerns of the Bill, when we do need some joined up conversations. Now, the noble Lord Lord Pannick and I think the noble Baroness, Lady Hayter, have talked about existing safeguards. Well, there's an obvious one at the moment. It's against the law to help somebody to go to Dignitas. And the person who wrote the guidelines on whether or not to press charges, of course, is now the Prime Minister. So and there are amendments made in Committee stage that reinstates this element of the DPP to undertake that.

But in answer to questions that I've tabled to the government, fortunately the the the justice Minister did reply basically indicating how many people had been had proceedings against them. On an average, it was one a year for the last decade and only two people had been convicted. But I'm still awaiting to hear about the arrests and charges made at never mind the proceedings. And to give an example, Sean Davison, who was in the papers in the summer. He's been arrested on the basis of helping 29 people take their own lives by going to Switzerland, not to Dignitas, but another place.

By the way, this is the same man well known, has already been convicted of helping his own mother take her own death against the law. In a different country, in a different jurisdiction. So this is why I was interested in saving questions in order to understand what's actually going on. And then the figures for people going to Switzerland are actually quite small. It is about 40. And one of the things that worries me, and I think worries quite a lot of people, is how this whole situation could start to become commonplace.

The Liverpool Care pathway became commonplace. Yeah. What a horrible way to die.

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Yeah that's right. The I specifically mentioned in Second Reading that my greatest concern of all, and I wasn't sure, but I would try to see that back in but I would try to see that back in direct coercion. Now, I appreciate some other noble Lords have already And if I have time, I will try and explain why I strongly support several of the other words, in particular, the speech by the noble Baroness, Lady Fox of Buckley, using the word encouragement, which using the word encouragement, which got support in certain parts of the House.

I think that's particularly interesting, bearing in mind that interesting, bearing in mind that the campaign group Dignity in Dying has now initiated a new element of has now initiated a new element of creating a conversation guide, anticipating the passage of this bill on how to start to bring up assisted dying in conversations with people. Never mind the coercion that very obviously exists coercion that very obviously exists in the medical professional about trying to coerce people into do not trying to coerce people into do not resuscitate.

So that is already happening in our medical system happening in our medical system today. And that is why I think several peers are genuinely worried. So talking to my amendments, I'll actually start with 49 first. And one of the things that I think we need to be mindful in the passing of legislation is this is an intended as the proposer and sponsor of the bill put forward, it did start off as a judge led process, and it's why I actually support in later groups what the noble Lord Lord Carlile of Berriew is planning to do.

But here we have a situation where it's turning into sort of a commissioner panel, and I think we need to make sure that the legislation is as simple as possible to the ordinary man and woman on the street. And it's why amendment 49, I appreciate the there are some legal niceties about what does the word person mean in law. I believe it can almost mean anybody. But I think we need to become more explicit. And that's why I've suggested talking about body corporate institutions, organisations and what in that I hope it might start to cover some of the issues that my noble friend Baroness Berridge raised about online issues.

I don't know if the Online Safety Act can cover this, but I do respect what noble Lords may think. What's she going on about? These people are dying anyway. We do have this general approach of trying to prevent suicide. So what would be different in hastening that? Well, this is where I also turn to amendment 47, talking about both external and internal. We've had a considerable debate about the external, some suggestions in the amendments and also to some extent, the burden.

And it is that burden that genuinely worries me. And the evidence is clear. We've already heard, I think, of the 35% suggested being in a state, I think in Western Australia, whether it's Oregon, Canada, Western Australia, Washington, the jurisdictions that collect data on this issue, between 35 and 59% of people cite being the burden. Then we heard in the Commons, I think it was or and another other skewing the one of the most things. This is from Professor Rowan.

Thinking about being a burden is an essential question. He worked clinically. He or she. Sorry, I don't know. Professor Rowan worked in the over 65 age group where there's a lot of terminal illness, some of it in the last six months, and suggesting we need to understand the population. There may be a terminal illness, often with comorbidity, and that comorbidity is often mental health. Comorbidity. As Doctor Price rightly, sensibly said, it would be very surprising somebody who's found out that they've got a terminal illness and less than six months to live, or perhaps even less than 12.

It would be surprising if there wasn't an element of depression at that point. But this is where we get into talking about burden. So this is where a group already feels burdened, and some of that may be excessive. That's when you start to get into some of these interpersonal pressures. It's also where the impairment will start to interact and amplify each other. And that can have in itself an important consequence in terms of the functional ability of mental capacity.

And according to Professor Owen, outside of the ad context, when looking at the Court of Protection, the Court of Protection themselves have been struggling to recognise that. So this is where trying to get some understanding of this, I think, is really important. But it's not. To the noble Baroness, Lady Rafferty's point somewhere where you can have just a training manual ready built. Now, my Lords, there's a lot more I'd like to say on this. It's already been referred to, I think, the Royal College of Psychiatrists, who are eventually allowed to give evidence orally to the Commons, and I'm delighted they were able to give evidence to the Lords select committee.

They haven't given the answer exactly. But they do refer to something involving the Human tissue authority, overseeing training, overseeing a network of independent assessors, trying to confirm aspects of the choices between them. And they're they're not subject to coercion. But I turn to this final point. And again, I would like to potentially spend have spent more time on this, but I'm also mindful of the Covid report that was given yesterday, thinking about vulnerability, but also people of ethnic minorities.

And Doctor Hussain gave some, I thought, compelling evidence to the Commons. What he said was ethnic minority communities are afraid they're going to be targeted, saying they will not access palliative care services. There are many people who may want it, but because they feel coerced, even internally, because they feel like a burden or due to social issues, especially those people who are structurally disadvantaged, that is what he found really difficult to weigh up and cannot pretend that it isn't going to happen.

And that is a much bigger proportion of the patients that he saw regularly in Bradford. There's an element here about Covid and vaccine hesitancy that's been experienced, but that is the concern that he raised. Again, he talked about his community where where people would not even go to hospital because they were worried that they might die from Covid, but as a consequence, they stayed at home and died even earlier. And suggesting this is not a theoretical risk. When Ken Leadbeater asked about training around coercion, he did talk about capacity, and I don't want to defer into that right now.

But it was a very interesting answer, which will return to when we consider clause three. But he said the safeguards for assisted dying must be higher, and he did not believe that elements were fit for purpose. Now, my Lords, this is really matters when we consider, as my noble friend Lord Deben referred to, it has been well documented. Of course, there will be some people where there's no issue about coercion to t those for those that burdens are seen it in other parts of healthcare.

I'm concerned we'll season this, and I hope that we can find a way to address that in this

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bill. I become exasperated or resentful about the time that we're resentful about the time that we're taking to consider these important amendments today. I would say gently, that had they been dealt gently, that had they been dealt with these issues in a different way in the other place, that we would not have to spend the time we are in this House dealing with some of these issues. And I would say of these issues. And I would say also that when we consider the amount of days in committee that we amount of days in committee that we spend on fairly important bills that come before us, sometimes 11, 12 days in committee and another three, 4 or 5 days on report, it is not unreasonable, I think, that we spend at least a few hours to spend at least a few hours to consider matters of life and death, and these amendments relating to
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Lord Dodds of Duncairn Portrait Lord Dodds of Duncairn (Democratic Unionist Party)
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and these amendments relating to coercion are at the heart. I think, of some of the concerns that many, many people have about this bill. It is central to the concerns we have heard about financial abuse, emotional abuse. We have heard about external influences, people feeling a burden and wanting to relieve themselves of that burden. These are critical issues. They are real issues. Those of us who have served as members of Parliament, those who have worked in the community, those who have dealt with real people in real understand and know the reality of what we're talking about.

And sometimes it's easy to dismiss these issues. People sometimes speak on television and others who are very strong. They're very confident. They have a lot of family support and resources around them. But today I was struck by the words of Lord Deben we must speak for the vulnerable. We must speak up for them. And there are many, many vulnerable people that I have come across in my work as an MP and one of the most deprived areas of Belfast who were suffering in the great loneliness and great financially straitened circumstances, but who felt pressure in today's environment where suicide is something that people themselves undergo.

But we're now talking about a situation and it comes to the point about, well, the safeguards are going to be introduced. They're stronger than what we have today, but we have a new circumstance being set up. We have a new regime whereby the state, for the first time and all its resources will be made available to assist another person to commit to, to help them end their lives. And that's a very, very different set of circumstances. So all the pressures, all the influences that vulnerable people will come under today will be massively increased, massively amplified when this new law comes into place.

If it does come in, I think it's very, very important that we take the time to consider these matters. I fully support the amendments in this group to a greater or lesser extent. I very much agree with the sentiments argued by the noble Lady, Lady Fox, on the issue of encouragement, and I think that that is something that needs to be in the face of the bill, if we're to provide all the safeguards that are necessary and whether you're for this bill or in principle against it, surely we must have the most robust, the strongest possible safeguards against coercion, pressure,

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encouragement or otherwise, that we can possibly have. It is. A pleasure.

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A pleasure. Thank you.

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My Lords. Shrinking amount of time we've

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given to looking at safeguards. He said. We've got to begin all over

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We've got to begin all over again here. We don't. And one of the things that has characterised this debate, regrettably, is too this debate, regrettably, is too few of the speakers have given any consideration at all to what has already been decided in the House already been decided in the House of Commons as really important, tough safeguards. I'm not going to tough safeguards. I'm not going to go through them now in the interest of time, because I know my noble friend, Lord Falconer will do so

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friend, Lord Falconer will do so when he responds to this debate. My Lord said an enormous amount

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My Lord said an enormous amount of time was given in the Lords. An enormous amount of time was given
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Lord Shinkwin Portrait Lord Shinkwin (Conservative)
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points about vulnerability. Some of us have been there. My Lords, this us have been there. My Lords, this is proper scrutiny. It is the House is proper scrutiny. It is the House of Lords at its best, and we should all, whichever side of the divide all, whichever side of the divide on this bill, we find ourselves in, we should all be very proud of that. we should all be very proud of that. My Lords, is someone who speaks from one patient's perspective.

I would never presume to know exactly would never presume to know exactly how the pain another person is how the pain another person is experiencing might feel to them as an individual, but I do think that the sense of incredible loneliness, the sense of incredible loneliness, compounded by a sense of disorientation, both parts of total pain as defined by the pioneer of pain as defined by the pioneer of specialist palliative care, which the noble Baroness Baroness Finlay the noble Baroness Baroness Finlay of Llandaff mentioned, Dame Cicely Saunders.

She described it as total pain makes these amendments dealing with coercion and pressure crucial. When I have been drowning in a pool of pain, the size of which in that moment seem so steep and slippery. I know from experience that I would have clutched at almost anything in an attempt to pull myself out, so I appreciate how coercion and pressure are so nuanced and subtle, and how much each of us in this House at some point in our lives, mainly to be protected from them.

So my little friend Baroness Coffey is absolutely right in speaking to her amendment 47 to mention the Royal College of Psychiatrists, and in her explanatory notes there, reference to the sense of being a burden as an internal coercion. My Lords, I can testify from personal experience, but in some cases it is the sense of being a burden or of the burden of pain, whether physical and or emotional, being simply too great to bear on your own, which can be the most powerful and damaging form of tourists.

Perhaps the one from which we meet the most protection. We need to recognise that in this Bill. And I note at this point that the bill doesn't require any questions to be asked as to why a person may wish to die. It's because we're better. Pause a moment for six eight on precisely. This issue was rejected in committee. In the other place that amendment three, in the name of another Baroness Baroness Finlay of Llandaff, and amendment 181 in the name of the noble Baroness Baroness Grey-Thompson and the noble Baroness Barran alone are so important.

And this Baroness Burt Baroness Ritchie and the other sponsors of amendment 48 have argued, we cannot divorce this internal tuition from the circumstances in which a disabled or older person, for example, might find themselves in, but have to factor those in. It's not just coercion or pressure by any other person that may prove to be the tipping point. My Lords, I hope your Lordships' House Lord Dear very careful consideration to the amendments on financial pressures such as amendment 462, which I thank the noble Lord Lord Hunt of Kings Heath for tabling so ably as we know that these are, of course, exacerbated when a person is living with a disability.

So, in closing, I particularly welcome amendment 846 in the name of my noble friend, the Baroness Berridge. And amendment 58 in the name of Baroness Penn Baroness Grey-Thompson, because the subtlety of pressure, particularly as it relates to disability, can definitely stem from cultural attitudes, whether institutional in terms of access to appropriate care, for example, or societal. My Lords, I give one example. I was laughed at in the street outside my home as recently as last weekend because of how I looked as a result of my disability.

That's not good for morale, to put it mildly. Now, to be honest, the mockery goes with the territory of being disabled, particularly when the anonymized vitriol on social media encourages teenagers, for example, to view disabled people as fair game. But my Lords, my question in relation to the bill and specifically amendment 58 is this how can being subject to such prejudice not affect a person's mental wellbeing or their sense of self-worth? And how could such a structural disadvantage in terms of the cumulative effect of being constantly exposed to such negative and discriminatory attitudes, not affect the person in a vulnerable situation who is considering assisted dying? It's inevitable, but how many non-disabled people factor that in? So my Lord Singh conclusion the fact that the sponsor of the bill does not appear to have factored it in, does not mean that the rest of us should fail to do so.

Intentional or indirect? Structural disadvantage is a critical factor, particularly for disabled people, and one we cannot ignore. It deserves to be in

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the bill. Yes. I've moved. I've moved my

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Yes. I've moved. I've moved my seat. Lord, so I wish to speak

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briefly as a member of the select committee. Who hasn't spoken. Lib Dem, I've. My Lords.

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We will. Hear. From you. Thank you very much. Thank you, my Lord. And I move

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Thank you, my Lord. And I move from opposition front because there was a presumption I was the front bench spokesman trying to force something up. I apologise, I wasn't something up. I apologise, I wasn't this house as a free vote and nobody's whipped. I happened to be sat on the front and I've moved back, so I understand the alarm I may have caused by standing up, then thinking that I was trying to somehow derail the debate, which I wasn't going to do.

I was just wasn't going to do. I was just trying to be helpful because lots of people spoke and and I respect every single person view in this House for and against, within my House for and against, within my own party. We have the same difficulties and but it is about evidence and, and I just want to try and help the, the the House today on this specific premise about coercion. We asked and sir Max Hill, the former Director of Public Prosecutions, said, and I quote, throughout the time I served as the DPP, we did not have coercion offences created by the bill, which I would suggest would be a significant advance.

Now, do we have the legal system in which we can investigate and take place before death? The major advantage of this bill, if I can put it this way, is scrutiny will be done
13:03
Lord Goddard of Stockport Portrait Lord Goddard of Stockport (Liberal Democrat)
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before death, unquote, which I think comes to one of the points think comes to one of the points that Baroness Stern Graham made about when you're dead, it's too late to find out what's gone on. late to find out what's gone on. And and specifically in the other place, monetary specific training on domestic violence, including on domestic violence, including coercive control and financial abuse, was introduced into the bill and agreed by an amendment tabled and agreed by an amendment tabled by Jess Astor MP, in the Commons.

Participating doctors, members and multidisciplinary panel will have to undergo specific training in this area, as well as assessing mental capacity so within the bill now, I believe some of the things and I think that was what Lord Pannick was alluding to, that within the bill there are safeguards, but the fact is, and it safeguards, but the fact is, and it would seem to me that we think in this House, this is the first time this has ever happened. And and the this has ever happened.

And and the fact is now there's 300, 300 million people across five continents have some form of assisted dying legislation. Not one of those countries has ever of those countries has ever repealed it. And it's right that we make it the safest and the best. And the amendments are debated at And the amendments are debated at length. But I forgive the cynicism of people who support the bill when, as was said last week, there was some humour in the House, one member saying in a competitive I'm sorry, I come second in getting the number of amendments down and another member.

This is not a competition. This is about getting this bill right and fit for purpose. And Lord Carlile was was perfect. And I find it quite amusing when I see Lord Carlile and Lord Pannick, it's worth the admission fee just to see the interaction. But his points were right. It was about trying to draw this to somewhere where we can come to a conclusion on it and actually move forward, and everybody speaks. But if people speak to the amendments and, and we try and get to a conclusion and Lord Dubs is right and, and I believe he's all truth in what he says, and we should give it time.

But we haven't got time. We have four Fridays. There are no more than four Fridays. The government have said they're not going to give way if we don't finish the debate of these amendments, and they are climbing every day. We're up to 1500 now. I believe. Then the bill falls and somebody, not me, but someone else might say, well, that's somebody's objective, is that we run out of time, we can start wringing our hands. And we were just trying to make it the best bill we could, but we ran out of time.

I'm very sorry. Well, that is not acceptable. Our goal here is to ensure legislation goes back to the other democratic place, fit for purpose and the best we can make it. And somehow we have to distil these amendments into something that is understandable.

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I don't want to interrupt the noble Lord for very long. I just noble Lord for very long. I just wanted to ask him, is he aware that this House does have the right to reject this bill, should it choose to do so? Because it's a private member's bill. There are no conventions that apply in that situation, and it's important that situation, and it's important that the House fulfils its scrutiny role. Another bill could be brought forward, which might be very different, but this is the bill we different, but this is the bill we are asked to debate, and we will debate it as best we can to improve

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it as best we can. And if the end of that purpose we run out of time, then the bill falls. Yeah. And it's not our fault. Well, it is our fault. It is our Well, it is our fault. It is our fault and it's a delegate. This.

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Given way, because he clearly is trying to be constructive in taking us forward. Isn't the real problem us forward. Isn't the real problem that a private member's bill is just not suitable for this issue, just not suitable for this issue, which is so complex and sensitive? We should have had a Royal Commission. I believe the Commons should then have had a vote in principle. The government should then have brought draft legislation. It should have gone to scrutiny. It should have gone to scrutiny.

And then, my Lords, both houses could deal with the issue properly. This is the problem, not your lordships, not the scrutiny we want to do. It's the very fact that you cannot possibly bring an assisted

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bill. Yeah.

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Well, unfortunately you can, because that's how this country works. It's called democracy. When works. It's called democracy. When 650 elected members, representing 72 million people by a majority, 72 million people by a majority, send it to this House, we have a duty and an honour to treat that duty and an honour to treat that bill with respect, not disdain, and threaten to derail it or run it. Our time.

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Our time. Could I just put it to him that what he is suggesting is that what he is suggesting is that however bad a bill is, however many. People are damaged by it. Whatever People are damaged by it. Whatever the mistakes which the government, the moment the bill is not suitable. the moment the bill is not suitable. For legislation, we can't go on discussing it until we get it right. I, as you know, am not in favour of

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this bill, but I'm even more not in favour of a bill. Which gets. It wrong and does terrible

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It wrong and does terrible damage. He surely isn't saying that we should just pass anything, because that's okay. When we think of the people who are going to be

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completely. The other side of the and I

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The other side of the and I respect your view on that. This has been scrutinised for over 100 hours. In the other place took evidence from over 500 people. This is not just a piece of paper sent up here

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just a piece of paper sent up here for us to determine. Regardless of the amount.

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Regardless of the amount. Of scrutiny, there. Are absolute conflicts between. Intent and.

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Intent and. Delivery and the reason there cannot be. Trust in how we can deliver this

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Trust in how we can deliver this in real. Life is the very point that has been. Made by Baroness O'Loan and Lord Shinkwin, that on

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O'Loan and Lord Shinkwin, that on the one hand, we are discussing how we can. The importance.

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The importance. Of coercion and and the importance of recognising it. And

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importance of recognising it. And yet it has been voted that you. Cannot ask.

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Cannot ask. The person why they want to die. I don't know how. Then you can possibly assess for coercion, possibly assess for coercion, because unless you can hear from the person in their own words, why the person in their own words, why it is that they want an assisted death. You can't even advise. On symptom control, let alone whether

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or not they've been coerced. And there is the conflict between. The intent.

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The intent. On page one and the what is expected in the delivery, and if it expected in the delivery, and if it has arrived here. With that level of conflict between what's on the first page of the bill and how it's first page of the bill and how it's expected to be delivered, then either we change that or it's not fit to pass through this house.

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fit to pass through this house. I respectfully accept that. And in fact, the problem is, the more I in fact, the problem is, the more I speak, the more I'll be intervened, which is quite the opposite of what I'm trying to do, which is speed I'm trying to do, which is speed the process up. And so all I'm, all I'm, all I'm trying to say is at the end of the day, we all want the best bill possible. I get that. And if that can't be managed, then then something else will have to happen.

something else will have to happen. And I was I was only trying to bring the evidence of three, you bring the evidence of three, you know, former deputy. Director of Public Prosecutions spoke, and one Public Prosecutions spoke, and one of them actually advanced to us because people have said, well, we've had no real life experience. we've had no real life experience. Well, I've got Parkinson's disease and I'm going to die. I have a terminal illness. He actually said, that's the committee.

And I would hopefully, if this bill was to pass, would avail myself of its of its ability. But and that's just one little anecdote from somebody, probably the only person that gave evidence who actually has a condition, that is, he confirmed to us freely. He wasn't asked it. And so I'm trying to do is balance the evidence because there are lots of people are quoting evidence. I just wanted to try and redress that a little bit and try and gently move it on a bit quicker, and I've completely failed because I've been stood up for nine minutes.

So I apologise to the House for taking up too much time.

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I, I, I'm very, very. Grateful to the noble Lord for giving way. And it was just on one giving way. And it was just on one particular point, which has been raised on a number of occasions about what happened in the other place and the number of hours that place and the number of hours that were dedicated in the other place. I just think it's really important to put on record that we receive in to put on record that we receive in this House a bill that is very different to the bill as it was first presented in the House of Commons, and many hours were taken Commons, and many hours were taken up in the other place on a bill that completely altered during that process.

If I can point to one process. If I can point to one particular issue, it's the process massively changed from a judge led massively changed from a judge led process to a panel. And in fact, of the 91.5 hours of debate in committee and Other place, 62 of committee and Other place, 62 of those were on a bill that still had the High Court process in it. So I think we have to reflect in our think we have to reflect in our deliberations that many hours were taken, rightly scrutinising that bill in the other place, but we now receive it in a very different form.



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receive it in a very different form. I apologise and I accept your position. Perhaps a High Court judge might resolve the issue then.

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judge might resolve the issue then. My Lord. I rise to support amendment 52.

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I rise to support amendment 52. In the name of the noble Baroness Baroness Grey-Thompson, and I do so, speaking as the and I do so, speaking as the government Chief Whip, who helped ensure that the Serious Crime Act 2015 was placed on the statute book, and then as the Justice Secretary, who was responsible for some of its provisions thereafter. I am hugely grateful to the noble Baroness for raising the vital question of domestic abuse and violence in the context of coercion, and I do not believe that that issue has been suitably explored before or canvassed or analysed, and I would be grateful for the sponsor for the Bill.

In his remarks, for his reflections on how we might protect some of the most vulnerable in our society. Before I do, I just wanted to respond very briefly to the point made by the noble and learned Lord. Lord Pannick Lord Pannick pointed out that there may well be inadequate protections for those people who are coerced or persuaded into declining treatment that might prolong their life at the end of prolong their life at the end of their life, there may well be inadequate protection, and there may well be a case for stronger protection.

But as has been pointed out before, there is all the world of difference between declining of difference between declining treatment that might preserve your life and having a lethal injection life and having a lethal injection that will end your life. And it is a point that the medical profession a point that the medical profession fully understand, and one that should be very firmly borne in mind. But I wanted to turn specifically But I wanted to turn specifically to the question, of course.
13:13
Lord Gove Portrait Lord Gove (Conservative)
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This is. At the heart of the bill. Is there really such a profound difference between an individual being able to say, I am going to stop chemotherapy, I'm going to stop eating because my life is intolerable. And that person saying to the doctor, I wish to have a potion that will have the same result. There is a difference, but the main difference is that the

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person can die with dignity. I think there is a profound

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I think there is a profound difference, but the the noble Lord has made his point, and I shall allow others to judge whether or not the narrowness of the distinction that he draws is appropriate on the whole question appropriate on the whole question of domestic violence. The legislation that was introduced in 2015 specifically introduced the 2015 specifically introduced the idea of coercive and controlling behaviour as an aspect of domestic violence. The idea that domestic violence. The idea that domestic violence need not require physical harm.

It was an advance in the law. harm. It was an advance in the law. It was brought forward by my friend Robert Buckland into that legislation, and it was absolutely vital that it did so. And it made vital that it did so. And it made us a world leading jurisdiction in recognising the danger of this particular type of abuse and violence. One of the reasons that it is so pernicious is that those it is so pernicious is that those who are subject to coercive and controlling behaviour as part of domestic violence, by definition, do not acknowledge or admit to it because the person who is because the person who is exercising that coercion or control, that bullying, that violence, is in that bullying, that violence, is in a position not just to intimidate, but then to punish the individual who chooses to speak out.

That is why the point that was made by my noble friend Baroness Berridge was so important. That's why it's vital that we have training amongst medical practitioners and others, because a victim of domestic abuse or violence may well say that they do willingly assent to certain treatments, because the nature of the domestic relationship is so toxic. The nature of coercion and control so malign, that even in those circumstances, their fear of the consequences will lead them to mask what their true feelings are.

But more than that, we know that domestic abuse and violence is directly linked to suicide. In the year to March 2024, there were 90 suicides which were linked to abusive relationships, 98 people, overwhelmingly women, who took their own lives as a result of the nature of domestic violence and abuse, the coercive and controlling behaviour to which they were subject. We know from the testimony of survivors of such relationships, and these are people who have been subject to non-violent domestic abuse, that 47% of them have considered taking their own lives.

I am sure that it is possible to draw up measures in this legislation, and more broadly, to ensure that we absolutely minimise the risk of those who are already victims becoming victim of an even greater crime. And I do hope that

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the sponsor of the bill can reassure us that those measures will be in place. Now.

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Now. Gentleman sits down. Would he. Accept that the point that. You've just made is.

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You've just made is. Absolutely dreadful, that people are committing suicide because they

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are committing suicide because they are in abusive relationships? But would he also accept. That there's more. Likelihood of them. Being

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Likelihood of them. Being prevented from that. Death under the bill that's.

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Now proposed? To the hon. Lady, the Baroness, for making that point? I do profoundly disagree with her on that, but I am grateful to her for that, but I am grateful to her for making that point. But I'm more grateful still to Baroness Grey-Thompson for having raised this issue, because it is precisely the nature of coercive and controlling behaviour within domestic settings as part of domestic violence and abuse that domestic violence and abuse that does need to be addressed in this legislation.

I have an open mind as to how it might be, but it must be.

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to how it might be, but it must be. To support the amendments. That are in this. Particular group. And I.

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And I. Think that the amendments are very important because, unlike very important because, unlike Baroness Hayter, I do not know what will be the outcome of this debate at the end. And she has some other knowledge of how this House is going to vote. I certainly do not know the answer, and therefore it is vital that we do spend the time and we do debate these amendments because words are important. And if anyone ought to know the value of individual words, it would be the noble and Lord Leong Lords in this House, because many of them spend their lives arguing on the edge of a pin about particular words, and matter of fact make a considerable amount of money, even just arguing about single words.

So words are important. So let us not try to pretend that words do not matter. And I also have to say that therefore the coercion influenced encouraged. We need to get this right, because this bill could pass
13:19
Lord McCrea of Magherafelt and Cookstown Portrait Lord McCrea of Magherafelt and Cookstown (Democratic Unionist Party)
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this House. Now, I know that there are those that actually want to shut down debate. In actual fact, I sat in the House of Commons yesterday or sorry, Wednesday at yesterday or sorry, Wednesday at Prime Minister's Question, and I did notice earlier on for quite did notice earlier on for quite considerable amount of debate, the person who raised it at Prime Minister's question actually was Minister's question actually was sitting here. That was the hon. Member for North West Hampshire. He Member for North West Hampshire.

He has left his position at the throne at the moment, but he was here for a considerable amount of it, and he was indignant and incensed that this House actually was wanting to look at this and scrutinise this bill. It was passed by them. I have to be in that other house for 25 to be in that other house for 25 years. And I also knew in those 25 years the other House was years the other House was successive governments got bills wrong and had to come back and wrong and had to come back and change those bills to suggest that just because the other members have just because the other members have passed the bill, somehow we must bow and surrender to their superior knowledge.

I do not believe that that is correct, and therefore I believe we ought to spend the time.

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Yes. I'm happy. Can I can I say that I think that the number of amendments here, that the number of amendments here, it's clear that this is about wrecking the bill. It's not about improvements. It's about wrecking improvements. It's about wrecking the bill. And as someone who has personally gone through this with my late wife suffering a very long my late wife suffering a very long and very painful death, who wanted to have the opportunity of of to have the opportunity of of ending her life, I think it's got to be something that, you know, that members should think about, that if if the reckless bill, thousands of other people will go

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through that same process. I have to say to the noble Lord that I do not believe that people that I do not believe that people are putting down amendments just simply to wreck a bill. That may be your opinion, but remember, other your opinion, but remember, other people have different opinions. Now, I respect the noble Lords opinion, I respect the noble Lords opinion, but I hope I hope that he would in turn respect my right to have an opinion as well.

And so therefore I am. I do believe that we must am. I do believe that we must scrutinise this Bill, and I do notice that Baroness Hayter objected to the fact that there was objected to the fact that there was nobody or practically no one from that was supporting the Bill speaking. I know of no one supporting the bill stopped from speaking. They didn't get up themselves to speak and therefore they weren't stopped. And if there are those that want to support this bill and get up and say they are free to do so, I certainly would like to hear their opinions just as well as I believe that I have an opinion that ought to be heard equally as they have, and therefore this is important.

And I do come from a family that knows what the reality of suicide means, and the heartbreak of suicide. Where we examine, we wonder, could something more have been done before that person ended their own lives? I suicide, and therefore I know the pain of that and the loneliness that they that they went through. And therefore, I believe we must get this right, because in the domestic abuse, coercive and controlling behaviour context, a victim may, due to intimidation or trauma, deny that their actions are actually caused by wrongful coercion.

And is the doctor supposed to be weighing the patient's words against the very limited evidence that they can seem, that they can they can see in an examination room? Professor Jane Monckton Smith OBE, Professor of Public protection at the University of Gloucestershire, said during her testimony to the select committee, emphasising the significant difficulties in relying solely on a person's verbal denial of abuse when assessing coercion, said and I quote, I have worked in this area for a very long time.

I have seen victims refuse medical help when they have been hit in the head with a hammer through fear. This is not an isolated example. If you speak to the other person here, I. I think they will probably agree with me. What I am saying is that coercive control is a serious social problem. It will impact on people who are looking or are going to look to this bill. And also in the Lords committee evidence standing together against domestic abuse, Cheryl Henry Leach said, and warned the difficulty is the lack of insight into the impact of coercive control on somebody's ability to make decisions, even though that has been enshrined in case law.

And can I just say, because I don't want to detain the debate longer, I have experienced over 50 years as a Minister, people coming to the end of their lives. I've been with them in their moments of their deepest pain, and also, as one of the noble Lords also said, I was there with the families after the occasion and trying to Minister to them, and also my 25 years as a member of Parliament in the other house, as a constituency member of Parliament, I know what it is, and if we close our minds to the fact that people can be coerced, sometimes it is done very subtly, sometimes it's done very gently within family dynamics, and that's very difficult for assessing doctors to detect in limited formal settings.

Therefore, I believe it is of vital importance that the words that are put into this legislation, if it is passed, are the correct words that cover all of these possibilities. Because remember, when the person takes that lethal injection or whatever potion they take, there is no return as far as this life is

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concerned. But they go to another. Intended to rise and speak to her again. My strong support for her again. My strong support for amendments 345, 46, 47, 48, 49, 52 and 58 a mere eight amendments under the 21. In this massive group, the interest of time. I will dump the interest of time. I will dump my notes on all of these and merely speak to amendment 58, in the name of the noble Baroness, my noble of the noble Baroness, my noble friend grey Grey Thompson, who has made a very crucial point, I think, with regard to amendment 58, because, my Lords, coercion and pressure do not always manifest themselves as direct, intentional themselves as direct, intentional acts by individuals.

Instead, they can arise from broader and societal structures and conditions that structures and conditions that constrain genuine choice. Where a person facing terminal illness is subject to circumstances such as subject to circumstances such as chronic poverty, social isolation, or systemic lack of quality healthcare, their options are severely limited. In such scenarios, the choice to pursue end of life options may not be a true options may not be a true expression of free will, but rather the result of enduring disadvantage the result of enduring disadvantage and unmet needs.

Now, during the Second Reading of the bill, my noble friend the Lord Moylan made
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Lord Blencathra Portrait Lord Blencathra (Conservative)
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noble friend the Lord Moylan made the telling point that many people contemplating suicide do not want to die. They just want their life circumstances to change for the better. So structural disadvantage refers to the social, economic and institutional barriers that systematically disadvantage certain groups. When terminally ill individuals lack access to palliative care, for example, social support or financial resources, they may feel compelled to consider end of life options not out of genuine preference, but because their suffering is exacerbated by these systemic failures and poverty as a profound social vulnerability.

A terminally ill person living in poverty may fear becoming a burden to family, or may lack the means to access pain relief, counselling or hospice care. The psychological and practical impact of poverty can create a sense of hopelessness, making the option of hastening death appear more acceptable or even inevitable. When systems persistently fail to address the needs of the most vulnerable. This neglect can be seen as a form of institutional or collective intent. Thus, the responsibility for coercion or pressure extends beyond individual actors to the structures which shaped people's lives and choices.

My knowledge that many years ago, my my illustrious predecessor, my constituency, the great Willie Whitelaw said to me, David, he said I was never interested in pensions until I turned age 65. Well, the one wonderful thing about this house of ours is the average age in here is 71, I understand, and our average death age is 81. That gives us a unique insight, as we've heard from many noble peers, gives us a unique insight into its sort of sort of infirmities.

We and our close relatives suffer and and actually very close experience of those near to us who have died as well from it. And now, my Lords, we also have heard from many noble Lords that experience of beating the odds, my noble friend Lord Polak and the noble Lord, Lord Griffiths earlier, that is beating the odds because the prognosis was not right. I think I quoted in my Second Reading speech that Sir William Osler, the father of modern medicine, this is in about the 1890s.

Medicine is the science of uncertainty and an art of probability. Now, my Lords, I'm tempted to quote an example, because my noble friend Baroness Berridge mentioned. Nice. Now, my Lords, I have experience of nice. I'm grateful to him in some ways and and hate them in others. Well, as one of the side effects of miss is that one's feet feel nailed to the ground, they're absolutely heavy as lead and don't move. 15 years ago, nice approved an experimental drug called Fampridine, and I was one of about 500 patients in the National Hospital.

Now, fampridine is an absolutely miraculous drug. What does it do? By fampridine? You saw it, in fact, this morning it helped me to stagger from my chair up here with assistance from my noble friends. I can walk not very fast, but I can manage to walk the Dispatch Box. And every six months I've got to do a walking test to see if my walking is not fast enough with the drug. They cut it off and I don't get it anymore. Two years ago they said, we want an experiment.

Stop taking it for two weeks to find the effects. The effect was, I couldn't get out of that blasted chair. I could hardly go to the loo at home. I couldn't even go to the fridge, I couldn't walk, my legs were absolutely dead. Now the point is, my Lord, that doesn't make me suicidal. But if if nice cut off that drug, I will find life absolutely unbearable. I would be sitting beside my noble friend Baroness Gray Thompson there on my chair.

I would not be able to walk or move at all. As I say, that doesn't make me suicidal, but I can imagine the effects. If I had. I have not. 2019 my Lord Griffiths I had a little problem with cancer in the margin. Beautifully cut it out. But if I had continued chemotherapy and was unable to walk and for example, I say I had to go for dialysis every couple of days, that would make life totally unbearable and I would not want to continue.

I'm not feeling suicidal at the moment, but I can imagine circumstances where those external pressures, the lack of drugs, the lack of a quality of life would drive people to want to take their own life. So, my Lords, end of life legislation to protect the autonomy and dignity of the terminally ill. It must acknowledge that coercion and pressure are not limited to overt acts by individuals. So incorporating structural disadvantage, poverty and lack of care and the definition of coerced or pressured ensures that the end of life choices are genuinely free and informed.

And by recognising these forms of indirect pressure, we can better protect the vulnerable individuals and uphold the fundamental values of dignity, autonomy and justice. So, in conclusion, my Lords, the proposed amendments adding influence and courage, clarifying pressure as our hand is externally or internally and broadening person to encompass corporate and individual actors would significantly enhance the safeguards in this bill. Also, the broader structural disadvantages such as poverty, need to be taken into account, which may persuade a person to end their life.

These changes would help ensure that decisions in life are made with the highest standards of voluntariness and autonomy, free from all forms of undue influence, pressure, or encouragement. Whether an individual's organisation or internalised feelings I support.

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All these amendments are. So far discussed, and it was

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So far discussed, and it was mentioned tangentially by the noble Baroness Collins. Collins and that Baroness Collins. Collins and that was institutional coercion. As somebody who's unfortunately had to somebody who's unfortunately had to bring a loved one into hospital to be brought in, to be treated and discharged on a number of large number of occasions. In recent years, I've become familiar with years, I've become familiar with the process called clocking, where an individual is brought into the an individual is brought into the hospital and the paperwork obviously has to be brought to bear, obviously has to be brought to bear, and the health staff have to fill it in and so on.

Now, if this legislation gets onto the statute book, in whatever form, it has to book, in whatever form, it has to be translated into paper that the health service will have to health service will have to actually deliver. When a patient is brought into the hospital. And already we have the do not
13:33
Lord Empey Portrait Lord Empey (Ulster Unionist Party)
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already we have the do not resuscitate aspect of an adoption, we will now going to have to have another set of paperwork. And if you've seen how it works frequently, the pressure that the staff is under from time to time, the fact that the people coming and going and dealing with the patient are frequently different, and the change at 8:00 in the morning and 8:00 in the evening, that paperwork has to be done by an individual. Sometimes a relatively junior member of staff.

And all of these things have to be translated into a box that has to be ticked. Now, how is that to be done? And the actual process that one has to go through, particularly dealing with somebody who's seriously ill, is in itself challenging. And when you have to ask the person, do you want me to tick the box that says do not resuscitate? That's a big thing to do, and the person needs to be coherent, informed, acceptable.

We are moving things to a stage well beyond that. I had the experience of being in in the hospice, and while it wasn't an issue with pain, that was the problem. But when the consultant comes along and says to your loved one, have you considered the D word? Now that sobers you up? And somebody who was perfectly intellectually, intellectually had the ability and the capability shuts down in front of your face completely, couldn't cope.

Have you considered the D word? So I would say, my Lords, these are emotional things. Coercion is a very hard thing to define. But I have to say to the noble Lord Pannick the difference between his scenario and what we're facing. The state is, is cooperating and providing the mechanism and delivering the mechanism for a person to end their life. That is the antithesis of what the medical profession and the National Health Service has stood for since its inception.

And with regard to how we treat things in this House, when bills come to us, of course we have a view on them, whether we are for them or against them. And I seem to remember that when the Brexit legislation came before this House, We have to be driven by our conscience, not by our parties, not by anything else. But, my Lord, remember, how is this to be translated into the room where the patient is sitting? What box is a junior nurse or a junior auxiliary going to be asked to tick? What is the question? Who is going to fill it out? And I think if we had had the as the noble Lord Hunt of Kings Heath said, if we'd had a Royal commission and a proper government bill, we could have answered these questions.

Instead of having to sit here and go through the whole process again. So I would just ask the noble and Lord Faulkner to bear these things in mind. These are gaps in the system which the staff are going to have to face, and you will get shifts coming on, and there'll be some members of those shifts who will refuse to participate. What kind of chaos is that going to create? These things need to be thought through and they're not thought through.



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Remind those that, of course I did vote for the Brexit legislation did vote for the Brexit legislation and in fact led the Labour Party into the lobby to support the final. into the lobby to support the final. T and I forgot what was called the final agreement on on Brexit.

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final agreement on on Brexit. Thank you, my Lords. I'd like to support the thrust of the support the thrust of the amendments in this group. But before I do that, I also want to before I do that, I also want to say a word or two on one of the issues that's come up this morning about the debate, and I hope the House might indulge me, just to quote a few lines from the maiden speech that was given yesterday by the right reverend Prelate, the Lord Bishop of Chester.

The house was a little, well, less well attended for the debate on the Sustainable Aviation Fuel Bill in Sustainable Aviation Fuel Bill in which he spoke. But I thought his words yesterday, the ones I'm going to read are very relevant to the debate and the tone of it. So I hope the House will forgive me, he hope the House will forgive me, he said. Much more importantly, because communication is a vital gift for those of us who nurture and curate community in communication, we need to learn to speak and to listen, he said.

He said this is almost always done in person and directly. Indeed, I argue that one of our primary vocations in this noble House is to be with and to listen for. Few
13:39
Lord Harper Portrait Lord Harper (Conservative)
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disciplines are more vital in the search for wisdom. The search I so search for wisdom. The search I so often witness in your Lordships' House. The question for me is not House. The question for me is not so much how we can be great again, but how we can be kindly present. but how we can be kindly present. Greatness is great, but grace is greater. And I think those words greater. And I think those words were wise ones. They moved me, and I think they're relevant to how we conduct ourselves in this debate going forward on these vital issues.

going forward on these vital issues. The noble and learned Lord Lord Carlile referred to the how useful this debate was, but I think it is actually vital. And the reason actually vital. And the reason that's the reason I quoted those words from the right reverend words from the right reverend Prelate, because the point of this debate is we've raised a range of debate is we've raised a range of issues, all connected with the capacity of people to give an informed choice.

The point of the debate is for all of us to listen to the concerns that have been expressed, but most particularly for the sponsor of the bill, the noble and learned Lord, Lord Falconer of Thoroton, to listen to the concerns that have been expressed. And I agree with the noble and learned Lord Lord Carlile, that Lord Falconer will then have the opportunity to talk to, to to noble Lords and bring forward at Report stage some amendments that deal with these issues.

Now, part of the problem here, and the reason why there are many amendments on the Order Paper and the reason why the debate and what's referred to this is, is going to be lengthy is because the House of Commons spent, I think, 23 hours in committee focussed on just the first three clauses of this legislation because they're very important. And that was from just, sorry, 17 hours from just 23 members of Parliament. But almost all of the proposals that we're talking about, some of them were brought up in the House of Commons, but they were almost all rejected or disposed of.

If some of them had actually been accepted and dealt with in the House of Commons, all we may be doing here was weren't dealt with in the House of Commons. And it is our job in this House to scrutinise legislation and to deal with the things that haven't been dealt with. And we're doing it on behalf of people. A number of the amendments on the paper today deal with people who are vulnerable and don't have the same opportunities as we do.

The one thing that we all have in common in this House is we're all privileged, not I'm talking about in terms of our material circumstances, but the one thing we all have is a voice. And there are many people in this country who don't have a voice. And many of the people that have been touched on in these amendments, people have poor material circumstances. People undergoing coercive, coercive control. As my noble friend Lord Gove suggested, those who have severe disabilities, they have no one to speak for us.

And it is our responsibility and duty to make sure we test these issues and make sure this bill is as good as it could be. And the the noble Lady Baroness Hayter of Kentish Town she did refer to whether in, I think reference to the noble and learned law Lord Carlile whether if some of these things were dealt with, he would support the bill. That isn't really the question. I've been very clear. I don't support the change, and I'll set out why in a moment in relation to one of the specific amendments.

But I have to confront the possibility. I won't find it welcome. She will, that this bill may become law, and if it becomes law, it is absolutely my responsibility. And it is the responsibility of everyone in this House to make sure the Bill has all of the protections in it for vulnerable people. And if we were to fail to do that, we would have failed the people of this country who we are supposed to be supporting. And that is our duty. There will be some people in this House, if the bill is improved, who will support it? There are some people that won't, but that isn't actually the point.

It's to get the bill in as good a shape as possible. So let me now turn to the amendments. Now, the first one I want to deal with is the one about encouragement, amendment 45, that was so powerfully moved by the Baroness Fox of Buckley and the reason why that's important. And I think the reason for that word is actually the the short debate that we saw between the noble and learned Lords, Panic and Carlisle about the present position. Now, I hesitate as a humble accountant to trespass in the debate between the noble and learned Lords.

But I would just make this point two points. First of all, there is a fundamental difference between somebody refusing treatment or not having treatment, and someone taking deliberate steps to kill them. Those are fundamentally different things. And I think trying to to to allied them is not helpful to the debate. But the noble Lord Pannick noble learned Lord Pannick talked about the status quo. Now the current position, as I understand it, is that if you assist somebody to take their own life and the the DPP investigates and the guidance at the moment does contain the concept of encouragement.

And there's a specific point about when the DPP is considering whether to prosecute you, is whether you have encouraged somebody to take their own life or to try to talk them out of it. The current position is if you have encouraged them not to take their own life, but you have nonetheless assisted them, that is treated much more favourably than if you have not tried to discourage them. And I think that subtle position in the status quo is something that we should maintain, because there's going to be something very important that will happen if this legislation passes, which is the reason I don't support it, is that it will effectively change society's view of suicide.

And it will it will in some circumstances, effectively support suicide, where currently we do not. And I think in those circumstances, the use of the word encouragement is vital, absolutely vital. And that's why I support the amendment, the, the and briefly, in closing, the second group that I strongly support is the amendments amendment tabled by Baroness Grey-Thompson about people's circumstances and about the support they get. I, the noble Lords, will remember from Second Reading. I'm particularly motivated in my concerns about this Bill by my experience of having been the Minister for Disabled People, and one of the things I recognise is that people's decision making can be affected by the support that they get.

And so there are two things. First of all, I want to make sure that all organs of the state don't are not less likely to provide someone with the support they need to live well and to live a good life, because there is this alternative of assisted suicide. And the second thing is, I want that person who's trying to make an informed decision to have access to that support, to live a good life and to live well. And if they don't have that, they are not making an informed, properly autonomous choice.

They are being pressured and forced into doing so because their choices are limited. And so I think both of those amendments, inserting the word encouraged, actually puts in place some of the protections that are currently in place that the DPP uses when assessing whether to prosecute people and to look at the material circumstances and the support people get. Vulnerable people get are vital. And so I hope that both of those amendments or or variants of them can find their way into

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this legislation. Okay. May I just follow up my noble friend's remarks? And he's an old friend. I campaigned for him several times in his constituency when he was an MP, and I will remain a friend of his, I hope. I want to just very quickly follow up on his remarks about what we might call the panic paradox between the call the panic paradox between the the decision to ask for an assisted death and the decision to refuse death and the decision to refuse any further medication or help that will continue your life for a short will continue your life for a short time.

I think my friend is right. time. I think my friend is right. They are not the same because I They are not the same because I believe that a decision to ask for a death when you know that death is a death when you know that death is inevitable, and a decision simply to deny any further help, sustenance, and starving yourself sustenance, and starving yourself to death as the only way of achieving that end. They are very different. And the difference is different.

And the difference is that if they are able to ask for a calm, assisted death, they will die with dignity and not in squalor. Having forced the system to cut off any hope of further life. So to that extent, I believe, my Lord, he knows that I do not. May I just finish there? I have two seconds. He knows I don't agree with him on this, but actually I absolutely believe he's right in saying it is believe he's right in saying it is a fundamental distinction.

And that is one of the reasons why I support this bill.
13:49
Lord Dobbs Portrait Lord Dobbs (Conservative)
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Before the noble.

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Lord sits down. I think it might help noble Lords to know that we are being followed, obviously, on are being followed, obviously, on Twitter and this issue, and I am aiming to save time here. This issue of the panic dilemma has actually been commented on by Philip Murray, who is a law lecturer at Robinson College in Cambridge, and he says the Cambridge, and he says the following. We may wish to seek his advice. I find it astonishing that various Lords and forgive me for the embarrassment, including those who should know better.

Brackets. Lord Pannick keep conflating Lord Pannick keep conflating withdrawal of treatment and assisted suicide. The act stroke assisted suicide. The act stroke omission distinction has underpinned morality and law for millennia, and I do hope that either the noble Lord Lord Pannick or the noble Lord Lord Dobbs will reach out to this gentleman to aid

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or noble Lord, so we won't spend any further time on that dilemma. Other views.

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Other views. Are available within the legal community, including, amongst many community, including, amongst many distinguished judges who I won't name, but there are many law reports which question this distinction, not least for the

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reasons that have just been given. Can I say the the debate. has.

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Been both enlightening from from all sides. But and there are very many distinctive speeches that will stay with me. And one of those was Lord Griffiths, who brought that very personal account. It's no longer in his place, but the the longer in his place, but the the concept. I mean, this is about concepts. We're talking about words, whether it's encouragement, whether it's coercion, whether it's pressure there in that similar collective of words. And I worry collective of words. And I worry that we are we're dancing with words a lot during this debate.

But words a lot during this debate. But the the word that Lord Griffiths brought to us this morning was autonomy. Now, autonomy is very autonomy. Now, autonomy is very important in this. And I know it's been described in the in the committee stages and on the floor committee stages and on the floor here today. Now I would be significantly more encouraged and significantly more encouraged and relieved if I could be absolutely sure that autonomy and freedom of action, freedom of movement,
13:51
Lord Mackinlay of Richborough Portrait Lord Mackinlay of Richborough (Conservative)
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action, freedom of movement, freedom of thought and freedom of decision was clear, unambiguous and untainted. But I cannot be so assured with the Bill as it stands, that is weak on the coercion nature. Now for no great reason. I left the chamber earlier on. My wife had arrived, and I just thought back to the two cases of Ruth Ellis and Kevin Bentley, and they were really significant cases that stopped the death penalty in this country. Very significant. And that was a long time ago.

When I think that perhaps the the morality and thoughts of this country were in a very different place from where we are today. But there was a thought that the potential of getting things wrong was enough, despite, one might say, you know, the good bits about the deterrent effect of the I mean, that's a whole different debate of the death penalty. We were willing to put all that aside because we did not want miscarriage that was so powerful. And yet here we are discussing this bill with lots of suggestions as to how we could strengthen the, you know, the coercive nature and make sure that people are not being pushed towards an early death that they did not want.

And yet we're almost flippant about that in this bill, because the words are all, well, they're old and they're ill anyway, so they don't really matter. And I have to say, in support of Baroness Grey-Thompson amendment 58 and I think Lord Deben, my noble friend Lord Deben knows we don't always agree on everything. I think he made a very powerful point that if you were to look at the bell curve, not just of our wealth and status of us in this house, I think we're actually probably to the left politically of the public, but we're certain to the right in terms of probable wealth and influence as a whole.

And there is a world of difference between how we if we were faced, this would be treated and the voice that we would have for ourselves and the way our families would know that they have agency and power to speak compared to others in society, and that could be the wealthy family would be in a different place because they could afford the help at home and the support in a care home as necessary. But those in the middle, perhaps with children who work away, which is increasingly likely in this country, they're the children are feeling guilty.

And there's lots of cases have been brought about the real situation, about how people feel. And in cases of that type of family, no problem of wealth, but problem of support by children and others. There would be this I don't want to be a burden. Debate would be coming to the fore and I I'm sorry, I forget the name, but one of our Northern Ireland colleagues mentioned, you know, the issue of do you know how much this costs the NHS? And I'll be exploring that in greater detail.

And I think amendment three touched on that about the having an independent person. I've laid amendments for another day that is examining whether the NHS should be part of this process at all. But I have to say in response to Baroness Hayter, yes, I could be encouraged, I could be encouraged. But I think the facets and the dimensions of autonomy, the facets and dimensions of coercion, I'm not sure how we can overcome them because people are complex, families are complex.

One situation in life is complex, and I'm afraid just as we were willing to change a major piece of criminal legislation on the back of two particular errors, we seem to be not so interested to look after the vulnerable within this bill. I wish I could advance an amendment that would make me satisfied. A lot of these amendments make me a little more satisfied, but I think no matter what we do, and I'm very tempted to follow the noble and Lord and learned Lord Carlile to say, I think we need to look at this whole area of the coercion pressure all over again, because it is absolutely apparent across this House that this point is the sticking point with many of us.

So yeah.

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What are you waiting for? My Lords, in their various ways,

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My Lords, in their various ways, the amendments in this group seek to protect those who are terminally ill from being coerced or pressured into a decision to seek an assisted into a decision to seek an assisted death. One of the most worrying concerns that have been raised by concerns that have been raised by opponents of this bill is the risk of especially vulnerable people from being encouraged or coerced into ending their own life. And the noble Lord Lord Dobbs was right noble Lord Lord Dobbs was right about that.

And for that reason, I don't think the committee should feel embarrassed about having spent feel embarrassed about having spent the time on this debate that we have. And now, as have been pointed have. And now, as have been pointed out, the bill already seeks to cover the coercion issue in the cover the coercion issue in the existing drafting. However, given that it creates a totally new role that it creates a totally new role for medical practitioners in a situation where a terminally ill situation where a terminally ill person wishes to end their life, noble Lords, in my opinion, are noble Lords, in my opinion, are surely right that a laser focus should be applied to delivering protections designed to prevent any such coercion or pressure.

As a number of speakers have pointed out, coercion can come from anywhere. Family members, friends, neighbours or other trusted people in our lives. It could come from an institution, and it doesn't have to be overt. It can and often does, take the subtlest of forms. The noble Baroness, Lady Finlay, vividly described situations of that of that nature, as did my noble friend Lord Deben. Of course, with someone suffering from a progressive terminal illness, the vast majority of family and friends will act in good faith to support their loved one through what is in many, if not most cases, an incredibly difficult time.

However, when framing legislation around a decision as momentous as whether to opt for an assisted death, and as the noble Lord Lord Carlile pointed out, human nature being what it is, it is doubly incumbent on us, I believe, to look for ways of safeguarding those who might be most susceptible to external pressure. Amendment three in the name of the noble Baroness Finlay of Llandaff, would state more clearly on the face of the bill that the decision to end one's life must be made independently.

My Lords, I hope that this is an amendment on which the noble and learned Lord, Lord Faulkner, will look favourably, as it seems to me, in tune with the Bill's aims and purpose. The question, though, as posed by the noble Lord Lord Pannick, is whether it is necessary. As far as I can see, in no part of this bill is there any indication that where a person finds it difficult to make a decision about an assisted death, or where the possibility of an assisted death hasn't even entered their head, it would be appropriate for their thoughts to be influenced or guided by another individual.

Indeed, the bill contains specific prohibitions on advertisement and promotion, as well as the offences set out in clause 34, in respect of inducing a person to seek an assisted death by dishonesty, coercion or pressure. My Lords, the Suicide Act 1961 is crystal clear that encouraging a person to commit suicide is an offence whether or not they do, in fact take their own life in the end. My noble friend Lord Evans, the noble, my noble friend Lord Gove cited parallel provisions in other statutes against that background.

It seems to me that this bill is about people making independent decisions about their own lives. And it was for that reason that I queried whether the noble Baroness Amendment was strictly necessary. Nevertheless, there are two watchwords with this bill, given its subject matter that I believe we should carry in our minds, particularly in the light of the speech of my noble friend Lord Shinkwin. And they are reassurance and clarity. Amendment three and others in this group would serve to deliver reassurance through greater clarity.

And that's why I suggested that the noble and learned Lord, Lord Faulkner, should consider these amendments with a sympathetic eye because they serve to put the bill's intentions around coercion beyond any reasonable doubt, and beyond any reasonable doubt, and they do so without any in any way they do so without any in any way aims.
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14:03
Baroness Merron Portrait Baroness Merron, The Parliamentary Under-Secretary for Health and Social Care (Labour)
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this context. I can also say that disclosure of personal data engages disclosure of personal data engages article eight of the Echr, and is regulated by the principles set regulated by the principles set down in the Data Protection Act. Detailed financial assessment of Detailed financial assessment of those connected to a person seeking assistance is likely to interfere with the privacy of those with the privacy of those individuals, particularly where there are no signs of coercion. The necessity of doing so is difficult to assess in the round.

Rather than considering this on a case by case considering this on a case by case basis. Turning now to amendments basis. Turning now to amendments 222 and 612. In the name of the noble Lady Baroness Hollins. noble Lady Baroness Hollins. Amendment 222 proposes a new clause to oblige the Secretary of State to provide specialist psychological assessment and support for persons considering an assisted death and considering an assisted death and their families. It also obliges the Secretary of State to establish bereavement support services, offering psychological support offering psychological support before an assisted death to all persons concerned.

My Lords, the Bill does not require families to know about an assisted death in advance, so requiring the offer to cycle of psychological services to them could create an undeliverable obligation on the Secretary of State. Amendment 612 would mandate the video recording of a person being assisted to end their own life. The amendment also requires the person to confirm in the video recording their identity, their wish to die of their own free will, their capacity, and that they are acting without persuasion or coercion.

The amendment requires that this recording is sent to the coroner within 72 hours of death, and creates a regulation making power for the Secretary of State concerning the practical arrangements for the recording, storing and transmission of the recordings. My Lords, requiring that a person's death be video recorded where they did not wish the event be recorded, could risk being a significant intrusion into the family and private life under article eight of the Echr. Since the bill includes several safeguards, this intrusion is unlikely to be considered justified and this amendment could also raise GDPR issues and concerns.

I turn now to amendment 460. In the name of the noble Lady Baroness Finlay. This amendment specifies a range of actions the panel must take into account when considering a person's psycho social and safeguarding circumstances. It includes a requirement to offer immediate access to safe housing and financial support where abuse is disclosed. As the bill is drafted, neither the panel nor the commissioner are provided with such a function, and it is not clear how this would interact with local authority.

Responsibility for housing provision. For the other amendments in this group, my Lords, where I make no detailed comments, although the amendments may be deliverable. Some are challenging to implement. For example, amendment 47 would require assessing doctors and the panel to assess a person's state of mind or private thoughts. Amendment 58 would require an assessment of indirect structural disadvantage, including poverty or lack of care. Whilst I only raise specific workability issues with a small number of amendments in this group, noble Lords will be aware that the other amendments in this group have not had technical drafting support from officials.

The issues raised by these other amendments are, rightly a matter for noble Lords to consider and decide, but I would note that the way they are currently drafted means they may not be fully workable, effective or

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enforceable. My Lords, in the course of this debate, we heard deeply personal information about the noble Lord Lord Empey, the noble Lord, Lord Lord Empey, the noble Lord, Lord McCrea, the noble Lord Lord Watts, the noble Lord Lord Polak, the noble Lord, Lord Griffiths, the noble Baroness Baroness Hollins, noble Baroness Baroness Hollins, the noble Lord Lord Carlile of Berriew, the noble Baroness Baroness Hayter, the noble Lord Baroness Hayter, the noble Lord Lord Shinkwin and the noble Baroness Baroness Grey-Thompson.

Could I express my profound respect Could I express my profound respect for people being willing to share in that way? Could I also make it clear that nothing I say in any way intends to disrespect any of what must have been quite difficult must have been quite difficult statements to make, and I really treasure many of the things that have been said, whether for or have been said, whether for or against the Bill. My Lords, as all noble Lords engage in the debate, know at the heart of the Bill, and there is no dispute about this, that the decision to have an assisted death has to be one.

And I
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Lord Falconer of Thoroton Portrait Lord Falconer of Thoroton (Labour)
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assisted death has to be one. And I quote the section the statute is one which the patient makes with a clear, settled and informed wish to end their own life, and has made that decision that they wish to end their own life voluntarily and has not been coerced or pressured by any other person into making it. There is no dispute in the House that there has to be appropriate safeguards, sufficient safeguards to ensure that there is not coercion. The current safeguards in the bill are as follows.

First of all, a doctor has to be satisfied that the person is not being coerced. Secondly, a second doctor has to be satisfied that the person is not being coerced. Thirdly, a panel has to assess whether the person is not being coerced. Fourthly, the first Doctor, after a period of reflection in signing a second declaration by the patient, has to be satisfied again that the person is not being coerced. And finally, the doctor providing the assistance has to be at the last moment satisfied that the person is not being coerced.

The two doctors that give the certificate at the beginning, both have had to have had specialist training in domestic abuse abuse, including training on identifying coercive control and domestic abuse, including identifying the effect of financial control. The panel, which considers the matter consists of a psychiatrist, a social worker and a senior lawyer. If either of the two doctors have any doubt about the position in relation to capacity, they have to consult a psychiatrist. Anybody who, by dishonesty, coercion or pressure, induces the patient to either execute a declaration that they want an assisted death or takes the assistance, is guilty of a criminal offence.

If all that the person does by dishonesty, coercion or pressure is to induce the person to execute a relevant document, the maximum sentence is 14 years. If, on the other hand, what they induce the person to do is to take their own life, then the maximum sentence is life. The question before the House in this debate is whether or not those protections are adequate to ensure that there is not coercion. I have before me a number of amendments.

Can I go through them? First of all, amendment number three, proposed by the Baroness Finlay. She wishes the word independent to come before the decision. I wholeheartedly agree with her that the decision has got to be independent, in the sense that it is a free decision made by the person unpressured or coerced in the way that I have described. I note and am always influenced by what the noble Earl Howe says in relation to it. He says, reassure us in relation to that.

There is no dispute between myself and Baroness Finlay that it has to be an independent decision. Is it clear enough on the face of the bill at the moment, with the deepest of respect to both the Baroness Finlay and the Earl Howe, it specifically says that the person has had to have made the decision to end their own life voluntarily and has not been coerced or pressured by any other person into making it. I, with respect it is clear enough on the face of the bill.

Amendment 46 that this is another amendment 45, which is that of Baroness Fox. She says, put in the word encouraged. In addition to the words coerced and pressured. I thought very carefully about that, and I am against putting that in. The reason I am against putting it in is I see the reality, and the reality will be somebody who is thinking about an assisted death will want to talk very frequently to those who love them. They may want to talk to the multidisciplinary team that is looking after them.

Suppose somebody says, I, I'm, I'm, I really, really want to go now. Should I take that opportunity? And if somebody says, I encourage you to make the decision that's best for you, what Baroness Fox is proposing is that that becomes a criminal offence, potentially imprisonable for 14 years or for life. And that just seems to me to be not sensible. Amendment 46. The noble Baroness Baroness Finlay says put in the words either influenced or encouraged.

I dealt with, encouraged, influenced the multidisciplinary team. The loved ones may well from the best motives, influence somebody to go ahead with it. I don't criticise them for that if that is what the person wants and it helps. Again, it seems to me wholly inappropriate to go beyond coerced or pressured. Amendment 47 the Baroness Coffey. It should be externally or internal pressure that one is concerned with external pressure. We can understand that somebody pressurising you to do it and pressure carries with it an inappropriate degree of influence.

But how? And my noble friend Baroness Merron referred to this. How does one in practice deal with an analysis of what what makes me want my life to end the pain, the lack of dignity, the sense that I'm not the person I was in front of my own children. That's internal pressure. And it might include me thinking, I do not want to go on with this. In part, I've only got 2 or 3 weeks to live. I want it to end, and the internal pressure is making me come to that conclusion.

It's an impossibility, it seems to me to ask people, in particular the law enforcement authorities, to investigate what's going on in my mind. So again, I've thought very carefully about that. And could I reassure the noble Lord Lord Ashcombe, that I've given each one of these amendments very careful thought, because they are important? But again, I don't think that is a practical solution. Then amendment 48 by Baroness Ritchie, who has given her apologies for not being here today, but I will deal with it.

She she wishes to leave out the words by any other person. It reflects the Baroness Coffey amendment. It doesn't have to be somebody who's putting you under pressure. It can be circumstances. And again, that is not a practical way of creating either a proper protection or a serious criminal offence. Again, for the same reasons that I asked in relation to Baroness Coffey, I don't think that

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is possible. Then an amendment 49 Baroness Coffey sorry, I apologise. Name is on the amendment that the noble and learned Lord has just mentioned, and this is was from Second Reading as well. Could he please outline what. There's loads please outline what. There's loads of people signing forms saying coercion or pressure hasn't happened. What is the situation with the internet? What is the situation for young people? I think we're really failing young people. If we don't make clear, how is that

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If we don't make clear, how is that practitioner going to know? Young people are pressured through non-human means nowadays. What the.

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What the. Bill does is makes it absolutely clear that it's got to be your own clear that it's got to be your own decision. If your views of the world are affected by the internet. world are affected by the internet. Suppose, for example, that you are ill and there is an organisation urging you to commit suicide. That urging you to commit suicide. That organisation should be liable if that is what happens. And just picking up amendment number 49, which the Baroness Coffey puts down, which the Baroness Coffey puts down, she wants a person to include a body, corporate or an organisation in relation to pressure.

And if in relation to pressure. And if there is a if there is an organisation or a body corporate that is putting pressure either on that is putting pressure either on a group of people or individuals and that makes them do it. So this is putting it over crudely. But suppose there's an organisation says do have an assisted death. I think it's the right thing for everybody or for you. And that constitutes pressure. My view is that should be covered by the bill.

Now I think the word person and she adverted to this person can generally include corporate person. Sorry, can I just finish. Just let me finish this. It can include both corporate person and human person. But can I talk to her separately

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about that to make sure that it's covered? Sorry, Baroness Fox. That's fine.

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That's fine. Some clarification needed in in relation to a number of the points that you've made. How does how do we know? How does anybody know? How we know? How does anybody know? How does the doctor know whether any of these scenarios have happened? Is these scenarios have happened? Is there anything in the bill that makes the doctor ask, explore? And makes the doctor ask, explore? And indeed, my word encouragement was that you would say not just were that you would say not just were you coerced or were you pressured pressurised, but were you encouraged because it would develop encouraged because it would develop a richer conversation? But is there anywhere in the bill where all of the things you've just said, it's the things you've just said, it's not you, the noble and learned Lord not you, the noble and learned Lord has just said? Apologies can be fleshed out and discussed and and fleshed out and discussed and and teased out because at the moment, as I understand it, and maybe I've got this wrong, you fill your form got this wrong, you fill your form in, somebody might even say, Will you coerced.

You say, no, that that's out the window and Bob's that's out the window and Bob's your uncle, you're eligible and off you go. I just it doesn't matter how often that process happens because you gave a number of first doctor, second doctor. If they all don't explore it, then how will we know whether it was anything other than a yes no? Because the noble and learned Lord has given a very rich explanation of what could have happened. But I don't think the bill allows us to find out if any of that will have occurred before

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the assisted death is enacted. Insulted by being called you, I

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Insulted by being called you, I think the noble Baroness Baroness Fox is not properly understanding how the bill operates for the two doctors and for the panel. They have to be satisfied that the let have to be satisfied that the let me finish and then come straight back. They have to be satisfied that the person is reaching a voluntary decision of their own. voluntary decision of their own. Uncoerced and Unpressured. There will be codes of practice that determine how that's done.

And determine how that's done. And what's more, the panel with the three experts on it have also got to be satisfied. The Baroness Barran just hold on a minute. The Baroness Fox is saying, well, Baroness Fox is saying, well, that's just a tick box exercise with respect. No, this is obviously a very serious matter. I would expect the doctors who do it and

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the panel who do it to take it seriously. Sorry. As the noble. Lord knows. I've spent. A lot of my life in East End

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housing. Estates in East End of. London working with people. And we. Did research. Quite some years ago, and we.

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Quite some years ago, and we. Discovered in the housing. Estates where I work that we have virtually every nation on earth represented in those housing estates. I spent a lot of my time working with Bengali families for probably nearly 40 years, and we know each other quite well. But in terms of do I really know what is going on in the minds of that community and that single mother trapped in a house who doesn't speak English after all these years? The truth is, I don't.

The truth is, it's really difficult to know in the same way that as a Yorkshireman, I find it really difficult to really help Southerners understand what is really going on in Yorkshire. And, you know, even though I've tried many, many times the quality of their fish and chips really don't cut it. So my Lords, one of my problems with this over certainty, this feels like a very white English conversation when actually we now live as a country, in a global community with many different cultures, from people all over the world.

And the idea in practice, because the thing that concerns me is the practicality of the lot of the discussion I've listened today, how in practice you actually understand coercion and encouragement, which I personally think is a really important word. I have no idea. I myself, having spent many years of my life with these people, would not pretend to

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know at such a point what I was really hearing and what it meant in practice for their life. I completely.

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I completely. Agree that it may well be that you and I would not understand different cultures and different different cultures and different people in relation to what they say, but there has to be two doctors and but there has to be two doctors and a panel that feel that they do understand sufficient to reach a understand sufficient to reach a conclusion. And if if they don't, then they cannot provide the satisfaction that is required by satisfaction that is required by the bill.

And and the idea that it's all people from a particular class and a particular demography class and a particular demography and a particular education that will make this bill work is with respect. Ron.

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Can I just ask, are we going to. Have enough people from these different cultures with the skills and knowledge to really enter into and knowledge to really enter into that kind of understanding, be they the doctors or the panels? I find the doctors or the panels? I find that as a practical proposition, really difficult to understand how it is going to work in the real

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it is going to work in the real world, in the East End of London. That will that. Will very much depend upon the

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Will very much depend upon the number of people who apply from particular groups. And I think one could be pretty sure, particularly could be pretty sure, particularly on the basis of the impact assessment that has been made, that there will be sufficient, I think probably it would. Sorry, it probably be sensible unless it's something we've not already dealt

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with, for me to make a bit of progress in relation to this. Okay. Forgive me. I'm just coming back

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Forgive me. I'm just coming back to the point that noble Lord Liddle Lord Carlile made about the point of the debate. I absolutely get of the debate. I absolutely get that the noble and learned Lord is very certain about the quality of very certain about the quality of the bill, and he's setting that out in his usual eloquent way. He must in his usual eloquent way. He must recognise, I think, having listened, if he followed my injunction from the right reverend Prelate, the the right reverend Prelate, the Bishop of Chester's words yesterday, if he's listened to the debate, that certainty is not shared by that certainty is not shared by many members of this House.

So my question is, and forgive me if he question is, and forgive me if he was going to get to this on some of the later minutes. He's now effectively said most of the amendments he's not persuaded by. amendments he's not persuaded by. If he doesn't accept that many noble Lords have concerns about this bill, and it's basically fine this bill, and it's basically fine as it is, I fear he's going to get to the point where many Lords who, picking up the noble Lady Baroness Hayter point, might have been persuaded to support it if it had been improved, are not going to be.

been improved, are not going to be. And I just wonder whether he was prepared to listen and amend the bill in any way at all.

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bill in any way at all. First of all, I'm sure I will not be able to reach the high standard of the right reverend Prelate the Bishop of Chester, but I will try. Secondly, I don't think that I am rejecting the principle of many of the amendments. And I'm saying, for example, in relation to an independent decision, for example, in relation to encouragement, that I think in practice the protection is there. I am also saying to the Baroness Coffey that I think her reference to organisations is something that I think we could discuss.

I think it may already be covered, but let's discuss it. But the noble Lord, Lord Harper, is right. I'm saying no to quite a lot of the amendments, in my opinion, because I don't think they're necessary, and I think there's adequate protection. It doesn't mean I'm not listening. And painful as it is, because I respect so many people who disagree with me that I do disagree with some people. And I'm very, very conscious as well of what the chief medical officer, Chris Whitty, said, which is do not overengineer this and make this a thicket that people cannot get through.

If you are serious about assisted dying, make sure it is. It is genuinely accessible to people and I am trying in what I am doing to strike that balance.

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Help my noble and learned friend in terms of the concerns that clearly have been expressed, clearly have been expressed, because I think a number of noble Lords have been talking really about what evidence is there. And the concern has been expressed in the last debate on Friday that if the last debate on Friday that if you're not going to have someone who has been intimately involved who has been intimately involved with the family or the person who's making the request, that becomes more difficult.

So there are a more difficult. So there are a number of suggestions that have been made. For example, would it be been made. For example, would it be possible to have a multi-disciplinary assessment of multi-disciplinary assessment of need and coercion early so that you could have the information? Noble Lord will know that when we make Lord will know that when we make these multi disciplinary assessments, usually you hear from assessments, usually you hear from everyone, you hear from the social worker, the housing officer, just as we do that for the multi-agency as we do that for the multi-agency risk assessment for domestic violence.

And and these domestic violence cases are really important. violence cases are really important. Would the noble Lord look again at how in the bill we could make sure how in the bill we could make sure that the evidence upon which these decisions are going to be made is there? And secondly, if I can just deal with Baroness Fox's amendment in relation to encouragement, the noble Lord will know. And I, I disclose to the House, because, of course, I was the Attorney general when the the DPP's guidelines are put out.

The whole purpose of looking and assessing encouragement was to make sure that no one else had put pressure. So that word encouragement, I think, very much comes from the DPP guidelines, which has meant that since they came in, only four prosecutions have been made, and they were made in relation to people who were identified as having participated in something which might have been homicide or manslaughter, which I know the noble learned Lord would think was entirely proper and others were not prosecuted.

So I wonder whether the noble Lord would think again about just looking at those issues to make sure that either on regulations by saying we shall do them, that we can have that clarity which might give reassurance to those who are

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issues. In relation to the multi-disciplinary team. The noble Baroness Baroness Hollins amendment. Amendment 2 to 2 is a bit close to that, but not quite there. Can I that, but not quite there. Can I come to it as I come to that in relation to the question of encouragement? Well, of course, the encouragement? Well, of course, the reason why the DPP's guidelines refers to encouragement is because the criminal offence at the moment is encouraging suicide, and that's dealing with a completely different concept.

May I go on into our

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concept. May I go on into our amendment 50, which is sorry. My Lord, thank you.

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My Lord, thank you. I'd like to go back to our noble colleague from Yorkshire, and I'm afraid I don't know your name and I afraid I don't know your name and I apologise. You talked about working

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apologise. You talked about working in the communities in the East End, and we are short of GPS as it is, and. Most of.

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Most of. Our GPS. Come from. An Anglo-Saxon. Background study.

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Background study. And he has referred the noble Lord, has referred. To the fact that we're. In. A position.

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A position. Where he, having worked with this community for a very. Long time. Still couldn't.

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Necessarily read the situation. And I wonder how we deal with. That. Because the GPS in that

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That. Because the GPS in that community may not have that. Even the. Long. Period of time. He's had.

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He's had. To assess. Can I answer that? You may not have been satisfied with my answer, have been satisfied with my answer, but I did answer it, which is to say, people have got to be satisfied that the decision is satisfied that the decision is voluntary and without coercion if they do not know because they can't read adequately the community, then read adequately the community, then they couldn't be satisfied.

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they couldn't be satisfied. I'm very grateful. The noble Lord has just made a point that a risk of coercion, being referring risk of coercion, being referring to a psychiatrist, it'd be very helpful to understand which clause in the bill he's referring to, in the bill he's referring to, because clause 12 six B is only about the capacity of the person. It's not talking about coercion. It's not talking about coercion. And I'm also conscious. That when. We capacity is on the balance of We capacity is on the balance of probabilities anyway.

So it'd be useful to understand. Which clause

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useful to understand. Which clause grounds. Of coercion. To that in a moment, because I think I've got to get through the amendments before we have to make progress a bit. But I completely understand the question. Amendment 50 was the noble Lord, Lord Evans. He basically said, when anybody tries to behave badly, trying to coerce or pressure somebody into making the decision to have an assisted death, that should be sufficient to bar it forever, even if it had no impact whatsoever in relation to it.

I see the force of that. I think it would be a wrong amendment for the following reasons. Somebody, a doctor, might go over the line, but it's absolutely clear that the person does definitely want an assisted death. I do not think they should be barred from doing that, because they are concerned about what may happen to the doctor, or what may happen to the person they love. If it is absolutely clear that they have not been coerced or pressured into it, then could I go to amendment 52? Baroness Grey-Thompson she is saying that somebody should not be subject to or at risk of coercive control.

Everybody agrees that the person who is adopting the assisted death should not be subject to coercive control at risk. If they are at risk, then I would expect the two doctors and the panel to investigate that fully. And if they are not satisfied that the person is reaching a decision of their own, then plainly an assisted death cannot go ahead. But I think we're all on the same page that the risk is something that has to be properly investigated and a conclusion reached, and then amendment 57 A.

This is Baroness Lawlor amendment saying not be you shouldn't be allowed to have an assisted death if they've been prompted to consider ending their own life, presumably in the context of assisted death by any professional person. It may well be. And clause five leaves it to the judgement of the doctor. Whether they raise the question or not with the patient. If they raise it, they have to raise it under clause five, in the context of the treatment available to the patient and all other options available, including palliative care.

I do not think that a doctor, or indeed any other professional person who makes a judgement that it would be sensible to raise it, that that should thereby debar the person from having an assisted death. I mean, I think I mean, by all means, let's prolong the debate again. But I

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means. Of authority, which the

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Of authority, which the professional person who is, in a way a public servant, and the trust which one endows in one's GP or family doctor, and that, as we've heard today from other people who heard today from other people who are medically qualified, has great weight with the patient. I speak as weight with the patient. I speak as someone who comes from a medical family. They constantly agonise about their treatment, their prescription for patients and their emotional condition and all that.

emotional condition and all that. But if one raises assisted dying with somebody who is terminally ill, with somebody who is terminally ill, you're one the professional, the

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you're one the professional, the Yes. And you? I completely appreciate

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And you? I completely appreciate what you're saying. She is, in effect, repeating what she said with such force and articulateness before. But my answer to that is that there will be some that there will be some professional people, and clause five recognises this who think. Suppose I'm saying I just can't Suppose I'm saying I just can't bear this. I want this to end. Would it be inappropriate in those circumstances for professional person in the context of all the other options to raise it? In my view, not, and in my view, it would be completely wrong to say that if you did raise it in those circumstances, that person, the patient, would be barred from ever having an assisted death.

Amendment 58. And it's the lead amendment. I'm saying not every other amendment. The lead member, you say that coercion or pressure should include intentional or indirect structural disadvantage, including poverty or lack of care. We are all agreed that coercion and pressure on an individual by another individual is not to be allowed, where the reason that you want an assisted death is because in your mind, you are influenced by your circumstances. For example, because you are poor, should you be barred from having an assisted death because of your poverty? In my view, not what the two doctors in the panel have got to be satisfied is that it's your own decision.

And

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then. It partly follows on the

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It partly follows on the comments of the noble Lady Baroness Fox. You mentioned in your previous answer to one of my amendments that answer to one of my amendments that the doctors would be able to investigate. I think many of us still don't understand how that investigation would take place. And in terms of understanding sort of the standard of proof. Minister the standard of proof. Minister Sarah Sackman in Another place said it would be on a civil standard. So in terms of balance of probability, in terms of balance of probability, is the noble and learned Lord saying that only has to be 51% certain that there's no coercion for the panel to carry on and an assisted death to be granted.



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assisted death to be granted. They have. To be satisfied that the person is not being. Don't worry, not being coerced. That means they've got to do the inquiries that are got to do the inquiries that are appropriate. If, for example, what the noble Lord was saying, they don't understand the community, don't understand the community, then they can't be satisfied. If, for example, they don't know enough about it, they can't be satisfied. It's not. Every case will depend It's not.

Every case will depend upon its individual circumstances. They will have to do what is They will have to do what is required in relation to it. Could I go to amendment 118, which is the noble Lord? Lord hunt, if you have a close relative or you are living with somebody who has previously been convicted of fraud, there has to be an independent financial assessment. That means if you're if you're if your child, grown up by this time committed a fraud, then there has to be an independent financial assessment of your circumstances before you can have an assisted death.

I am strongly against the idea that if a relative of yours committed such a an offence, that would mean there would have to be a yet further layer that you had to be gone through, there is still all of those protections. The noble Lord

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Lord Farmer, of course. I mean. First of all, my Lords, I.

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First of all, my Lords, I. Think this is a new practice. But every answer one gives, the person then responds by repeating

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person then responds by repeating their speech. So if it's new, yes. I do think. The if. You read the companion. The committee.

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The committee. Stage, we are entitled to speak more than once. And I think it's more helpful to do it this way. I'm

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more helpful to do it this way. I'm the 11th amendment. In this group. That the noble Lord has so. Eloquently dismissed. So far, but I.

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So far, but I. Think he's got about another ten to go. My Lords. I just want to make. Two points. First of all.

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First of all. Does he not reflect. On all. The concerns have. Been expressed that. This bill might have had a

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This bill might have had a smoother passage if he'd shown any disposition whatsoever to take any of these issues away and reflect on of these issues away and reflect on them before coming back at Report stage. The second. My Lords, I did

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mention in my speech the. The. Human Tissue Authority, the legislation that does provide some legislation that does provide some protection and investigation to make sure that a donor is not make sure that a donor is not getting a financial reward. Would he at least look at that to see if there's any way in which we could

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there's any way in which we could reflect that in this legislation? First of. All.

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Hold on. First of all, it's quite distracting to have somebody quite distracting to have somebody quite distracting to have somebody phoning you. Phone a friend. In relation to your question, I've not dismissed all of them. I've dismissed all of them. I've accepted that we should look at some of them in relation to it, and very many of the ones that I am not accepting are because it's already covered in the bill. But I am rejecting some of them on the basis rejecting some of them on the basis that I don't think they're practical.

When you talk about the donor, I think you were talking donor, I think you were talking about, for example, somebody who may benefit from the will of the may benefit from the will of the patient. And indeed, that's a point that's raised by the noble Lord Lord Farmer very, very often the Lord Farmer very, very often the person who most supports you in relation to is the person you love most, and it's going to benefit under your will. So very, very frequently, the people who have frequently, the people who have taken a loved one to, to, to, to Switzerland are the person who's then going to inherit under the then going to inherit under the will.

That does not make them bad, and I would most certainly not and I would most certainly not exclude people who benefit under the will of the person who dies, because they've helped them. In this respect, it seems to me to not properly recognise the importance of human relations in relation to it. I've dealt with the noble Lord Lord Farmer his point about the will. He's got a second point, that if you had a friend who was convicted of a criminal offence involving financial fraud of some sort, you shouldn't be able to have an assisted death unless there's an investigation of your financial position.

Well, if it's if I reject it in relation to the noble Lord, Lord hunt, in relation to a close relative or the person you speak with, than I think for the reasons I've given, it also doesn't apply in relation to a friend. Amendment 181. The noble Baroness Baroness Grey-Thompson, proposes that the the doctor must ask why and seek specific confirmation that is not coerced. There's no specific requirement on the face of the bill for that. It's a matter for the two doctors to determine what they think the right course is.

If they felt that they could not reach a decision without asking why or without asking, are you being coerced, then they would have to ask that that there is no prohibition. It is, as the noble Lord Lord Pannick said, a decision in each case for the two doctors and the panel to decide what is the best way to reach the conclusion. Is this person being coerced and that is the that is sorry. That is the question that all of these things are addressing.



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So the two doctors could ask an entirely different set of questions to each person who is requesting to

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end their life. Depending on the circumstances of the of if if, for example, the of the of if if, for example, the doctor had a had a very severe doubt about whether or not somebody was being coerced, I would expect them to ask very, very many them to ask very, very many questions about their domestic circumstances. Suppose, however, it was somebody who had said right from the outset was a, was a was of of a clearly somebody who was not of a clearly somebody who was not in the slightest bit on the face of it, at the risk of coercion, a it, at the risk of coercion, a person of 60, in the full flush of his or her pomp, as it were.

I his or her pomp, as it were. I can't bear the thought of this illness, and the idea that this illness, and the idea that this person is being coerced is, is, is, is, is not really plausible. Then I would expect the doctor to be asking different sorts of questions asking different sorts of questions from the sorts of questions that you would be asking if the circumstances of his home life was circumstances of his home life was completely different, and it obviously would depend what you knew as the doctor, or have found

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knew as the doctor, or have found out as the panel about the circumstances of the individual. I apologise for interrupting my friend, but could I just point out that the BMA themselves are very clear that the doctors should be able to make their own judgement in in all of these cases?

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The noble Baroness Baroness Hollins amendment to two two, which, Hollins amendment to two two, which, as I understand it, is to establish a specialist service to provide psychological assessment and psychological assessment and support and then bereavement for support for those seeking an support for those seeking an assisted death. My noble friend Baroness Meren has indicated what Baroness Meren has indicated what the difficulties are in relation to that in relation to the question of that in relation to the question of a psychological assessment, the the position is that there's been some work done abroad in relation to this.

California introduced additionally to what was required additionally to what was required by the law in a particular part of California, and a psychiatric assessment for everybody who wanted an assisted death. And they concluded that that was not concluded that that was not necessary because the numbers of psychiatric assessments were producing nothing. And it's only where special requirements were required that suggest that it was a good thing. So so I think it is a I good thing. So so I think it is a I respect the suggestion, but I don't think that it is necessary.

Article think that it is necessary. Article amendment 229 the noble Lord, Lord Goodman, before making a declaration, that's before the patient makes his or her first declaration, she or he should have an interview with a social worker who has to be satisfied that they are not operating under external pressure. I respect the reason for why that has been put in, but it seems to me to be. It is. It's it's not necessary where you've got two doctors, the panel, one of whom is a social worker.

Then article amendment 460, Baroness Finlay panel had to investigate any safeguarding concerns and psychological psychosocial factors and must and must. And then there's a list of concerns. They've got to go through all of them again, if there are safeguarding concerns, they would have to investigate them. Obviously, if there are psychosocial factors. That would presumably mean how your circumstances impact your mind. If those factors would have an effect on whether or not it looked like you might be being coerced, then of course you've got to investigate them.

But I'm not in favour of the list that the noble Baroness, Baroness Finlay, suggests. Again, I would suggest that the right way to approach it is to leave it to the individual doctor in every case to conclude what the position is. Then article 462 this is the noble Lord, Lord, Lord Hunt of Kings Heath. He is suggested that the patient has to go through an independent financial assessment. There's got to be a report from the Revenue and Customs, the Financial Conduct Authority and local safeguarding boards that there's no concerns and there's got to be no reasonable grounds to exist to suspect.

The applicant's decision has been influenced by financial motive. I, I think that one should be if there is a suggestion that the that the that the patient's motive has been affected by somebody else with a financial motivation that plainly has to be investigated. I am strongly against the idea that everybody who wants an assisted death, the commissioner and the panel have got to go and ask Her Majesty's, His Majesty's Revenue and Customs, the Financial Conduct Authority, as to what their financial position is.

Amendment 612, which is Baroness Hollins. The Baroness Hollins proposed that there be a recording of the moment of the provision of assistance, and I think this is in this group, because that proves that there's no coercion. I have two points in relation to that. The bill specifically requires the relevant doctors to stay until the patient has died. I think that is adequate protection. The noble Baroness, Baroness Meren, referred to the legal issue of whether or not you can be filmed in your last moments, and I wasn't I wasn't thinking about the law.

I was thinking about the idea that it was this moment

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would have to be filmed when I might not want it. It felt.

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It felt. A little intrusive to me. Amendment 726. The noble, the noble Amendment 726. The noble, the noble Lord, Lord Sandhurst. He suggests that the Secretary of State must that the Secretary of State must have an obligation to to consider, or he must issue. I think the noble or he must issue. I think the noble Lord is saying a a code of practice in connection with whether a person has been coerced. I respect that has been coerced. I respect that suggestion.

It comes from the Law Society. Can I take it away and think about it? It seems to me to think about it? It seems to me to be perfectly sensible. And then. be perfectly sensible. And then. Amendment 846 Baroness Berridge she says the Secretary of State must issue statutory guidance on pressure. I think my response to pressure. I think my response to the noble Lord Lord Sandhurst indicates that a code of practice on coercion sounds right. Whether on coercion sounds right.

Whether it covers what the Baroness, what the noble Lady Baroness Berridge is saying, I don't know, but I'm more than happy to include her in any discussions. I'm so sorry that it's taken so long to go through all of taken so long to go through all of those, but I'm. I'm very grateful Baroness.

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Before the noble Lord sits down, a very quick question. I cannot find in the bill the powers of investigation, which would allow the doctors to carry out the investigation to which he is repeatedly referred. If people

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repeatedly referred. If people don't cooperate, that's it. I think with the greatest respect. Baroness O'Loan. She's missed the point. If if the if the doctor cannot be satisfied, for example, the person says, I'm not example, the person says, I'm not telling you things, then he can never be satisfied. That's the protection.

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protection. The answer to the question I asked earlier. Please just answer. Just before. My hon. Friend.

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My hon. Friend. Sits down. Can I can I just indicate that. Perhaps we can. Shoot one fox?

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There was a suggestion that there wasn't enough. Non-anglo-saxon GP's available to do this.

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to do this. I've just looked. At the facts. 46% were born. Of GPS, were. Born out. Of.

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Of. The UK and 25% from the from Asia. Very grateful to my noble Asia. Very grateful to my noble friend Lord Watts for mentioning that because that's what was being whispered to me, but I didn't have the statistics. I'm very grateful

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the statistics. I'm very grateful to the noble Lord Lord Watts for providing. This has.

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This has. Clearly been a long debate. And. I think. For good reason. As one of the noble Lords said, actually coercion and pressure is a really major concern of many, many people about the way that this bill is written. And I'd like very briefly to respond, and I am well aware of the time, but a lot of points have been made. I'm not going to go through them all. You'll all be relieved to know, but I do think that there, first of all, the word encouragement is taken from the Director of Public Prosecutions guidelines, and for good reason, because the Director of Public Prosecutions recognised the power of a person in authority over a person who is vulnerable, and.

That is why it would tend towards prosecution of assistance coming from a person in authority. I would include doctors in that, but also it was thought to be prison staff, nurses and and others who are employed in that role.
14:52
Baroness Finlay of Llandaff Portrait Baroness Finlay of Llandaff (Crossbench)
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I I'm sure it's in trouble. Could I just make this point? Because there's been a number of references to the DPP's guidelines for accuracy. Will the noble Lady accept that paragraph 45 of the guidelines says a prosecution is less likely to be required if and it's item five, the actions of the suspect may be characterised as reluctant encouragement in the face of a determined wish on the part of the victim to commit suicide, the

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sake of accuracy. For the. Sake of accuracy. I completely

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Sake of accuracy. I completely accept that, and I would ask the noble Lord, the noble and learned Lord whilst I'm speaking. Perhaps Lord whilst I'm speaking. Perhaps he might also see whether I am correct that if a person in authority was encouraging, that would tend towards prosecution. That was my understanding. If I can raise a few points, though, I think the noble Lord, Lord hunt, the noble Lord, Lord hunt, absolutely hit the nail on the head when he pointed out that if we had a Royal commission and went through a Royal commission and went through the processes and and so on fully, then we might be in a different then we might be in a different place.

Now, the one of the big problems that we have encountered in looking at this bill has been what has been to be in scope and what is deemed to be out of scope what is deemed to be out of scope of the bill. And if you do not have the services available, then you do the services available, then you do not have true choice. And that is a real problem. And yet those of us that are trying to put down that are trying to put down amendments to bring specialist palliative care provision into palliative care provision into scope to match and stay parallel with any developments within assisted dying service, have repeatedly been told, and I have checked up, and it is in the companion that we cannot extend scope that this was deemed out of scope and therefore, in a way, we feel a bit stuck about how we can make sure that people do get the services they need in terms of the Minister.

The Minister pointed out, as the bill says, and as has been a concern to some of us, in fact, a lot of us that I'm beg your pardon, I there's a quote that I wanted to. There we are. I found it again that the family do not have to be informed. And I think behind that is exactly the concern about the grief. Take the 19 year old with perhaps an osteosarcoma with metastasis. The parents have been looking after him from childhood through all his treatment, doing all they can to enhance his quality of life.

And he says he wants to now go for an assisted death and he does not want his parents told. And the first thing that they hear is a phone call to say that he is now dead, having had lethal drugs. And there may be a whole lot of issues that they're aware have been going on in that 19 year old's life that they would have shared with those who've been involved in his care. And I would say that this is pretty close to some patients that I've looked after in terms of cases where developing into an adult when you're terminally ill is very difficult, and transition issues are very difficult.

But the other aspect of that is that having spoken to people and heard from people who have a relative who has gone for euthanasia, usually euthanasia rather than assisted suicide, the often they feel devastated that their love was not enough to support the person, that they felt that they failed. Why couldn't they have helped the person find ways forward, or access the services they need? And I would like to just quote from Lord Faulkner's own commission with demos in relation to the lack of services, because and it says the Commission does not accept that any of these forms of pressure could be a legitimate motivation for a terminally ill individual to seek an assisted death.

Therefore, it is essential that any future system should contain safeguards designed to ensure, as much as possible, that any decision to seek an assisted suicide is a genuinely voluntary and autonomous choice, not influenced by another person's wishes or by constrained social circumstances such as lack of access to adequate end of life care and support. The motivation behind many of the amendments that have been put down today has been precisely to deal with that problem. The last thing that I would like to address, in fact there are there are two.

One is the concept of how sure do you have to be? And the civil standard of proof of 51%, which does seem remarkably low when you're going to be determining the eligibility of someone to have lethal drugs. And the implication during the debate that occurred in the other place that actually the doctor shouldn't be asking the person, why is it that you want to end your life? And yet, in clinical practice, whenever patients say, I've had enough, I do not want to go on.

You answer that with a question and the question with a question, and it feels like an onion. You take layer on, layer off, and you find out what what happens and you find many remediable aspects to their situation. Often they might seem trivial to some people, but they have been wearing people down. And I am frankly horrified whenever I hear of inadequate care of people not getting the pain relief that they need. Because firstly, morphine does not kill you.

It's a good drug for pain relief, given appropriately in the right dose, at the right time, for the right reason. That's what prescribing analgesia is about. That's completely different to giving a massive overdose of lethal drugs. And all the ones in the world, as we know, have not been fully assessed. And if I can turn very briefly and I apologise, I didn't mean earlier on the discussion over consent refusal versus seeking an assisted death, but these really are fundamentally different.

A patient who is seriously ill and having some intervention that they without which they would have already died is have is consenting every time they have an intervention to carry on having it. If they withdraw their consent and you carry on imposing that treatment, that is actually tort or assault, if they have the capacity to withhold that consent, if they do not have the capacity to hold that consent because they have a delirium or whatever, then you must go through the best interest decision making processes as outlined very clearly in the Mental Capacity Act.

However, if somebody has a life expectancy that may go on for who knows how long, because we know we cannot predict prognosis and they are requesting you to do something to them to bring their life to an end, then actually, it's the person who is providing the lethal drugs who is consenting to do that at the request of the patient. And the patient dies much earlier than they would have died otherwise. And I really am concerned that there is a misunderstanding out there that somehow specialist palliative care, providing good analgesia and providing symptom control is somehow masquerading as shortening life because it isn't.

And to claim that people who die with specialist palliative care input, of which there are thousands every year, do not die with dignity, I have to say I have to defend my professional colleagues and the hospice services. Dignity enhancing therapy has been developed within the palliative care community as to demonstrate how other services may have failed and how you can enhance dignity. And if I'm happy to take.

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The the. Would you agree for one second that that even if someone second that that even if someone has good hospice care and the best medications that they can, there medications that they can, there are still patients that suffer and have pain before death, despite all

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have pain before death, despite all the actions of the of those people who are trying to alleviate it. Yes. Thank you for your intervention.

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Thank you for your intervention. And perhaps it might be helpful for us to have a conversation outside this chamber, but I would just say this chamber, but I would just say that pain is complex. It is not only physical, it has multiple only physical, it has multiple components. And of the patients who I've looked after, the ones who had the we had the most difficulty the we had the most difficulty looking after, we discovered that there were very many issues in the there were very many issues in the psychosocial domain, the emotional domain, things that had happened in the past, some of which we didn't the past, some of which we didn't know about at the time.

But I do not want to go off message from these amendments, which is really important. These amendments were put down in good faith to address put down in good faith to address the concerns that have been expressed all around the House, and expressed all around the House, and I'm disappointed that we haven't got to the point of saying we will all sit down together. I think those of us that have drafted amendments will sit down together, and we will discuss how we should be bringing something back at Report stage to manage the situation that we've highlighted in the debate today, which is a very profound concern over coercion, abuse and all the other factors that go along with that.

Apart from

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amendment. Is it your. Lordship's pleasure that. This amendment.

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This amendment. Be withdrawn? Amendment by leave withdrawn?

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withdrawn? Spent nearly. Four hours, 45 minutes on that group of amendments. I think this would be a convenient

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I think this would be a convenient point to adjourn the House. I beg resumed. The question is that the House.

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The question is that the House. Be resumed. As many of that opinion will say. Content. The contrary not contents.

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The contents have it. Yes. My Lords, I beg to move that the

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My Lords, I beg to move that the House do now adjourn.

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House do now adjourn. But that the House that the
09:30
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