Lords Chamber
Friday 5th December 2025
Skip to latest contribution
This debate has concluded
(began 1 month, 2 weeks ago)
Watch LiveSkip to latest contribution
This debate has concluded
10:06
Legislation: Dogs (Protection of Livestock) (Amendment) Bill - third reading
-
Legislation: Dogs (Protection of Livestock) (Amendment) Bill - third reading
My My Lords, My Lords, I My Lords, I should My Lords, I should like My Lords, I should like to My Lords, I should like to notify the House of the retirement with effect from today of the noble Lord Lord Stone of Blackheath, pursuant to section one of the House of Lords Reform Act, 2014. On behalf of the House, I acknowledge the noble Lords contribution to the work of the House. Third Reading of the dogs. Protection of Livestock
**** Possible New Speaker ****
Amendment Bill Baroness Coffey. My Lords, I beg to move that
**** Possible New Speaker ****
Amendment Bill Baroness Coffey. My Lords, I beg to move that
10:06
10:07
Baroness Coffey (Conservative)
-
-
Baroness Coffey (Conservative)
>> My Lords, I beg to move that this bill do now pass. I have to say, my Lords, the farming community will be delighted that so community will be delighted that so many peers are here for the Third Reading of this important bill. Livestock worrying has devastating consequences, both animals and farmers, and it can be horrific, causing brutal injuries that are tragically, often fatal. And there are instances of stress causing pregnant livestock to miscarry and separation of mothers and their young, leading to hypothermia or starvation.
This modest bill will modernise the Dogs (Protection of Livestock) Act 1953, ensuring it reflects the needs of modern day farming, strengthening policing powers so they can do their job more effectively, giving the police powers of entry and allowing them to seize and detain dogs and to collect evidence. At the moment, particularly, collecting evidence tends to rely on the goodwill of the owners of the suspected dog. Now, I was contacted by a peer this week, the Liberal Baroness, lady who I see in her place with the concern that had been passed on to her, that the word parts in clause one, subsection A, might be interpreted as referring only to footpaths or bridleways or similar.
And it was it was it be important to make it clear that pass had its
This modest bill will modernise the Dogs (Protection of Livestock) Act 1953, ensuring it reflects the needs of modern day farming, strengthening policing powers so they can do their job more effectively, giving the police powers of entry and allowing them to seize and detain dogs and to collect evidence. At the moment, particularly, collecting evidence tends to rely on the goodwill of the owners of the suspected dog. Now, I was contacted by a peer this week, the Liberal Baroness, lady who I see in her place with the concern that had been passed on to her, that the word parts in clause one, subsection A, might be interpreted as referring only to footpaths or bridleways or similar.
And it was it was it be important to make it clear that pass had its
10:08
Legislation: Dogs (Protection of Livestock) (Amendment) Bill - Bill Do Now Pass.
Baroness Coffey (Conservative)
-
Legislation: Dogs (Protection of Livestock) (Amendment) Bill - Bill Do Now Pass.
Baroness Coffey (Conservative)
ordinary meaning? And I intend to do that. Anyone who has driven down country roads will know that farmers move livestock. Now, the bill specifically extends the scope of the provisions to. They do not of the provisions to. They do not only apply to a field that a farmer may own or where livestock are kept. It recognises agricultural It recognises agricultural practices means that animals are often transferred from one field to another, and the current legislation does not apply. Where legislation does not apply.
Where animals are crossing a road and a dog is out of control, or indeed other sections, which is not the actual specific field. So in recognition of that, the bill includes roads and paths as locations where an offence may take place. That will give farmers greater reassurance when moving livestock. And I do understand that parts will have its ordinary meaning. I hope that gives the noble Baroness Assurance, and I hope that I'm sure the Minister will confirm that in her response. My Lords, this bill actually originally started two years ago, in December 2023, when I took it through the Commons, when I was formerly an MP, and my noble friend Lord Colgrain stood ready last year to take it through this House.
And then the election was called. But I do want to thank the new Defra Ministers who recognise the importance of this issue and ensured it became a government handout bill that has allowed us a good passage, but in particular to thank EFRA Brandreth, who picked up the bill shortly after becoming a newly elected MP in Cheshire and who has navigated it through the Commons. Of course, I want to thank the NFU and all those who made multiple representations from right around the country, and I particularly want to thank the officials from Defra who have been working on this for some considerable time.
I do believe this Bill is a straightforward way to make sure that we help our farmers, whose primary role is to grow food, to put on our plates, and should not be worrying literally about other people's animals, worrying their livestock. I beg to move. Yay!
Where animals are crossing a road and a dog is out of control, or indeed other sections, which is not the actual specific field. So in recognition of that, the bill includes roads and paths as locations where an offence may take place. That will give farmers greater reassurance when moving livestock. And I do understand that parts will have its ordinary meaning. I hope that gives the noble Baroness Assurance, and I hope that I'm sure the Minister will confirm that in her response. My Lords, this bill actually originally started two years ago, in December 2023, when I took it through the Commons, when I was formerly an MP, and my noble friend Lord Colgrain stood ready last year to take it through this House.
And then the election was called. But I do want to thank the new Defra Ministers who recognise the importance of this issue and ensured it became a government handout bill that has allowed us a good passage, but in particular to thank EFRA Brandreth, who picked up the bill shortly after becoming a newly elected MP in Cheshire and who has navigated it through the Commons. Of course, I want to thank the NFU and all those who made multiple representations from right around the country, and I particularly want to thank the officials from Defra who have been working on this for some considerable time.
I do believe this Bill is a straightforward way to make sure that we help our farmers, whose primary role is to grow food, to put on our plates, and should not be worrying literally about other people's animals, worrying their livestock. I beg to move. Yay!
10:10
Lord Colgrain (Conservative)
-
-
Lord Colgrain (Conservative)
The question is that this bill do now pass. frontbench responses. I too would like to add my thanks to your Lordships' House and to the other place for their speed and constructive nature of the passage of this bill. As I said at Second Reading, I borne personal witness to horrible dog attacks on sheep, for which this bill will make dog owners more accountable. The farming community is facing strong headwinds at the moment, and this small and seemingly innocuous bill will provide when it receives Royal Assent.
The best possible Christmas present to all livestock owners.
The best possible Christmas present to all livestock owners.
10:10
Baroness Mallalieu (Labour)
-
-
Baroness Mallalieu (Labour)
Yes.
**** Possible New Speaker ****
I would like to add my voice to praise for the noble Baroness, who has pursued this bill for some has pursued this bill for some considerable time, and to express gratitude both to her and to the Minister, for allowing it to pass Minister, for allowing it to pass from grateful sheep owners and dog owners everywhere. Thank you.
**** Possible New Speaker ****
I would like to add my voice to praise for the noble Baroness, who has pursued this bill for some has pursued this bill for some considerable time, and to express gratitude both to her and to the Minister, for allowing it to pass Minister, for allowing it to pass from grateful sheep owners and dog owners everywhere. Thank you.
10:11
The Earl of Effingham (Conservative)
-
-
The Earl of Effingham (Conservative)
>> Well done. >> My Lords. >> Please let me thank the noble Baroness. Lady Coffey, the first female deputy Prime Minister in British history, for her work on this bill, which embodies the steadfast conservative commitment to farmers. We should also flag the many organisations who have campaigned for and been instrumental in delivering reform in this area. His Majesty's Loyal Opposition is fully supportive of the Bill, which is a long overdue update to the law and of genuine benefit to rural communities such as the one that I myself live in.
This bill will, among other measures, extend the powers available to the police to enforce the law against incidents of livestock worrying. With an estimated 34,000 incidents of livestock worrying every year across England and Wales. This issue is of key concern not only because of the significant financial costs, but also because of the distress it causes to farmers who truly care for the animals in their keep, who and who themselves have to bear both the emotional and monetary scars.
It also includes new protection for the 45,000 alpacas and llamas, whose UK population continues to grow, and they will now be afforded the same protections as other livestock under the 1953 act. By enhancing powers of enforcement, encouraging responsible dog ownership and securing justice for those negatively impacted. This bill delivers for both farmers and their livestock. We commend the bill to your Lordships' House, and we look forward to seeing it complete its final stages. complete its final stages.
This bill will, among other measures, extend the powers available to the police to enforce the law against incidents of livestock worrying. With an estimated 34,000 incidents of livestock worrying every year across England and Wales. This issue is of key concern not only because of the significant financial costs, but also because of the distress it causes to farmers who truly care for the animals in their keep, who and who themselves have to bear both the emotional and monetary scars.
It also includes new protection for the 45,000 alpacas and llamas, whose UK population continues to grow, and they will now be afforded the same protections as other livestock under the 1953 act. By enhancing powers of enforcement, encouraging responsible dog ownership and securing justice for those negatively impacted. This bill delivers for both farmers and their livestock. We commend the bill to your Lordships' House, and we look forward to seeing it complete its final stages. complete its final stages.
10:13
Baroness Hayman of Ullock, The Parliamentary Under-Secretary of State for Environment, Food and Rural Affairs (Labour)
-
-
Baroness Hayman of Ullock, The Parliamentary Under-Secretary of State for Environment, Food and Rural Affairs (Labour)
My Lords, I'm very grateful to all noble Lords for their contributions and for their support for this Bill through its passage in the House. I would like to thank the hon. Member for Chester South and Eddisbury for introducing this very important Bill in the other place, and, of course, to thank the noble Lady Baroness Coffey, for successfully guiding the Bill through this House. But also keeping at it, I think, is the is the description. So I'm really pleased that, as we've heard, the bill makes really important changes to strengthen police powers and also increases fines as a deterrent, as well as expanding the scope to include incidents on camelids.
I'd also just to reference roads and paths. As the noble Lady Baroness Coffey mentioned, we'd had an email from my noble friend Baroness Mallalieu, so I'd just like to clarify that the ordinary meanings of road and path are broad, and we would expect the courts to interpret road or path broadly to include things like tracks, for example, in order that it doesn't have that narrow meaning, which the noble Lady was concerned about. The passing of this bill is clearly important for our farmers and their livestock, and the strength and provisions will send a clear message that livestock worrying is a serious offence, and responsible dog owners must be accountable.
The provisions will serve as a deterrent, but also restore confidence among farmers and members of rural communities, many of whom live in fear of the devastating impact of such incidents, and that what the impact they have on their livelihoods and also the welfare of their animals. This bill is a truly meaningful step forward in our commitment to animal welfare, and to those who work tirelessly to sustain our agricultural sector, and I look forward to seeing the positive impact that it will have.
I'd also just to reference roads and paths. As the noble Lady Baroness Coffey mentioned, we'd had an email from my noble friend Baroness Mallalieu, so I'd just like to clarify that the ordinary meanings of road and path are broad, and we would expect the courts to interpret road or path broadly to include things like tracks, for example, in order that it doesn't have that narrow meaning, which the noble Lady was concerned about. The passing of this bill is clearly important for our farmers and their livestock, and the strength and provisions will send a clear message that livestock worrying is a serious offence, and responsible dog owners must be accountable.
The provisions will serve as a deterrent, but also restore confidence among farmers and members of rural communities, many of whom live in fear of the devastating impact of such incidents, and that what the impact they have on their livelihoods and also the welfare of their animals. This bill is a truly meaningful step forward in our commitment to animal welfare, and to those who work tirelessly to sustain our agricultural sector, and I look forward to seeing the positive impact that it will have.
10:15
-
Good question is that this bill do now pass, as many of that
**** Possible New Speaker ****
opinion will say, content. Content. Content content, the content
**** Possible New Speaker ****
habit. Message from the Commons that they have passed the pension schemes Bill to which they desire.
**** Possible New Speaker ****
schemes Bill to which they desire. The agreement of your lordships. My Lords, I beg to move that
**** Possible New Speaker ****
My Lords, I beg to move that time. The question is that this bill be now read a first time, as many be now read a first time, as many of that opinion will say. Content the contrary, not content. The contents have it.
**** Possible New Speaker ****
opinion will say, content. Content. Content content, the content
**** Possible New Speaker ****
habit. Message from the Commons that they have passed the pension schemes Bill to which they desire.
**** Possible New Speaker ****
schemes Bill to which they desire. The agreement of your lordships. My Lords, I beg to move that
**** Possible New Speaker ****
My Lords, I beg to move that time. The question is that this bill be now read a first time, as many be now read a first time, as many of that opinion will say. Content the contrary, not content. The contents have it.
10:15
Lord Kennedy of Southwark (Labour)
-
-
Lord Kennedy of Southwark (Labour)
My Lords, as I've done on previous days, I will make a short statement about proceedings today before we start Committee stage of everything we're about to say remains in line with how business usually would move forward, and has done so on the previous two days of committee. The Government Whips Office distributed and updated groupings to noble Lords yesterday on the noble friend, Lord Falconer of Thoroton has set a target for today's debates. The government remains neutral, but I would highlight that we have only had considered three groups in the two previous days, with only one group debated on the last sitting Friday.
I would hope that noble Lords can make much greater progress today, to ensure that a wider range of important amendments can be scrutinised in the time available. I remind our laws that there is significant public interest in the bill, and there are strongly held views both for and against the bill. It is right all sides that we undertake detailed scrutiny, but also we seek to make much more progress. My Lords, this is Committee stage, so participants in the debate should address their remarks to the amendments under consideration and not make long Second Reading speeches going way beyond the substantive amendments being debated.
This should help us make progress at the Committee stage many times before standing at this Dispatch Box as Government Chief Whip and previously standing the opposite Dispatch Box as Opposition Chief Whip, I have stressed the importance of the companion to assist us on our debates, and I do so again today. In particular, I refer noble Lords to page 143 .8.81, which makes clear that noble Lords should not summarise or repeat others at length, not make Second Reading speeches and the points made should be relevant to the amendments being discussed and .8.82 on page 143 that when withdrawing amendments, noble Lords should be brief.
We also do not take interventions on interventions, and if a noble Lord is intervened on it, is for a brief questions of clarification, not a speech .4.29 on page 60 makes that clear for all members. I am sure all noble Lords will want to show the House at its best. I urge all noble Lords participate in participating to continue to debate the issues before the House, with the usual courtesy and respect that we all expect, and not to let themselves at a house down by doing anything other than that.
I remind the House again, as I did last sitting Friday, that the microphones in the House are sensitive. Noble Lords should also take care. In remarks made during conversations in the chamber that they would not broadcast live. If you wish to speak to other colleagues, please do so outside the chamber. To avoid disrupting the debate, I can recommend the Long Room, the Peers Guest Room and the Royal Gallery as ideal places to go. Finally, to help colleagues in planning their day, I expect the House to rise again at a convenient point around 3 p.m.
It could be slightly before that or slightly after, but that will end around that time. I will return to the house this afternoon to make a further statement to help colleagues conclude the debate. colleagues conclude the debate.
I would hope that noble Lords can make much greater progress today, to ensure that a wider range of important amendments can be scrutinised in the time available. I remind our laws that there is significant public interest in the bill, and there are strongly held views both for and against the bill. It is right all sides that we undertake detailed scrutiny, but also we seek to make much more progress. My Lords, this is Committee stage, so participants in the debate should address their remarks to the amendments under consideration and not make long Second Reading speeches going way beyond the substantive amendments being debated.
This should help us make progress at the Committee stage many times before standing at this Dispatch Box as Government Chief Whip and previously standing the opposite Dispatch Box as Opposition Chief Whip, I have stressed the importance of the companion to assist us on our debates, and I do so again today. In particular, I refer noble Lords to page 143 .8.81, which makes clear that noble Lords should not summarise or repeat others at length, not make Second Reading speeches and the points made should be relevant to the amendments being discussed and .8.82 on page 143 that when withdrawing amendments, noble Lords should be brief.
We also do not take interventions on interventions, and if a noble Lord is intervened on it, is for a brief questions of clarification, not a speech .4.29 on page 60 makes that clear for all members. I am sure all noble Lords will want to show the House at its best. I urge all noble Lords participate in participating to continue to debate the issues before the House, with the usual courtesy and respect that we all expect, and not to let themselves at a house down by doing anything other than that.
I remind the House again, as I did last sitting Friday, that the microphones in the House are sensitive. Noble Lords should also take care. In remarks made during conversations in the chamber that they would not broadcast live. If you wish to speak to other colleagues, please do so outside the chamber. To avoid disrupting the debate, I can recommend the Long Room, the Peers Guest Room and the Royal Gallery as ideal places to go. Finally, to help colleagues in planning their day, I expect the House to rise again at a convenient point around 3 p.m.
It could be slightly before that or slightly after, but that will end around that time. I will return to the house this afternoon to make a further statement to help colleagues conclude the debate. colleagues conclude the debate.
10:19
Lord Falconer of Thoroton (Labour)
-
-
Lord Falconer of Thoroton (Labour)
Could I thank the Chief Whip for his statement? Could I also express the gratitude of the whole House, particularly those involved in this, for the work done by his office, in particular Mr. Michael Blakeley, for getting groupings in a very, very difficult situation? I pay a tribute to him. We have approximately seven days left to get through the Committee stage, which I believe we can do with goodwill. From my part, that means I must ensure that I demonstrate and listen to the concerns of this house, which I will do.
**** Possible New Speaker ****
House. House to be again in committee on the terminally ill
**** Possible New Speaker ****
committee on the terminally ill adults. End of life bill, Lord Falconer of Thoroton. I beg to move that the House do
**** Possible New Speaker ****
I beg to move that the House do now resolve itself into a committee upon the bill. The question is that the House do now again resolve itself into a do now again resolve itself into a committee upon the bill, as many of that opinion will say. Content the contrary, not content. The contents contrary, not content. The contents have it. Clause one, amendment four Baroness Berger.
**** Possible New Speaker ****
House. House to be again in committee on the terminally ill
**** Possible New Speaker ****
committee on the terminally ill adults. End of life bill, Lord Falconer of Thoroton. I beg to move that the House do
**** Possible New Speaker ****
I beg to move that the House do now resolve itself into a committee upon the bill. The question is that the House do now again resolve itself into a do now again resolve itself into a committee upon the bill, as many of that opinion will say. Content the contrary, not content. The contents contrary, not content. The contents have it. Clause one, amendment four Baroness Berger.
10:20
-
My Lords, I rise to speak to the group of amendments that begin with amendment four to clause one. My amendments four, two, 492, 53, oh amendments four, two, 492, 53, oh four, 337, 446 and 448 raise the eligibility for the provision of assistance under the Bill from 18 to 25. There is no reason, either in law or principle, why we should assume that the age of 18 is the right age for eligibility for an assisted death. It is not only an arbitrary starting point, but it is also contrary to the mounting evidence of when the brain is fully formed, which I will come to in
10:20
Amendment:4
Baroness Berger (Labour)
-
Amendment:4
Baroness Berger (Labour)
just a moment. When I asked the Children's Commissioner, Dame Rachel de Souza, whose role it is to promote and protect the rights of children and young people, what she thought of the age of 18 being used as a cliff edge for eligibility under the bill. She answered that the reality of life on the ground is those of you who work with health will know is that 18 is not really a thing when it comes to the most vulnerable. That is extended to 25.
She went on to say, I think that we are missing a trick by thinking somehow 18 is the cut off. I really do strongly think that I would like the committee to consider that noble Lords will be aware that there are a range of existing circumstances where the age of 25 is already seen as a threshold to adulthood, instead of 18. This is particularly relevant when we consider vulnerable young people with a terminal illness that we need to consider in this legislation, lest we forget that children are not currently mentioned in the bill.
The point was forcefully made to the to the select Committee. The Children's Commissioner said. They are the children. I am worried about children with special educational needs, children who are already in hospital with life limiting diseases, children who have education, health and care plans that provide support for them until the age of 25. The reason that they do that is they are vulnerable, whether it is mental health concerns, whether it is because they have had terrible lives, they might have all sorts of problems, including suicidal ideation.
It is a real concern. Noble Lords will know that local, local authorities are responsible for preparing and maintaining EHC for children and young people with special educational needs up to the age of 25. Our local authorities have a statutory responsibility for young people up to this age, particularly those in care and those with special educational needs. And it was more than a decade ago that the Department for health, in its document feature in mind, recommended an extension of child and adolescent mental health services up until the age of 25 to end the practice of discharging young people out of mental health services at 18.
In the context of criminal justice, I am mindful of the words of the noble Lord, Lord Faulkner himself, who said in his speech in 2021 on the police, crime, Sentencing and Courts Bill that a whole life term should never be imposed on an offender aged 18 to 20, but only on somebody unequivocally an adult. I hope he will agree with me that death is not a less weighty matter than life in prison. We have heard concerns during the progress of this bill from experts who work with teenagers and young adults that it will be safer and more in line with the evidence to raise the minimum age for assisted dying to 25.
It is by this point that the brain is more fully developed and decision making capabilities are more secure. In general, the brain does not finish developing until a person is in their mid 20s, and this is particularly the case for the prefrontal cortex, which governs our decision making functions and our ability to think flexibly about potential outcomes. Noble Lords may have seen research announced only last week by the University of Cambridge to suggest that the brain is only fully developed into our early 30s.
I believe we are here to make good law, and one of the ways we do this is to listen when experts speak and to take their counsel. The simple fact of having enabled experts to give their evidence to this House over recent months does not amount to adequate scrutiny. If that evidence simply languishes on the pages of Hansard, instead of being used to shape our work. Of course, I know that an assisted death would would only be available to young people with a six month prognosis, but we know that it is not always accurate and is, as I've learnt, particularly difficult to get right with young people who can go on to live for years beyond an initial terminal diagnosis.
In their written evidence to the Other place, the charity together for Short Lives wrote that we are concerned that the requirement for an accurate prognosis to be provided for a person to be considered as terminally ill may result in ambiguity when considering the eligibility of young people with life threatening conditions whose prognosis is uncertain. Whilst the majority of adults only need palliative care at the end of their lives, many young people with life limiting and life threatening conditions require palliative care over a much longer period, often from birth or even in the womb.
During this time, it is common for their conditions to fluctuate, meaning many young people may experience relatively long periods of stability. It is therefore much more difficult to provide an accurate prognosis and identify when a young person is moving towards their end of life, stage together for Short lives also recommends that under this bill, we consider how those aged 18 to 25 with the education, health and care plans how they will be affected. The bill, as it currently stands, is at risk of pushing young people with life limiting conditions into thinking that reaching the age of 18 means that they are not obliged to consider whether they should continue to live or not.
What does this say about how we value their lives? We also cannot ignore the unique responsibilities faced by young people today. We know that social media has become a powerful driver of harm. Research from the Molly Rose Foundation, a suicide prevention charity, shows that vulnerable young people are disproportionately exposed to posts that glamorise suicide or present suicidal thoughts as normal, appealing or even fashionable. Alarmingly, 68% of young people with low wellbeing are being served this type of content.
In such an environment, how can we claim to be safeguarding young people if, beyond the hospital bed, the digital world is telling them that their lives are not worth living? If this content is impacting young people when they are well, how much more so will it play on the mind of a terminally ill young person to allow access to assisted dying at an age when external pressures are so pervasive, and when identity and resilience are still forming risks compounding vulnerability rather than offering protection.
When families, carers and local services should be striving to provide the very best care, we would instead be sending them confused and dangerous message that 18 year olds are instead now ready to choose and plan their own deaths. This list. This is of particular concern when we consider young people with learning disabilities, and how competence should be established in those cases, particularly given the fact that young people with learning disabilities receive worse health care in general, as evidenced by the National Child Mortality Database, which exposed in their Learning Disabilities and Autism study that children aged 4 to 17 with a diagnosed learning disability accounted for 31% of all deaths, despite only 2.5% of children in the UK having a diagnosed learning disability.
And the challenges with the health service that misses a lot, that misses lots of health issues for this group of children and young people. Because of communication and advocacy barriers. The 2023 learning from Lives and Deaths. People with a Learning Disability and Autistic People report found that 42% of deaths of people with a learning disability were rated as avoidable, compared with 22% for the general population. It is in this context, and for all the other reasons I have set out, that I am strongly persuaded that raising the age of eligibility to 25 is the right thing to do.
I am also haunted by the words of one child that was shared with us at the select committee. The young person said, I'm in care. I've got disabilities. The government will pay for me to die under this bill, but it won't pay for me to live. I conclude with a final contribution from the from the Children's Commissioner, where she said I would far rather that we erred on the side of caution, protecting those who have had terrible lives, terrible experience, experiences, have been abused, have had their families turn them out.
Protecting those who are suffering from extreme mental illness. Protecting those with special educational needs and disabilities, protecting anorexic children who are heading into adulthood and saying, let's on the side of caution and go for 25. I am clear that we must continue to say to children and young people, yes, your life matters. Even if it will be a short life, it matters.
She went on to say, I think that we are missing a trick by thinking somehow 18 is the cut off. I really do strongly think that I would like the committee to consider that noble Lords will be aware that there are a range of existing circumstances where the age of 25 is already seen as a threshold to adulthood, instead of 18. This is particularly relevant when we consider vulnerable young people with a terminal illness that we need to consider in this legislation, lest we forget that children are not currently mentioned in the bill.
The point was forcefully made to the to the select Committee. The Children's Commissioner said. They are the children. I am worried about children with special educational needs, children who are already in hospital with life limiting diseases, children who have education, health and care plans that provide support for them until the age of 25. The reason that they do that is they are vulnerable, whether it is mental health concerns, whether it is because they have had terrible lives, they might have all sorts of problems, including suicidal ideation.
It is a real concern. Noble Lords will know that local, local authorities are responsible for preparing and maintaining EHC for children and young people with special educational needs up to the age of 25. Our local authorities have a statutory responsibility for young people up to this age, particularly those in care and those with special educational needs. And it was more than a decade ago that the Department for health, in its document feature in mind, recommended an extension of child and adolescent mental health services up until the age of 25 to end the practice of discharging young people out of mental health services at 18.
In the context of criminal justice, I am mindful of the words of the noble Lord, Lord Faulkner himself, who said in his speech in 2021 on the police, crime, Sentencing and Courts Bill that a whole life term should never be imposed on an offender aged 18 to 20, but only on somebody unequivocally an adult. I hope he will agree with me that death is not a less weighty matter than life in prison. We have heard concerns during the progress of this bill from experts who work with teenagers and young adults that it will be safer and more in line with the evidence to raise the minimum age for assisted dying to 25.
It is by this point that the brain is more fully developed and decision making capabilities are more secure. In general, the brain does not finish developing until a person is in their mid 20s, and this is particularly the case for the prefrontal cortex, which governs our decision making functions and our ability to think flexibly about potential outcomes. Noble Lords may have seen research announced only last week by the University of Cambridge to suggest that the brain is only fully developed into our early 30s.
I believe we are here to make good law, and one of the ways we do this is to listen when experts speak and to take their counsel. The simple fact of having enabled experts to give their evidence to this House over recent months does not amount to adequate scrutiny. If that evidence simply languishes on the pages of Hansard, instead of being used to shape our work. Of course, I know that an assisted death would would only be available to young people with a six month prognosis, but we know that it is not always accurate and is, as I've learnt, particularly difficult to get right with young people who can go on to live for years beyond an initial terminal diagnosis.
In their written evidence to the Other place, the charity together for Short Lives wrote that we are concerned that the requirement for an accurate prognosis to be provided for a person to be considered as terminally ill may result in ambiguity when considering the eligibility of young people with life threatening conditions whose prognosis is uncertain. Whilst the majority of adults only need palliative care at the end of their lives, many young people with life limiting and life threatening conditions require palliative care over a much longer period, often from birth or even in the womb.
During this time, it is common for their conditions to fluctuate, meaning many young people may experience relatively long periods of stability. It is therefore much more difficult to provide an accurate prognosis and identify when a young person is moving towards their end of life, stage together for Short lives also recommends that under this bill, we consider how those aged 18 to 25 with the education, health and care plans how they will be affected. The bill, as it currently stands, is at risk of pushing young people with life limiting conditions into thinking that reaching the age of 18 means that they are not obliged to consider whether they should continue to live or not.
What does this say about how we value their lives? We also cannot ignore the unique responsibilities faced by young people today. We know that social media has become a powerful driver of harm. Research from the Molly Rose Foundation, a suicide prevention charity, shows that vulnerable young people are disproportionately exposed to posts that glamorise suicide or present suicidal thoughts as normal, appealing or even fashionable. Alarmingly, 68% of young people with low wellbeing are being served this type of content.
In such an environment, how can we claim to be safeguarding young people if, beyond the hospital bed, the digital world is telling them that their lives are not worth living? If this content is impacting young people when they are well, how much more so will it play on the mind of a terminally ill young person to allow access to assisted dying at an age when external pressures are so pervasive, and when identity and resilience are still forming risks compounding vulnerability rather than offering protection.
When families, carers and local services should be striving to provide the very best care, we would instead be sending them confused and dangerous message that 18 year olds are instead now ready to choose and plan their own deaths. This list. This is of particular concern when we consider young people with learning disabilities, and how competence should be established in those cases, particularly given the fact that young people with learning disabilities receive worse health care in general, as evidenced by the National Child Mortality Database, which exposed in their Learning Disabilities and Autism study that children aged 4 to 17 with a diagnosed learning disability accounted for 31% of all deaths, despite only 2.5% of children in the UK having a diagnosed learning disability.
And the challenges with the health service that misses a lot, that misses lots of health issues for this group of children and young people. Because of communication and advocacy barriers. The 2023 learning from Lives and Deaths. People with a Learning Disability and Autistic People report found that 42% of deaths of people with a learning disability were rated as avoidable, compared with 22% for the general population. It is in this context, and for all the other reasons I have set out, that I am strongly persuaded that raising the age of eligibility to 25 is the right thing to do.
I am also haunted by the words of one child that was shared with us at the select committee. The young person said, I'm in care. I've got disabilities. The government will pay for me to die under this bill, but it won't pay for me to live. I conclude with a final contribution from the from the Children's Commissioner, where she said I would far rather that we erred on the side of caution, protecting those who have had terrible lives, terrible experience, experiences, have been abused, have had their families turn them out.
Protecting those who are suffering from extreme mental illness. Protecting those with special educational needs and disabilities, protecting anorexic children who are heading into adulthood and saying, let's on the side of caution and go for 25. I am clear that we must continue to say to children and young people, yes, your life matters. Even if it will be a short life, it matters.
10:29
Baroness Watkins of Tavistock (Crossbench)
-
-
Baroness Watkins of Tavistock (Crossbench)
Year noble Lady wishes to move >> Year noble Lady wishes to move the amendment. Amendment proposed. Clause one, page one, line six. Leave out 18 and insert 25.
**** Possible New Speaker ****
I want to stand to support in principle this amendment based on principle this amendment based on the research in relation to cerebral development. I think it's well made, and I think it's an well made, and I think it's an example of something that we are really here to think through to enhance the bill. However, I would enhance the bill. However, I would like to point out that the bill does exclude anybody with a lack of does exclude anybody with a lack of capacity.
So several of the people that the previous Baroness referred to would not be entitled to consider assisted dying.
**** Possible New Speaker ****
I want to stand to support in principle this amendment based on principle this amendment based on the research in relation to cerebral development. I think it's well made, and I think it's an well made, and I think it's an example of something that we are really here to think through to enhance the bill. However, I would enhance the bill. However, I would like to point out that the bill does exclude anybody with a lack of does exclude anybody with a lack of capacity.
So several of the people that the previous Baroness referred to would not be entitled to consider assisted dying.
10:30
Lord Winston (Labour)
-
-
Lord Winston (Labour)
I thought, may I suggest that the noble Lady meaning absolutely well and obviously clearly a very emotional area, has actually forgotten the real science. She's not a neuroscientist, and indeed, I don't think that the commissioner is a neuroscientist, the greatest expert in the United Kingdom on teenage neuroscience is almost unquestionably Sarah-jayne Blakemore, who works partly in London, partly in Cambridge, and, of course, has been working extensively in the United at UCL for a long period of time.
She has studied teenagers in great detail, and it's very clear from her work on teenagers making decisions that they can make decisions in the right environment and in the right circumstances, and I think one has to be very, very careful about making assertions about teenagers. There are many people who are well over the age of 25 who cannot make these decisions either. And I think we have to be quite clear that we may need to take this sort of thing into consideration, but I don't think it's necessarily relevant in this amendment.
She has studied teenagers in great detail, and it's very clear from her work on teenagers making decisions that they can make decisions in the right environment and in the right circumstances, and I think one has to be very, very careful about making assertions about teenagers. There are many people who are well over the age of 25 who cannot make these decisions either. And I think we have to be quite clear that we may need to take this sort of thing into consideration, but I don't think it's necessarily relevant in this amendment.
10:31
Baroness Stroud (Conservative)
-
-
Baroness Stroud (Conservative)
Thank you. speak in support of the noble Lady Baroness Virgin. And I will limit my remarks, because some of them have already been referred to in previous comments by speakers. But I think the reality is that maturity is a scale, and choosing to proceed with assisted dying at the age of 18 poses difficult questions, which we must grapple with about the neurological maturity required for true, settled and informed consent on a matter of such gravity, and not just particular circumstances.
I intend to speak to a subsequent grouping in relation to amendment 22, in the name of the noble Baroness, Lady Grey-thompson, but some of the points I will make then are also relevant to this grouping. I note that research undertaken by the Sentencing Council in 2024, which focussed on aggravating and mitigating factors in sentencing guidelines, has this to say with regard to age and maturity, age and or lack of maturity can affect the offender's responsibility for the offence and the effect of the sentence on the offender.
Either or both of these considerations may justify a reduction in the sentence. The report goes on to note that, in particular, young adults typically aged 18 to 25 are still developing neurologically and consequently may be less able to evaluate the consequences of their actions, limit impulsivity, and limit risk taking. Young adults are likely to be susceptible to peer pressure, and are more likely to take risks or behave impulsively when in company with their peers. My Lords, I do not want to cross over into debate on the subsequent group, but this seems highly relevant to our deliberations on on age and the appropriate age for assisted dying.
Of course, age and maturity are mitigating factors only and therefore discretionary. But it seems extraordinary to me that the principle of maturity is one which is accepted in a legal context, and there remain calls for dedicated sentencing guidelines for 18 to 25 year olds in recognition of this. Yet the bill, as drafted, does not seem to adequately account for this in a similar manner, with regard to the permanent decision to end one's own life. So I would be grateful if the noble and learned Lord, Lord Falconer, could comment on this when he responds to the debate.
My Lords, the autonomy on which this bill is purportedly built must be grounded in safeguards commensurate with the irreversible nature of the proposed act. With regards to the age of eligibility, I do not believe the bill as drafted meets this standard. For these reasons and more, I support the amendments in the names of the noble Baroness, Lady Birger, Noble, Baroness, Lady Lawlor, as well as those in the name of the noble Baroness, Lady Gowdie and noble Lord Lord Moylan.
I intend to speak to a subsequent grouping in relation to amendment 22, in the name of the noble Baroness, Lady Grey-thompson, but some of the points I will make then are also relevant to this grouping. I note that research undertaken by the Sentencing Council in 2024, which focussed on aggravating and mitigating factors in sentencing guidelines, has this to say with regard to age and maturity, age and or lack of maturity can affect the offender's responsibility for the offence and the effect of the sentence on the offender.
Either or both of these considerations may justify a reduction in the sentence. The report goes on to note that, in particular, young adults typically aged 18 to 25 are still developing neurologically and consequently may be less able to evaluate the consequences of their actions, limit impulsivity, and limit risk taking. Young adults are likely to be susceptible to peer pressure, and are more likely to take risks or behave impulsively when in company with their peers. My Lords, I do not want to cross over into debate on the subsequent group, but this seems highly relevant to our deliberations on on age and the appropriate age for assisted dying.
Of course, age and maturity are mitigating factors only and therefore discretionary. But it seems extraordinary to me that the principle of maturity is one which is accepted in a legal context, and there remain calls for dedicated sentencing guidelines for 18 to 25 year olds in recognition of this. Yet the bill, as drafted, does not seem to adequately account for this in a similar manner, with regard to the permanent decision to end one's own life. So I would be grateful if the noble and learned Lord, Lord Falconer, could comment on this when he responds to the debate.
My Lords, the autonomy on which this bill is purportedly built must be grounded in safeguards commensurate with the irreversible nature of the proposed act. With regards to the age of eligibility, I do not believe the bill as drafted meets this standard. For these reasons and more, I support the amendments in the names of the noble Baroness, Lady Birger, Noble, Baroness, Lady Lawlor, as well as those in the name of the noble Baroness, Lady Gowdie and noble Lord Lord Moylan.
10:34
Baroness Hollins (Crossbench)
-
-
Baroness Hollins (Crossbench)
Thank you my. Lord.
**** Possible New Speaker ****
You support the noble Lady
**** Possible New Speaker ****
You support the noble Lady Baroness Berger in this. I'd like to just add to earlier comments the to just add to earlier comments the transition from children's to adult services at 18 is well known to be services at 18 is well known to be a very confusing and destabilising period, during which key clinical period, during which key clinical relationships are lost and important elements of a young person's history may not be carried forward. These factors are directly relevant to assessing decision making capacity and identifying safeguarding concerns for individuals aged 18 and above who may seek assisted dying.
I think also raising the minimum age to a higher age would allow for any medical advances. For example, with emerging new treatments that might change a young person's prognosis. And so it's important not to be too hasty. I was also going to comment on the Scottish Sentencing Council, and I just wanted to add that. The sort of something, again, about the developmental process which is still underway, which can increase susceptibility to influence and vulnerability to risk taking, and the likelihood of short term, emotionally driven decision making.
Just have to think about the the fact that in that age group, the biggest cause of death is actually accidental death. The research done by the Sentencing Council, you know, also shows that also further research shows that maturity may be delayed by adverse childhood experiences. And it's therefore reasonable to assume that some young adults with serious illness may carry such developmental vulnerabilities into their decision making around the end of life. And I think the Sentencing Council guideline suggesting lower culpability and a greater capacity for change than older adults really does endorse the suggestion that we should we should change the age, the minimum age to 25.
This is an irreversible decision. We need enhanced safeguards for this age group, and I support the amendments.
**** Possible New Speaker ****
You support the noble Lady
**** Possible New Speaker ****
You support the noble Lady Baroness Berger in this. I'd like to just add to earlier comments the to just add to earlier comments the transition from children's to adult services at 18 is well known to be services at 18 is well known to be a very confusing and destabilising period, during which key clinical period, during which key clinical relationships are lost and important elements of a young person's history may not be carried forward. These factors are directly relevant to assessing decision making capacity and identifying safeguarding concerns for individuals aged 18 and above who may seek assisted dying.
I think also raising the minimum age to a higher age would allow for any medical advances. For example, with emerging new treatments that might change a young person's prognosis. And so it's important not to be too hasty. I was also going to comment on the Scottish Sentencing Council, and I just wanted to add that. The sort of something, again, about the developmental process which is still underway, which can increase susceptibility to influence and vulnerability to risk taking, and the likelihood of short term, emotionally driven decision making.
Just have to think about the the fact that in that age group, the biggest cause of death is actually accidental death. The research done by the Sentencing Council, you know, also shows that also further research shows that maturity may be delayed by adverse childhood experiences. And it's therefore reasonable to assume that some young adults with serious illness may carry such developmental vulnerabilities into their decision making around the end of life. And I think the Sentencing Council guideline suggesting lower culpability and a greater capacity for change than older adults really does endorse the suggestion that we should we should change the age, the minimum age to 25.
This is an irreversible decision. We need enhanced safeguards for this age group, and I support the amendments.
10:36
Baroness Rebuck (Labour)
-
-
Baroness Rebuck (Labour)
Lord Dear let me just. >> State that for very different reasons. I have a great deal of respect for both the noble Ladies, Baroness Lawlor and Baroness Berger, Baroness Lawlor and Baroness Berger, but in this instance, I have serious qualms about these amendments in relation to raising the minimum age for receiving assistance to end one's own life to either 21 or 25. I think we need to hold on to the standard age that we consider adult responsibility to begin.
That is 18 as indeed the bill does. I actually worry we are already getting ourselves into a tangle on age issues. For example, the proposals to lower the voting age is now to 16, and I wonder how the sponsor of the bill will hold the line at 18, when those newly enfranchised 16 to 18 year olds start demanding equal entitlements from 16. I mean, logically, those teens will have a point when they argue, if you trust us to decide on the future of our country, why not trust us to decide on the future of our own fate if we fit the other eligibility criteria? So I would like some reassurances from the noble Lord, Lord Faulkner, that this age slippage won't happen, but also that the age 18 is a watertight age in terms of eligibility.
And there's other amendments later on. Conversely, can I ask the noble Baroness Cass, is there a danger of unintended consequences of using the argument that the young brain hasn't developed sufficiently at 18 to make such important decisions? It does make me anxious when neuro development research is cited about cognitive development and a lack of maturity about anyone under the age of 25, and that's used to challenge the decision making capacity of anyone between the ages of 21 or 25.
I mean, I fear that that could be used regressively. I mean, how can we trust 18 to 25 year olds to vote or be asked to take on any adult responsibilities if their brains are still developing? So where are we going to end up? So I think we need to avoid unintentionally institutionalising state paternalism that robs young adults of their individual rights and limits the the choices on their own fate in various ways. The cultural shift to infantilize the post 18 cohort, which is a broader problem, is, in my opinion, regressive.
And just finally, I am very sympathetic to the concerns that have been raised here already. I do think it might be worth considering some kind of a carve out for 18 to 25 year olds on E.H. but that would be an exception, not a rule. I understand that viscerally. The idea of any young person, 1920, having a terminal diagnosis and then being offered the choice of an even earlier death fills me with horror, gives me the chills, and it's tragic.
But I still think 18, if tightly protected by the sponsors of the bill, is adequate in relation to age safeguards. There are plenty of other safeguards I'm worried about without adding to them. And I also think there's a problem of a culture being created for the young in general of suicidal ideation. By this bill. However, I would say that these amendments don't resolve those broader problems that I have.
That is 18 as indeed the bill does. I actually worry we are already getting ourselves into a tangle on age issues. For example, the proposals to lower the voting age is now to 16, and I wonder how the sponsor of the bill will hold the line at 18, when those newly enfranchised 16 to 18 year olds start demanding equal entitlements from 16. I mean, logically, those teens will have a point when they argue, if you trust us to decide on the future of our country, why not trust us to decide on the future of our own fate if we fit the other eligibility criteria? So I would like some reassurances from the noble Lord, Lord Faulkner, that this age slippage won't happen, but also that the age 18 is a watertight age in terms of eligibility.
And there's other amendments later on. Conversely, can I ask the noble Baroness Cass, is there a danger of unintended consequences of using the argument that the young brain hasn't developed sufficiently at 18 to make such important decisions? It does make me anxious when neuro development research is cited about cognitive development and a lack of maturity about anyone under the age of 25, and that's used to challenge the decision making capacity of anyone between the ages of 21 or 25.
I mean, I fear that that could be used regressively. I mean, how can we trust 18 to 25 year olds to vote or be asked to take on any adult responsibilities if their brains are still developing? So where are we going to end up? So I think we need to avoid unintentionally institutionalising state paternalism that robs young adults of their individual rights and limits the the choices on their own fate in various ways. The cultural shift to infantilize the post 18 cohort, which is a broader problem, is, in my opinion, regressive.
And just finally, I am very sympathetic to the concerns that have been raised here already. I do think it might be worth considering some kind of a carve out for 18 to 25 year olds on E.H. but that would be an exception, not a rule. I understand that viscerally. The idea of any young person, 1920, having a terminal diagnosis and then being offered the choice of an even earlier death fills me with horror, gives me the chills, and it's tragic.
But I still think 18, if tightly protected by the sponsors of the bill, is adequate in relation to age safeguards. There are plenty of other safeguards I'm worried about without adding to them. And I also think there's a problem of a culture being created for the young in general of suicidal ideation. By this bill. However, I would say that these amendments don't resolve those broader problems that I have.
10:40
Baroness Butler-Sloss (Crossbench)
-
-
Baroness Butler-Sloss (Crossbench)
I understand very much the points made by the noble Lord Winston and the noble Baroness Fox. I come to this issue from a rather different position. I used to try a lot of cases, some of them of terminally ill young people, generally from the ages of 15 up to 25 or more. And there were a number of cases of undoubtedly those with capacity with terminal illness who were also suffering, not very surprisingly, from depression or confused as to what it is they really wanted.
And they came before me for all sorts of reasons, unconnected with whether they should live or die. From their perspective, what I was looking at was what the medical evidence was as to the sort of support that they ought to have. And I just raised, despite the neuroscientist issue, which I think is an important one, and despite the point that 18 is the age of so far being able to vote and down to 16 with the present government. But whether you are looking at how much you care about the future of this country, and when you're looking at what you care about you yourself, and do you want to die because you are going to die in the next few months? The doctors may be right or wrong as to six months, and we know many diagnoses are actually inaccurate.
I think that may be the most important of all decisions that has to be made, which is life and death. And consequently I am concerned about 18 from my own experience, whether it should be 21 or 25, I think is arguable, but I am worried that it sticks at 18. that it sticks at 18.
And they came before me for all sorts of reasons, unconnected with whether they should live or die. From their perspective, what I was looking at was what the medical evidence was as to the sort of support that they ought to have. And I just raised, despite the neuroscientist issue, which I think is an important one, and despite the point that 18 is the age of so far being able to vote and down to 16 with the present government. But whether you are looking at how much you care about the future of this country, and when you're looking at what you care about you yourself, and do you want to die because you are going to die in the next few months? The doctors may be right or wrong as to six months, and we know many diagnoses are actually inaccurate.
I think that may be the most important of all decisions that has to be made, which is life and death. And consequently I am concerned about 18 from my own experience, whether it should be 21 or 25, I think is arguable, but I am worried that it sticks at 18. that it sticks at 18.
10:42
Lord Moore of Etchingham (Non-affiliated)
-
-
Lord Moore of Etchingham (Non-affiliated)
My Lords, I rise in support of the noble Baroness, Lady Burgess Amendment, and I do think it's reasonable to have these considerations about the different way people think and feel at different times in their life. One of the big discussions we have more broadly about this bill is how do what are the cognitive capacities of old people very important in the freedom of their decision? In a similar way, I think it's reasonable to talk about the cognitive capacities of very young people, and I think in particular, that one of the things that makes very young people different from older people is that they, naturally enough, have very little encounter with death.
They're much less likely to have come across situations in which people die and people that they know have died. They simply don't know what it involves. And by the way, I think if if it was banned all through the world, that anybody under the age of 25 would fight in a war, we would hardly have any wars, because one reason the soldiers were prepared to fight in wars is because they don't understand death. When they're very young, they're ready for they're ready for anything.
And I think and I think we can we can tell that, that there is very often a culture of suicide that's very strong in young people because it's a romantic idea. And indeed, the poet Keats expressed it absolutely beautifully in his ode to a Nightingale when he speaks about being half in love with Easeful death and the joy of ceasing on the midnight with no pain. And of course, he knew of what he spoke because in a sense, because he was suffering from a terminal illness, and he indeed he died before he was 25.
So I think we need to and I thought Baroness Berger brought this out and others too. We need to think about what are the influences on young people which may go in that direction. If they suffer from a terminal illness that becomes even more acute. They, because of their lack of experience and in these matters, and they will be under greater pressure, quite possibly, to feel that suicide is is the way out and is somehow a noble thing to do.
I remember at school I was a very brilliant boy who was 18, and he wrote a very short poem which he just said, if I should die, think only this of me or Nwe. And. Was a very clever thing to write. And he did subsequently commit suicide, aged 19. I do ask noble Lords to think about what it actually might be like in such a situation at such an age. My Lords.
They're much less likely to have come across situations in which people die and people that they know have died. They simply don't know what it involves. And by the way, I think if if it was banned all through the world, that anybody under the age of 25 would fight in a war, we would hardly have any wars, because one reason the soldiers were prepared to fight in wars is because they don't understand death. When they're very young, they're ready for they're ready for anything.
And I think and I think we can we can tell that, that there is very often a culture of suicide that's very strong in young people because it's a romantic idea. And indeed, the poet Keats expressed it absolutely beautifully in his ode to a Nightingale when he speaks about being half in love with Easeful death and the joy of ceasing on the midnight with no pain. And of course, he knew of what he spoke because in a sense, because he was suffering from a terminal illness, and he indeed he died before he was 25.
So I think we need to and I thought Baroness Berger brought this out and others too. We need to think about what are the influences on young people which may go in that direction. If they suffer from a terminal illness that becomes even more acute. They, because of their lack of experience and in these matters, and they will be under greater pressure, quite possibly, to feel that suicide is is the way out and is somehow a noble thing to do.
I remember at school I was a very brilliant boy who was 18, and he wrote a very short poem which he just said, if I should die, think only this of me or Nwe. And. Was a very clever thing to write. And he did subsequently commit suicide, aged 19. I do ask noble Lords to think about what it actually might be like in such a situation at such an age. My Lords.
10:45
Baroness Hayter of Kentish Town (Labour)
-
-
Baroness Hayter of Kentish Town (Labour)
About a. Dying there. not being offered. They're going to be asking, and I think to think of a 23 year old, 24 year old in pain, about to die, possibly within weeks or months. And we turn round and say, I'm really sorry you've had children, you've taken big decisions in your life, you've taken career decisions. You've seen, you know, your parents, whatever has happened to them and to then say, but I'm sorry, you're 24 years of age and you cannot be helped in your last few days or months, weeks, possibly because you're only 24, I find extraordinary, I think that we, you know, the age of 18 is probably the right one, but can we just remember these people are dying and they're suffering.
Those are the people who are going to be applying for this.
Those are the people who are going to be applying for this.
10:45
Lord Sandhurst (Conservative)
-
-
Lord Sandhurst (Conservative)
My Lords, I rise with some caution. But because these I think are deep waters. But I think we should on the side of caution, I support Baroness Berger because this is an entirely new process. If, assuming the bill comes into form in some form, then the age can always be lowered in the light of experience and also in which experience I mean that of the human brain and how people are considering these things. And what has prompted me to say this in particular is the report in the Times on the 25th of November of the study by Cambridge's MRC Cognition and Brain Sciences Unit, which compared the brains of 3802 people between 0 and 90 years using data sets of MRI diffusion scans, which map neural connections by tracking how water molecules move through the brain tissues.
My Lords, what this found, very simply, is that the childhood brain, its topology, runs from birth until the turning point at the age of nine, and then it transitions into the adolescent phase, an era which it found. This is completely dispassionate, lasts right up to the age of 32 on average early 30s. See the brain's neural wiring shift into the adult mode, and I emphasise that word adult male. This is the longest era, which lasts over three decades.
A third turning point, around the age of 66, marks the start of an early ageing phase. And for those of us who are a bit older, the late ageing brain takes shape at around 83 years old, and I would simply conclude, my Lords, by reading this and I quote from the report, while puberty offers a clear start, the end of adolescence is much harder to pin down scientifically. Based purely on neural architecture, we find that adolescent like changes in the brain's structure end around the early 30s.
My Lord, if that is the architecture, then this stage in this bill we should be looking at 25 and not a younger age.
My Lords, what this found, very simply, is that the childhood brain, its topology, runs from birth until the turning point at the age of nine, and then it transitions into the adolescent phase, an era which it found. This is completely dispassionate, lasts right up to the age of 32 on average early 30s. See the brain's neural wiring shift into the adult mode, and I emphasise that word adult male. This is the longest era, which lasts over three decades.
A third turning point, around the age of 66, marks the start of an early ageing phase. And for those of us who are a bit older, the late ageing brain takes shape at around 83 years old, and I would simply conclude, my Lords, by reading this and I quote from the report, while puberty offers a clear start, the end of adolescence is much harder to pin down scientifically. Based purely on neural architecture, we find that adolescent like changes in the brain's structure end around the early 30s.
My Lord, if that is the architecture, then this stage in this bill we should be looking at 25 and not a younger age.
10:48
The Lord Bishop of Leicester (Bishops)
-
-
The Lord Bishop of Leicester (Bishops)
Amen. I'd like to rise to support this amendment, and I do support this amendment, and I do also do so with some caution, noting that these are deep waters. But I hope, my Lords, that you will But I hope, my Lords, that you will forgive me for pointing out the blindingly obvious that as I look around your noble Lords house, I around your noble Lords house, I don't see any 18 to 25 year olds sat on these benches, and the voices of children and young people are, seems to me vital in such a debate.
The role of Children's Commissioner was created in order to ensure that the voices of children and young people were heard within your noble Lords House, and indeed within the other place. Therefore, when the Children's Commissioner, who I know personally, who's visited my own diocese, who I've seen at work listening to children and young people, she is herself and her staff are superbly skilled at that work. And when she urges us to be cautious in this, I believe we should listen. And therefore I urge consideration of that note of caution.
The role of Children's Commissioner was created in order to ensure that the voices of children and young people were heard within your noble Lords House, and indeed within the other place. Therefore, when the Children's Commissioner, who I know personally, who's visited my own diocese, who I've seen at work listening to children and young people, she is herself and her staff are superbly skilled at that work. And when she urges us to be cautious in this, I believe we should listen. And therefore I urge consideration of that note of caution.
10:49
Baroness Berridge (Conservative)
-
-
Baroness Berridge (Conservative)
By Lords. Lords. to which I added my name. I note that the private member's bill in the in the name of the noble and learned Lord also has this requirement, as well as this bill of the safeguard of a six month prognosis. But I am interested when one looks at this in relation to those over 18, what pre-legislative scrutiny or consultation that the noble and learned Lord had, or the other bill sponsor from the other place had? In terms of the science.
Now, I'm not a scientist, but I have taken I have a researcher as a scientist. So I took advice on how to treat the science. When one speaks in a debate with those who have great eminence, such as the noble Lord, Lord Winston, because it is relevant, I believe, having looked at that to the age limit under the bill, there will be specific groups of vulnerability for certain groups of young people as the noble Lady, Lady Fox outlined. But those are in later groups, from peer reviewed studies, from peer reviewed studies, which I am told is the best way to begin to treat the science.
It is that the brain reaches the full size physically the age of 14, but the neural circuitry does not develop to enable the enhanced decision making and cognitive function until the age of 25. I am also informed, and I'm sorry to disagree with my noble friend Lord Sandhurst, that the study that was quoted by the BBC is viewed as an outlier from the peer reviewed studies that we have in this regard. And we also need to look at whether terminally ill adolescents. And I'm grateful to the noble Lady, Lady Hamer, for for reminding us of that.
We also need to consider, though, that there are psychological reports that there may be an unrealised concept of the finality of death, which I think is relevant to what the noble Lord Lord Moore said. As the Children's Commissioner, in her evidence to the select committee, stated in her letter of evidence, and I quote, compelling arguments have been made about the additional difficulties present in diagnosing young people in this age group and predicting with certainty certainty the chance of living for six months, which could, of course, if that's wrong, lead to an earlier untimely death if assisted dying is made available to them.
So I was really intrigued by that statement and sought to look at the evidence, the scientific evidence. And I have found peer reviewed papers, one particularly from the University of Manchester, reporting historical data that finds that even with advanced diseases such as thyroid cancer, they this group have a better rate of survival than adults over the age of 25. Reporting that the report outlines that it could be a more efficacious response to treatment, as a younger body may be better to receive, better able to receive it.
It may be due to an elevated sense of hope that is often reported in young adults. And it might also be because such a devastating diagnosis at that age is hard to fathom, as it's not a disease they think would ever happen to them. And that sense of hope possibly contributes to a positive impact on the immune system, thus resulting in that better response to the administered medication. The second reason that I outlined in addition to this is that as the noble Lady, Lady Hollins did briefly allude to is that there is significantly increasing life expectancy in terminally ill young adults due to these incredible advances that we're beginning to see in treatments such as advanced immune therapies and personalised genotype directed treatment, both of which have seen an increased survival rates of up to five years in up to 80% of patients with terminal cancers.
So although we will come to the matter, as I say, of young people and the Ahrq in a later group, I think it's right to reiterate that we have this in policy terms, that we treat those between 18 and 25 differently for certain in certain situations. And the Children's Commissioner also brought to our attention that there's already a gap for for young people that they often fall into at age 16 and 17. Some community palliative care services end at 16, and then others don't begin at 18.
And it does make me wonder whether we need to be thinking more about their access to specialist specialist palliative care in this bill in later groups. So could the noble and learned Lord. Lord outline what process was there before both of these bills were put together to look into the scientific evidence? It seems to me the assumption in both of the bills is that a six month prognosis affects or applies to all groups of the population in the same way. Is that indeed the case? We also know, of course, from evidence from the European Society of Medical Oncology, professor Stone, that a six month prognosis is inaccurate in over half of cases, so is six months the right level to use? That might be a connected change? Or is 18 too young an age? So I'd be grateful to know from the noble and learned Lord whether he, if he has not already engaged with this science, and with the assistance of the noble Lord.
Lord Winston. I do think this is a valuable way of looking at the evidence behind amendment four.
Now, I'm not a scientist, but I have taken I have a researcher as a scientist. So I took advice on how to treat the science. When one speaks in a debate with those who have great eminence, such as the noble Lord, Lord Winston, because it is relevant, I believe, having looked at that to the age limit under the bill, there will be specific groups of vulnerability for certain groups of young people as the noble Lady, Lady Fox outlined. But those are in later groups, from peer reviewed studies, from peer reviewed studies, which I am told is the best way to begin to treat the science.
It is that the brain reaches the full size physically the age of 14, but the neural circuitry does not develop to enable the enhanced decision making and cognitive function until the age of 25. I am also informed, and I'm sorry to disagree with my noble friend Lord Sandhurst, that the study that was quoted by the BBC is viewed as an outlier from the peer reviewed studies that we have in this regard. And we also need to look at whether terminally ill adolescents. And I'm grateful to the noble Lady, Lady Hamer, for for reminding us of that.
We also need to consider, though, that there are psychological reports that there may be an unrealised concept of the finality of death, which I think is relevant to what the noble Lord Lord Moore said. As the Children's Commissioner, in her evidence to the select committee, stated in her letter of evidence, and I quote, compelling arguments have been made about the additional difficulties present in diagnosing young people in this age group and predicting with certainty certainty the chance of living for six months, which could, of course, if that's wrong, lead to an earlier untimely death if assisted dying is made available to them.
So I was really intrigued by that statement and sought to look at the evidence, the scientific evidence. And I have found peer reviewed papers, one particularly from the University of Manchester, reporting historical data that finds that even with advanced diseases such as thyroid cancer, they this group have a better rate of survival than adults over the age of 25. Reporting that the report outlines that it could be a more efficacious response to treatment, as a younger body may be better to receive, better able to receive it.
It may be due to an elevated sense of hope that is often reported in young adults. And it might also be because such a devastating diagnosis at that age is hard to fathom, as it's not a disease they think would ever happen to them. And that sense of hope possibly contributes to a positive impact on the immune system, thus resulting in that better response to the administered medication. The second reason that I outlined in addition to this is that as the noble Lady, Lady Hollins did briefly allude to is that there is significantly increasing life expectancy in terminally ill young adults due to these incredible advances that we're beginning to see in treatments such as advanced immune therapies and personalised genotype directed treatment, both of which have seen an increased survival rates of up to five years in up to 80% of patients with terminal cancers.
So although we will come to the matter, as I say, of young people and the Ahrq in a later group, I think it's right to reiterate that we have this in policy terms, that we treat those between 18 and 25 differently for certain in certain situations. And the Children's Commissioner also brought to our attention that there's already a gap for for young people that they often fall into at age 16 and 17. Some community palliative care services end at 16, and then others don't begin at 18.
And it does make me wonder whether we need to be thinking more about their access to specialist specialist palliative care in this bill in later groups. So could the noble and learned Lord. Lord outline what process was there before both of these bills were put together to look into the scientific evidence? It seems to me the assumption in both of the bills is that a six month prognosis affects or applies to all groups of the population in the same way. Is that indeed the case? We also know, of course, from evidence from the European Society of Medical Oncology, professor Stone, that a six month prognosis is inaccurate in over half of cases, so is six months the right level to use? That might be a connected change? Or is 18 too young an age? So I'd be grateful to know from the noble and learned Lord whether he, if he has not already engaged with this science, and with the assistance of the noble Lord.
Lord Winston. I do think this is a valuable way of looking at the evidence behind amendment four.
10:54
Lord Weir of Ballyholme (Democratic Unionist Party)
-
-
Lord Weir of Ballyholme (Democratic Unionist Party)
My Lords.
**** Possible New Speaker ****
This is an important group of amendments, particularly to those of us who have an interest in young people. And I think it's very important that we have we have heard today, actually, a range of heard today, actually, a range of opinions on where the issue of age eligibility should lie. And it seems to me that when dealing with seems to me that when dealing with age eligibility within this bill, there are three critical questions. there are three critical questions.
First of all, whether there should be a lower age limit in terms of whether there should be at the lower end of eligibility, that there should be an age limit below which it is impossible to access assisted dying. Secondly, if it is agreed that there should be an age limit whether 18 is the appropriate age, and thirdly, which are posed, I think, by the two sets of amendments within this group. If we feel that 18 is too young an age, what is the appropriate age that we should set on the first issue? I am glad to say, at least, that the proponents of this bill have put forward have not gone down the line, as has been argued, I think, by some lobbyists, and has been the case in, for example, Belgium and the Netherlands, that there should be no lower age limits.
And I welcome the fact that this at least seems to be accepted by the proponents of this bill. I would, however, reiterate, I think the question that has been asked, and I look forward to Lord Faulkner summing up in relation to this as to what assurances we can have, that if we ended up with a position where the eligibility was at 18, what confidence can we have that that will be stuck to on the second issue of whether 18 is the appropriate level? I cannot claim any particular knowledge or expertise on neuroscience, but I do have a lot of experience having served twice as education Minister in Northern Ireland.
And I'm sure if you speak to anyone in any of the jurisdictions who has served in that sort of role, the greatest privilege that you have in that ministerial capacity is on a day to day basis, on every single day, meeting young people and talking to them about their life lived experiences. And it is a great joy to meet the many very healthy, confident young people who can look forward to a lifetime ahead of them. But it is also the case that you come across a number of young people who are very vulnerable, young people who have very, extremely life limiting conditions, and young people who are effectively in terminal illness.
And in my experience, the families of those young people reorientate themselves through their love so that the focus of almost all family activity is on that, that young person. But the by-product of that times can be that some of those young people feel themselves to be a burden to their family, that they are disrupting everything that their family is, and not allowing their family to lead a normal life. They feel that sometimes a sense of guilt. And I think that while we, I'm sure will come on to it in later stages, the concern of what might be described as self-imposed coercion, people coming to the conclusion that they will be doing a service to their loved ones by going down this route of assisted suicide.
We know that that there have been concerns raised in relation to the disabled and the elderly feeling under a particular level of pressure, but I think it would be naive to believe that young people in that position are also not being feel themselves being pressurised, and I do not want to be in a situation where a young person in the run up to the 18th birthday feels. How can I facilitate my family by taking that that ultimate step. So I would contend, I think that with the issue of maturity, that 18 is perhaps in this case, not the right boundary point.
Finally, there comes to the question of whether it should be 21 or 25. There are competing amendments. And here, while I came into this in a fairly agnostic manner, I am persuaded much more towards the position of Baroness Berger persuaded in many ways, by the words of the Children's Commissioner. Now again, I've had considerable experience of dealing with both the Children's Commissioner in England and her opposite number in Northern Ireland, and in my experience, children's commissioners tend to have a particular worldview when they look towards young people.
They want the world to be quite permissive towards those young people. They are progressive in their nature. Sometimes I have to confess a little bit to progressive for my own liking on some certain subjects, but they always were possible to extend rights to children that are that are normally given to adults. And so when we see a situation such as this, where a children's commissioner is effectively saying, be very careful in relation to the law, do not extend this to younger people between 18 and 25.
I think we do need to actually pay cognisance to that and not just the evidence to the Select committee. But I'll conclude, I think, by some remarks of the Children's Commissioner under this bill and I quote, under this bill, people the children love will choose to end their own lives. They will need compassion and support to navigate the complexity of that grief, and it will shape the way they think about their own lives and deaths, especially those with disabilities, additional vulnerabilities or life limiting conditions who have shared with me their worries of being treated as lesser.
That is why I am calling upon the government to support the proposed amendment by Baroness Berger to extend the minimum age, as drafted in the bill for 18 to 25. Not to do so. Fails to recognise the protection we grant children who face complexity and adversity until age 25. So I conclude with those remarks, and I look forward to hearing, particularly from Lord Falconer, if he is to suggest that 18 is still the appropriate age, I would be very keen to hear the rationale as to why it shouldn't be, why it wouldn't be accepting.
I think the
**** Possible New Speaker ****
very wise amendment of Baroness Berger. I know. I think. The noble Lady. Baroness Berger has opened up a.
**** Possible New Speaker ****
Baroness Berger has opened up a. Very important point. In this debate. And her excellent opening speech
**** Possible New Speaker ****
And her excellent opening speech certainly highlighted many of the issues. The noble Lord Lord Winston issues. The noble Lord Lord Winston is has spoken about cognitive reasoning, and indeed the evidence is that cognitive reasoning is well developed at the age of 18, but the other aspects being sensitive to stress, social influence, impulse control, and emotional regulation don't develop by that age, and they carry on developing. And the evidence is that they carry on up until 25.
I find it interesting in this debate that we consider children or young people driving in cars with peers that actually that limit potentially should be raised. And that's because of the problem
**** Possible New Speaker ****
This is an important group of amendments, particularly to those of us who have an interest in young people. And I think it's very important that we have we have heard today, actually, a range of heard today, actually, a range of opinions on where the issue of age eligibility should lie. And it seems to me that when dealing with seems to me that when dealing with age eligibility within this bill, there are three critical questions. there are three critical questions.
First of all, whether there should be a lower age limit in terms of whether there should be at the lower end of eligibility, that there should be an age limit below which it is impossible to access assisted dying. Secondly, if it is agreed that there should be an age limit whether 18 is the appropriate age, and thirdly, which are posed, I think, by the two sets of amendments within this group. If we feel that 18 is too young an age, what is the appropriate age that we should set on the first issue? I am glad to say, at least, that the proponents of this bill have put forward have not gone down the line, as has been argued, I think, by some lobbyists, and has been the case in, for example, Belgium and the Netherlands, that there should be no lower age limits.
And I welcome the fact that this at least seems to be accepted by the proponents of this bill. I would, however, reiterate, I think the question that has been asked, and I look forward to Lord Faulkner summing up in relation to this as to what assurances we can have, that if we ended up with a position where the eligibility was at 18, what confidence can we have that that will be stuck to on the second issue of whether 18 is the appropriate level? I cannot claim any particular knowledge or expertise on neuroscience, but I do have a lot of experience having served twice as education Minister in Northern Ireland.
And I'm sure if you speak to anyone in any of the jurisdictions who has served in that sort of role, the greatest privilege that you have in that ministerial capacity is on a day to day basis, on every single day, meeting young people and talking to them about their life lived experiences. And it is a great joy to meet the many very healthy, confident young people who can look forward to a lifetime ahead of them. But it is also the case that you come across a number of young people who are very vulnerable, young people who have very, extremely life limiting conditions, and young people who are effectively in terminal illness.
And in my experience, the families of those young people reorientate themselves through their love so that the focus of almost all family activity is on that, that young person. But the by-product of that times can be that some of those young people feel themselves to be a burden to their family, that they are disrupting everything that their family is, and not allowing their family to lead a normal life. They feel that sometimes a sense of guilt. And I think that while we, I'm sure will come on to it in later stages, the concern of what might be described as self-imposed coercion, people coming to the conclusion that they will be doing a service to their loved ones by going down this route of assisted suicide.
We know that that there have been concerns raised in relation to the disabled and the elderly feeling under a particular level of pressure, but I think it would be naive to believe that young people in that position are also not being feel themselves being pressurised, and I do not want to be in a situation where a young person in the run up to the 18th birthday feels. How can I facilitate my family by taking that that ultimate step. So I would contend, I think that with the issue of maturity, that 18 is perhaps in this case, not the right boundary point.
Finally, there comes to the question of whether it should be 21 or 25. There are competing amendments. And here, while I came into this in a fairly agnostic manner, I am persuaded much more towards the position of Baroness Berger persuaded in many ways, by the words of the Children's Commissioner. Now again, I've had considerable experience of dealing with both the Children's Commissioner in England and her opposite number in Northern Ireland, and in my experience, children's commissioners tend to have a particular worldview when they look towards young people.
They want the world to be quite permissive towards those young people. They are progressive in their nature. Sometimes I have to confess a little bit to progressive for my own liking on some certain subjects, but they always were possible to extend rights to children that are that are normally given to adults. And so when we see a situation such as this, where a children's commissioner is effectively saying, be very careful in relation to the law, do not extend this to younger people between 18 and 25.
I think we do need to actually pay cognisance to that and not just the evidence to the Select committee. But I'll conclude, I think, by some remarks of the Children's Commissioner under this bill and I quote, under this bill, people the children love will choose to end their own lives. They will need compassion and support to navigate the complexity of that grief, and it will shape the way they think about their own lives and deaths, especially those with disabilities, additional vulnerabilities or life limiting conditions who have shared with me their worries of being treated as lesser.
That is why I am calling upon the government to support the proposed amendment by Baroness Berger to extend the minimum age, as drafted in the bill for 18 to 25. Not to do so. Fails to recognise the protection we grant children who face complexity and adversity until age 25. So I conclude with those remarks, and I look forward to hearing, particularly from Lord Falconer, if he is to suggest that 18 is still the appropriate age, I would be very keen to hear the rationale as to why it shouldn't be, why it wouldn't be accepting.
I think the
**** Possible New Speaker ****
very wise amendment of Baroness Berger. I know. I think. The noble Lady. Baroness Berger has opened up a.
**** Possible New Speaker ****
Baroness Berger has opened up a. Very important point. In this debate. And her excellent opening speech
**** Possible New Speaker ****
And her excellent opening speech certainly highlighted many of the issues. The noble Lord Lord Winston issues. The noble Lord Lord Winston is has spoken about cognitive reasoning, and indeed the evidence is that cognitive reasoning is well developed at the age of 18, but the other aspects being sensitive to stress, social influence, impulse control, and emotional regulation don't develop by that age, and they carry on developing. And the evidence is that they carry on up until 25.
I find it interesting in this debate that we consider children or young people driving in cars with peers that actually that limit potentially should be raised. And that's because of the problem
11:02
Baroness Finlay of Llandaff (Crossbench)
-
-
Baroness Finlay of Llandaff (Crossbench)
of peer pressure. When I had the pleasure of having a visiting professorship in the Netherlands, I professorship in the Netherlands, I came across a fairly horrifying case of a young man, a teenager in case of a young man, a teenager in his late teens, who had been diagnosed with a really very aggressive tumour, and his friends all came round and said, when are you going to go for euthanasia? He you going to go for euthanasia? He hadn't even had discussions over treatment, and this happened to be a tumour that was going to be very chemo therapy sensitive.
And actually I was quite shocked at the influence that the peer group can have on somebody. The noble Lady Baroness Hayter spoke about suffering and pain, and one of the difficulties I think, that we have with this bill is that neither the word suffering nor pain occur anywhere in it. So I wonder if the noble Lord, in considering how he manages this amendment or group of amendments, will recognise that one solution may be to require an enhanced assessment of those between 18 and 25.
If the age limit is not actually going to be raised, but that at these young people should have a more in-depth assessment not only of their.
**** Possible New Speaker ****
Lord Levy will. Know that at present, an 18 to
**** Possible New Speaker ****
Know that at present, an 18 to 25 year old who maybe has a 25 year old who maybe has a terminal diagnosis legally, if has the capacity, can withdraw their the capacity, can withdraw their consent to treatment. Do they go through a different capacity
**** Possible New Speaker ****
through a different capacity 25? I'm delighted that the noble Lord has asked me that question, because it reminds me of a patient that I had who was a young man with an advanced testicular tumour, who had refused treatment and was referred to me, and I looked after him for a couple of years during the time that he became more and more ill with his metastatic disease, and he consistently refused treatment. However, when he was moribund and his parents had come in and were sitting at the bedside, he suddenly asked me, is it too late to change my mind and have treatment? At that point, I was very indebted to my local oncologist, who I phoned and we arranged transfer that day to the Marsden, who then treated him because that was his wish.
Certainly my assessments of him every time I saw him were not to persuade him to have treatment, but to allow him to talk about his fears and his difficulties. That is the role of specialist palliative care. When you are looking after these young people who are very, very vulnerable. And I am simply suggesting that the way the bill is written, the assessments may not be adequate.
**** Possible New Speaker ****
I listen to the noble Ladies individual case. My question was very specific. Is, is somebody at very specific. Is, is somebody at 25 given a different mental capacity assessment based on their capacity assessment based on their their wishing to withdraw treatment to somebody who is 18 to 25? That is the specific question based on
**** Possible New Speaker ****
is the specific question based on what the noble Lady is now suggesting happens in this bill. The issue about the Mental
**** Possible New Speaker ****
The issue about the Mental Capacity Act is that each assessment must be done individually, and it relates to the decision that is to be made, the size of the decision, the time and the personal characteristics. So there is no absolute if we are talking about safety in relation to this bill and avoiding abuse, I'm simply trying to suggest that one way forward may be to ensure that the assessment of young people's eligibility is particularly thorough, and it may need to have different criteria, and it may need to look at whether they do indeed have pain or suffering.
**** Possible New Speaker ****
I wonder if you might be kind enough, because she is, after all, a hugely respected individual in a hugely respected individual in the field of which she is such an expert. I don't doubt that for a moment. But Sarah Jane Blakemore, moment. But Sarah Jane Blakemore, who is a fellow of the Royal Society, has been spending her time looking at peer pressure. That's looking at peer pressure. That's what her publications have been largely about. And the question really is, is she really suggesting really is, is she really suggesting that a young person of, let's say, 18 dying of a horrible, painful cancer will be subject to peer pressure? Peer pressure, of course, she might be from pressure from doctors, but peer pressure, I doubt
**** Possible New Speaker ****
that I. I would say I was simply
**** Possible New Speaker ****
I would say I was simply relating what I found when I was in the Netherlands with peer pressure on young people because of the on young people because of the normalisation of euthanasia across that society.
**** Possible New Speaker ****
that society. My Lords, my Lords. I'm sorry. Go on. As Sarah Blakemore's been Go on. As Sarah Blakemore's been widely referred to, it might be useful to just directly quote her.
And actually I was quite shocked at the influence that the peer group can have on somebody. The noble Lady Baroness Hayter spoke about suffering and pain, and one of the difficulties I think, that we have with this bill is that neither the word suffering nor pain occur anywhere in it. So I wonder if the noble Lord, in considering how he manages this amendment or group of amendments, will recognise that one solution may be to require an enhanced assessment of those between 18 and 25.
If the age limit is not actually going to be raised, but that at these young people should have a more in-depth assessment not only of their.
**** Possible New Speaker ****
Lord Levy will. Know that at present, an 18 to
**** Possible New Speaker ****
Know that at present, an 18 to 25 year old who maybe has a 25 year old who maybe has a terminal diagnosis legally, if has the capacity, can withdraw their the capacity, can withdraw their consent to treatment. Do they go through a different capacity
**** Possible New Speaker ****
through a different capacity 25? I'm delighted that the noble Lord has asked me that question, because it reminds me of a patient that I had who was a young man with an advanced testicular tumour, who had refused treatment and was referred to me, and I looked after him for a couple of years during the time that he became more and more ill with his metastatic disease, and he consistently refused treatment. However, when he was moribund and his parents had come in and were sitting at the bedside, he suddenly asked me, is it too late to change my mind and have treatment? At that point, I was very indebted to my local oncologist, who I phoned and we arranged transfer that day to the Marsden, who then treated him because that was his wish.
Certainly my assessments of him every time I saw him were not to persuade him to have treatment, but to allow him to talk about his fears and his difficulties. That is the role of specialist palliative care. When you are looking after these young people who are very, very vulnerable. And I am simply suggesting that the way the bill is written, the assessments may not be adequate.
**** Possible New Speaker ****
I listen to the noble Ladies individual case. My question was very specific. Is, is somebody at very specific. Is, is somebody at 25 given a different mental capacity assessment based on their capacity assessment based on their their wishing to withdraw treatment to somebody who is 18 to 25? That is the specific question based on
**** Possible New Speaker ****
is the specific question based on what the noble Lady is now suggesting happens in this bill. The issue about the Mental
**** Possible New Speaker ****
The issue about the Mental Capacity Act is that each assessment must be done individually, and it relates to the decision that is to be made, the size of the decision, the time and the personal characteristics. So there is no absolute if we are talking about safety in relation to this bill and avoiding abuse, I'm simply trying to suggest that one way forward may be to ensure that the assessment of young people's eligibility is particularly thorough, and it may need to have different criteria, and it may need to look at whether they do indeed have pain or suffering.
**** Possible New Speaker ****
I wonder if you might be kind enough, because she is, after all, a hugely respected individual in a hugely respected individual in the field of which she is such an expert. I don't doubt that for a moment. But Sarah Jane Blakemore, moment. But Sarah Jane Blakemore, who is a fellow of the Royal Society, has been spending her time looking at peer pressure. That's looking at peer pressure. That's what her publications have been largely about. And the question really is, is she really suggesting really is, is she really suggesting that a young person of, let's say, 18 dying of a horrible, painful cancer will be subject to peer pressure? Peer pressure, of course, she might be from pressure from doctors, but peer pressure, I doubt
**** Possible New Speaker ****
that I. I would say I was simply
**** Possible New Speaker ****
I would say I was simply relating what I found when I was in the Netherlands with peer pressure on young people because of the on young people because of the normalisation of euthanasia across that society.
**** Possible New Speaker ****
that society. My Lords, my Lords. I'm sorry. Go on. As Sarah Blakemore's been Go on. As Sarah Blakemore's been widely referred to, it might be useful to just directly quote her.
11:07
Baroness Cass (Crossbench)
-
-
Baroness Cass (Crossbench)
What she said is the following. Most of these age cut-offs have not Most of these age cut-offs have not been based on what we know about brain development, because they were decided way before we knew were decided way before we knew anything about how the brain develops during adolescence. So what I would say is these kinds of decisions about age cut-offs and she's referring to the various different age cut-offs for drinking, different age cut-offs for drinking, marriage, etcetera, etcetera should incorporate the new knowledge about brain development during adolescence.
On the other hand, this is a question I'm asked often. I don't think the neuroscience can provide an age for you. We can't say, oh, the neuroscience shows that the brain becomes adult at age 18 or 24 or whatever it might be. It's much more complex than that. She goes on to describe how different brain regions develop and mature at different rates, and she talks about the individual differences in the speed of brain development. So she says, so what I would say is that what we know from neuroscience is the kind of age range, the very broad age range when the brain becomes mature and adult.
And that's much later than 18, between 20s and 30s for most people. So of course, that can generate an age at which you become legally adult. So that is what Sarah-jayne Blakemore has said. And on the basis of that, I would support Baroness Finlay suggestion that during that 18 to 25 year period, there should be enhanced and careful assessment taking
**** Possible New Speaker ****
account of that perspective. I apologise for interrupting
**** Possible New Speaker ****
I apologise for interrupting this, but it's been a very, very good debate and it might be helpful if I indicate what my position in relation to this is for the thinking behind 18 is that 18 is the decision, the age at which you can make your own decisions about can make your own decisions about medical care. So if you are somebody who is suffering from a terminal illness, you can decide at 18 if you want to withdraw treatment, for example, or what the treatment should be.
Yes. In answer to Baroness Berridge, we were aware of the different views about when
On the other hand, this is a question I'm asked often. I don't think the neuroscience can provide an age for you. We can't say, oh, the neuroscience shows that the brain becomes adult at age 18 or 24 or whatever it might be. It's much more complex than that. She goes on to describe how different brain regions develop and mature at different rates, and she talks about the individual differences in the speed of brain development. So she says, so what I would say is that what we know from neuroscience is the kind of age range, the very broad age range when the brain becomes mature and adult.
And that's much later than 18, between 20s and 30s for most people. So of course, that can generate an age at which you become legally adult. So that is what Sarah-jayne Blakemore has said. And on the basis of that, I would support Baroness Finlay suggestion that during that 18 to 25 year period, there should be enhanced and careful assessment taking
**** Possible New Speaker ****
account of that perspective. I apologise for interrupting
**** Possible New Speaker ****
I apologise for interrupting this, but it's been a very, very good debate and it might be helpful if I indicate what my position in relation to this is for the thinking behind 18 is that 18 is the decision, the age at which you can make your own decisions about can make your own decisions about medical care. So if you are somebody who is suffering from a terminal illness, you can decide at 18 if you want to withdraw treatment, for example, or what the treatment should be.
Yes. In answer to Baroness Berridge, we were aware of the different views about when
11:10
Lord Falconer of Thoroton (Labour)
-
-
Lord Falconer of Thoroton (Labour)
your brain and maturity develop and what Baroness Cass said is what Baroness Cass said is absolutely. She read Sarah Jane Blakemore's view, which these age Blakemore's view, which these age cut-offs that the law imposes generally are not based upon a generally are not based upon a close study of neurology. They are the laws attempt to reflect the laws attempt to reflect maturity. And yes, I am very, very aware of the fact that if you're 18, you may be more emotionally impulsive, you may be more easily influenced than somebody of 25 or 20 4 or 23.
Equally, anybody who has had contact with people who are young, who are terminally ill, you will find some 18 year olds are incredibly thoughtful and mature, and some 18 year olds are not, for obvious reasons. I am very influenced by the fact that I have been listening to people expressing real concern about this in this House. I think still, 18 is probably the right age, but I'm very influenced by what Baroness Finlay and Baroness Cass have said, that maybe the answer is some assurance that there is a more intense assessment in relation to people between 18 to 25.
The Bill says that you can only have an assisted death if you've got a clear, settled and informed wish to end your life, and it's been done voluntarily, how can we be sure between 18 and 25? Well, there are two doctors in the panel. They've got to decide it, but maybe some additional thing might be required. Can I suggest this because we're slightly going round in circles again and repeating ourselves, that I indicate that I will talk to, particularly Baroness Cass and Baroness Finlay, and that we come back at reports and see whether or not and I am not saying I am going to change the age of 18, but I'm saying, do we need a more thorough assessment for people between 18 and 25? That is broadly that is broadly my position.
Equally, anybody who has had contact with people who are young, who are terminally ill, you will find some 18 year olds are incredibly thoughtful and mature, and some 18 year olds are not, for obvious reasons. I am very influenced by the fact that I have been listening to people expressing real concern about this in this House. I think still, 18 is probably the right age, but I'm very influenced by what Baroness Finlay and Baroness Cass have said, that maybe the answer is some assurance that there is a more intense assessment in relation to people between 18 to 25.
The Bill says that you can only have an assisted death if you've got a clear, settled and informed wish to end your life, and it's been done voluntarily, how can we be sure between 18 and 25? Well, there are two doctors in the panel. They've got to decide it, but maybe some additional thing might be required. Can I suggest this because we're slightly going round in circles again and repeating ourselves, that I indicate that I will talk to, particularly Baroness Cass and Baroness Finlay, and that we come back at reports and see whether or not and I am not saying I am going to change the age of 18, but I'm saying, do we need a more thorough assessment for people between 18 and 25? That is broadly that is broadly my position.
11:12
Baroness Lawlor (Conservative)
-
-
Baroness Lawlor (Conservative)
Answer for his intervention. I'm very grateful for that. I would like to point out, before I begin, that I do think many noble Lords feel there's a very great difference between a decision to refuse treatment or withdraw treatment, which may or may not end one's life, and to ask for something which will definitely end one's life. And I think that that is, I know it's a point that is brought up by supporters of the Bill, but I rise, my Lords, to put forward my amendments in clause to clause one, amendment five, and related amendments two 52 58305338 and 311.
**** Possible New Speaker ****
I just wonder if the noble Lady might think it might be wise for us might think it might be wise for us all to find out. After the discussions with the Baroness Cass and the Baroness Finlay, what the and the Baroness Finlay, what the noble Lord, Lord Faulkner, is proposing to do. Before we discuss
**** Possible New Speaker ****
this any further. Amen. I thank I thank the noble and
**** Possible New Speaker ****
I thank I thank the noble and learned Lady, but I have a few points to add to the discussion, and I hope noble Lords will show the customary courtesy, particularly with views to which
**** Possible New Speaker ****
they have objections. Consider joining.
**** Possible New Speaker ****
Consider joining. A meeting with the noble Lord Faulkner to talk about her. Faulkner to talk about her. Additional points in the way that I think the majority of the House is really keen to move on in order that we can facilitate further. that we can facilitate further. Well done for her. Her question, and I certainly will consider it, but I think it's important that we have a discussion about what I regard as a compromise motion, which may be useful in the discussions which noble Lords have with the sponsor or those who wish
**** Possible New Speaker ****
to proceed in that way. I wonder if the noble Lady, for
**** Possible New Speaker ****
I wonder if the noble Lady, for whom I have a great deal of respect, would consider whether she's really adding anything at all to the debate. By continuing, we can read her amendments, we can read her her amendments, we can read her amendments. We know the difference between 18 and 21 and 25, and the between 18 and 21 and 25, and the noble and learned Lord, with whom I do not disagree on the fundamental principle behind this bill are both of the view that if we are to have proper discussion on this bill and get through the Committee stage in the way that's expected of us as the House of Lords, when the noble Lord intervenes and says he's willing to hold discussions, meaningful discussions, that's what we should do and move on to next business.
**** Possible New Speaker ****
Lord Lord Carlile for his intervention. I would recall one of my first horrific experiences in my first horrific experiences in the Lordships in your Lordships chamber. When I sat on those benches, we were speaking about a benches, we were speaking about a bill to which the noble Lord was opposed and he asked the frontbench opposed and he asked the frontbench to say I was out of order in speaking, because I had gone out to get a glass of water, having sat get a glass of water, having sat not only through that debate, but through all previous debates, that hardened me to the sort of objections to free speech in their Lordships Chamber.
And I was very disappointed in that debate, and others to have noble Lords from the other side shouting at me, shame, shame. If I mentioned abuse with which they disagreed, and soon I would like to persist with my compromise motion and amendment, and I hope I will be brief. But if noble Lords continue to interrupt me, it'll make it more difficult. We have heard, and I will not repeat the arguments we have heard, but we have heard. 18 is too young, and given what we know about neurological science, I have one piece of evidence to add to the whole house, not the private discussions which might take place because as I understand the the rules, this is a Committee of the whole House.
And so we have heard about that. And I'll return to that with one additional piece of information. We have heard also that the law recognises the special vulnerability of young people until the legal age of majority, and how it supports different groups. And I'd like to go back to something the noble Lord Lord Morse said, because he referred to how difficult it was for older people, and even those who may not have given a great deal of thought to the subject of dying.
But I would add to that to understand what it is to choose to die. For most, the thought of mention of death is distant, and the way we now have as a society been conditioned to see death rather in euphemistic terms, in the very language we use, reinforces that remoteness in the multigenerational families of the past, whether the members shared a house visited frequently, supported one another in all the challenges they met every day in life. Death with its traditional rituals, the funeral, the period of mourning, were ever present in the lives of children as they grew up.
I remember as a young, a very young
**** Possible New Speaker ****
child, seeing a dead mother in childbirth apologise. For. Interrupting the noble Lady, but
**** Possible New Speaker ****
Interrupting the noble Lady, but I think the house has really made it clear that the my noble friend it clear that the my noble friend Lord, could I, could I finish? Can I finish what I'm saying? My noble friend Lord Falconer of Thoroton friend Lord Falconer of Thoroton has already made a concession that he would like very much to discuss. he would like very much to discuss. I yes, I want to ask the noble Lady if she would please go straight to the compromise that she is proposing, rather than referring to various other speeches that have
**** Possible New Speaker ****
already been made here. The Baroness Blackstone for that
**** Possible New Speaker ****
The Baroness Blackstone for that intervention. And I am going to my point. I do think it's important for the whole argument to recall the arguments I am not repeating, though I had some of the very same points or similar ones, and I have points or similar ones, and I have cut them, and we have heard also that the in the context of the bill, that the in the context of the bill, we are dealing with rare and sad cases of young adults diagnosed with terminal illness.
But I don't think we can underestimate the decision, which is one of the suggestions to end one's own life as opposed to withdraw treatment. Given the very variable assessments we get. And the science is very difficult, consultants will tell you they get different slides back from the lab depending on how the various laboratory scientists look and the pharmacological people look at the evidence. And it is difficult to know how long they will live. Moreover, the bill becomes law.
It is probable, and we have heard today that its provisions will gradually become looser in practice. And and I would add, the idea of killing yourself and having helped to kill yourself will become normalised under these circumstances, which are not, alas, those of a dystopian fantasy, but are most likely future. If this bill in its present guise has its way, the common depressions and anxieties of late adolescence, which often translate to thoughts of suicide, will be encouraged. And I just speak here as someone who has taught 18 to 21 year olds in university, people who have been referred to me to teach history, but who have suffered terribly emotional stresses which they can't cope with, and their tutors have mentioned privately they want to commit suicide.
They have already tried, but they want to continue doing their course on whatever. And will you take them on? So it may be objected that since 18 is the legal age of majority, whatever choices are being opened for, adults must stretch down to a person's 18th birthday, and I just add here, noble Lords, to the research in neurosciences. And we have spoken a lot about neuroscientists view of
**** Possible New Speaker ****
emotional maturity. But here. You are coming forward with a compromise, and I'm just not really compromise, and I'm just not really clear what what that is, because it seems that it's still the same evidence as before.
**** Possible New Speaker ****
evidence as before. intervention. Yes, I. Briefly say to those who are
**** Possible New Speaker ****
Briefly say to those who are objecting, or to those who take the view that the intervention of the view that the intervention of the noble and learned Lord should bring the debate to an end. May I just say, and I haven't spoken so far in this committee at all. May I just say the debate we're having is about 18, 21 or 25, and the noble and learned Lord has not said that he is willing to compromise on any of those.
As I understand it, he wishes to persist with 18, though he's willing to look at additional safeguards. It doesn't seem to me, therefore, that his offer of discussions, welcome no doubt, is actually addresses the core question in the debate, so I don't see why it is brought to an end simply by the intervention.
**** Possible New Speaker ****
Yeah, yeah. Yeah yeah. Keep going.
**** Possible New Speaker ****
Keep going. My Lords. Up until 25, people often struggle to to grasp what often struggle to to grasp what that death is irreversible. They understand it in emotional terms. The point that death ends a The point that death ends a person's life on Earth, but they do not really grasp the sense in which not really grasp the sense in which both those who accept and those who deny the afterlife know that life as we know it ends. And I will refer here to somebody who hasn't been mentioned.
Professor Lee Somerville. She's a Harvard academic who is director of the Affective Neuroscience and Development Lab and specialises in psychology. Adolescents do about, as well as adults, quite rightly, on cognition tests, for instance. But if they're feeling strong emotions, these results can plummet. The problem seems to be that teenagers have not yet developed a strong brain that keeps emotions under control. I have suggested 21, though not 25, is a lower limit. I regard this as as a compromise.
I propose this at the outset. The medical evidence, as I say, would point to 25. I myself am happy to support that. And to conclude, opponents might say, however, that the seven year gap between the age at which, for legal purposes, a person thought to be an adult and that at which they become eligible for assisted suicide is simply too long. But no young person should be presented with the option of taking his own life, and certainly not those who have been diagnosed as having a terminal illness.
They are not physically, psychologically, or emotionally developed to the maturity needed to to make a judgement devoid of emotion. Although my moderate amendment places the age of eligibility at 21 and I stress it's a compromise, I
**** Possible New Speaker ****
would be prepared to support other noble Lords for 25, I. Thank you.
**** Possible New Speaker ****
Thank you. I just want to rise briefly to respond to an earlier point in the debate by the noble Lord, Lord Winston, who I respect greatly for his medical expertise. He quoted his medical expertise. He quoted Sarah-jayne Blakemore. And in a comment that hasn't been said
**** Possible New Speaker ****
I just wonder if the noble Lady might think it might be wise for us might think it might be wise for us all to find out. After the discussions with the Baroness Cass and the Baroness Finlay, what the and the Baroness Finlay, what the noble Lord, Lord Faulkner, is proposing to do. Before we discuss
**** Possible New Speaker ****
this any further. Amen. I thank I thank the noble and
**** Possible New Speaker ****
I thank I thank the noble and learned Lady, but I have a few points to add to the discussion, and I hope noble Lords will show the customary courtesy, particularly with views to which
**** Possible New Speaker ****
they have objections. Consider joining.
**** Possible New Speaker ****
Consider joining. A meeting with the noble Lord Faulkner to talk about her. Faulkner to talk about her. Additional points in the way that I think the majority of the House is really keen to move on in order that we can facilitate further. that we can facilitate further. Well done for her. Her question, and I certainly will consider it, but I think it's important that we have a discussion about what I regard as a compromise motion, which may be useful in the discussions which noble Lords have with the sponsor or those who wish
**** Possible New Speaker ****
to proceed in that way. I wonder if the noble Lady, for
**** Possible New Speaker ****
I wonder if the noble Lady, for whom I have a great deal of respect, would consider whether she's really adding anything at all to the debate. By continuing, we can read her amendments, we can read her her amendments, we can read her amendments. We know the difference between 18 and 21 and 25, and the between 18 and 21 and 25, and the noble and learned Lord, with whom I do not disagree on the fundamental principle behind this bill are both of the view that if we are to have proper discussion on this bill and get through the Committee stage in the way that's expected of us as the House of Lords, when the noble Lord intervenes and says he's willing to hold discussions, meaningful discussions, that's what we should do and move on to next business.
**** Possible New Speaker ****
Lord Lord Carlile for his intervention. I would recall one of my first horrific experiences in my first horrific experiences in the Lordships in your Lordships chamber. When I sat on those benches, we were speaking about a benches, we were speaking about a bill to which the noble Lord was opposed and he asked the frontbench opposed and he asked the frontbench to say I was out of order in speaking, because I had gone out to get a glass of water, having sat get a glass of water, having sat not only through that debate, but through all previous debates, that hardened me to the sort of objections to free speech in their Lordships Chamber.
And I was very disappointed in that debate, and others to have noble Lords from the other side shouting at me, shame, shame. If I mentioned abuse with which they disagreed, and soon I would like to persist with my compromise motion and amendment, and I hope I will be brief. But if noble Lords continue to interrupt me, it'll make it more difficult. We have heard, and I will not repeat the arguments we have heard, but we have heard. 18 is too young, and given what we know about neurological science, I have one piece of evidence to add to the whole house, not the private discussions which might take place because as I understand the the rules, this is a Committee of the whole House.
And so we have heard about that. And I'll return to that with one additional piece of information. We have heard also that the law recognises the special vulnerability of young people until the legal age of majority, and how it supports different groups. And I'd like to go back to something the noble Lord Lord Morse said, because he referred to how difficult it was for older people, and even those who may not have given a great deal of thought to the subject of dying.
But I would add to that to understand what it is to choose to die. For most, the thought of mention of death is distant, and the way we now have as a society been conditioned to see death rather in euphemistic terms, in the very language we use, reinforces that remoteness in the multigenerational families of the past, whether the members shared a house visited frequently, supported one another in all the challenges they met every day in life. Death with its traditional rituals, the funeral, the period of mourning, were ever present in the lives of children as they grew up.
I remember as a young, a very young
**** Possible New Speaker ****
child, seeing a dead mother in childbirth apologise. For. Interrupting the noble Lady, but
**** Possible New Speaker ****
Interrupting the noble Lady, but I think the house has really made it clear that the my noble friend it clear that the my noble friend Lord, could I, could I finish? Can I finish what I'm saying? My noble friend Lord Falconer of Thoroton friend Lord Falconer of Thoroton has already made a concession that he would like very much to discuss. he would like very much to discuss. I yes, I want to ask the noble Lady if she would please go straight to the compromise that she is proposing, rather than referring to various other speeches that have
**** Possible New Speaker ****
already been made here. The Baroness Blackstone for that
**** Possible New Speaker ****
The Baroness Blackstone for that intervention. And I am going to my point. I do think it's important for the whole argument to recall the arguments I am not repeating, though I had some of the very same points or similar ones, and I have points or similar ones, and I have cut them, and we have heard also that the in the context of the bill, that the in the context of the bill, we are dealing with rare and sad cases of young adults diagnosed with terminal illness.
But I don't think we can underestimate the decision, which is one of the suggestions to end one's own life as opposed to withdraw treatment. Given the very variable assessments we get. And the science is very difficult, consultants will tell you they get different slides back from the lab depending on how the various laboratory scientists look and the pharmacological people look at the evidence. And it is difficult to know how long they will live. Moreover, the bill becomes law.
It is probable, and we have heard today that its provisions will gradually become looser in practice. And and I would add, the idea of killing yourself and having helped to kill yourself will become normalised under these circumstances, which are not, alas, those of a dystopian fantasy, but are most likely future. If this bill in its present guise has its way, the common depressions and anxieties of late adolescence, which often translate to thoughts of suicide, will be encouraged. And I just speak here as someone who has taught 18 to 21 year olds in university, people who have been referred to me to teach history, but who have suffered terribly emotional stresses which they can't cope with, and their tutors have mentioned privately they want to commit suicide.
They have already tried, but they want to continue doing their course on whatever. And will you take them on? So it may be objected that since 18 is the legal age of majority, whatever choices are being opened for, adults must stretch down to a person's 18th birthday, and I just add here, noble Lords, to the research in neurosciences. And we have spoken a lot about neuroscientists view of
**** Possible New Speaker ****
emotional maturity. But here. You are coming forward with a compromise, and I'm just not really compromise, and I'm just not really clear what what that is, because it seems that it's still the same evidence as before.
**** Possible New Speaker ****
evidence as before. intervention. Yes, I. Briefly say to those who are
**** Possible New Speaker ****
Briefly say to those who are objecting, or to those who take the view that the intervention of the view that the intervention of the noble and learned Lord should bring the debate to an end. May I just say, and I haven't spoken so far in this committee at all. May I just say the debate we're having is about 18, 21 or 25, and the noble and learned Lord has not said that he is willing to compromise on any of those.
As I understand it, he wishes to persist with 18, though he's willing to look at additional safeguards. It doesn't seem to me, therefore, that his offer of discussions, welcome no doubt, is actually addresses the core question in the debate, so I don't see why it is brought to an end simply by the intervention.
**** Possible New Speaker ****
Yeah, yeah. Yeah yeah. Keep going.
**** Possible New Speaker ****
Keep going. My Lords. Up until 25, people often struggle to to grasp what often struggle to to grasp what that death is irreversible. They understand it in emotional terms. The point that death ends a The point that death ends a person's life on Earth, but they do not really grasp the sense in which not really grasp the sense in which both those who accept and those who deny the afterlife know that life as we know it ends. And I will refer here to somebody who hasn't been mentioned.
Professor Lee Somerville. She's a Harvard academic who is director of the Affective Neuroscience and Development Lab and specialises in psychology. Adolescents do about, as well as adults, quite rightly, on cognition tests, for instance. But if they're feeling strong emotions, these results can plummet. The problem seems to be that teenagers have not yet developed a strong brain that keeps emotions under control. I have suggested 21, though not 25, is a lower limit. I regard this as as a compromise.
I propose this at the outset. The medical evidence, as I say, would point to 25. I myself am happy to support that. And to conclude, opponents might say, however, that the seven year gap between the age at which, for legal purposes, a person thought to be an adult and that at which they become eligible for assisted suicide is simply too long. But no young person should be presented with the option of taking his own life, and certainly not those who have been diagnosed as having a terminal illness.
They are not physically, psychologically, or emotionally developed to the maturity needed to to make a judgement devoid of emotion. Although my moderate amendment places the age of eligibility at 21 and I stress it's a compromise, I
**** Possible New Speaker ****
would be prepared to support other noble Lords for 25, I. Thank you.
**** Possible New Speaker ****
Thank you. I just want to rise briefly to respond to an earlier point in the debate by the noble Lord, Lord Winston, who I respect greatly for his medical expertise. He quoted his medical expertise. He quoted Sarah-jayne Blakemore. And in a comment that hasn't been said
11:25
Lord Harper (Conservative)
-
-
Lord Harper (Conservative)
comment that hasn't been said already in this debate, which was, I think the noble Lord, Lord Winston talked about the context in which decisions are made. She said in a paper. Adolescence is characterised by making risky decisions. And she said this suggests that decision making in adolescence may be particularly modulated by emotion and social factors. For example, when adolescents are with peers or in other affective hot contexts. So I think what that what that tells me, and that's relevant to an to an earlier discussion is it's not just the age of the person that's relevant.
And that's why I think the amendment for the noble Baroness Berger has brought forward is very helpful. But the context in the decision making. So I listened carefully to what the noble and learned Lord, Lord Falconer said about the thought process that he was going to undertake. Having listened carefully to some experts and I, and I'm I'm like him. I'm torn on the age issue because I think Baroness Berger amendment is very helpful in, I think, setting out some of the issues.
But I was also very struck by what Baroness Fox said. And so I'm slightly torn about whether the age is the right way of doing it. And now whether it's an assessment, I don't know. But the final point I would make is
**** Possible New Speaker ****
I was struck by what what Baroness Berridge said. I just want to ask the noble Lord, does he think we should try Lord, does he think we should try to reach the grouping? Ten during the course of today?
**** Possible New Speaker ****
the course of today? Well, I was trying to I'm trying to make a brief remark. I've only spoken for one minute and 45 seconds, and if I keep getting interrupted, I won't be able to sit down. I was literally going to make one more point, having listened to one more point, having listened to the debate. This is, after all, supposed to be a debate where we listen to what noble Lords have
**** Possible New Speaker ****
said particularly and and respond. Could he please answer my question? Should we try to reach
**** Possible New Speaker ****
question? Should we try to reach Group ten today? I do want to try and make progress, which is why I was trying progress, which is why I was trying to keep my remarks very brief. If the noble Lord keeps interrupting me, then they will necessarily take me, then they will necessarily take longer. All I was going to say was one further point. I was very struck by what Baroness Berridge struck by what Baroness Berridge said about the difference in the medical prognosis on a number of conditions for younger people.
So what I was going to suggest to the noble Lord, Lord Falconer, as well as perhaps looking at the assessment process, is the extent to which clinical advice and evidence can be brought in to see whether the the prognosis for all the the terminal diagnosis for a younger person, if that is qualitatively different as listening to Baroness Berridge it did appear to be that may be the appropriate way of, of of picking up the concerns, I think, that are widely shared.
But I also accept and Baroness Fox made this point. You know, the law does have to have some clarity to it. And I also like her having lots of different ages is very difficult. So I think perhaps listening to the points that Baroness Berridge made may be a way forward. And I would commend it to the noble and Lord, Lord, when he undertakes that thought process for what he may bring forward at report.
And that's why I think the amendment for the noble Baroness Berger has brought forward is very helpful. But the context in the decision making. So I listened carefully to what the noble and learned Lord, Lord Falconer said about the thought process that he was going to undertake. Having listened carefully to some experts and I, and I'm I'm like him. I'm torn on the age issue because I think Baroness Berger amendment is very helpful in, I think, setting out some of the issues.
But I was also very struck by what Baroness Fox said. And so I'm slightly torn about whether the age is the right way of doing it. And now whether it's an assessment, I don't know. But the final point I would make is
**** Possible New Speaker ****
I was struck by what what Baroness Berridge said. I just want to ask the noble Lord, does he think we should try Lord, does he think we should try to reach the grouping? Ten during the course of today?
**** Possible New Speaker ****
the course of today? Well, I was trying to I'm trying to make a brief remark. I've only spoken for one minute and 45 seconds, and if I keep getting interrupted, I won't be able to sit down. I was literally going to make one more point, having listened to one more point, having listened to the debate. This is, after all, supposed to be a debate where we listen to what noble Lords have
**** Possible New Speaker ****
said particularly and and respond. Could he please answer my question? Should we try to reach
**** Possible New Speaker ****
question? Should we try to reach Group ten today? I do want to try and make progress, which is why I was trying progress, which is why I was trying to keep my remarks very brief. If the noble Lord keeps interrupting me, then they will necessarily take me, then they will necessarily take longer. All I was going to say was one further point. I was very struck by what Baroness Berridge struck by what Baroness Berridge said about the difference in the medical prognosis on a number of conditions for younger people.
So what I was going to suggest to the noble Lord, Lord Falconer, as well as perhaps looking at the assessment process, is the extent to which clinical advice and evidence can be brought in to see whether the the prognosis for all the the terminal diagnosis for a younger person, if that is qualitatively different as listening to Baroness Berridge it did appear to be that may be the appropriate way of, of of picking up the concerns, I think, that are widely shared.
But I also accept and Baroness Fox made this point. You know, the law does have to have some clarity to it. And I also like her having lots of different ages is very difficult. So I think perhaps listening to the points that Baroness Berridge made may be a way forward. And I would commend it to the noble and Lord, Lord, when he undertakes that thought process for what he may bring forward at report.
11:28
Baroness Spielman (Conservative)
-
-
Baroness Spielman (Conservative)
Yes. >> My Lords. >> I haven't spoken previously on this Bill, nor have I put down any this Bill, nor have I put down any amendments. But as Chief Inspector responsible for inspecting children's social care as well as children's social care as well as education in mainstream and special schools, I have visited many institutions with children with life limiting conditions, and I recognise that this bill has profound implications for many children and young adults, and I'm speaking in support of the amendments to raise the minimum age for eligibility, and in particular, in support of Baroness Berger amendments to amend minimum age limits to 25 throughout.
There are and always will be children in their teens with terminal illnesses and who'll be thinking about their own futures in the context of the choice they would be empowered to make from their very first day as adults, before they have any experience of adult palliative care. Even though the provisions now rightly prevent medical practitioners from initiating the subject of assisted dying with children, we know that young people seek out and are influenced by all kinds of information freely available online, and we have plenty of precedents.
Consider what young people can already see on suicide, eating disorders, puberty blockers and cross-sex hormones, and indeed claiming invalidity benefits. These precedents show that no matter what constraints are placed, there will be freely available video content promoting assisted dying, and that some of it will coach viewers in how to pass mental capacity tests, which reveals the unpalatable prospect of children reaching their 18th birthday and immediately demanding their right to a state delivered death with little or no opportunity for adult services to be deployed to offer supportive alternatives, and many terminally ill children will be classified as vulnerable under existing laws if they have an education, health or care plan, as is highly likely for a child with a terminal illness, or if they're in continuous care, as is the case for many severely disabled children, then they receive statutory protections to age 25.
In effect, one part of the state would be responsible for safeguarding and protecting the child, while another would simultaneously be responsible for providing death on demand. This level of incoherence will tie public services in extraordinary knots, and only lawyers will benefit. There has to be some alignment. It's therefore surely right to give these groups of young people the extra time that the law currently allows to form views and make decisions about their adult lives more generally. As others have said, the growing body of evidence on adolescent brain development and impulsivity does also point us towards a minimum age of 25.
For such a fundamental choice, adolescence is often characterised by heightened emotions and foolish choices, and making foolish choices is a normal and natural part of growing up. But in most cases we survive those foolish choices and can look back and perhaps laugh at our melodramatic younger selves. But it is tragic when these heightened emotions lead children and young adults to end their lives, when a little more time and maturity might have seen them through their moments of greatest unhappiness. But the young people who've chosen assisted dying in a fit of adolescent bleakness will already be dead.
And the noble Lord Lord Moore of Etchingham made some strong and persuasive points here about the adolescent understanding of death. I, too, fear downward pressure on the age limit. I won't repeat the arguments have been made, and while we haven't yet reached the groups where capacity will be discussed, I believe that we need to think about eating disorders in particular in the context of age limits, as clad has laid out very clearly, issues of capacity are going to be particularly difficult for this miserable group of disorders, which are relatively common among teenagers, clad notes that international practice does show that people with anorexia have been found to have capacity to end their lives using assisted dying frameworks.
The particular problems that the provisions of this bill present for decisions relating to capacity of young people with eating disorders, will be discussed in future groups. But there's an age related aspect that I think we should note here, because I think we're likely to find that it's impossible to find drafting amendments to capacity provisions that will mitigate or solve the problem. These are disorders that most commonly begin in the mid to late teens, and for those who recover from them, which is sadly not all, but many do.
Recovery typically takes seven, ten, 7 to 10 years, so by the mid 20s, most people who are going to recover from anorexia have done so. So this simple increase in the minimum age may well be the most pragmatic and effective adjustment to mitigate a serious risk. So for all these reasons, therefore, I support Baroness Berger amendments.
There are and always will be children in their teens with terminal illnesses and who'll be thinking about their own futures in the context of the choice they would be empowered to make from their very first day as adults, before they have any experience of adult palliative care. Even though the provisions now rightly prevent medical practitioners from initiating the subject of assisted dying with children, we know that young people seek out and are influenced by all kinds of information freely available online, and we have plenty of precedents.
Consider what young people can already see on suicide, eating disorders, puberty blockers and cross-sex hormones, and indeed claiming invalidity benefits. These precedents show that no matter what constraints are placed, there will be freely available video content promoting assisted dying, and that some of it will coach viewers in how to pass mental capacity tests, which reveals the unpalatable prospect of children reaching their 18th birthday and immediately demanding their right to a state delivered death with little or no opportunity for adult services to be deployed to offer supportive alternatives, and many terminally ill children will be classified as vulnerable under existing laws if they have an education, health or care plan, as is highly likely for a child with a terminal illness, or if they're in continuous care, as is the case for many severely disabled children, then they receive statutory protections to age 25.
In effect, one part of the state would be responsible for safeguarding and protecting the child, while another would simultaneously be responsible for providing death on demand. This level of incoherence will tie public services in extraordinary knots, and only lawyers will benefit. There has to be some alignment. It's therefore surely right to give these groups of young people the extra time that the law currently allows to form views and make decisions about their adult lives more generally. As others have said, the growing body of evidence on adolescent brain development and impulsivity does also point us towards a minimum age of 25.
For such a fundamental choice, adolescence is often characterised by heightened emotions and foolish choices, and making foolish choices is a normal and natural part of growing up. But in most cases we survive those foolish choices and can look back and perhaps laugh at our melodramatic younger selves. But it is tragic when these heightened emotions lead children and young adults to end their lives, when a little more time and maturity might have seen them through their moments of greatest unhappiness. But the young people who've chosen assisted dying in a fit of adolescent bleakness will already be dead.
And the noble Lord Lord Moore of Etchingham made some strong and persuasive points here about the adolescent understanding of death. I, too, fear downward pressure on the age limit. I won't repeat the arguments have been made, and while we haven't yet reached the groups where capacity will be discussed, I believe that we need to think about eating disorders in particular in the context of age limits, as clad has laid out very clearly, issues of capacity are going to be particularly difficult for this miserable group of disorders, which are relatively common among teenagers, clad notes that international practice does show that people with anorexia have been found to have capacity to end their lives using assisted dying frameworks.
The particular problems that the provisions of this bill present for decisions relating to capacity of young people with eating disorders, will be discussed in future groups. But there's an age related aspect that I think we should note here, because I think we're likely to find that it's impossible to find drafting amendments to capacity provisions that will mitigate or solve the problem. These are disorders that most commonly begin in the mid to late teens, and for those who recover from them, which is sadly not all, but many do.
Recovery typically takes seven, ten, 7 to 10 years, so by the mid 20s, most people who are going to recover from anorexia have done so. So this simple increase in the minimum age may well be the most pragmatic and effective adjustment to mitigate a serious risk. So for all these reasons, therefore, I support Baroness Berger amendments.
11:33
Lord Ashcombe (Conservative)
-
-
Lord Ashcombe (Conservative)
I would like.
**** Possible New Speaker ****
We may. All remember. And I suspect. The odd.
**** Possible New Speaker ****
The odd. And sometimes what may now seem very troubling ideas that pass
**** Possible New Speaker ****
through our minds during those years, many of. Us have also. Watched our children navigate
**** Possible New Speaker ****
Watched our children navigate that turbulent stage of life. And some of us, I dare say, grandchildren. But I'm not there grandchildren. But I'm not there yet. These formative years are full of experimentation, confusion, and growth. They are not the years in which irreversible decisions should be entertained, and therefore I'm very much in favour of increasing the age limit to the age of 25. And as the noble Lady, Lady Berger has suggested. suggested.
**** Possible New Speaker ****
We may. All remember. And I suspect. The odd.
**** Possible New Speaker ****
The odd. And sometimes what may now seem very troubling ideas that pass
**** Possible New Speaker ****
through our minds during those years, many of. Us have also. Watched our children navigate
**** Possible New Speaker ****
Watched our children navigate that turbulent stage of life. And some of us, I dare say, grandchildren. But I'm not there grandchildren. But I'm not there yet. These formative years are full of experimentation, confusion, and growth. They are not the years in which irreversible decisions should be entertained, and therefore I'm very much in favour of increasing the age limit to the age of 25. And as the noble Lady, Lady Berger has suggested. suggested.
11:34
Lord Markham (Conservative)
-
-
Lord Markham (Conservative)
If I may, I think this has been a really good discussion showing the range of views and expert opinion that we have here. And I think I heard from Lord Faulkner that he was willing to look at the age question. I think he said that he was more likely to add safeguards. Well, if.
**** Possible New Speaker ****
Hang on. noble Lords. Quoting Lord Falconer. Lord Falconer. Specifically
**** Possible New Speaker ****
Lord Falconer. Specifically ruled out changing. The age. He wanted to put qualifications
**** Possible New Speaker ****
He wanted to put qualifications on it. That was as far as he went. The point I was making. And again, I'm sure he will speak for again, I'm sure he will speak for himself in a moment that he was willing to look at that. He did say he was more likely to look at additional safeguards between 18 and 25. But I think he said, and again, here, correct me if I'm wrong, that he's willing to have further discussions with, you know, a lot of the experts we've got here make some Baroness Cass Baroness Finlay and I'm sure others as well.
If you look at the whole question around that age, really is the as a product of the good debate that we've had here today. So I think I've heard that he's taking on board the comments. He's willing to go away with the experts here and look at this whole question and hopefully come back with something which reflects the reasonable view of everyone here today. So I think we're being shown a way forward. And what I am keen to do is there are a lot of other things I'm keen to hear about, like the residency question later on, the other groupings.
And so at this point, I think we've got what we're looking for, have we not, in terms of a good discussion on this, and I hope that we could continue and talk about some of the other groups.
**** Possible New Speaker ****
Hang on. noble Lords. Quoting Lord Falconer. Lord Falconer. Specifically
**** Possible New Speaker ****
Lord Falconer. Specifically ruled out changing. The age. He wanted to put qualifications
**** Possible New Speaker ****
He wanted to put qualifications on it. That was as far as he went. The point I was making. And again, I'm sure he will speak for again, I'm sure he will speak for himself in a moment that he was willing to look at that. He did say he was more likely to look at additional safeguards between 18 and 25. But I think he said, and again, here, correct me if I'm wrong, that he's willing to have further discussions with, you know, a lot of the experts we've got here make some Baroness Cass Baroness Finlay and I'm sure others as well.
If you look at the whole question around that age, really is the as a product of the good debate that we've had here today. So I think I've heard that he's taking on board the comments. He's willing to go away with the experts here and look at this whole question and hopefully come back with something which reflects the reasonable view of everyone here today. So I think we're being shown a way forward. And what I am keen to do is there are a lot of other things I'm keen to hear about, like the residency question later on, the other groupings.
And so at this point, I think we've got what we're looking for, have we not, in terms of a good discussion on this, and I hope that we could continue and talk about some of the other groups.
11:36
Lord Falconer of Thoroton (Labour)
-
-
Lord Falconer of Thoroton (Labour)
By my position. I was responding to the debate, which gave rise to to the debate, which gave rise to real concerns about the age, and I understood the Baroness Finlay and the Baroness Cass to say maybe a way forward would be looking to see if there were additional safeguards from 18 to 25 that would involve me having a discussion with them, and if if they were satisfied that there were additional safeguards and that they thought the age of 18 was right, then that would obviously have an effect on me.
If there were other arguments that were going to put. I'd obviously take them on board as well. My experience of the house is that if one sees a way forward, then maybe before one goes on making the same arguments as before, that one sees whether or not the compromise that sensible members of the House might think would be enough. Let's see if that works and see if that could attract support at report. That was what I was thinking.
If there were other arguments that were going to put. I'd obviously take them on board as well. My experience of the house is that if one sees a way forward, then maybe before one goes on making the same arguments as before, that one sees whether or not the compromise that sensible members of the House might think would be enough. Let's see if that works and see if that could attract support at report. That was what I was thinking.
11:37
Baroness Berridge (Conservative)
-
-
Baroness Berridge (Conservative)
Lord True sits down. Could I just draw his attention to the fact that the amendments I've laid in that the amendments I've laid in relation to Ehcp and and Ehcp, with just additional assessment criteria are currently grouped in group seven? And so it may be that if the noble and learned Lord has that meeting, that that would enable me to like maybe withdraw some amendments that if those conditions, if that is also a compromise that might be available.
11:37
Lord Kamall (Conservative)
-
-
Lord Kamall (Conservative)
I very much welcome that suggestion. I could also say I welcome your Harper's suggestion, welcome your Harper's suggestion, because what Lord Harper is saying, as I understand it, is, let's look as well at the clinical diagnosis of people. And I'm more than happy because that's the point that the Baroness Finlay also is. I'm more than happy to include both those than happy to include both those things, and if they both want to come, I would welcome them.
**** Possible New Speaker ****
Frontbench frontbenchers. Frontbench. Frontbencher. Frontbench. Frontbench. Frontbench. Frontbench. Frontbench. Frontbench. Frontbench. Frontbench. My Lords, one of the reasons I am hesitant to one of the reasons I am hesitant to get up is I just want to ensure that this is a debate, that everyone must feel that their voice has been heard. Yeah, what we don't has been heard. Yeah, what we don't want is to make law on the basis for people to look back and say, we did not properly debate that particular issue.
So if all noble Lords who wish to speak in this debate have spoken, then I am very happy to make my own contribution.
**** Possible New Speaker ****
But if there are any other noble Lords who wish to make their point, I think I should let give way. Well said Lord Kamall.
**** Possible New Speaker ****
Well said Lord Kamall. Yeah. Okay, well, that answers that question. I tried my best, but I question. I tried my best, but I really want to make that point clear. I think it's really important that everyone who feels they want to speak and have. But I they want to speak and have. But I would also say to my to friends, noble friends that otherwise that it's also very important to respect the rules and the conventions, to speak to the amendments and not to repeat Second Reading speeches or to make wider debates.
So I hope we can get that appropriate balance. And also I'm also taking time in making these points. So I will try and try and be brief and can I? I do actually want to pay tribute to noble, noble Lady Baroness Berger, especially the way that she delivered a select committee process. I think that would precede our deliberations in committee. I think the evidence submitted to that committee will be invaluable to noble Lords as we continue our work to scrutinise this Bill. If I can just turn to the specific amendments without making very long speeches about it, but just reflecting, changing that minimum age, I was talking to a noble, noble, noble and learned friend about this, and he says, frankly, the whole issue around age is a mess and the law around.
And I think that's actually come out in some discussions. And sometimes I think we're speaking from our own experience. Those of us people like me, who've got my children my 20s, two in their 20s, I think, could they really do they really have the capacity to make this decision? But actually at other times I sit in awe of them and the decisions they make. They they express maturity way beyond 20 years. In fact, maturity more than people who are much older than them. So I think it very much depends on the individual in these cases.
And I think what we have to look at is, is there a way to achieve that right balance? Because otherwise we're just going to set another age limit when you know, you can join the Army at 16, but you can't you can't actually serve in combat until you're 18. The government is talking about reducing the voting age to 16, but then we are hearing debates on neurological competence or neurological capacity. And I think it's really important that we understand these points and we express these points.
The other thing I have to say is the sorry, the number of points is that this whole debate about neurological development, because I think what the point that was made or the point that came out for me from that debate of neurological debate, is that there's no such thing as the science that science is. Science is contestable. And we found that and we've heard the various points from various noble Lords who are experts in their field. So I think we have to be very careful to say the science says this.
We should be very careful around that, because it also has implications for other decisions. I just want to turn to a couple of points I think were made where I think it may already be treated in the bill, and I want to check that no other, no one Lord Falconer of Thoroton understanding of what's in the bill here. I think no one Baroness Hollins made a point about what happens if there's a new treatment available. Well, I'm pretty sure that clause two says something about cannot be reversed by treatment.
So I think that probably does take care of the noble Baroness Hollins points. But I would really like to know Lord Falconer, to noble Lord Falconer to make share his interpretation of whether that addresses the concerns. The noble Lady Baroness Hayter said, think about these young people who will be suffering in pain. But nowhere, nowhere does it say in clause two it doesn't use the word pain or suffering. And we have to be very careful and make sure that we actually read what's in the bill when we're making these points.
I do think, though, and I do welcome the intervention by the noble and learned Lord Falconer about while he wants. He he's quite clear about the age 18. He is sympathetic to the idea of cognitive development and maturity between the ages of 18 and 25, and that there might be some discussion. And who knows, I cannot speak for the noble Lord. Lord, he's and he's obviously looked into this issue very deeply, but perhaps in those discussions he may well be persuaded.
I mean, I know he's saying at the moment, 18 but if, if, if there is strong evidence, but clearly he's open to enhanced measures for those between 18 and 25. And I think that is something I think that hopefully the whole House will welcome. There are many other points I can make, but I think actually I've covered those points. I think at this point it's really important to hear from both the government, but also what
**** Possible New Speaker ****
the noble Lord, Lord believes in response to many of the points that have been raised here. Here. My Lords. I'm grateful.
**** Possible New Speaker ****
I'm grateful. To noble Lords for their contributions in this debate today contributions in this debate today on the age of eligibility for those who are provided for with assistance under this bill, as I've made clear previously, and I would wish to reiterate, I will keep my wish to reiterate, I will keep my comments limited to the issues on which the government has major legal, technical or operational workability concerns. My Lords, the amendments tabled by noble Ladies Baroness Berger, Baroness Lawlor and Baroness Hollins seek to raise the age at which an individual would be eligible for the provision of assistance.
Under this bill. The points that I wish to raise here relate to the European Convention on Human Rights. There are potential risks that I am raising to inform the noble the decision making of noble Lords, but I wish to be clear that the underlying policies are rightly a matter for Parliament. Under the European Convention, the amendments in this group could give rise to legal challenge, for example, that
**** Possible New Speaker ****
Frontbench frontbenchers. Frontbench. Frontbencher. Frontbench. Frontbench. Frontbench. Frontbench. Frontbench. Frontbench. Frontbench. Frontbench. My Lords, one of the reasons I am hesitant to one of the reasons I am hesitant to get up is I just want to ensure that this is a debate, that everyone must feel that their voice has been heard. Yeah, what we don't has been heard. Yeah, what we don't want is to make law on the basis for people to look back and say, we did not properly debate that particular issue.
So if all noble Lords who wish to speak in this debate have spoken, then I am very happy to make my own contribution.
**** Possible New Speaker ****
But if there are any other noble Lords who wish to make their point, I think I should let give way. Well said Lord Kamall.
**** Possible New Speaker ****
Well said Lord Kamall. Yeah. Okay, well, that answers that question. I tried my best, but I question. I tried my best, but I really want to make that point clear. I think it's really important that everyone who feels they want to speak and have. But I they want to speak and have. But I would also say to my to friends, noble friends that otherwise that it's also very important to respect the rules and the conventions, to speak to the amendments and not to repeat Second Reading speeches or to make wider debates.
So I hope we can get that appropriate balance. And also I'm also taking time in making these points. So I will try and try and be brief and can I? I do actually want to pay tribute to noble, noble Lady Baroness Berger, especially the way that she delivered a select committee process. I think that would precede our deliberations in committee. I think the evidence submitted to that committee will be invaluable to noble Lords as we continue our work to scrutinise this Bill. If I can just turn to the specific amendments without making very long speeches about it, but just reflecting, changing that minimum age, I was talking to a noble, noble, noble and learned friend about this, and he says, frankly, the whole issue around age is a mess and the law around.
And I think that's actually come out in some discussions. And sometimes I think we're speaking from our own experience. Those of us people like me, who've got my children my 20s, two in their 20s, I think, could they really do they really have the capacity to make this decision? But actually at other times I sit in awe of them and the decisions they make. They they express maturity way beyond 20 years. In fact, maturity more than people who are much older than them. So I think it very much depends on the individual in these cases.
And I think what we have to look at is, is there a way to achieve that right balance? Because otherwise we're just going to set another age limit when you know, you can join the Army at 16, but you can't you can't actually serve in combat until you're 18. The government is talking about reducing the voting age to 16, but then we are hearing debates on neurological competence or neurological capacity. And I think it's really important that we understand these points and we express these points.
The other thing I have to say is the sorry, the number of points is that this whole debate about neurological development, because I think what the point that was made or the point that came out for me from that debate of neurological debate, is that there's no such thing as the science that science is. Science is contestable. And we found that and we've heard the various points from various noble Lords who are experts in their field. So I think we have to be very careful to say the science says this.
We should be very careful around that, because it also has implications for other decisions. I just want to turn to a couple of points I think were made where I think it may already be treated in the bill, and I want to check that no other, no one Lord Falconer of Thoroton understanding of what's in the bill here. I think no one Baroness Hollins made a point about what happens if there's a new treatment available. Well, I'm pretty sure that clause two says something about cannot be reversed by treatment.
So I think that probably does take care of the noble Baroness Hollins points. But I would really like to know Lord Falconer, to noble Lord Falconer to make share his interpretation of whether that addresses the concerns. The noble Lady Baroness Hayter said, think about these young people who will be suffering in pain. But nowhere, nowhere does it say in clause two it doesn't use the word pain or suffering. And we have to be very careful and make sure that we actually read what's in the bill when we're making these points.
I do think, though, and I do welcome the intervention by the noble and learned Lord Falconer about while he wants. He he's quite clear about the age 18. He is sympathetic to the idea of cognitive development and maturity between the ages of 18 and 25, and that there might be some discussion. And who knows, I cannot speak for the noble Lord. Lord, he's and he's obviously looked into this issue very deeply, but perhaps in those discussions he may well be persuaded.
I mean, I know he's saying at the moment, 18 but if, if, if there is strong evidence, but clearly he's open to enhanced measures for those between 18 and 25. And I think that is something I think that hopefully the whole House will welcome. There are many other points I can make, but I think actually I've covered those points. I think at this point it's really important to hear from both the government, but also what
**** Possible New Speaker ****
the noble Lord, Lord believes in response to many of the points that have been raised here. Here. My Lords. I'm grateful.
**** Possible New Speaker ****
I'm grateful. To noble Lords for their contributions in this debate today contributions in this debate today on the age of eligibility for those who are provided for with assistance under this bill, as I've made clear previously, and I would wish to reiterate, I will keep my wish to reiterate, I will keep my comments limited to the issues on which the government has major legal, technical or operational workability concerns. My Lords, the amendments tabled by noble Ladies Baroness Berger, Baroness Lawlor and Baroness Hollins seek to raise the age at which an individual would be eligible for the provision of assistance.
Under this bill. The points that I wish to raise here relate to the European Convention on Human Rights. There are potential risks that I am raising to inform the noble the decision making of noble Lords, but I wish to be clear that the underlying policies are rightly a matter for Parliament. Under the European Convention, the amendments in this group could give rise to legal challenge, for example, that
11:44
Baroness Merron, The Parliamentary Under-Secretary for Health and Social Care (Labour)
-
-
Baroness Merron, The Parliamentary Under-Secretary for Health and Social Care (Labour)
excluding people who are under 21 or under 25 years old from or under 25 years old from accessing, assisting, dying may not be justified under article 2 or 8 of the or that this amounts to unjustified discrimination. Under unjustified discrimination. Under article 14, noble Lords will be aware that differential treatment, such as raising the age of eligibility, may be lawful. If it is possible to persuade the courts to agree that the age limit is justified, necessary and proportionate, there would need to be a reasonable justification for restricting access to assisted dying to people aged either 21 and over or 25 and over, and noble
**** Possible New Speaker ****
Lords will want to consider this in relation to these amendments. Ask it to be clear, because I
**** Possible New Speaker ****
Ask it to be clear, because I wasn't entirely clear from what she said. If we decided to limit in said. If we decided to limit in some way whether it was to do with age or in some other way, the noble and learned law falconer might decide. And we were to put that into primary legislation. Isn't it into primary legislation. Isn't it the case that that is the law in the country, in all the European Court can do is say it's not compatible, but it still remains the law? Or is she saying something different? Because if we pass
**** Possible New Speaker ****
primary legislation, that is the law of the land, isn't it? I'm actually saying the point
**** Possible New Speaker ****
I'm actually saying the point that I was making right at the end, just before I sat down, that noble Lords will want to consider the points that I have raised in relation to these amendments, and I'm sure they will take into I'm sure they will take into account what the noble Lord has just said to.
**** Possible New Speaker ****
just said to. I'm grateful to everybody who has contributed to the debate. I've
**** Possible New Speaker ****
Lords will want to consider this in relation to these amendments. Ask it to be clear, because I
**** Possible New Speaker ****
Ask it to be clear, because I wasn't entirely clear from what she said. If we decided to limit in said. If we decided to limit in some way whether it was to do with age or in some other way, the noble and learned law falconer might decide. And we were to put that into primary legislation. Isn't it into primary legislation. Isn't it the case that that is the law in the country, in all the European Court can do is say it's not compatible, but it still remains the law? Or is she saying something different? Because if we pass
**** Possible New Speaker ****
primary legislation, that is the law of the land, isn't it? I'm actually saying the point
**** Possible New Speaker ****
I'm actually saying the point that I was making right at the end, just before I sat down, that noble Lords will want to consider the points that I have raised in relation to these amendments, and I'm sure they will take into I'm sure they will take into account what the noble Lord has just said to.
**** Possible New Speaker ****
just said to. I'm grateful to everybody who has contributed to the debate. I've
11:46
Lord Falconer of Thoroton (Labour)
-
-
Lord Falconer of Thoroton (Labour)
made my position moderately clear in relation to what we should do about this, and I think we should take that course. And I sense that take that course. And I sense that the House is quite happy that we should take that course. Can I just deal very, very briefly with three deal very, very briefly with three points? I completely understand the points that have been made about people of 18 being impulsive, often being emotionally immature, and just to pick up Baroness Stroud just to pick up Baroness Stroud point.
That's why the Sentencing Council specifically refers to it. But it's a different question here as to what the age limit should be. If people are emotionally immature, then they won't have a subtle view about what to do in these circumstances. But some people will in relation to it. Could I answer Lord Kamall point, which is what happens about new developments in medicine that would extend the life, then the answer would be that you would have not have six months or less to live, which I think was the answer that he was giving in relation to it.
I've made my position clear. I would invite the Baroness Berger and the light of where we've got to to withdraw her amendments, and similarly with everybody else, so that we can now move on to the next issue.
That's why the Sentencing Council specifically refers to it. But it's a different question here as to what the age limit should be. If people are emotionally immature, then they won't have a subtle view about what to do in these circumstances. But some people will in relation to it. Could I answer Lord Kamall point, which is what happens about new developments in medicine that would extend the life, then the answer would be that you would have not have six months or less to live, which I think was the answer that he was giving in relation to it.
I've made my position clear. I would invite the Baroness Berger and the light of where we've got to to withdraw her amendments, and similarly with everybody else, so that we can now move on to the next issue.
11:47
Lord Mackinlay of Richborough (Conservative)
-
-
Lord Mackinlay of Richborough (Conservative)
Thank you.
**** Possible New Speaker ****
In the 2021. It was the passage of the police, crime, Sentencing of the police, crime, Sentencing and Courts Bill where his view was unequivocally or very clearly that unequivocally or very clearly that age of 21 is the unequivocal age of age of 21 is the unequivocal age of adulthood. And I would assume that he's heard the views across this he's heard the views across this House. We had the say the the Baroness Lawlor alternative 18, 25, 21 was advanced.
Wouldn't it be a useful compromise if he were to declare to the House today that he would actively consider the age of 21 as the right age, as he did when considering whole life orders in a previous bill that he spoke up for the age of 21, within that would be very helpful.
**** Possible New Speaker ****
In the 2021. It was the passage of the police, crime, Sentencing of the police, crime, Sentencing and Courts Bill where his view was unequivocally or very clearly that unequivocally or very clearly that age of 21 is the unequivocal age of age of 21 is the unequivocal age of adulthood. And I would assume that he's heard the views across this he's heard the views across this House. We had the say the the Baroness Lawlor alternative 18, 25, 21 was advanced.
Wouldn't it be a useful compromise if he were to declare to the House today that he would actively consider the age of 21 as the right age, as he did when considering whole life orders in a previous bill that he spoke up for the age of 21, within that would be very helpful.
11:48
Lord Falconer of Thoroton (Labour)
-
-
Lord Falconer of Thoroton (Labour)
The comments of mine that you're referring the noble Lord is referring to, is in relation to whether you should impose a whole life term on somebody under 21. I recognise, as the Sentencing Council does, that issues of immaturity might make that inappropriate in certain cases. However, in relation to this position, the question is what is the age at which you might be capable of taking a settled decision? The concerns that the House has expressed about people between 18 and 25 make me think the right course is to consider whether there are ways to deal with that in a way that the House would feel satisfactory at report.
I think that's the right course.
I think that's the right course.
11:48
Baroness Rebuck (Labour)
-
-
Baroness Rebuck (Labour)
Yeah. reassurance that with the changing franchise to 16, that there won't be any slippage in relation to this be any slippage in relation to this bill from 18 downwards? I think that's a reasonable question because according to some people, because according to some people, 16 is now mature enough and adult enough to decide the fate of the future of the country and people decisions made here. So is there not a danger? Can he guarantee that won't happen?
11:49
Lord Falconer of Thoroton (Labour)
-
-
Lord Falconer of Thoroton (Labour)
Yeah. that the age is not going to go down from 18 as far as this bill is concerned, as far as the noble Baroness is concerned, the future is not in my gift, unfortunately. However, as far as the future is concerned, I think it extremely, extremely unlikely that a subsequent Parliament is going to reduce that age.
11:49
Baroness Berger (Labour)
-
-
Baroness Berger (Labour)
Yeah. has been, I think, an important debate and I think really has encapsulated what this House is here to do. There are, of course, other amendments in this group from Baroness Goldie and Lord Moylan and that we haven't discussed. And it's just worth putting on record that these seek to prevent discussions with children and will be an essential question to scrutinise that we're going to discuss in the next group. I just wish to very briefly respond to three points that have been made during this group, because I think it's quite relevant and important to conversations as they will continue, no doubt because of the the weight of opinion and a support that has come forward for these amendments.
I listened very closely to Baroness Fox, and I just want to make clear that for all of these young people, it is not the exception. It is impossible to imagine a young person who wouldn't have an E.H. and that's the context in which I presented and spoke to these debates. So it's not just a small group, it's we anticipate all of them, apart from a young person who might receive a terminal diagnosis over the age of 25 and will not have time to have an ehcp.
But otherwise, we are considering all young people in this context with an ehcp that local authorities have a statutory responsibility for. And it's in that context, as I said, that I make those representations. I listened very closely to my noble friend Lord Winston, and he did make some important comments. And it's clear that there are some elements of brain development that do evolve and complete by the age of 18. But there are many others that don't. There are, and I have in front of me what the global experts and authorities on adolescent brain development Professor Laurence Steinberg, Professor Casey, who's the expert on neurobiological maturation, professor J.
Who is the MRI pioneer in adolescent brain research. They all say that the prefrontal cortex, responsible for executive functions does not reach its maturity until the early to mid 20s, continuing to develop well past the age of 18, and that an 18 year old does not yet have the capacity. And I'm also minded. Again, we've had a lot of comments from Professor Jane Sarah-jayne Blakemore. She is the leading UK neuroscience neuroscientist on adolescence, and she has said an 18 year old does not yet have the fully mature capacity for long term planning and evaluation of consequences that characterises adult executive functioning.
I think we should listen to her comments very, very closely. And finally, my noble friend Baroness Hayter said that young people wouldn't be asked. It would be something they would request. And I just point to the bill that currently does enable a doctor to raise this with anyone from the age of 18. So it is in that context specifically that I've brought forward these amendments. I won't refer to all the other important contributions and comments that have been made, but I just want to make one final point that it has been very clear from the debate in the other place that even some of those most in favour of assisted dying in principle, are highly concerned about the risk of children and young people being drawn into it, and that the amendments in this group have just sought to act on both their concern and the evidence that this House took during our own select committee in all the debate we've had, and will continue to have no doubt on this bill, we have to grapple with the simple fact that there is no going back if we get it wrong.
And for young people in particular, we should, as we have been asked to do on the side of caution, I'm very glad to hear that my learned and normal noble friend, Lord Faulkner, will consider an assessment for those aged 19 to 24 further, but I urge him to accept the simplest and strongest safeguard of all to raise the eligibility to 25, and I really look forward to further discussions on these matters. And with that, I beg leave to withdraw the amendment standing in my name.
I listened very closely to Baroness Fox, and I just want to make clear that for all of these young people, it is not the exception. It is impossible to imagine a young person who wouldn't have an E.H. and that's the context in which I presented and spoke to these debates. So it's not just a small group, it's we anticipate all of them, apart from a young person who might receive a terminal diagnosis over the age of 25 and will not have time to have an ehcp.
But otherwise, we are considering all young people in this context with an ehcp that local authorities have a statutory responsibility for. And it's in that context, as I said, that I make those representations. I listened very closely to my noble friend Lord Winston, and he did make some important comments. And it's clear that there are some elements of brain development that do evolve and complete by the age of 18. But there are many others that don't. There are, and I have in front of me what the global experts and authorities on adolescent brain development Professor Laurence Steinberg, Professor Casey, who's the expert on neurobiological maturation, professor J.
Who is the MRI pioneer in adolescent brain research. They all say that the prefrontal cortex, responsible for executive functions does not reach its maturity until the early to mid 20s, continuing to develop well past the age of 18, and that an 18 year old does not yet have the capacity. And I'm also minded. Again, we've had a lot of comments from Professor Jane Sarah-jayne Blakemore. She is the leading UK neuroscience neuroscientist on adolescence, and she has said an 18 year old does not yet have the fully mature capacity for long term planning and evaluation of consequences that characterises adult executive functioning.
I think we should listen to her comments very, very closely. And finally, my noble friend Baroness Hayter said that young people wouldn't be asked. It would be something they would request. And I just point to the bill that currently does enable a doctor to raise this with anyone from the age of 18. So it is in that context specifically that I've brought forward these amendments. I won't refer to all the other important contributions and comments that have been made, but I just want to make one final point that it has been very clear from the debate in the other place that even some of those most in favour of assisted dying in principle, are highly concerned about the risk of children and young people being drawn into it, and that the amendments in this group have just sought to act on both their concern and the evidence that this House took during our own select committee in all the debate we've had, and will continue to have no doubt on this bill, we have to grapple with the simple fact that there is no going back if we get it wrong.
And for young people in particular, we should, as we have been asked to do on the side of caution, I'm very glad to hear that my learned and normal noble friend, Lord Faulkner, will consider an assessment for those aged 19 to 24 further, but I urge him to accept the simplest and strongest safeguard of all to raise the eligibility to 25, and I really look forward to further discussions on these matters. And with that, I beg leave to withdraw the amendment standing in my name.
11:53
Deputy Chair of Committees.
Baroness Scott of Needham Market (Liberal Democrat)
-
Deputy Chair of Committees.
Baroness Scott of Needham Market (Liberal Democrat)
Is it your Lordship's pleasure that the amendment be withdrawn? The amendment is by leave withdrawn. The amendment is by leave withdrawn. Amendment five Baroness Lawlor not moved in clause one, amendment six
**** Possible New Speaker ****
Lord Falconer of Thoroton Lord. In this group, which is Group three, there are a number of
**** Possible New Speaker ****
Lord Falconer of Thoroton Lord. In this group, which is Group three, there are a number of
11:53
Amendment:s6
Lord Falconer of Thoroton (Labour)
-
Amendment:s6
Lord Falconer of Thoroton (Labour)
three, there are a number of amendments put forward by me, but also two amendments put forward by backbench peers which are in the backbench peers which are in the same sort of area. These are drafting changes. If anybody drafting changes. If anybody objects to any of the drafting chamber changes, I won't move them when the time comes. If there is no objection, I will move them. As objection, I will move them. As long as there's going to be no vote at this stage. Can I just go through them very quickly? Amendment number six, that makes clear that the person who has to be over 18 has to have the preliminary discussion referred to in clause five, and it's making clear which I something that I say is very explicit in the bill amendments eight and nine in the names, respectfully, Lord Moylan and Baroness Goudie seek to make explicit the same thing, and I hope they will accept that I am giving effect to what they are saying in relation to that.
Going on to another topic of of drafting changes, amendments 290, 366 and 931. In this group they get rid of a duplication issue. Everybody wants domestic abuse to refer to both coercion and control and financial abuse that has been achieved by incorporating the definition of domestic abuse in the Domestic Abuse Act 2021. In some parts of the bill, as it's currently drafted, we've left in the wider definition of domestic abuse, which is now duplicative because of bringing in the definition of domestic abuse, which is at the top of page one of the if the doctor who will no longer agree to act or can't act, has either died or has suffered illness.
These amendments delete the word illness and simply provide for a mechanism where the doctor cannot or will not continue to act. You can get a new doctor in relation to it. That's amendment. Given the numbers of those, then amendment 405, clause 12 five requires that the doctors who are doing the assessment make sure that there is appropriate adjustment for language and literary barriers. I am putting forward a new draft that is clearer, but does not in any way change the sense amendment 413.
It's permissible for where a doctor has a doubt about something, and he's one of the two assessing doctors. He has to get a second opinion on the clinical diagnosis for the person in relation to the second doctor. We the bill, said he if he still had, if he had a doubt, he could rely on the opinion obtained by the First Doctor. But that seems to us to be illogical. If the second Doctor has a doubt, even after reading that opinion, then he should get an opinion of his own.
And that's the effect of amendment 413. And then a final amendment drafting amendment. Amendment 416, this redraught clause 1303 1303, deals with the situation where the second doctor has said no. He doesn't think the conditions are satisfied. In those circumstances. You can get another doctor to come in, but we've redraughted clause 1303 to make clear that if the second second doctor says yes, he's got to give explicitly reasons why he's disagreeing. Disagreeing with the first second doctor, I commend these drafting changes to the House.
I beg to move amendment number six.
**** Possible New Speaker ****
Clause one, page one, line six. Insert the words as printed on the marshalled list. And I must inform
Going on to another topic of of drafting changes, amendments 290, 366 and 931. In this group they get rid of a duplication issue. Everybody wants domestic abuse to refer to both coercion and control and financial abuse that has been achieved by incorporating the definition of domestic abuse in the Domestic Abuse Act 2021. In some parts of the bill, as it's currently drafted, we've left in the wider definition of domestic abuse, which is now duplicative because of bringing in the definition of domestic abuse, which is at the top of page one of the if the doctor who will no longer agree to act or can't act, has either died or has suffered illness.
These amendments delete the word illness and simply provide for a mechanism where the doctor cannot or will not continue to act. You can get a new doctor in relation to it. That's amendment. Given the numbers of those, then amendment 405, clause 12 five requires that the doctors who are doing the assessment make sure that there is appropriate adjustment for language and literary barriers. I am putting forward a new draft that is clearer, but does not in any way change the sense amendment 413.
It's permissible for where a doctor has a doubt about something, and he's one of the two assessing doctors. He has to get a second opinion on the clinical diagnosis for the person in relation to the second doctor. We the bill, said he if he still had, if he had a doubt, he could rely on the opinion obtained by the First Doctor. But that seems to us to be illogical. If the second Doctor has a doubt, even after reading that opinion, then he should get an opinion of his own.
And that's the effect of amendment 413. And then a final amendment drafting amendment. Amendment 416, this redraught clause 1303 1303, deals with the situation where the second doctor has said no. He doesn't think the conditions are satisfied. In those circumstances. You can get another doctor to come in, but we've redraughted clause 1303 to make clear that if the second second doctor says yes, he's got to give explicitly reasons why he's disagreeing. Disagreeing with the first second doctor, I commend these drafting changes to the House.
I beg to move amendment number six.
**** Possible New Speaker ****
Clause one, page one, line six. Insert the words as printed on the marshalled list. And I must inform
11:58
Deputy Chair of Committees.
Baroness Scott of Needham Market (Liberal Democrat)
-
Deputy Chair of Committees.
Baroness Scott of Needham Market (Liberal Democrat)
marshalled list. And I must inform the committee that if amendment six is agreed to, I will not be able to call amendment nine by reasons of call amendment nine by reasons of pre-emption. We now come to amendment seven, which is an amendment to amendment six. Baroness Coffey.
**** Possible New Speaker ****
Baroness Coffey. This is a really important group, and I appreciate that. The noble Lord Lord Falconer of Thoroton has
**** Possible New Speaker ****
Baroness Coffey. This is a really important group, and I appreciate that. The noble Lord Lord Falconer of Thoroton has
11:58
Baroness Coffey (Conservative)
-
-
Baroness Coffey (Conservative)
Lord Lord Falconer of Thoroton has suggested quite a lot of this drafting changes, but I think it goes further beyond that. But speaking specifically to my First Amendment, amendment seven, the reason I put this in about being their first preliminary discussion is we've actually just had a significant debate about the issue of age. Now in the Commons, the bill government Ministers who had helped take this bill through the House voted against the idea that this could be raised against the amendment that came through.
That was one. But they voted against it where it could be raised with somebody under the age of 18. So that's why the debate on age has been significant and why I've put this particular amendment in. So the one of my wider concerns is that how many preliminary discussions will somebody have? This is not going to be an easy decision for somebody, particularly a young person, to have about thinking, is this the right time? Is it so unbearable that I actually want my life to end later in the bill? There's quite a lot of procedure about recording medical information, but the reason why I'm interested in making sure it is there first discussion is that we don't have, as can sometimes happen, an informal off the record discussion as part of this really important process.
So I'll be interested to hear what other noble Lords think about trying to be specific, recognising the concerns that this part amendments to this bill so far have been seeking to address. Now, my Lords, one of the things that I'm would be interested in hearing is just trying to understand if there are any discussions, other discussions that could take place that would not qualify as preliminary discussions. So, for example, does clause five, subsection three permit a practitioner to have a general chat about it? Could this happen before somebody was 18? I expect the answer may become no, but as I say, I'm somewhat nervous because of the new clause two that was debated and Report stage in the Commons.
So in terms of that, I'm just trying to put a slightly extra safeguard and to give very clear guidelines to the registered medical practitioners at this point that in a way, when you have that first conversation, the clock starts ticking. And formally we have to start recording now. My Lords, the noble Lord has tabled a series of amendments, but I put it to him. Actually, quite a lot of these amendments go further than just drafting. Now, when I asked the question, I raised this at in a committee recently, the government has refused to say which amendments made it easy, which amendments they've actually got involved in, in which they help.
And basically the suggestion was go and read Hansard. Well, my Lords, I have and there's an amendment in here where in a variety of places where there's been something done actually with Kim Leadbeater, a tabling amendments, and all of a sudden that's now been watered down. And one of those is about through illness. So I don't know why all of a sudden we're seeing specifically an amendment put in now being removed. Now, I don't want to get into the whole debate about doctor shopping and others that's actually being considered in a group elsewhere.
So I'm grateful to the noble Lord, Lord Faulkner, for already indicating that if any of these are to be challenged, he won't move them to a vote and won't assume they just go through on the nod. So I'm grateful for that. And on that basis, I'll be withdrawing my amendment seven. But I think it really we do need to understand what is going on now in terms of the issues regarding domestic abuse. I think the noble Lord eloquently was referring to other parts of the legislation, but this was a key decision or key discussion initiated by Jess Asato, and I think others may come in to discuss this particular point, and I'm not aware that Jess Asato has been involved on potential amendments to what she thought she had secured.
And I'm not going to repeat all of her Commons speech at all, but it was very clear aspects of thinking about the extra forms of abuse which she specifically managed to get into this bill. She felt it was important because actually, currently not enough healthcare professionals have training for that. I go further in terms of Jack Abbott had tabled an amendment at committee, and this was to do with the interpreters, which I think is now covered by amendments 170 and 405.
And by removing from must to and changing it to all reasonable steps. Very specifically, Kim Leadbeater had said I would be happy to move the amendments in my name. They seem very sensible and I am happy to support them. Along with the General Medical Council's Good Medical Practice, which sets out the principles, values and standards of professional behaviour expected of doctors. It is a belt and braces approach to an issue that is very important, for reasons that several hon. Members have set out.
That's what she said in the other house. Why is this now being
**** Possible New Speaker ****
watered down? I apologise for interrupting.
**** Possible New Speaker ****
I think there's a profound misunderstanding. If you look at clause eight, because the point clause eight, because the point that the Baroness Coffey is making is a very important point. Jess Sato was incredibly keen that Sato was incredibly keen that domestic abuse, including coercive control and financial abuse, be mandatory. So if you look at clause eight Subclause eight, it says the regulations must provide that the practitioner involved must have training about the following. And D is domestic abuse.
If you then go to ten, you'll see that domestic abuse must be training in respect of coercive control and financial abuse. That was the point that Jessie was keen to get. If you then go to the top of page 41, you'll see that the definition of domestic abuse includes controlling or coercive behaviour and economic abuse. So all that is happening here is not a watering down of any of that. It is simply avoiding the duplication between clause 810 and the wide definition of domestic abuse.
At the age of 41, I quite understand why the noble Baroness might be slightly confused about it, because it's it's slightly complicated, but that's the intention. It is not to water down
**** Possible New Speaker ****
for one second any of the protections. My Lords, I don't think I am
**** Possible New Speaker ****
My Lords, I don't think I am confused at all. I just know this is what Jess Sato tried to get into the bill to give her assurances, the bill to give her assurances, and nothing has changed. I'd actually moved on to the amendment from Jack Abbott, which and that from Jack Abbott, which and that amendment was very important in terms of moving on to the aspects terms of moving on to the aspects of illness. That is an example, as I say, of where the government said they'd worked with the promoter of the bill and quote.
The challenge of actually of this group. And I'm thinking of what Lord Burt said earlier, is that we're actually covering multiple issues on the basis of drafting changes, and I'd rather get into the substance of some of this when we get into groups later on. But it does say in the very unlikely circumstances that the doctor who agreed to give a second opinion dies or because of illness or whatever reason, is unable to continue to rewrite, to seek a second opinion elsewhere. But my point is by removing the phrase illness that was specifically included in the bill.
And I'm trying to understand, hopefully, when he replies to this group of amendments why he is seeking to do that. I've already heard him talk about we can just go round and find another doctor, but the government, and in particular, I'm very keen to hear from the government what their views are because they are also the ones that worked with the sponsor of the Bill in the Commons to get this phrasing in about illness right, we'll move on to some of the other groups.
So here we go. Amendment 459. This was to do with independent doctors. And whether or not information can be passed on that is four, five, nine in the sorry in the House of Commons. And as a consequence here I think it is forgive me. It's a section for sponsors amendment 416. And I think there's more than one reference. Now. Again, there was significant debate when Sarah Olney introduced an amendment in the Commons in Committee stage, and that's to reduce the possibility of abuse by making sure that the second independent doctor has available the reasons why the first independent doctor concluded that the person was not eligible.
Now, my interpretation of this amendment, that the noble Lord Lord Falconer of Thoroton has put through, is that that goes away. So the second Doctor, there won't be the two reports and then the there's further about other aspects of the reports that are going to be there. Now, this brought attention from other MPs. Lewis Atkinson talked about this in terms of recognising that with these various touch points, and I appreciate the effort that has gone to try and have safeguards on these different matters.
But the provision for different five different touch points of assessment is one of the strengths of the bill. And each assessment should be done in a way that can be progressed with more information. The bill's record keeping provisions. The assessment should become increasingly informed throughout the process, and therefore there should be an opportunity for a lot of these to be shared with the panel as it's currently proposed in the bill. And indeed, Kim Leadbeater absolutely said that she had been minded to support Sarah Olney's amendment.
But again, with some of these changes, they are being taken out. I'm not entirely clear about section 417 disability definition and section eight amendment. I do somewhat understand, although there seems to be only one reference point where the whole issue of section six of the Equality Act 2010 isn't actually used anywhere is. There's only one reference to that. But my Lords, I think this particular group of amendments does need careful scrutiny as we go through the different groups for later discussion.
One of the aspects that we need to make sure is that the extensive debate, the extensive concessions made in the other House that all of a sudden, through just a few changes here and there, don't suddenly go away. In fact, as we know in this House, we're even considering what further safeguards there could be. So, my Lords, one of the reasons for rising today was to bring this to the attention of the House. I'm not suggesting the noble Lord has done this in bad faith.
He may think this is just being more efficient, but the extent of the debate and the support in the other place, indeed the support of Kim Leadbeater to several of these amendments as they originally drafted, means I think that we should be asking the noble Lord Lord Falconer of Thoroton to think again, and that we will get into some of the detailed debate in future groups. I want to.
That was one. But they voted against it where it could be raised with somebody under the age of 18. So that's why the debate on age has been significant and why I've put this particular amendment in. So the one of my wider concerns is that how many preliminary discussions will somebody have? This is not going to be an easy decision for somebody, particularly a young person, to have about thinking, is this the right time? Is it so unbearable that I actually want my life to end later in the bill? There's quite a lot of procedure about recording medical information, but the reason why I'm interested in making sure it is there first discussion is that we don't have, as can sometimes happen, an informal off the record discussion as part of this really important process.
So I'll be interested to hear what other noble Lords think about trying to be specific, recognising the concerns that this part amendments to this bill so far have been seeking to address. Now, my Lords, one of the things that I'm would be interested in hearing is just trying to understand if there are any discussions, other discussions that could take place that would not qualify as preliminary discussions. So, for example, does clause five, subsection three permit a practitioner to have a general chat about it? Could this happen before somebody was 18? I expect the answer may become no, but as I say, I'm somewhat nervous because of the new clause two that was debated and Report stage in the Commons.
So in terms of that, I'm just trying to put a slightly extra safeguard and to give very clear guidelines to the registered medical practitioners at this point that in a way, when you have that first conversation, the clock starts ticking. And formally we have to start recording now. My Lords, the noble Lord has tabled a series of amendments, but I put it to him. Actually, quite a lot of these amendments go further than just drafting. Now, when I asked the question, I raised this at in a committee recently, the government has refused to say which amendments made it easy, which amendments they've actually got involved in, in which they help.
And basically the suggestion was go and read Hansard. Well, my Lords, I have and there's an amendment in here where in a variety of places where there's been something done actually with Kim Leadbeater, a tabling amendments, and all of a sudden that's now been watered down. And one of those is about through illness. So I don't know why all of a sudden we're seeing specifically an amendment put in now being removed. Now, I don't want to get into the whole debate about doctor shopping and others that's actually being considered in a group elsewhere.
So I'm grateful to the noble Lord, Lord Faulkner, for already indicating that if any of these are to be challenged, he won't move them to a vote and won't assume they just go through on the nod. So I'm grateful for that. And on that basis, I'll be withdrawing my amendment seven. But I think it really we do need to understand what is going on now in terms of the issues regarding domestic abuse. I think the noble Lord eloquently was referring to other parts of the legislation, but this was a key decision or key discussion initiated by Jess Asato, and I think others may come in to discuss this particular point, and I'm not aware that Jess Asato has been involved on potential amendments to what she thought she had secured.
And I'm not going to repeat all of her Commons speech at all, but it was very clear aspects of thinking about the extra forms of abuse which she specifically managed to get into this bill. She felt it was important because actually, currently not enough healthcare professionals have training for that. I go further in terms of Jack Abbott had tabled an amendment at committee, and this was to do with the interpreters, which I think is now covered by amendments 170 and 405.
And by removing from must to and changing it to all reasonable steps. Very specifically, Kim Leadbeater had said I would be happy to move the amendments in my name. They seem very sensible and I am happy to support them. Along with the General Medical Council's Good Medical Practice, which sets out the principles, values and standards of professional behaviour expected of doctors. It is a belt and braces approach to an issue that is very important, for reasons that several hon. Members have set out.
That's what she said in the other house. Why is this now being
**** Possible New Speaker ****
watered down? I apologise for interrupting.
**** Possible New Speaker ****
I think there's a profound misunderstanding. If you look at clause eight, because the point clause eight, because the point that the Baroness Coffey is making is a very important point. Jess Sato was incredibly keen that Sato was incredibly keen that domestic abuse, including coercive control and financial abuse, be mandatory. So if you look at clause eight Subclause eight, it says the regulations must provide that the practitioner involved must have training about the following. And D is domestic abuse.
If you then go to ten, you'll see that domestic abuse must be training in respect of coercive control and financial abuse. That was the point that Jessie was keen to get. If you then go to the top of page 41, you'll see that the definition of domestic abuse includes controlling or coercive behaviour and economic abuse. So all that is happening here is not a watering down of any of that. It is simply avoiding the duplication between clause 810 and the wide definition of domestic abuse.
At the age of 41, I quite understand why the noble Baroness might be slightly confused about it, because it's it's slightly complicated, but that's the intention. It is not to water down
**** Possible New Speaker ****
for one second any of the protections. My Lords, I don't think I am
**** Possible New Speaker ****
My Lords, I don't think I am confused at all. I just know this is what Jess Sato tried to get into the bill to give her assurances, the bill to give her assurances, and nothing has changed. I'd actually moved on to the amendment from Jack Abbott, which and that from Jack Abbott, which and that amendment was very important in terms of moving on to the aspects terms of moving on to the aspects of illness. That is an example, as I say, of where the government said they'd worked with the promoter of the bill and quote.
The challenge of actually of this group. And I'm thinking of what Lord Burt said earlier, is that we're actually covering multiple issues on the basis of drafting changes, and I'd rather get into the substance of some of this when we get into groups later on. But it does say in the very unlikely circumstances that the doctor who agreed to give a second opinion dies or because of illness or whatever reason, is unable to continue to rewrite, to seek a second opinion elsewhere. But my point is by removing the phrase illness that was specifically included in the bill.
And I'm trying to understand, hopefully, when he replies to this group of amendments why he is seeking to do that. I've already heard him talk about we can just go round and find another doctor, but the government, and in particular, I'm very keen to hear from the government what their views are because they are also the ones that worked with the sponsor of the Bill in the Commons to get this phrasing in about illness right, we'll move on to some of the other groups.
So here we go. Amendment 459. This was to do with independent doctors. And whether or not information can be passed on that is four, five, nine in the sorry in the House of Commons. And as a consequence here I think it is forgive me. It's a section for sponsors amendment 416. And I think there's more than one reference. Now. Again, there was significant debate when Sarah Olney introduced an amendment in the Commons in Committee stage, and that's to reduce the possibility of abuse by making sure that the second independent doctor has available the reasons why the first independent doctor concluded that the person was not eligible.
Now, my interpretation of this amendment, that the noble Lord Lord Falconer of Thoroton has put through, is that that goes away. So the second Doctor, there won't be the two reports and then the there's further about other aspects of the reports that are going to be there. Now, this brought attention from other MPs. Lewis Atkinson talked about this in terms of recognising that with these various touch points, and I appreciate the effort that has gone to try and have safeguards on these different matters.
But the provision for different five different touch points of assessment is one of the strengths of the bill. And each assessment should be done in a way that can be progressed with more information. The bill's record keeping provisions. The assessment should become increasingly informed throughout the process, and therefore there should be an opportunity for a lot of these to be shared with the panel as it's currently proposed in the bill. And indeed, Kim Leadbeater absolutely said that she had been minded to support Sarah Olney's amendment.
But again, with some of these changes, they are being taken out. I'm not entirely clear about section 417 disability definition and section eight amendment. I do somewhat understand, although there seems to be only one reference point where the whole issue of section six of the Equality Act 2010 isn't actually used anywhere is. There's only one reference to that. But my Lords, I think this particular group of amendments does need careful scrutiny as we go through the different groups for later discussion.
One of the aspects that we need to make sure is that the extensive debate, the extensive concessions made in the other House that all of a sudden, through just a few changes here and there, don't suddenly go away. In fact, as we know in this House, we're even considering what further safeguards there could be. So, my Lords, one of the reasons for rising today was to bring this to the attention of the House. I'm not suggesting the noble Lord has done this in bad faith.
He may think this is just being more efficient, but the extent of the debate and the support in the other place, indeed the support of Kim Leadbeater to several of these amendments as they originally drafted, means I think that we should be asking the noble Lord Lord Falconer of Thoroton to think again, and that we will get into some of the detailed debate in future groups. I want to.
12:11
Baroness Keeley (Labour)
-
-
Baroness Keeley (Labour)
My Lords, I want to speak briefly in this group to mention my amendment 420, which could sit behind beside amendment 419 from the noble and Lord, Lord Falconer. But it has not been, of course, put in this group. This group is labelled drafting changes. But as we have just heard, the effect they would have goes further than that. I have tabled amendment 420 to be discussed in a later group to address a concern that the grounds on which a coordinating doctor can drop out are already too wide.
But I see the amendments in this group from the noble Lords. Lord Falconer actually compound that problem by expanding the grounds even further. I therefore feel I must speak briefly in this debate, despite the fact that my amendment comes later. Because your Lordships' House needs to be aware of the concern I am seeking to raise in which the noble Baroness, Lady Coffey, also has. My amendment 420 highlights that these provisions should be limited to cases of death or illness. Clause 14 fails to define in which situations it would be unacceptable.
It would be acceptable for the state to not be concerned that the doctor is unwilling, as the noble Baroness, Lady Coffey has highlighted in her amendment. 420 A the danger is that the current wording would allow the risk of changing doctors until the wanted answer is given. These probing amendments are going to be discussed later, and they will focus on the need to restrict the grounds for changing the coordinating doctor by excluding the words unwilling, which both amendments 420 and 428 address.
So it would be helpful if my noble friend, the noble Lord, Lord Falconer, could answer these questions on this matter. How do we distinguish between a doctor who is unwilling due to conscience, and one who is unwilling due to suspicion, without a requirement to record the specific reasons for unwillingness? Is there a danger that we are creating a black box? If a doctor steps away because they are uncomfortable, for instance, with a family member's influence, surely the system needs to capture that specific hesitation before a new doctor is appointed.
And will the noble Lord, Lord Falconer specify what circumstances cross the line where the state should be more curious as to why the doctor is unwilling to.
But I see the amendments in this group from the noble Lords. Lord Falconer actually compound that problem by expanding the grounds even further. I therefore feel I must speak briefly in this debate, despite the fact that my amendment comes later. Because your Lordships' House needs to be aware of the concern I am seeking to raise in which the noble Baroness, Lady Coffey, also has. My amendment 420 highlights that these provisions should be limited to cases of death or illness. Clause 14 fails to define in which situations it would be unacceptable.
It would be acceptable for the state to not be concerned that the doctor is unwilling, as the noble Baroness, Lady Coffey has highlighted in her amendment. 420 A the danger is that the current wording would allow the risk of changing doctors until the wanted answer is given. These probing amendments are going to be discussed later, and they will focus on the need to restrict the grounds for changing the coordinating doctor by excluding the words unwilling, which both amendments 420 and 428 address.
So it would be helpful if my noble friend, the noble Lord, Lord Falconer, could answer these questions on this matter. How do we distinguish between a doctor who is unwilling due to conscience, and one who is unwilling due to suspicion, without a requirement to record the specific reasons for unwillingness? Is there a danger that we are creating a black box? If a doctor steps away because they are uncomfortable, for instance, with a family member's influence, surely the system needs to capture that specific hesitation before a new doctor is appointed.
And will the noble Lord, Lord Falconer specify what circumstances cross the line where the state should be more curious as to why the doctor is unwilling to.
12:13
Baroness Grey-Thompson (Crossbench)
-
-
Baroness Grey-Thompson (Crossbench)
My Lords, my Lords.
**** Possible New Speaker ****
I did. Originally request that later amendments that I've got on disability language, as defined under the Equality Act be moved into this group. But they weren't. into this group. But they weren't. And I do think it's important that we have a chance to debate those as well. Language is the dress of well. Language is the dress of thought, and person with a disability is not language that's used in the Equality Act. However, used in the Equality Act. However, if the noble Lady Baroness Coffey is seem to misunderstand these amendments, I think I've misunderstood them as well.
And I'm particularly concerned about amendments two, 93, 66 and 931 around domestic abuse and coercive control, which I've spoken other debates about. I do believe these amendments go beyond merely drafting changes, and I think the wording as it now exists, does water down what the training is likely to be around domestic abuse. So, for example, it could be a course on physical or sexual abuse, but doesn't necessarily mean that it's as comprehensive as I believe I need it to be.
And just in, you know, conscious of time would just be really interested if the noble and Lord or the sponsor in another place, the right hon. Member for Batley and Spen, has spoken to the right hon. Member of Lowestoft about the impact of these amendments on the work that Josesito did, because I think it's really important we understand the context of what we thought was coming from the Commons and what these changes might mean to the bill.
**** Possible New Speaker ****
I did. Originally request that later amendments that I've got on disability language, as defined under the Equality Act be moved into this group. But they weren't. into this group. But they weren't. And I do think it's important that we have a chance to debate those as well. Language is the dress of well. Language is the dress of thought, and person with a disability is not language that's used in the Equality Act. However, used in the Equality Act. However, if the noble Lady Baroness Coffey is seem to misunderstand these amendments, I think I've misunderstood them as well.
And I'm particularly concerned about amendments two, 93, 66 and 931 around domestic abuse and coercive control, which I've spoken other debates about. I do believe these amendments go beyond merely drafting changes, and I think the wording as it now exists, does water down what the training is likely to be around domestic abuse. So, for example, it could be a course on physical or sexual abuse, but doesn't necessarily mean that it's as comprehensive as I believe I need it to be.
And just in, you know, conscious of time would just be really interested if the noble and Lord or the sponsor in another place, the right hon. Member for Batley and Spen, has spoken to the right hon. Member of Lowestoft about the impact of these amendments on the work that Josesito did, because I think it's really important we understand the context of what we thought was coming from the Commons and what these changes might mean to the bill.
12:15
Lord Moylan (Conservative)
-
-
Lord Moylan (Conservative)
My Lords, I rise to speak briefly to my amendment number nine briefly to my amendment number nine in this group, but before I do so could I thank the noble and learned Lord, Lord Thornton, for Lord Lord, Lord Thornton, for Lord Falconer of Thoroton, for making clear his intentions as regards moving his own amendments in committee. I did write to him, in fact, twice about this without getting a clear answer, but there has been a clear answer today, which is that he is not going to move amendments to which there is objection.
So it is good to know what his intentions are, because otherwise we could end up in a situation which I think would not be convenient to the committee and would certainly contradict our normal practice of having to hold divisions in committee, which normally would be referred very properly to report. So I welcome what he said. My own amendment number nine is fairly easily disposed of because the noble Lord, the noble and learned Lord, has explained that there is we both, he and I have identified, and indeed the noble Baroness, Lady Goudie, I believe in her.
Amendment number eight have identified one of a number of blatant errors in the bill, where it says two different things in two different places. And we have drafted amendments which correct that. And that's essentially what they do. We have drafted them differently. And I think the sensible thing would be if the noble Lord did not move his amendment six today, because it would pre-empt mine, but instead, I think the sensible and normal thing, the courteous thing would be to say that he would discuss the matter with the drafting, with Lady Goudie and myself outside committee between now and report, so that we had agreement that the same amendment, we had agreement on the appropriate amendment, since I prefer not to have my amendment pre-empted, since I say with some humility in front of the noble and learned Lord that I think mine is better drafted than his.
So it is good to know what his intentions are, because otherwise we could end up in a situation which I think would not be convenient to the committee and would certainly contradict our normal practice of having to hold divisions in committee, which normally would be referred very properly to report. So I welcome what he said. My own amendment number nine is fairly easily disposed of because the noble Lord, the noble and learned Lord, has explained that there is we both, he and I have identified, and indeed the noble Baroness, Lady Goudie, I believe in her.
Amendment number eight have identified one of a number of blatant errors in the bill, where it says two different things in two different places. And we have drafted amendments which correct that. And that's essentially what they do. We have drafted them differently. And I think the sensible thing would be if the noble Lord did not move his amendment six today, because it would pre-empt mine, but instead, I think the sensible and normal thing, the courteous thing would be to say that he would discuss the matter with the drafting, with Lady Goudie and myself outside committee between now and report, so that we had agreement that the same amendment, we had agreement on the appropriate amendment, since I prefer not to have my amendment pre-empted, since I say with some humility in front of the noble and learned Lord that I think mine is better drafted than his.
12:17
Baroness Hollins (Crossbench)
-
-
Baroness Hollins (Crossbench)
I just want to. >> Speak briefly to amendment 405, because the Equality Act. >> Is, is is relevant to it, it
**** Possible New Speaker ****
Is, is is relevant to it, it providing a legal duty to provide reasonable adjustments for disabled people, which is defined quite people, which is defined quite broadly, and I think would include a person who was terminally ill. Could I suggest that the way that it's currently worded, which is to say the Redraughting changes it to the doctor, must take all reasonable steps to ensure effective communication with the noble Leonard Lord. Consider changing his drafting to the doctor. Must ensure reasonable adjustments are provided to ensure effective communication.
**** Possible New Speaker ****
Is, is is relevant to it, it providing a legal duty to provide reasonable adjustments for disabled people, which is defined quite people, which is defined quite broadly, and I think would include a person who was terminally ill. Could I suggest that the way that it's currently worded, which is to say the Redraughting changes it to the doctor, must take all reasonable steps to ensure effective communication with the noble Leonard Lord. Consider changing his drafting to the doctor. Must ensure reasonable adjustments are provided to ensure effective communication.
12:18
Lord Shinkwin (Conservative)
-
-
Lord Shinkwin (Conservative)
So to speak, on amendment 405. >> So to speak, on amendment 405. It's a pleasure to to follow the noble Baroness Baroness Hollins and noble Baroness Baroness Hollins and to echo some of the points she touched on, and I clarify that the amendment is in the name of the noble. And Leonard Lord Maude Lord Falconer of Thoroton, and I do so because as a disabled person who is on the National Disability Council in the late 1990s developing codes of practice and advising the government on the importance of language, a point that the noble Baroness has just mentioned.
I fail to see how changing the bill's work from must first ensure the provision of adjustments for language and literary literacy barriers, which was the language of the amendment adopted by the Other place to take all reasonable steps. Cannot do anything other than weaken this bill. Now, the Lord would have us believe that this is a drafting change. Indeed, he said in his opening remarks. It makes it clearer, but I would contend this is no drafting change.
And yes, it does change the sense of meaning this amendment takes us backwards because it fundamentally returns one of the bill's safeguards, such as they are, which was inserted as a result of Jack Abbot's committee amendment in the other place, and which the bill's sponsor in the other place described as very sensible. She was very happy to support it. So I have a few questions for the noble Lords, which I'll be really grateful if you could answer.
In his closing remarks. Is this House being asked to believe that today the bill's sponsor in the other place is very happy for the noble and learned Lords effectively to overrule her, to confirm in his closing remarks to confirm in his closing remarks that she and Mr. Abbott have been consulted, or is it that together the noble and learned Lords and learned better have decided to water down one of the few safeguards in the Bill because, well, it's only the House of Lords no one's going to notice.
And the whole point of the bill is to make it as easy as possible for people to have assisted dying. So let's just minimise the constraints. My Lords, I began my career at the Royal National Institute for Deaf People during the first Blair government. It was an exciting time. To Tony Blair's credit and that of the noble Lord, Lord Hutton. As Health Secretary digital hearing aids were introduced on the NHS, the R and D when I worked there was listened to and it should be now.
So in his closing remarks to the noble Lords, noble and learned Lords explain why his amendments implicitly or specific amendments, implicitly ignores the finding made this year by R&D and Science Health. In their report that some patients did not understand their diagnoses or treatments. My Lords, as a disabled person, I want to thank most sincerely our Labour colleagues. I know I owe a debt to the Labour Party's long standing and noble in the true sense of the word.
Noble commitment to advancing disability rights. My Lords, this amendment underlines an inescapable but painful truth. This bill makes a mockery of that fine, noble and honourable tradition. It shreds a tradition that deserves to be preserved, not sacrificed in such a profoundly cynical and misleading way as to make out, as this amendment does, that this is somehow only a drafting change. There is a reason why not one organisation of or for disabled people supports this bill.
They know disabled people need this bill like a hole in the head. I marvel that the noble and murdered Lord does not seem to realise that this bill is actually dangerous enough already, without the removal of provisions that would at least acknowledge the obligation to first ensure communication adjustments were made. For example, for people with learning disabilities or users of British Sign Language. So, my Lords, I close with this point. The very last thing, the last thing we should be doing as a House is endorsing an attempt to make this bill an even poorer piece of proposed legislation that it already is.
Noble Lords to be forgiven, that that was not possible, as his amendment 405 clearly states, the noble and learned Lord is perfectly capable of making his very poorly drafted bill even worse.
I fail to see how changing the bill's work from must first ensure the provision of adjustments for language and literary literacy barriers, which was the language of the amendment adopted by the Other place to take all reasonable steps. Cannot do anything other than weaken this bill. Now, the Lord would have us believe that this is a drafting change. Indeed, he said in his opening remarks. It makes it clearer, but I would contend this is no drafting change.
And yes, it does change the sense of meaning this amendment takes us backwards because it fundamentally returns one of the bill's safeguards, such as they are, which was inserted as a result of Jack Abbot's committee amendment in the other place, and which the bill's sponsor in the other place described as very sensible. She was very happy to support it. So I have a few questions for the noble Lords, which I'll be really grateful if you could answer.
In his closing remarks. Is this House being asked to believe that today the bill's sponsor in the other place is very happy for the noble and learned Lords effectively to overrule her, to confirm in his closing remarks to confirm in his closing remarks that she and Mr. Abbott have been consulted, or is it that together the noble and learned Lords and learned better have decided to water down one of the few safeguards in the Bill because, well, it's only the House of Lords no one's going to notice.
And the whole point of the bill is to make it as easy as possible for people to have assisted dying. So let's just minimise the constraints. My Lords, I began my career at the Royal National Institute for Deaf People during the first Blair government. It was an exciting time. To Tony Blair's credit and that of the noble Lord, Lord Hutton. As Health Secretary digital hearing aids were introduced on the NHS, the R and D when I worked there was listened to and it should be now.
So in his closing remarks to the noble Lords, noble and learned Lords explain why his amendments implicitly or specific amendments, implicitly ignores the finding made this year by R&D and Science Health. In their report that some patients did not understand their diagnoses or treatments. My Lords, as a disabled person, I want to thank most sincerely our Labour colleagues. I know I owe a debt to the Labour Party's long standing and noble in the true sense of the word.
Noble commitment to advancing disability rights. My Lords, this amendment underlines an inescapable but painful truth. This bill makes a mockery of that fine, noble and honourable tradition. It shreds a tradition that deserves to be preserved, not sacrificed in such a profoundly cynical and misleading way as to make out, as this amendment does, that this is somehow only a drafting change. There is a reason why not one organisation of or for disabled people supports this bill.
They know disabled people need this bill like a hole in the head. I marvel that the noble and murdered Lord does not seem to realise that this bill is actually dangerous enough already, without the removal of provisions that would at least acknowledge the obligation to first ensure communication adjustments were made. For example, for people with learning disabilities or users of British Sign Language. So, my Lords, I close with this point. The very last thing, the last thing we should be doing as a House is endorsing an attempt to make this bill an even poorer piece of proposed legislation that it already is.
Noble Lords to be forgiven, that that was not possible, as his amendment 405 clearly states, the noble and learned Lord is perfectly capable of making his very poorly drafted bill even worse.
12:25
Baroness O'Loan (Crossbench)
-
-
Baroness O'Loan (Crossbench)
Yeah, yeah. I'd like to just ask the. >> Noble. >> Lord, Lord Faulkner, whether he could clarify for me the impact of amendment 290 and whether it amendment 290 and whether it actually deals with matters of coercive control and economic abuse effectively. For the purposes of the legislation. I ask this because amendment 290 effectively removes the words, including coercive control and financial abuse from the bill, and it goes on in the same principle applies to amendment 366 and amendment 93 one removes the requirement for members of the panel to receive training in coercive control and financial abuse.
Now there is a difference, even taking into account the Domestic Abuse Act, which I'll come back to in a second. There's a difference between coercion and pressure and coercive control and abuse. And I think it's for that reason that I would like to support the comments previously made about, for example, Kim Leadbeater in the Commons being very pleased to support mandated training in domestic abuse, including coercive control and financial abuse. And the health Minister in the Commons committee, noting that the amendment would require training regulations to include mandatory training relating to domestic abuse, including coercive and financial abuse, which clearly would ramp up the requirement.
However, when one looks at the definition of domestic abuse in section one of the of the Domestic Abuse Act 2021, it refers to behaviour in the context of personal relationships. Persons who are connected, and there's a list of the persons who are connected and the section one. Section four of the act doesn't actually cover those who are not personally connected, but who may well be capable of bringing enormous influence upon people on behalf of those who are connected.
So I think, for example, of financial advisers and lawyers and even doctors and people like that who may be able to put pressure on people. And we have seen situations in which such pressure has been brought to bear. So I asked the noble Lords Minister, does he consider that the situations in which pressure may be brought to bear, not by somebody personally connected, should be perhaps otherwise provided for? My Lords? The group also contains amendments to clauses ten and 13, the provisions in relation to a situation in which a doctor is unable or willing to act as the independent doctor, and there are provisions in three, three, two, 418 and 419 for a further referral.
If a doctor is unable or unwilling to continue. And of course, reasons for unwillingness could continue could include ethical concerns or suspicions of undue influence on the patient. And despite the fact that there is a provision that he can seek specialist advice on this, there may be a situation in which the doctor will simply withdraw from the process and the single additional referral was approved in the other place to protect the patient, and these amendments would actually enable doctor shopping to occur.
And we're going to come back to those in Group 44. Moreover, my Lords, if a doctor withdraws from completing the process because of suspicions of possible or undue influence, the reason must surely be recorded. Amendment 405 removes from the face of the bill the requirement to have regard to language and literacy barriers, replacing it with this new, more general requirement to take all reasonable steps to ensure effective communication, the noble Baroness Baroness Hollins explained during the previous debate the extent to which people with a disability have complex needs which must be satisfied to enable understanding the inclusion of the words, all reasonable steps, etc.
introduces a far less specific test, and consideration must be given to setting standards for the level of communication which is required. My Lords, I have to ask the noble and learned Lord, does this amendment inadvertently disadvantage those with specific learning difficulties and similar vulnerable groups? I move to amendment 403, which proposals proposes the removal of clause 11 eight, and has the effect of removing the provision that the coordinating doctor could assist, could seek a specialist assessment for the independent doctor.
That's laudable, but there is a question whether, if the independent doctor has concerns about the coordinating, coordinating doctor who they may have used for a second opinion on capacity or terminal illness, would they, with the removal of of clause eight, be be deprived of the ability to seek true, truly independent information they need, which I think was an important safeguard? My Lords amendment 416 to clause 13 would require the the would remove the requirement to provide a second independent doctor appointed under clause 1302 with the report by the first independent doctor setting out the reasons why the first independent doctor was not satisfied that the application for an assisted death should be granted.
It was one of only 25 concessions made to those with concerns about the bill in committee. On the other place, Doctor Elizabeth Davis, a consultant geriatrician, gave evidence that a record of refusal and the reasons for it are vital and it must be traceable and auditable. And that was a view endorsed by the Medical Defence Union, given the concerns that the chief medical officer or subsequent doctors would be unable to identify patterns of doubt, the second independent doctor will therefore be unsighted as to the reasons why a fellow professional reached a different and negative conclusion.
This is a further diminution of the protection currently provided by the clause. Otherwise, the state will be unable to inform the new independent doctor by the first. Independent doctor declined to complete the process. Amendment 416 is described as clarification, since a refusal by a doctor may be because of suspicions of coercion or ineligibility, can the noble Lord, the Lord, Lord Faulkner, tell the House why he wants to remove the opportunity for the second independent doctor to consider the first independent Doctor's reason for refusal? This surely provides an additional safeguard, particularly given the noble Lords amendments to remove the terms coercive control and financial abuse from the bill.
Now there is a difference, even taking into account the Domestic Abuse Act, which I'll come back to in a second. There's a difference between coercion and pressure and coercive control and abuse. And I think it's for that reason that I would like to support the comments previously made about, for example, Kim Leadbeater in the Commons being very pleased to support mandated training in domestic abuse, including coercive control and financial abuse. And the health Minister in the Commons committee, noting that the amendment would require training regulations to include mandatory training relating to domestic abuse, including coercive and financial abuse, which clearly would ramp up the requirement.
However, when one looks at the definition of domestic abuse in section one of the of the Domestic Abuse Act 2021, it refers to behaviour in the context of personal relationships. Persons who are connected, and there's a list of the persons who are connected and the section one. Section four of the act doesn't actually cover those who are not personally connected, but who may well be capable of bringing enormous influence upon people on behalf of those who are connected.
So I think, for example, of financial advisers and lawyers and even doctors and people like that who may be able to put pressure on people. And we have seen situations in which such pressure has been brought to bear. So I asked the noble Lords Minister, does he consider that the situations in which pressure may be brought to bear, not by somebody personally connected, should be perhaps otherwise provided for? My Lords? The group also contains amendments to clauses ten and 13, the provisions in relation to a situation in which a doctor is unable or willing to act as the independent doctor, and there are provisions in three, three, two, 418 and 419 for a further referral.
If a doctor is unable or unwilling to continue. And of course, reasons for unwillingness could continue could include ethical concerns or suspicions of undue influence on the patient. And despite the fact that there is a provision that he can seek specialist advice on this, there may be a situation in which the doctor will simply withdraw from the process and the single additional referral was approved in the other place to protect the patient, and these amendments would actually enable doctor shopping to occur.
And we're going to come back to those in Group 44. Moreover, my Lords, if a doctor withdraws from completing the process because of suspicions of possible or undue influence, the reason must surely be recorded. Amendment 405 removes from the face of the bill the requirement to have regard to language and literacy barriers, replacing it with this new, more general requirement to take all reasonable steps to ensure effective communication, the noble Baroness Baroness Hollins explained during the previous debate the extent to which people with a disability have complex needs which must be satisfied to enable understanding the inclusion of the words, all reasonable steps, etc.
introduces a far less specific test, and consideration must be given to setting standards for the level of communication which is required. My Lords, I have to ask the noble and learned Lord, does this amendment inadvertently disadvantage those with specific learning difficulties and similar vulnerable groups? I move to amendment 403, which proposals proposes the removal of clause 11 eight, and has the effect of removing the provision that the coordinating doctor could assist, could seek a specialist assessment for the independent doctor.
That's laudable, but there is a question whether, if the independent doctor has concerns about the coordinating, coordinating doctor who they may have used for a second opinion on capacity or terminal illness, would they, with the removal of of clause eight, be be deprived of the ability to seek true, truly independent information they need, which I think was an important safeguard? My Lords amendment 416 to clause 13 would require the the would remove the requirement to provide a second independent doctor appointed under clause 1302 with the report by the first independent doctor setting out the reasons why the first independent doctor was not satisfied that the application for an assisted death should be granted.
It was one of only 25 concessions made to those with concerns about the bill in committee. On the other place, Doctor Elizabeth Davis, a consultant geriatrician, gave evidence that a record of refusal and the reasons for it are vital and it must be traceable and auditable. And that was a view endorsed by the Medical Defence Union, given the concerns that the chief medical officer or subsequent doctors would be unable to identify patterns of doubt, the second independent doctor will therefore be unsighted as to the reasons why a fellow professional reached a different and negative conclusion.
This is a further diminution of the protection currently provided by the clause. Otherwise, the state will be unable to inform the new independent doctor by the first. Independent doctor declined to complete the process. Amendment 416 is described as clarification, since a refusal by a doctor may be because of suspicions of coercion or ineligibility, can the noble Lord, the Lord, Lord Faulkner, tell the House why he wants to remove the opportunity for the second independent doctor to consider the first independent Doctor's reason for refusal? This surely provides an additional safeguard, particularly given the noble Lords amendments to remove the terms coercive control and financial abuse from the bill.
12:32
Baroness Berger (Labour)
-
-
Baroness Berger (Labour)
I want to speak very, very briefly, just to raise my serious concerns about the three amendments that remove specification for domestic abuse training. That's amendments two, 90, 366 and 931. In the Commons, this was a significant area of concern for all MPs, specifically about the risks to those suffering domestic abuse, and as such, the sponsor of the Bill in the Commons accepted the amendment, which introduced explicit requirements for training on domestic abuse, including coercive control and financial abuse.
And I did listen very, very closely to the intervention from my learned and noble friend about the definition which is contained in section 56, part two, that does mention control and financial abuse. But just because the definition of domestic abuse in the bill includes coercive control and financial abuse, it does not remain that training on domestic abuse will always include both those things. A training provider would not have an obligation on the face of the bill to cover all aspects of the definition, whereas the bill, as it is currently drafted and as we receive it, includes specifically both coercive control and financial abuse to be included in that training.
And I just would urge my Leonard Noble friends to reconsider those amendments based on the contributions and the other place, and to ensure that training covers and encompasses all those particular and specific elements.
And I did listen very, very closely to the intervention from my learned and noble friend about the definition which is contained in section 56, part two, that does mention control and financial abuse. But just because the definition of domestic abuse in the bill includes coercive control and financial abuse, it does not remain that training on domestic abuse will always include both those things. A training provider would not have an obligation on the face of the bill to cover all aspects of the definition, whereas the bill, as it is currently drafted and as we receive it, includes specifically both coercive control and financial abuse to be included in that training.
And I just would urge my Leonard Noble friends to reconsider those amendments based on the contributions and the other place, and to ensure that training covers and encompasses all those particular and specific elements.
12:34
Baroness Finlay of Llandaff (Crossbench)
-
-
Baroness Finlay of Llandaff (Crossbench)
Of. Lord Low. amendment six. Because I think my concerns also relate to the amendment in the name of the noble Lord, Lord Moylan. It doesn't seem to reflect the way that seriously ill children behave. I've looked after children dying of malignancies and they knew they were dying, and they asked really straightforward questions. They would ask about how they would die. They would want to have in-depth conversations. And indeed, I recall one little boy who asked me if he could play football in heaven after another little boy in an adjacent room had died a few weeks earlier, these children asked in explicit details, and they wanted to have lots of conversations.
Another one said he would die after his goldfish died. Sadly, that was prophetic and when he was close to death, he asked his divorced parents to come in and to promise to look after his siblings together. These children know each other and they want to ask questions and they need to have them answered. I'm not sure with this. Amendment six how doctors are meant to respond to these children when they are asking questions, because at the moment you respond gently and openly and explore with them what they're really asking about in an age appropriate way.
But I have a concern that this could make people feel risk averse about having open communication with these children and letting children remain isolated with their fears. They hear about assisted dying on the news, they hear about it in the media and indeed the ethical aspects of part of the senior school curriculum in some areas. So I really am concerned that amendment six, whilst well-intentioned and the adjacent amendments, might actually make the day to day looking after these children as they're dying more difficult.
Amendment 107 and 405 seem to lower the threshold for communication, and I'm grateful to the noble Lady Baroness Coussins for pointing out that whenever an interpreter is used, they must be a registered public service interpreter to avoid the poor communication scenario I referred to last week. Speech and language therapists are essential, so I'll ask the noble Lord, Lord Faulkner, to explain how with his amendment you would judge effective as is listed in the amendment, and how would you assess reasonable steps? Because these seem very subjective and I'm not sure how that would actually be monitored.
Others have spoken to the other amendments, so I look forward to hearing from the noble Lord. His comments.
Another one said he would die after his goldfish died. Sadly, that was prophetic and when he was close to death, he asked his divorced parents to come in and to promise to look after his siblings together. These children know each other and they want to ask questions and they need to have them answered. I'm not sure with this. Amendment six how doctors are meant to respond to these children when they are asking questions, because at the moment you respond gently and openly and explore with them what they're really asking about in an age appropriate way.
But I have a concern that this could make people feel risk averse about having open communication with these children and letting children remain isolated with their fears. They hear about assisted dying on the news, they hear about it in the media and indeed the ethical aspects of part of the senior school curriculum in some areas. So I really am concerned that amendment six, whilst well-intentioned and the adjacent amendments, might actually make the day to day looking after these children as they're dying more difficult.
Amendment 107 and 405 seem to lower the threshold for communication, and I'm grateful to the noble Lady Baroness Coussins for pointing out that whenever an interpreter is used, they must be a registered public service interpreter to avoid the poor communication scenario I referred to last week. Speech and language therapists are essential, so I'll ask the noble Lord, Lord Faulkner, to explain how with his amendment you would judge effective as is listed in the amendment, and how would you assess reasonable steps? Because these seem very subjective and I'm not sure how that would actually be monitored.
Others have spoken to the other amendments, so I look forward to hearing from the noble Lord. His comments.
12:36
Baroness Berridge (Conservative)
-
-
Baroness Berridge (Conservative)
Rise to speak briefly, particularly to raise attention to section one one amendment 170 that section one one amendment 170 that has recently been added to the group. In an effort to short circuit, we will come to the issues of interpreters much later on. I've laid an amendment one seven for which quite simply says an interpreter must be over the age of 18, and it won't surprise the the noble Lady, Lady Meryn, that I have a whole cluster of amendments that are just dealing with maybe inadvertent, not covering off situations, those who are under 18.
So I invite the noble and learned Lord to look at that amendment, to see whether it can just quite swiftly with the others that relate to children, be clarified and dealt with. But I rise also in this group to speak to the noble and learned Lords. Amendments 332418419417. Sorry, out of order there and 425, which I do believe are a genuine attempt to deal with the report from the Delegated Powers and Regulatory Reform Committee, where they advised the sponsor of the bill to remove the clause 15 power and to align the other clauses.
Because there were inconsistent wordings within the clause. But I do want to reiterate that the reassurance was given in the other place, that there would be one second opinion by another doctor. But unless the doctor really I think it goes back to the noble Lords opener when when we're talking about can't, I think we need to cover that off in the bill, and the bill was covering death or illness. That's obvious situations of can't fulfil the function but won't is obviously a different scenario.
So unless the doctor in my view is unable, for whatever reasons, to perform that function, if we don't stick to the word can't, then we will get potentially the opening up of being able to choose the number of doctors, having maybe some kind of discussion, and then they don't want to act, whether it's for the reasons outlined by the noble Lady lady and lady Goody. And then you can have a number of, of, of sort of assessments or discussions which don't become a formal refusal, which is then documented.
So I don't think the noble and learned Lord intended to actually, by changing clauses ten and 13, broaden the scenarios where a further referral could be made to any situation in which the doctor is unable or unwilling to continue it inadvertently. I think this has been happening, and I know that in the in the groups, the my noble friend Lord Harper has laid amendments regarding particular scenarios. So it may be that obviously death and illness. The Minister, Mr. Kinnock, in the other place, I think, mentioned family circumstances or emergencies, that perhaps the way ahead here and I'm trying to pre-empt when we get to the further group, is that perhaps we could have a clause that outlines more circumstances than the two that are on the face of the bill.
But obviously, as lawyers, we know that we can never cover off every circumstance that would justify a doctor saying, I can't do this function anymore. Not I won't. Then perhaps a system whereby a doctor who wants to withdraw and his circumstance, his or her circumstances are not in the paragraphs, should have to go to the panel and say, I've got a situation that isn't within the framework of the legislation, but I can't, for these reasons, perform that function. So I hope the noble and learned Lord would not move as he's promised those amendments.
But we could come back to it in the group that deals substantively with exploring the scenarios where the doctor, the doctor cannot act.
So I invite the noble and learned Lord to look at that amendment, to see whether it can just quite swiftly with the others that relate to children, be clarified and dealt with. But I rise also in this group to speak to the noble and learned Lords. Amendments 332418419417. Sorry, out of order there and 425, which I do believe are a genuine attempt to deal with the report from the Delegated Powers and Regulatory Reform Committee, where they advised the sponsor of the bill to remove the clause 15 power and to align the other clauses.
Because there were inconsistent wordings within the clause. But I do want to reiterate that the reassurance was given in the other place, that there would be one second opinion by another doctor. But unless the doctor really I think it goes back to the noble Lords opener when when we're talking about can't, I think we need to cover that off in the bill, and the bill was covering death or illness. That's obvious situations of can't fulfil the function but won't is obviously a different scenario.
So unless the doctor in my view is unable, for whatever reasons, to perform that function, if we don't stick to the word can't, then we will get potentially the opening up of being able to choose the number of doctors, having maybe some kind of discussion, and then they don't want to act, whether it's for the reasons outlined by the noble Lady lady and lady Goody. And then you can have a number of, of, of sort of assessments or discussions which don't become a formal refusal, which is then documented.
So I don't think the noble and learned Lord intended to actually, by changing clauses ten and 13, broaden the scenarios where a further referral could be made to any situation in which the doctor is unable or unwilling to continue it inadvertently. I think this has been happening, and I know that in the in the groups, the my noble friend Lord Harper has laid amendments regarding particular scenarios. So it may be that obviously death and illness. The Minister, Mr. Kinnock, in the other place, I think, mentioned family circumstances or emergencies, that perhaps the way ahead here and I'm trying to pre-empt when we get to the further group, is that perhaps we could have a clause that outlines more circumstances than the two that are on the face of the bill.
But obviously, as lawyers, we know that we can never cover off every circumstance that would justify a doctor saying, I can't do this function anymore. Not I won't. Then perhaps a system whereby a doctor who wants to withdraw and his circumstance, his or her circumstances are not in the paragraphs, should have to go to the panel and say, I've got a situation that isn't within the framework of the legislation, but I can't, for these reasons, perform that function. So I hope the noble and learned Lord would not move as he's promised those amendments.
But we could come back to it in the group that deals substantively with exploring the scenarios where the doctor, the doctor cannot act.
12:40
Lord Ashcombe (Conservative)
-
-
Lord Ashcombe (Conservative)
My Lords, I wish to express my particular concern regarding particular concern regarding amendment 416 being proposed. The question I must put to the noble Lord is this why should an independent doctor, tasked with providing a second opinion not have access to the notes of the first? It is truly intended that he wishes to prevent any influence upon the second medical professional, even when the 1st May have identified grounds for dissatisfaction and declined to proceed with the possibility of assisted death.
We have already engaged in lengthy debates on crucial matters of decision making, capacity and the risks of coercion. What if the first independent doctor had uncovered evidence of precisely such concerns? This situation inevitably calls to mind the troubling prospect that a patient, or indeed another party exerting influence upon that patient might seek out a doctor willing to endorse the view of the coordinating physician. Surely, my Lords, the medical notes generated throughout the process are of fundamental importance to all involved in the Hope medical profession, and it cannot be right that they should be withheld from any participant in the decision making claim.
I, therefore, earnestly ask the noble and learned Lord to give me his thoughts on this, as I don't really consider this to be a straight drafting issue in this amendment.
We have already engaged in lengthy debates on crucial matters of decision making, capacity and the risks of coercion. What if the first independent doctor had uncovered evidence of precisely such concerns? This situation inevitably calls to mind the troubling prospect that a patient, or indeed another party exerting influence upon that patient might seek out a doctor willing to endorse the view of the coordinating physician. Surely, my Lords, the medical notes generated throughout the process are of fundamental importance to all involved in the Hope medical profession, and it cannot be right that they should be withheld from any participant in the decision making claim.
I, therefore, earnestly ask the noble and learned Lord to give me his thoughts on this, as I don't really consider this to be a straight drafting issue in this amendment.
12:42
Baroness Lawlor (Conservative)
-
-
Baroness Lawlor (Conservative)
My Lord, I would like to refer just to the noble Lord the sponsor's amendment six. And because I have concerns with it in inserting the words, has a preliminary discussion with the registered medical practitioner amendment six, which is described as a drafting change, adds to the uncertainty about what discussion takes place with the patient and when. It's a dangerous uncertainty, as the bill would stand, if so amended, it would be left open for one or more such discussions to take place before the person is 18.
So long as the discussion which is required as a preliminary discussion itself, takes place after the person has reached 18. In particular, the proposed amendments does nothing to restrict the scope of five three, which permits a medical practitioner to engage in preliminary discussion about assisted dying with a patient who raises the subject. Since there is nothing to tie the discussion referred to as a preliminary discussion to be inserted in clause one with a preliminary discussion my in five three, the amendment will not stop these discussions from taking place with under 18 and the grammatically and a such and such refers to any such and such, and the word preliminary does not imply a restriction on number that could be 1 or 100.
Preliminary discussions. And although five three does not oblige the registered medical practitioner to discuss assisted dying with the under the bill's provisions with any patient who raises it, five six does indeed oblige the practitioner concerned to direct the patient to where they can have the preliminary discussion, and that is the preliminary discussion. Therefore, even as amended, the bill requires that any patient, whatever their age, who raises the possibility of assisted dying under the bill is enabled to have a discussion about it.
Nor can it be objected that in paragraph six the reference to the not a preliminary discussion, since here D refers back to where preliminary discussion is as used in the proceedings. Paragraph 3 to 5 of the clause where the phrase is a preliminary discussion, or such a preliminary discussion. That is to say, any preliminary discussion of the matter. These points may seem technical and pernickety, but consider how the bill, even as amended, might leave a young person to end their life prematurely without proper adult consideration of the matter.
Take a 16 or 17 year old who is suffering from a disease that makes their life expectancy uncertainty, has been warned they might die rapidly or deteriorate and die at any time. We may all try to imagine that we can hardly know how such a young person might feel isolated, lonely, afraid, perhaps sensitive to remarks of innuendo, real or imagined, or indeed some of the what we've heard today about social media and pressures from peers in Holland, I think, was raised the Netherlands, while also sharing not only the worries about the illness, but sharing the normal thoughts of people of that age, which even those in the best health, depressed and unsure of themselves have.
How easy for the unfortunate young person to say I wish I were dead? As it stands, even as amended, the bill not only allows but requires such a person, although under 18, to be given the chance to discuss assisted dying, allowing them to have everything ready so that as soon as they turn 18, if their diagnosis is unchanged so that their life expectancy is less than six months, they can have a discussion as referred to in clause one to be assisted to die had they not been facilitated, and having preliminary discussions before 18, and so affirming their resolve to die, the person might well, with added maturity, decide differently.
So I would add, and have already argued that at 18 they are still too young. And if I ask the noble Lord if those under the age of 18 or better a higher age are to be properly protected, will not the bill state unambiguously that no discussion of their availing of assisted dying under the bill is permitted, even if if they raise the subject on pain of their being made ineligible under the bill.
So long as the discussion which is required as a preliminary discussion itself, takes place after the person has reached 18. In particular, the proposed amendments does nothing to restrict the scope of five three, which permits a medical practitioner to engage in preliminary discussion about assisted dying with a patient who raises the subject. Since there is nothing to tie the discussion referred to as a preliminary discussion to be inserted in clause one with a preliminary discussion my in five three, the amendment will not stop these discussions from taking place with under 18 and the grammatically and a such and such refers to any such and such, and the word preliminary does not imply a restriction on number that could be 1 or 100.
Preliminary discussions. And although five three does not oblige the registered medical practitioner to discuss assisted dying with the under the bill's provisions with any patient who raises it, five six does indeed oblige the practitioner concerned to direct the patient to where they can have the preliminary discussion, and that is the preliminary discussion. Therefore, even as amended, the bill requires that any patient, whatever their age, who raises the possibility of assisted dying under the bill is enabled to have a discussion about it.
Nor can it be objected that in paragraph six the reference to the not a preliminary discussion, since here D refers back to where preliminary discussion is as used in the proceedings. Paragraph 3 to 5 of the clause where the phrase is a preliminary discussion, or such a preliminary discussion. That is to say, any preliminary discussion of the matter. These points may seem technical and pernickety, but consider how the bill, even as amended, might leave a young person to end their life prematurely without proper adult consideration of the matter.
Take a 16 or 17 year old who is suffering from a disease that makes their life expectancy uncertainty, has been warned they might die rapidly or deteriorate and die at any time. We may all try to imagine that we can hardly know how such a young person might feel isolated, lonely, afraid, perhaps sensitive to remarks of innuendo, real or imagined, or indeed some of the what we've heard today about social media and pressures from peers in Holland, I think, was raised the Netherlands, while also sharing not only the worries about the illness, but sharing the normal thoughts of people of that age, which even those in the best health, depressed and unsure of themselves have.
How easy for the unfortunate young person to say I wish I were dead? As it stands, even as amended, the bill not only allows but requires such a person, although under 18, to be given the chance to discuss assisted dying, allowing them to have everything ready so that as soon as they turn 18, if their diagnosis is unchanged so that their life expectancy is less than six months, they can have a discussion as referred to in clause one to be assisted to die had they not been facilitated, and having preliminary discussions before 18, and so affirming their resolve to die, the person might well, with added maturity, decide differently.
So I would add, and have already argued that at 18 they are still too young. And if I ask the noble Lord if those under the age of 18 or better a higher age are to be properly protected, will not the bill state unambiguously that no discussion of their availing of assisted dying under the bill is permitted, even if if they raise the subject on pain of their being made ineligible under the bill.
12:46
Baroness Fox of Buckley (Non-affiliated)
-
-
Baroness Fox of Buckley (Non-affiliated)
My. >> Lords, just. >> I thought that the noble Lady Baroness Keeley really explained some of my concerns. I thought that was very helpful. So just a couple of quick questions, maybe for the noble and learned Lord Faulkner. Why is it that an independent doctor's report no longer has to say why there was a refusal? I just I don't understand why the words reason for refusal have been omitted. So maybe that could be clarified, because one of the things that I think that's going to be very important in terms of reassuring those of us who have concerns that there are, that safeguarding is being taken seriously, is as much transparency as possible within the process, and that the recording of information is constantly there, because I suppose I'm troubled by the by the word in in amendment 416 or in, in the word unwillingness and not understanding or probing or having any way of finding out why somebody is unwilling.
Now, I, I don't understand that unwillingness might well refer to not being available or not being able to. But if a doctor steps away, maybe because they feel uncomfortable about the family members undue influence, all of the things that we've heard, some kind of coercion taking place, it does seem relevant that that information is recorded somewhere because it's a red flag, an early warning. It's only an opinion. The second doctor doesn't need to take any notice of it, but it would at least say something's wrong.
Whereas if they just say the doctor's not doing it because he's unwilling, I mean, we don't know anything. And in this process, there has to be a way, surely all the time, of checking that this isn't that, that, that everybody knows that things are being done in good faith. I'm afraid that some of these drafting amendments seem to make things more obscure unintentionally, but the wording is not us more information, but removing information, and therefore the noble and learned Lord to look at redraughting his redraughting so that we can have a bit a bit of clarity.
Now, I, I don't understand that unwillingness might well refer to not being available or not being able to. But if a doctor steps away, maybe because they feel uncomfortable about the family members undue influence, all of the things that we've heard, some kind of coercion taking place, it does seem relevant that that information is recorded somewhere because it's a red flag, an early warning. It's only an opinion. The second doctor doesn't need to take any notice of it, but it would at least say something's wrong.
Whereas if they just say the doctor's not doing it because he's unwilling, I mean, we don't know anything. And in this process, there has to be a way, surely all the time, of checking that this isn't that, that, that everybody knows that things are being done in good faith. I'm afraid that some of these drafting amendments seem to make things more obscure unintentionally, but the wording is not us more information, but removing information, and therefore the noble and learned Lord to look at redraughting his redraughting so that we can have a bit a bit of clarity.
12:49
Lord Sandhurst (Conservative)
-
-
Lord Sandhurst (Conservative)
About that. >> About that. >> I'll be very short. Having listened to this, I'm more and more persuaded that we must have reasons, persuaded that we must have reasons, because there will be no coroner's inquest and we need to know. And we do know that some doctors have misbehaved in the past. It doesn't always come out, and one does need to have a paper trail that if concerns start to rise about doctor X, we can actually see what doctor Y has been saying as well as doctor X.
12:49
Lord Wolfson of Tredegar (Conservative)
-
-
Lord Wolfson of Tredegar (Conservative)
My Lords, I can be extremely brief because. Of the information given by the noble and learned Lord and also the substantive issues as to domestic abuse and interpreters and various other matters will be dealt with in their appropriate place. At the risk of undermining my reputation as a legal geek, could I invite the noble Lord of Lords attention to his amendment 350 and in particular the member's explanatory statement? Because I understand the amendment, but I do not understand the statement.
The amendment leaves out from two to the end of the line and insert section 12, four and seven, which are about the sharing of specialist opinions. The explanatory statement says the drafting changes consequential on subsection four being added to to clause 12. Now, clause 12 already has a subsection four and the noble Lords amendments to clause 12 are to subsections five and eight. So I do not know whether the explanatory statement has confused me. And in fact the change is not consequential on a new subsection four being added, but just stands in and of itself.
So it may be that I'm confused unnecessarily, but if the noble Lords could just clear that minor point up, I'd be grateful.
The amendment leaves out from two to the end of the line and insert section 12, four and seven, which are about the sharing of specialist opinions. The explanatory statement says the drafting changes consequential on subsection four being added to to clause 12. Now, clause 12 already has a subsection four and the noble Lords amendments to clause 12 are to subsections five and eight. So I do not know whether the explanatory statement has confused me. And in fact the change is not consequential on a new subsection four being added, but just stands in and of itself.
So it may be that I'm confused unnecessarily, but if the noble Lords could just clear that minor point up, I'd be grateful.
12:51
Baroness Merron, The Parliamentary Under-Secretary for Health and Social Care (Labour)
-
-
Baroness Merron, The Parliamentary Under-Secretary for Health and Social Care (Labour)
My Lords, I too shall be brief. >> My Lords, I too shall be brief. All but three of the amendments in this group have been tabled by the this group have been tabled by the bill's sponsor, and as has been discussed, they make a series of drafting changes to the bill, including making sure that terms are consistent throughout and removing ambiguity and duplication. The government is neutral on all of the policy choices that are reflected in these amendments, as it is on the bill as a whole.
It has, as is usual, provided drafting support to make the bill legally workable. And, my Lords, to and part of the discussion today. It is, of course, for the sponsor and for Parliament to determine if any of the amendments that the sponsor has chosen to table has changed the intent of amendments that were debated in the other place. My Lords, amendment seven in this group, tabled by the noble Lady Baroness Coffey, seeks to amend amendment six by changing a reference in clause one to be from a preliminary discussion to their first preliminary discussion.
It does not make any wider changes to the Bill. To provide for more than one preliminary discussion to take place, so this may lead to uncertainty. As with all amendments that have not technical input from the government, noble Lords may wish to note that the current drafting of this amendment may require further consideration in order to make it fully workable, effective and enforceable. My Lords Amendments eight and amendment nine, on which I raised no specific workability issues, appear to be trying to achieve the same purpose as amendment six, tabled by the sponsor of the bill.
But I would note that amendments eight and nine have not had the technical drafting support from officials and therefore may not be fully workable, effective and enforceable.
It has, as is usual, provided drafting support to make the bill legally workable. And, my Lords, to and part of the discussion today. It is, of course, for the sponsor and for Parliament to determine if any of the amendments that the sponsor has chosen to table has changed the intent of amendments that were debated in the other place. My Lords, amendment seven in this group, tabled by the noble Lady Baroness Coffey, seeks to amend amendment six by changing a reference in clause one to be from a preliminary discussion to their first preliminary discussion.
It does not make any wider changes to the Bill. To provide for more than one preliminary discussion to take place, so this may lead to uncertainty. As with all amendments that have not technical input from the government, noble Lords may wish to note that the current drafting of this amendment may require further consideration in order to make it fully workable, effective and enforceable. My Lords Amendments eight and amendment nine, on which I raised no specific workability issues, appear to be trying to achieve the same purpose as amendment six, tabled by the sponsor of the bill.
But I would note that amendments eight and nine have not had the technical drafting support from officials and therefore may not be fully workable, effective and enforceable.
12:53
Lord Falconer of Thoroton (Labour)
-
-
Lord Falconer of Thoroton (Labour)
Whereas I am. changes. Some legitimate points, in particular, my Baroness Finlay and Baroness Lawlor were made, but which didn't really go to the drafting points. Can I go to the concerns that various members have expressed? First of all, Baroness Coffey her concern in relation to amendment six and her amendment seven was to try to prevent doctors having a conversation with people. I'm not saying this in a bad or a good way. This is what she wants, particularly before they reach 18.
There's a point there, but it's nothing to do with the change that I've introduced by amendment six. The effect of my amendment six is only to make it clear that there has to be a preliminary discussion before you can go ahead to assisted death. And the reason I've done it is to make it clear it's one of the eligibility conditions. It says nothing about what should be talked about, or whether or not such conversation should take place under 18.
In fact, as Baroness Coffey referred to in clause six, it says that no registered medical practitioner or other health professional can raise the subject of a provision of assistance in accordance with this act, with a person who is under the age of 18. So, in fact, I do not think Baroness Coffey amendment would have would have, as it were, added to that protection already. But the key point is, all that amendment six is doing is saying you've got to have a clause five discussion.
The next point that was raised, which was raised by a number of peers, was, I am watering down the protection in relation to domestic abuse, that, as a matter of drafting is wrong. It is only a matter of convenience that having defined domestic abuse as including everything as defined in the Domestic Abuse Act 2021, you get coercion as a form of domestic abuse. You get control as a form of domestic abuse, and you get economic abuse as a form of domestic abuse.
So to avoid having to repeat that, every time you refer to training, you simply you, you refer to domestic abuse. And that's then defined at the top of page 41 in the bill. And I very much hope that people will accept that. That's the position Baroness O'Loan is shaking her head raises a different point, which is what is the position in relation to abuse that is not domestic. So your lawyer is exercising undue influence on you. That's a point that I will respond to in writing.
But it's not a it's a it's not a point raised by my drafting change because all of the restrictions have been in relation to domestic abuse, not to what the lawyers would call undue influence. But it's a perfectly legitimate point, which I will come back to in
**** Possible New Speaker ****
correspondence with her. Sure. Can I just ask you on this very specific point and for for the specific point and for for the record, I think many noble Lords will want to hear specifically how he is going to ensure that the Bill he is going to ensure that the Bill makes sure that when it comes to the training, that all elements of domestic abuse are set up will be
**** Possible New Speaker ****
domestic abuse are set up will be covered in that training, particularly given the concerns raised both in the other place and in this place. The reason.
**** Possible New Speaker ****
The reason. Covered already. Is because what the bill says is the training must cover domestic abuse. Domestic abuse is defined by reference to the Domestic Abuse Act 2021. Domestic abuse in the 2021 act includes coercion, control and economic abuse. So that's how that's how there's a mandatory requirement in the bill for all of those things to be covered. Could I go on to the to the to the to the sorry.
**** Possible New Speaker ****
Just before the. Lord moves on the definition of economic abuse in the Domestic economic abuse in the Domestic Abuse Act is limited and it's limited to actions which will prevent the person from getting prevent the person from getting money or prevent their ability to spend money. If I remember correctly, there could well be financial abuse, which is depriving a person very large sums of money a person very large sums of money while they're still able to get money and to spend money.
So I thought.
**** Possible New Speaker ****
I'll certainly give that thought. But my. My reading of the definition of
**** Possible New Speaker ****
My reading of the definition of domestic abuse in the Domestic Abuse Act it is an Abuse Act it is an effective means of covering that of economic abuse habitually seen economic abuse habitually seen between domestic partners. So I think it covers it. But I will certainly because of my respect for certainly because of my respect for the Baroness O'Loan look and see whether or not it needs to be expanded. But what she's talking about, what the. Sorry, I apologise for calling you.
She what the noble Baroness is referring to is a is a problem in relation to the definition of domestic abuse generally in relation to economic abuse, which I don't think is there, and we're certainly not the intention of the 2021 act. Could I go on to the other issues? First of all, other than illness, what's happening there is where one or other of the two doctors withdraws from the process, not giving a reason, but simply withdraws from the process. I completely understand what the Baroness Fox is saying, which is if the if the.
I'm withdrawing because I think this person's being pressured, that must be recorded somewhere, and any other doctors have got to be able to see that. But what we're dealing with here is not that situation. We're simply dealing with a doctor who withdraws and gives no reason. Should the person, the patient have to establish that there is a good reason for the withdrawal? Or is it enough that they have withdrawn and are no longer willing to participate? All that the amendment has done is say if you can't or won't go on, then you can get another doctor, which is not a change in sense.
It is only a change in relation to making clear what those provisions. And when I say those provisions, the provisions I'm referring to are those that allow for a replacement doctor when one of the other doctors, when the originally appointed one can't go on. Can I go
**** Possible New Speaker ****
on to to clause. Sorry, sorry. I think I understand what what's
**** Possible New Speaker ****
I think I understand what what's been said there, but is there anywhere explicit where that anywhere explicit where that withdrawal is queried. I think I I'm under the impression that there I'm under the impression that there is nowhere where you say, why are you withdrawing? You know what I you withdrawing? You know what I mean? So it's that reason versus that reason. So I'm really delighted to hear the noble and learned Lord agree with me that certain withdrawals suggest something that should be noted down where in the bill and and forgive my ignorance.
Where in the bill does that happen? Because I don't see it anywhere. And if it just
**** Possible New Speaker ****
refer me, that would be good. First of all, in relation. To there's no need to question somebody about why they're withdrawing, if there is material that is relevant to it, then I need to check with the bill to see that to check with the bill to see that it's recorded. But the bill contains regular provisions where everything has to be recorded. But if it's not, if it's not adequately if it's not, if it's not adequately covered. So if somebody says, I'm withdrawing, I think you're being coerced, then obviously that should be recorded.
I will make sure that be recorded. I will make sure that that is covered. Clause 405 the
**** Possible New Speaker ****
Lord Singh. Sorry, sorry. Genuinely want to just. Understand this.
**** Possible New Speaker ****
Understand this. The worry that we had about this being a drafting difference is being a drafting difference is simply because when you could only withdraw on the grounds of illness, withdraw on the grounds of illness, the situation didn't, or death which the the the situation about which the the the situation about why you withdrew didn't arise. And therefore I think there is a genuine issue here that when you remove that, there is a situation in which people can withdraw without giving notice as to why it should be.
And there ought therefore to be something. And the noble Lord has rightly said he'll look at some part of it. But there must be something that makes sure that if somebody withdraws because there is some issue seriously in connection with this decision that he has, or she has to say what it is, because if we don't have that, then this does become a very much weakening point. I know that the noble Lord doesn't want it to become that, but without something that insists upon that information being given, it does become much weaker.
And it is therefore not a
**** Possible New Speaker ****
drafting point until that is put right. When it is, it is a drafting point. That's right, I.
**** Possible New Speaker ****
That's right, I. Completely accept, I don't accept it's not a drafting point, but that may be a dancing on the head of a pin. The point that both head of a pin. The point that both the Baroness Fox and the Lord Deben are making is effectively make sure that if you're leaving for a reason that if you're leaving for a reason that would give rise to problems, make sure it's properly recorded and I completely accept that. And and I completely accept that.
And we'll make sure that that is the position, because it seems to me to be a valid point. Then, in relation to clause 405, the Lord Shinkwin made a speech saying it's a watering down. It's not a watering down at all. With respect. What the current draft says is when carrying out an assessment in accordance with subsection two, the assessing doctor must first ensure the provision of adjustment adjustments for language and literacy barriers, including the use of interpreters. And the new draft says that the relevant doctor must take all reasonable steps to ensure that there is effective communication between the assessing doctor and the person being assessed, including, where appropriate, using an interpreter.
Now, Lord Shinkwin is shaking his head and more than happy to talk to him about how that could be a change. And if there is some change he would like in relation to it, then let's put it in. But it is in legal terms to my I, wider because it covers a much wider ambit without providing any inadequate protection. But maybe the right course is if me and Lord Shinkwin sit down and he identifies the changes that he would like for at the moment I can't see them.
**** Possible New Speaker ****
I, I thank the Lord. I'll be very brief. Would consider very brief. Would consider withdrawing his amendments because the change had simply right. I would imagine the House would find acceptable is to do what the acceptable is to do what the sponsor of the bill in the other place also found it acceptable,
**** Possible New Speaker ****
which was to accept Mr. Abbott's amendment. I do not need to withdraw the amendment because if he objects to it, I won't push it at committee. It really depends on what one gets to when one gets to report and what I'm saying at the moment, I can't see the difference. I'm more than happy to talk to him before we get to report. And if there's valid points, because if there are valid points, then let's put them in. But at the moment it looks to me just
**** Possible New Speaker ****
as good, if not better protection. Sure. In terms of the amendment as
**** Possible New Speaker ****
In terms of the amendment as it's currently tabled, I wouldn't be able to accept it because I have be able to accept it because I have numerous other amendments on disability language, BSL, different levels of interpretation on which levels of interpretation on which are all really important in terms of having these conversations. So of having these conversations. So the offer that noble and Lord made to the noble Lord Lord Shinkwin. I'd be delighted to join the meeting as well, to see how the noble and Lords amendments can be improved to get further down the road.
And what we're actually trying to do is making sure that people go into this decision making
**** Possible New Speaker ****
process, clearly understanding the decision that they're taking. That if such a meeting was to
**** Possible New Speaker ****
That if such a meeting was to take place, I'd be delighted to meet it. To ask the noble Lord, consider the alternative wording
**** Possible New Speaker ****
consider the alternative wording that I proposed when I spoke to the amendment. Mr. Lord, both. Baroness Sugg would be very
**** Possible New Speaker ****
Baroness Sugg would be very welcome to this meeting, which is expanding all the time. Secondly, the language that the Baroness the language that the Baroness Hollins proposed was reasonable adjustments, which is which is in the first draft, but not the second. The reason we haven't used the word reasonable adjustments is because reasonable adjustments is come from the Disability Act, and we want to be that and wider in relation. So it gives greater width. Our
**** Possible New Speaker ****
amendment. I did suggest that it's the Equality Act, not the Disability Equality Act, not the Disability Act, the Equality Act. And I did suggest that actually looking at somebody and the definition of disability in the Equality Act with respect to something like this respect to something like this would in fact include somebody, for example, with a long term condition example, with a long term condition or mental illness, as well as. Any other disabling condition that you
**** Possible New Speaker ****
might be referring to. Baroness is right. It's the Equality Act, not the Disability Act. I apologise for that. If you Act. I apologise for that. If you restrict it to that, then you are restricting it to a particular thing and we think it should be widen that. But again, at this, at this ever expanding meeting we can we can talk about that 460 Lord
**** Possible New Speaker ****
we can talk about that 460 Lord Ashcombe was, was. Was particularly. Exercised by the fact that the,
**** Possible New Speaker ****
Exercised by the fact that the, the second doctor wouldn't see the report of the first doctor, there would be some degree of of of of of problem. I mean, Lord Ashcombe will know that where a second doctor is, is, is brought in, where a referral is made to effectively a new practitioner, the the coordinating doctor must provide the new doctor with a copy of the previous report. And then if the new doctor is satisfied as to all the matters mentioned in clause 11 and that's capacity, etc.
then he's got to say why he's disagreeing with the old doctor. So so Lord Ashcombe legitimate sharpness in relation to the point was, I think based upon an improper understanding of amendment 460, which, which which only allows this to happen once the new doctor sees the report of the old doctor. Now, in the light of my exchange with Lord Moylan, which is right, I'm not going to move my amendment, because although Baroness Coffey was kind enough to indicate that she would withdraw her amendment to my amendment because the the noble Lord Lord Moynihan thinks that his drafting is better than that of the.
Then we will have to wait and see in report, but don't hold it against me when I come back with the same amendment at report. Thank you very much.
There's a point there, but it's nothing to do with the change that I've introduced by amendment six. The effect of my amendment six is only to make it clear that there has to be a preliminary discussion before you can go ahead to assisted death. And the reason I've done it is to make it clear it's one of the eligibility conditions. It says nothing about what should be talked about, or whether or not such conversation should take place under 18.
In fact, as Baroness Coffey referred to in clause six, it says that no registered medical practitioner or other health professional can raise the subject of a provision of assistance in accordance with this act, with a person who is under the age of 18. So, in fact, I do not think Baroness Coffey amendment would have would have, as it were, added to that protection already. But the key point is, all that amendment six is doing is saying you've got to have a clause five discussion.
The next point that was raised, which was raised by a number of peers, was, I am watering down the protection in relation to domestic abuse, that, as a matter of drafting is wrong. It is only a matter of convenience that having defined domestic abuse as including everything as defined in the Domestic Abuse Act 2021, you get coercion as a form of domestic abuse. You get control as a form of domestic abuse, and you get economic abuse as a form of domestic abuse.
So to avoid having to repeat that, every time you refer to training, you simply you, you refer to domestic abuse. And that's then defined at the top of page 41 in the bill. And I very much hope that people will accept that. That's the position Baroness O'Loan is shaking her head raises a different point, which is what is the position in relation to abuse that is not domestic. So your lawyer is exercising undue influence on you. That's a point that I will respond to in writing.
But it's not a it's a it's not a point raised by my drafting change because all of the restrictions have been in relation to domestic abuse, not to what the lawyers would call undue influence. But it's a perfectly legitimate point, which I will come back to in
**** Possible New Speaker ****
correspondence with her. Sure. Can I just ask you on this very specific point and for for the specific point and for for the record, I think many noble Lords will want to hear specifically how he is going to ensure that the Bill he is going to ensure that the Bill makes sure that when it comes to the training, that all elements of domestic abuse are set up will be
**** Possible New Speaker ****
domestic abuse are set up will be covered in that training, particularly given the concerns raised both in the other place and in this place. The reason.
**** Possible New Speaker ****
The reason. Covered already. Is because what the bill says is the training must cover domestic abuse. Domestic abuse is defined by reference to the Domestic Abuse Act 2021. Domestic abuse in the 2021 act includes coercion, control and economic abuse. So that's how that's how there's a mandatory requirement in the bill for all of those things to be covered. Could I go on to the to the to the to the sorry.
**** Possible New Speaker ****
Just before the. Lord moves on the definition of economic abuse in the Domestic economic abuse in the Domestic Abuse Act is limited and it's limited to actions which will prevent the person from getting prevent the person from getting money or prevent their ability to spend money. If I remember correctly, there could well be financial abuse, which is depriving a person very large sums of money a person very large sums of money while they're still able to get money and to spend money.
So I thought.
**** Possible New Speaker ****
I'll certainly give that thought. But my. My reading of the definition of
**** Possible New Speaker ****
My reading of the definition of domestic abuse in the Domestic Abuse Act it is an Abuse Act it is an effective means of covering that of economic abuse habitually seen economic abuse habitually seen between domestic partners. So I think it covers it. But I will certainly because of my respect for certainly because of my respect for the Baroness O'Loan look and see whether or not it needs to be expanded. But what she's talking about, what the. Sorry, I apologise for calling you.
She what the noble Baroness is referring to is a is a problem in relation to the definition of domestic abuse generally in relation to economic abuse, which I don't think is there, and we're certainly not the intention of the 2021 act. Could I go on to the other issues? First of all, other than illness, what's happening there is where one or other of the two doctors withdraws from the process, not giving a reason, but simply withdraws from the process. I completely understand what the Baroness Fox is saying, which is if the if the.
I'm withdrawing because I think this person's being pressured, that must be recorded somewhere, and any other doctors have got to be able to see that. But what we're dealing with here is not that situation. We're simply dealing with a doctor who withdraws and gives no reason. Should the person, the patient have to establish that there is a good reason for the withdrawal? Or is it enough that they have withdrawn and are no longer willing to participate? All that the amendment has done is say if you can't or won't go on, then you can get another doctor, which is not a change in sense.
It is only a change in relation to making clear what those provisions. And when I say those provisions, the provisions I'm referring to are those that allow for a replacement doctor when one of the other doctors, when the originally appointed one can't go on. Can I go
**** Possible New Speaker ****
on to to clause. Sorry, sorry. I think I understand what what's
**** Possible New Speaker ****
I think I understand what what's been said there, but is there anywhere explicit where that anywhere explicit where that withdrawal is queried. I think I I'm under the impression that there I'm under the impression that there is nowhere where you say, why are you withdrawing? You know what I you withdrawing? You know what I mean? So it's that reason versus that reason. So I'm really delighted to hear the noble and learned Lord agree with me that certain withdrawals suggest something that should be noted down where in the bill and and forgive my ignorance.
Where in the bill does that happen? Because I don't see it anywhere. And if it just
**** Possible New Speaker ****
refer me, that would be good. First of all, in relation. To there's no need to question somebody about why they're withdrawing, if there is material that is relevant to it, then I need to check with the bill to see that to check with the bill to see that it's recorded. But the bill contains regular provisions where everything has to be recorded. But if it's not, if it's not adequately if it's not, if it's not adequately covered. So if somebody says, I'm withdrawing, I think you're being coerced, then obviously that should be recorded.
I will make sure that be recorded. I will make sure that that is covered. Clause 405 the
**** Possible New Speaker ****
Lord Singh. Sorry, sorry. Genuinely want to just. Understand this.
**** Possible New Speaker ****
Understand this. The worry that we had about this being a drafting difference is being a drafting difference is simply because when you could only withdraw on the grounds of illness, withdraw on the grounds of illness, the situation didn't, or death which the the the situation about which the the the situation about why you withdrew didn't arise. And therefore I think there is a genuine issue here that when you remove that, there is a situation in which people can withdraw without giving notice as to why it should be.
And there ought therefore to be something. And the noble Lord has rightly said he'll look at some part of it. But there must be something that makes sure that if somebody withdraws because there is some issue seriously in connection with this decision that he has, or she has to say what it is, because if we don't have that, then this does become a very much weakening point. I know that the noble Lord doesn't want it to become that, but without something that insists upon that information being given, it does become much weaker.
And it is therefore not a
**** Possible New Speaker ****
drafting point until that is put right. When it is, it is a drafting point. That's right, I.
**** Possible New Speaker ****
That's right, I. Completely accept, I don't accept it's not a drafting point, but that may be a dancing on the head of a pin. The point that both head of a pin. The point that both the Baroness Fox and the Lord Deben are making is effectively make sure that if you're leaving for a reason that if you're leaving for a reason that would give rise to problems, make sure it's properly recorded and I completely accept that. And and I completely accept that.
And we'll make sure that that is the position, because it seems to me to be a valid point. Then, in relation to clause 405, the Lord Shinkwin made a speech saying it's a watering down. It's not a watering down at all. With respect. What the current draft says is when carrying out an assessment in accordance with subsection two, the assessing doctor must first ensure the provision of adjustment adjustments for language and literacy barriers, including the use of interpreters. And the new draft says that the relevant doctor must take all reasonable steps to ensure that there is effective communication between the assessing doctor and the person being assessed, including, where appropriate, using an interpreter.
Now, Lord Shinkwin is shaking his head and more than happy to talk to him about how that could be a change. And if there is some change he would like in relation to it, then let's put it in. But it is in legal terms to my I, wider because it covers a much wider ambit without providing any inadequate protection. But maybe the right course is if me and Lord Shinkwin sit down and he identifies the changes that he would like for at the moment I can't see them.
**** Possible New Speaker ****
I, I thank the Lord. I'll be very brief. Would consider very brief. Would consider withdrawing his amendments because the change had simply right. I would imagine the House would find acceptable is to do what the acceptable is to do what the sponsor of the bill in the other place also found it acceptable,
**** Possible New Speaker ****
which was to accept Mr. Abbott's amendment. I do not need to withdraw the amendment because if he objects to it, I won't push it at committee. It really depends on what one gets to when one gets to report and what I'm saying at the moment, I can't see the difference. I'm more than happy to talk to him before we get to report. And if there's valid points, because if there are valid points, then let's put them in. But at the moment it looks to me just
**** Possible New Speaker ****
as good, if not better protection. Sure. In terms of the amendment as
**** Possible New Speaker ****
In terms of the amendment as it's currently tabled, I wouldn't be able to accept it because I have be able to accept it because I have numerous other amendments on disability language, BSL, different levels of interpretation on which levels of interpretation on which are all really important in terms of having these conversations. So of having these conversations. So the offer that noble and Lord made to the noble Lord Lord Shinkwin. I'd be delighted to join the meeting as well, to see how the noble and Lords amendments can be improved to get further down the road.
And what we're actually trying to do is making sure that people go into this decision making
**** Possible New Speaker ****
process, clearly understanding the decision that they're taking. That if such a meeting was to
**** Possible New Speaker ****
That if such a meeting was to take place, I'd be delighted to meet it. To ask the noble Lord, consider the alternative wording
**** Possible New Speaker ****
consider the alternative wording that I proposed when I spoke to the amendment. Mr. Lord, both. Baroness Sugg would be very
**** Possible New Speaker ****
Baroness Sugg would be very welcome to this meeting, which is expanding all the time. Secondly, the language that the Baroness the language that the Baroness Hollins proposed was reasonable adjustments, which is which is in the first draft, but not the second. The reason we haven't used the word reasonable adjustments is because reasonable adjustments is come from the Disability Act, and we want to be that and wider in relation. So it gives greater width. Our
**** Possible New Speaker ****
amendment. I did suggest that it's the Equality Act, not the Disability Equality Act, not the Disability Act, the Equality Act. And I did suggest that actually looking at somebody and the definition of disability in the Equality Act with respect to something like this respect to something like this would in fact include somebody, for example, with a long term condition example, with a long term condition or mental illness, as well as. Any other disabling condition that you
**** Possible New Speaker ****
might be referring to. Baroness is right. It's the Equality Act, not the Disability Act. I apologise for that. If you Act. I apologise for that. If you restrict it to that, then you are restricting it to a particular thing and we think it should be widen that. But again, at this, at this ever expanding meeting we can we can talk about that 460 Lord
**** Possible New Speaker ****
we can talk about that 460 Lord Ashcombe was, was. Was particularly. Exercised by the fact that the,
**** Possible New Speaker ****
Exercised by the fact that the, the second doctor wouldn't see the report of the first doctor, there would be some degree of of of of of problem. I mean, Lord Ashcombe will know that where a second doctor is, is, is brought in, where a referral is made to effectively a new practitioner, the the coordinating doctor must provide the new doctor with a copy of the previous report. And then if the new doctor is satisfied as to all the matters mentioned in clause 11 and that's capacity, etc.
then he's got to say why he's disagreeing with the old doctor. So so Lord Ashcombe legitimate sharpness in relation to the point was, I think based upon an improper understanding of amendment 460, which, which which only allows this to happen once the new doctor sees the report of the old doctor. Now, in the light of my exchange with Lord Moylan, which is right, I'm not going to move my amendment, because although Baroness Coffey was kind enough to indicate that she would withdraw her amendment to my amendment because the the noble Lord Lord Moynihan thinks that his drafting is better than that of the.
Then we will have to wait and see in report, but don't hold it against me when I come back with the same amendment at report. Thank you very much.
13:08
Baroness Coffey (Conservative)
-
-
Baroness Coffey (Conservative)
I thank the noble and learned Lord. For his extensive responses. I think it reflects that even just a difference between ensure and take reasonable steps are actually different. In law and what is expected. So I think I'm grateful to him for saying now that he isn't going to try and press these committee and to allow us the opportunity to meet him and indeed others on some of these issues where we think they go beyond what is just might be considered legal drafting.
I am slightly concerned that the government didn't reply to a particular one, but I will take that up separately with the
**** Possible New Speaker ****
Minister. But with that I beg leave to withdraw. Oh. Leonard, my noble friend sits
**** Possible New Speaker ****
Leonard, my noble friend sits down. I wonder if the noble Lord might take the opportunity just to respond to the point I put to him to confirm the drafting of that
**** Possible New Speaker ****
to confirm the drafting of that it. In the note.
**** Possible New Speaker ****
In the note. But can I write to him on that? With that, I beg leave to withdraw. Sorry. There's Lord Dobbs
**** Possible New Speaker ****
wants to come in. No. With that, I beg the leave of the House to withdraw. Amendment seven. Is it your.
**** Possible New Speaker ****
Lordship's pleasure that amendment seven be withdrawn? Amendment by leave withdrawn. Amendment by leave withdrawn. Amendment six, Lord Faulkner. Is it your pleasure that the that your pleasure that the that amendment six be withdrawn? The amendment is by leave withdrawn. amendment is by leave withdrawn. Amendment eight Baroness Goudie not moved. Not moved. Amendment nine Lord Moylan not moved. We now come to amendment ten, in the name of Baroness Finlay of Llandaff.
I am slightly concerned that the government didn't reply to a particular one, but I will take that up separately with the
**** Possible New Speaker ****
Minister. But with that I beg leave to withdraw. Oh. Leonard, my noble friend sits
**** Possible New Speaker ****
Leonard, my noble friend sits down. I wonder if the noble Lord might take the opportunity just to respond to the point I put to him to confirm the drafting of that
**** Possible New Speaker ****
to confirm the drafting of that it. In the note.
**** Possible New Speaker ****
In the note. But can I write to him on that? With that, I beg leave to withdraw. Sorry. There's Lord Dobbs
**** Possible New Speaker ****
wants to come in. No. With that, I beg the leave of the House to withdraw. Amendment seven. Is it your.
**** Possible New Speaker ****
Lordship's pleasure that amendment seven be withdrawn? Amendment by leave withdrawn. Amendment by leave withdrawn. Amendment six, Lord Faulkner. Is it your pleasure that the that your pleasure that the that amendment six be withdrawn? The amendment is by leave withdrawn. amendment is by leave withdrawn. Amendment eight Baroness Goudie not moved. Not moved. Amendment nine Lord Moylan not moved. We now come to amendment ten, in the name of Baroness Finlay of Llandaff.
13:10
AMDT: 10
Baroness Finlay of Llandaff (Crossbench)
-
AMDT: 10
Baroness Finlay of Llandaff (Crossbench)
My Lords, we now come to issues >> My Lords, we now come to issues around residency. My Lords, my amendment ten is a probing amendment. I have had to word it this way because I was trying to put in other wording about people resident in the Crown dependencies who may be treated in England particularly, or possibly Wales, but I was told that was out of scope. And after several attempts at wording, this seemed the only way for us to address the issue.
May I make it clear I do not want to create England and Wales as a destination for deaf tourism, and therefore I will be withdrawing amendment ten. But it's the only way I could address this major loophole in select Committee on this bill. I raise the issue of those who live in the Isle of Man or Jersey, or indeed Scotland, where proposed legislation has different eligibility criteria to the criteria outlined in this bill. Many patients are treated in England from across these borders.
Patients from Jersey go to Southampton regularly on ambulance flights or if the sea is calm by sea. Similarly, patients go to Liverpool from the Isle of Man. They go there for treatment procedures, including radiotherapy. All types of investigations and procedures, because on those islands the facilities are understandably relatively limited and the cross-border flow from Scotland is therefore less than this. Now a patient who is seriously ill may be transferred for treatment, and when they're aware that they have a rapidly progressive, serious and life threatening illness, they may want to be transferred back to their home to avail themselves of an assisted death in that area.
We know that at the time of being given bad news, suicidality and thoughts of death are at their most prominent. Because patients are shocked, they often haven't actually considered their own mortality in depth, and therefore it's when they're being treated in England that they're most likely to raise the question of an assisted death. When legislation has passed in their own jurisdictions. So in select committee, I asked Minister Salmon from the Ministry of Justice what the position would be for a doctor, nurse or other healthcare professional involved in arranging transfer back to the Isle of Man or Jersey, knowing that transfer would facilitate an assisted death outside England and Wales, and the patient would not be eligible.
Under the parameters of this bill. The response from both the Minister and from Paul Candler, official, was would indeed be a criminal offence transfer because they would be caught by the suicide act. As Paul Candler explained, this bill essentially carves out from prosecution people who are acting in England and Wales in conformity with the scheme set out in the legislation. Therefore, on assisted death being arranged outside England and Wales, is outside the parameters of the scheme of this Bill, and so therefore would be caught by the 1961 Suicide Act.
I asked the same question of sir Max Hill as he was Director of Public Prosecutions. His reply was that if you're operating as a medical or other professional within the legal jurisdiction of England and Wales, you must obey the law of England and Wales, he said. To quote, the guidance is simply to obey the law of the country in which you are acting, taking decisions and the rest of it, I think I'm afraid to say, but it's as simple as that.
So ask the noble Lord, Lord Faulkner, what is the position for doctors and nurses treating any very seriously ill patient in Liverpool or Southampton? Prince principally those areas who may say in the course of an in-depth conversation about their illness, potential course of it and so on, when they may be contemplating death for the first time, that they want to go home, to have an assisted death in their own home. What discussions has he had with the medical defence unions and the BMA about this legal liability, and what is the legal position of these doctors if they actually accede to the patient's wishes to return home? My Lords, I
**** Possible New Speaker ****
will now turn to my other amendment in this group. Not very grateful. I'm sure the
**** Possible New Speaker ****
Not very grateful. I'm sure the legal advice that she's been given is absolutely correct. My point is, surely this problem arises now is this. This bill doesn't change the position in any way? No.
**** Possible New Speaker ****
position in any way? No. With all due respect, I'm not aware that the legislation has actually been enacted in either the
**** Possible New Speaker ****
actually been enacted in either the Isle of Man or Jersey. So it. Isn't it wasn't a problem. When it is enacted. The.
**** Possible New Speaker ****
Problem. Arises whether this bill is enacted or it's not. Well.
**** Possible New Speaker ****
We're discussing the wording of this bill with due respect, and I raised it as a concern for clarification. And I think it does need clarification, because if noble Lords are anticipating that this bill will pass and the legislation in the other legislation in the other jurisdictions will pass, then we cannot leave a legal loophole or difficulty which might actually jeopardise the care of patients coming to England from the Crown dependencies. That's why I've raised it.
May I now turn to amendment number 11? In this group currently, the bill speaks of the person being ordinarily resident in England and Wales. But the problem is with the word ordinarily. In 1983, Lord Scarman in the House of Lords judgement stated that ordinarily resident refers to a man's abode in a particular place or country which he has adopted voluntarily and for settled purposes as part of the regular order of his life for the time being. So far so good. But in healthcare contexts, the overseas
May I make it clear I do not want to create England and Wales as a destination for deaf tourism, and therefore I will be withdrawing amendment ten. But it's the only way I could address this major loophole in select Committee on this bill. I raise the issue of those who live in the Isle of Man or Jersey, or indeed Scotland, where proposed legislation has different eligibility criteria to the criteria outlined in this bill. Many patients are treated in England from across these borders.
Patients from Jersey go to Southampton regularly on ambulance flights or if the sea is calm by sea. Similarly, patients go to Liverpool from the Isle of Man. They go there for treatment procedures, including radiotherapy. All types of investigations and procedures, because on those islands the facilities are understandably relatively limited and the cross-border flow from Scotland is therefore less than this. Now a patient who is seriously ill may be transferred for treatment, and when they're aware that they have a rapidly progressive, serious and life threatening illness, they may want to be transferred back to their home to avail themselves of an assisted death in that area.
We know that at the time of being given bad news, suicidality and thoughts of death are at their most prominent. Because patients are shocked, they often haven't actually considered their own mortality in depth, and therefore it's when they're being treated in England that they're most likely to raise the question of an assisted death. When legislation has passed in their own jurisdictions. So in select committee, I asked Minister Salmon from the Ministry of Justice what the position would be for a doctor, nurse or other healthcare professional involved in arranging transfer back to the Isle of Man or Jersey, knowing that transfer would facilitate an assisted death outside England and Wales, and the patient would not be eligible.
Under the parameters of this bill. The response from both the Minister and from Paul Candler, official, was would indeed be a criminal offence transfer because they would be caught by the suicide act. As Paul Candler explained, this bill essentially carves out from prosecution people who are acting in England and Wales in conformity with the scheme set out in the legislation. Therefore, on assisted death being arranged outside England and Wales, is outside the parameters of the scheme of this Bill, and so therefore would be caught by the 1961 Suicide Act.
I asked the same question of sir Max Hill as he was Director of Public Prosecutions. His reply was that if you're operating as a medical or other professional within the legal jurisdiction of England and Wales, you must obey the law of England and Wales, he said. To quote, the guidance is simply to obey the law of the country in which you are acting, taking decisions and the rest of it, I think I'm afraid to say, but it's as simple as that.
So ask the noble Lord, Lord Faulkner, what is the position for doctors and nurses treating any very seriously ill patient in Liverpool or Southampton? Prince principally those areas who may say in the course of an in-depth conversation about their illness, potential course of it and so on, when they may be contemplating death for the first time, that they want to go home, to have an assisted death in their own home. What discussions has he had with the medical defence unions and the BMA about this legal liability, and what is the legal position of these doctors if they actually accede to the patient's wishes to return home? My Lords, I
**** Possible New Speaker ****
will now turn to my other amendment in this group. Not very grateful. I'm sure the
**** Possible New Speaker ****
Not very grateful. I'm sure the legal advice that she's been given is absolutely correct. My point is, surely this problem arises now is this. This bill doesn't change the position in any way? No.
**** Possible New Speaker ****
position in any way? No. With all due respect, I'm not aware that the legislation has actually been enacted in either the
**** Possible New Speaker ****
actually been enacted in either the Isle of Man or Jersey. So it. Isn't it wasn't a problem. When it is enacted. The.
**** Possible New Speaker ****
Problem. Arises whether this bill is enacted or it's not. Well.
**** Possible New Speaker ****
We're discussing the wording of this bill with due respect, and I raised it as a concern for clarification. And I think it does need clarification, because if noble Lords are anticipating that this bill will pass and the legislation in the other legislation in the other jurisdictions will pass, then we cannot leave a legal loophole or difficulty which might actually jeopardise the care of patients coming to England from the Crown dependencies. That's why I've raised it.
May I now turn to amendment number 11? In this group currently, the bill speaks of the person being ordinarily resident in England and Wales. But the problem is with the word ordinarily. In 1983, Lord Scarman in the House of Lords judgement stated that ordinarily resident refers to a man's abode in a particular place or country which he has adopted voluntarily and for settled purposes as part of the regular order of his life for the time being. So far so good. But in healthcare contexts, the overseas
13:17
Amendment: 10
Baroness Finlay of Llandaff (Crossbench)
-
Amendment: 10
Baroness Finlay of Llandaff (Crossbench)
to interpret and apply on an individual case basis. People fell through the gaps and the NHS was not recovering their costs. Then the noble Lord Lord Harper, in his time as then immigration Minister in 2014, pointed out we need to do a better job of making sure front line professionals have a simpler system. The problem with the definition in the bill is that it could, I think, cover someone who is now living in another country, but has an address of convenience in England and Wales.
For whatever reason, we know that there are thousands of empty properties owned by people who are not living permanently in this country. Apart from the over 187,000 homes that are owned by people living permanently abroad, there are 5.5 million people who are British passport holders or have residency visas to live in the UK, but are living abroad permanently. So what is the position of these people if they wish to access an assisted death here, as they would not currently be eligible for NHS treatment? And if it is to be NHS funded? However, if they came to live in the UK for a year, they would then become eligible for the NHS.
But with the prognosis of six months or less, they would be expected to be dead within that time. That, of course, assumes that there's any accuracy in prognostication, which there is not. But, my Lords, let me put to you a scenario which is sadly not infrequent. A person working for the Foreign and Commonwealth Office in an embassy abroad becomes seriously and terminally ill and is repatriated to the UK. The house is rented out and they have to give notice, so they go to live in a different area, hopefully one with good specialist palliative care services who can provide them with support, but not being able to be in their own home, surrounded by their own things that they easily become very depressed without contact with people who would otherwise have a role in their lives.
So let's look at the scenario under this bill. Supposing they decide they want an assisted death, they will not have been resident for 12 months prior to making the first declaration to request an assisted death. Will that person who may have worked all their life in service of this country now be ineligible? And I see the noble Lord, Lord Faulkner is nodding that they would, I
**** Possible New Speaker ****
bill. Sorry. Hold on. My nods must not
**** Possible New Speaker ****
Sorry. Hold on. My nods must not be misinterpreted. I understand the question. If, for example, you live in Britain and you go and become in Britain and you go and become the first secretary in the US, you don't cease to be ordinarily resident in the UK. If you're a resident in the UK. If you're a soldier and you go abroad and serve for nine months abroad, you don't cease to be ordinarily resident. So I was only nodding. Yes, I've got
**** Possible New Speaker ****
I was only nodding. Yes, I've got the question, but I think the solution you're proposing is not necessarily one I would agree with. Okay, I'm grateful for that clarification. And we'll come back to your comments on on these afterwards.
**** Possible New Speaker ****
Forgive me, noble Lady, but if one reads of clause 11C, it's not one reads of clause 11C, it's not only has to be ordinarily resident and has been so resident for at and has been so resident for at least 12 months. Consequently, unless being in an embassy is still unless being in an embassy is still seen as being resident for the previous 12 months, the point that right.
**** Possible New Speaker ****
right. I'm most grateful for that intervention, because many people who work in the embassies abroad don't live in the embassy. They live in apartments, houses or whatever in the vicinity of the embassy. So I believe that the wording of the bill as written prompted my probing amendment. So I ask the noble Lord, in the light of this, is he comfortable with the vagueness of the term ordinarily, or does he see merit in reconsidering this wording carefully to clarify the residency requirement to avoid death tourism and ensure others are not discriminated against? I beg to move.
For whatever reason, we know that there are thousands of empty properties owned by people who are not living permanently in this country. Apart from the over 187,000 homes that are owned by people living permanently abroad, there are 5.5 million people who are British passport holders or have residency visas to live in the UK, but are living abroad permanently. So what is the position of these people if they wish to access an assisted death here, as they would not currently be eligible for NHS treatment? And if it is to be NHS funded? However, if they came to live in the UK for a year, they would then become eligible for the NHS.
But with the prognosis of six months or less, they would be expected to be dead within that time. That, of course, assumes that there's any accuracy in prognostication, which there is not. But, my Lords, let me put to you a scenario which is sadly not infrequent. A person working for the Foreign and Commonwealth Office in an embassy abroad becomes seriously and terminally ill and is repatriated to the UK. The house is rented out and they have to give notice, so they go to live in a different area, hopefully one with good specialist palliative care services who can provide them with support, but not being able to be in their own home, surrounded by their own things that they easily become very depressed without contact with people who would otherwise have a role in their lives.
So let's look at the scenario under this bill. Supposing they decide they want an assisted death, they will not have been resident for 12 months prior to making the first declaration to request an assisted death. Will that person who may have worked all their life in service of this country now be ineligible? And I see the noble Lord, Lord Faulkner is nodding that they would, I
**** Possible New Speaker ****
bill. Sorry. Hold on. My nods must not
**** Possible New Speaker ****
Sorry. Hold on. My nods must not be misinterpreted. I understand the question. If, for example, you live in Britain and you go and become in Britain and you go and become the first secretary in the US, you don't cease to be ordinarily resident in the UK. If you're a resident in the UK. If you're a soldier and you go abroad and serve for nine months abroad, you don't cease to be ordinarily resident. So I was only nodding. Yes, I've got
**** Possible New Speaker ****
I was only nodding. Yes, I've got the question, but I think the solution you're proposing is not necessarily one I would agree with. Okay, I'm grateful for that clarification. And we'll come back to your comments on on these afterwards.
**** Possible New Speaker ****
Forgive me, noble Lady, but if one reads of clause 11C, it's not one reads of clause 11C, it's not only has to be ordinarily resident and has been so resident for at and has been so resident for at least 12 months. Consequently, unless being in an embassy is still unless being in an embassy is still seen as being resident for the previous 12 months, the point that right.
**** Possible New Speaker ****
right. I'm most grateful for that intervention, because many people who work in the embassies abroad don't live in the embassy. They live in apartments, houses or whatever in the vicinity of the embassy. So I believe that the wording of the bill as written prompted my probing amendment. So I ask the noble Lord, in the light of this, is he comfortable with the vagueness of the term ordinarily, or does he see merit in reconsidering this wording carefully to clarify the residency requirement to avoid death tourism and ensure others are not discriminated against? I beg to move.
13:21
Baroness Coffey (Conservative)
-
-
Baroness Coffey (Conservative)
Amendment proposed clause one, page one. Line eight. Leave out page one. Line eight. Leave out paragraphs C and D. Originally tabled amendment 15.
**** Possible New Speaker ****
Which are withdrawn. And because it looked like I was being trying to be nasty and stop being trying to be nasty and stop the bucket list for people or stopping going on holiday. And that wasn't my intention. My intention was to think about residency in a proper way. And bearing in mind previous comments from the from the Minister, I've ended up replacing one amendment with four. In order to be precise, through the bill. But in essence, what this is about is I am not convinced that simply being ordinarily resident is enough.
And the reason I say that is you can actually be ordinarily resident in more than one country. You can only be domiciled in one country. So the issue here is who is this bill really trying to cater for? I think it should be. And bearing in mind amendments 23, proposed by my noble friend Lord Frost, is that we should be looking frankly at UK citizens, those that the government has decided to give indefinite leave to remain and keep it at that.
Now, the element of ordinarily resident is that you can have settlement for a purpose. The single purpose could be you state that your settlement, your purpose for being ordinarily resident, is simply to take advantage of this bill. And I don't think that's enough in terms of some of the other amendments that have been tabled by my noble friend Lord Lansley. Nor do I want this extending that you can live anywhere in the United Kingdom. And indeed, my noble friend Lord Moylan has anticipated perhaps some of the things where people have moved abroad and then want to come back.
I think the essence of this bill should be that it's focusing on providing provision in this country for people who permanently live in this country, and that is why I think domiciled is a better test than simply ordinarily resident. Whereas I say you can be actually ordinarily resident in more than one country.
**** Possible New Speaker ****
Which are withdrawn. And because it looked like I was being trying to be nasty and stop being trying to be nasty and stop the bucket list for people or stopping going on holiday. And that wasn't my intention. My intention was to think about residency in a proper way. And bearing in mind previous comments from the from the Minister, I've ended up replacing one amendment with four. In order to be precise, through the bill. But in essence, what this is about is I am not convinced that simply being ordinarily resident is enough.
And the reason I say that is you can actually be ordinarily resident in more than one country. You can only be domiciled in one country. So the issue here is who is this bill really trying to cater for? I think it should be. And bearing in mind amendments 23, proposed by my noble friend Lord Frost, is that we should be looking frankly at UK citizens, those that the government has decided to give indefinite leave to remain and keep it at that.
Now, the element of ordinarily resident is that you can have settlement for a purpose. The single purpose could be you state that your settlement, your purpose for being ordinarily resident, is simply to take advantage of this bill. And I don't think that's enough in terms of some of the other amendments that have been tabled by my noble friend Lord Lansley. Nor do I want this extending that you can live anywhere in the United Kingdom. And indeed, my noble friend Lord Moylan has anticipated perhaps some of the things where people have moved abroad and then want to come back.
I think the essence of this bill should be that it's focusing on providing provision in this country for people who permanently live in this country, and that is why I think domiciled is a better test than simply ordinarily resident. Whereas I say you can be actually ordinarily resident in more than one country.
13:23
Lord Lansley (Conservative)
-
-
Lord Lansley (Conservative)
I think I think my amendments come earlier. Let me just I've not previously spoken on this bill. So I do hope that noble Lords will understand that I approach the tabling of amendments and speaking to them simply from the point of view of trying to secure that the bill is workable. It is, of course, a bill which is intended to be provided essentially by the National Health Service. And so where I am coming from in these amendments in this group is entirely to say we must make this service workable by the National Health Service.
And if I were to put what I have to say into one sentence, it would be so let us have definitions in relation to eligibility by reference to residents, which accord with those definitions which are presently used by the National Health Service. And let's not try to ask the NHS to become immigration inspectors. So but there is, I'm afraid, also the longer version, and I'll try to keep it as short as I can. I have amendments 11 B 258 B305A together with my noble friend Earl Howe 306 C and 449B, they are all about from my point of view.
They're not about trying to bring Scots into England and Wales for this purpose. They're about aligning the definitions in this bill for a service provider with the NHS, with the definitions that are used day by day in the provision of NHS services. And I think this is not a bureaucratic issue. It is a practical issue. If the NHS is providing a service to somebody, then they should be able if and that service may, of course, in our circumstances will be something of a substantial character relating to what developed into palliative or end of life care, then they should be in a position to be able to provide an assisted dying service.
If it is a service for which that person is eligible. I leave aside, if I may, the question of whether they come from overseas or Crown dependencies, because from my point of view, those persons would not be ordinarily resident inside the United Kingdom. So the question does, and they're not registered necessarily with a probably not registered with a medical practice in England, Wales. So they would not be eligible for those reasons. So from my point of view, it does come back to ordinarily resident, which as the noble Lady Baroness Finlay correctly said, isn't defined in statute.
It is it is understood in the National Health Service and where it is used by the case. She referred to Crown and London Borough of Barnet, ex parte Shah. The Shah case, where scar said that ordinarily resident is where a person normally lives voluntarily and for a settled purpose, forming part of the regular pattern of their lives. Now, it does appear in statute in the sense that the NHS Wales Act requires that services be provided for those persons who, for the time being, are ordinarily resident in Wales.
No further definition of ordinarily resident, and of course the overseas visitor charging legislation is secondary legislation, but of course uses the ordinarily resident test in that secondary legislation. So what is caused interesting in this context is that although ordinarily resident, is in theory, a test of whether one has access, free access to NHS services, or whether one is subject to charging in practice, general, I shouldn't. Sorry, no pun intended. In general practices, when somebody registers with that practice, they complete form DCMS one which ask those from abroad to identify whether they would be subject to visitor charging outside the practice.
But that form also states, and I quote, any one can register with a GP practice and receive free medical care from that practice. So what we actually find is that so far as the NHS is concerned, primary care, essentially community care, everything other than secondary care is available free to people who are ordinarily resident. And they don't ask and they don't check. So from my point of view, the most important thing we should absolutely have in our minds is are we asking the NHS to change all the practices of their recent history and do something completely different? Now I'm going to turn a longer speech into a short speech.
There are very interesting amendments from my noble friends Lord Moylan Baroness Coffey Baroness Coffey is very interesting because the question of domicile is a very challenging one in this context. But we would be asking the NHS not only to become immigration inspectors, but also to be tax inspectors, since they have to, since the question of where one is domiciled is a tax issue as well as an immigration issue, I don't think we need to go there at all. And these amendments, all they do is very simply take out the ordinarily the all these, these other amendments, but they also change what is in the bill because the bill says ordinarily resident in clause one, ordinary resident in England and Wales or or Wales, and has been so resident for at least 12 months, ending with the date of the first declaration.
Well, firstly, in the NHS, I am not aware that anybody tests whether somebody is ordinarily resident in England and Wales. They simply ask are you ordinarily resident in United Kingdom? Because it is simply a matter of whether one is charged for NHS services or not. So if somebody from Scotland, a later group, will examine this in more detail. Of course, somebody from Scotland registers with an English practice. They don't say. Are you ordinarily resident in England? No, they don't ask at all.
But if they did ask, they would ask. Are you ordinarily resident in United Kingdom? Because that is the only operative test. Secondly, they do not ask, have you been ordinarily resident for 12 months? Still less? I have to say, with apologies to the noble Lady Baroness Grey-Thompson 60 months. As one of the amendments asks, they don't ask at all because it is a matter of fact, under common law, it's a matter of fact of whether one is ordinarily resident for the time being.
So I don't I don't intend to dwell on a large number of amendments in this group. I simply want to say, from my point of view, when we come to report, my hope is that the noble and learned Lord, the sponsor for whose time in discussion about this I have valued. Thank you. I hope that he, as the sponsor of this Bill, might recognise that we would be better off simply amending the bill to take out the reference to England and Wales to, and likewise in the subsequent clauses eight 1017.
There are consequential changes as well, and make the eligibility test very straightforward, that it is about whether one is ordinarily resident in the United Kingdom, I think necessarily, because that is the only test that we have at the moment in common law, and that that it is as is currently used for the time being. And then we rest on those. The proposition that one is both ordinarily resident and registered with a medical practice, which aligns it with NHS practice.
So from my point of view, I know we will go on and I will be among those who, at a later group, will be looking to strengthen the safeguards that are being applied to the eligibility tests. But I don't regard this question of residence as a safeguard. I regard pretty much all of these amendments other I, I would like to say my own as being devices to create bureaucratic impediments to people's eligibility for this service and whatever we may think in principle for or against the bill.
I do not think we should be depriving people who are accessing NHS services in this country from access to this service, for reasons of bureaucratic differentiation, rather than because they are eligible or otherwise for substantive reasons. So I hope that when we come to report, my amendments might find favour with the sponsor of the Bill.
And if I were to put what I have to say into one sentence, it would be so let us have definitions in relation to eligibility by reference to residents, which accord with those definitions which are presently used by the National Health Service. And let's not try to ask the NHS to become immigration inspectors. So but there is, I'm afraid, also the longer version, and I'll try to keep it as short as I can. I have amendments 11 B 258 B305A together with my noble friend Earl Howe 306 C and 449B, they are all about from my point of view.
They're not about trying to bring Scots into England and Wales for this purpose. They're about aligning the definitions in this bill for a service provider with the NHS, with the definitions that are used day by day in the provision of NHS services. And I think this is not a bureaucratic issue. It is a practical issue. If the NHS is providing a service to somebody, then they should be able if and that service may, of course, in our circumstances will be something of a substantial character relating to what developed into palliative or end of life care, then they should be in a position to be able to provide an assisted dying service.
If it is a service for which that person is eligible. I leave aside, if I may, the question of whether they come from overseas or Crown dependencies, because from my point of view, those persons would not be ordinarily resident inside the United Kingdom. So the question does, and they're not registered necessarily with a probably not registered with a medical practice in England, Wales. So they would not be eligible for those reasons. So from my point of view, it does come back to ordinarily resident, which as the noble Lady Baroness Finlay correctly said, isn't defined in statute.
It is it is understood in the National Health Service and where it is used by the case. She referred to Crown and London Borough of Barnet, ex parte Shah. The Shah case, where scar said that ordinarily resident is where a person normally lives voluntarily and for a settled purpose, forming part of the regular pattern of their lives. Now, it does appear in statute in the sense that the NHS Wales Act requires that services be provided for those persons who, for the time being, are ordinarily resident in Wales.
No further definition of ordinarily resident, and of course the overseas visitor charging legislation is secondary legislation, but of course uses the ordinarily resident test in that secondary legislation. So what is caused interesting in this context is that although ordinarily resident, is in theory, a test of whether one has access, free access to NHS services, or whether one is subject to charging in practice, general, I shouldn't. Sorry, no pun intended. In general practices, when somebody registers with that practice, they complete form DCMS one which ask those from abroad to identify whether they would be subject to visitor charging outside the practice.
But that form also states, and I quote, any one can register with a GP practice and receive free medical care from that practice. So what we actually find is that so far as the NHS is concerned, primary care, essentially community care, everything other than secondary care is available free to people who are ordinarily resident. And they don't ask and they don't check. So from my point of view, the most important thing we should absolutely have in our minds is are we asking the NHS to change all the practices of their recent history and do something completely different? Now I'm going to turn a longer speech into a short speech.
There are very interesting amendments from my noble friends Lord Moylan Baroness Coffey Baroness Coffey is very interesting because the question of domicile is a very challenging one in this context. But we would be asking the NHS not only to become immigration inspectors, but also to be tax inspectors, since they have to, since the question of where one is domiciled is a tax issue as well as an immigration issue, I don't think we need to go there at all. And these amendments, all they do is very simply take out the ordinarily the all these, these other amendments, but they also change what is in the bill because the bill says ordinarily resident in clause one, ordinary resident in England and Wales or or Wales, and has been so resident for at least 12 months, ending with the date of the first declaration.
Well, firstly, in the NHS, I am not aware that anybody tests whether somebody is ordinarily resident in England and Wales. They simply ask are you ordinarily resident in United Kingdom? Because it is simply a matter of whether one is charged for NHS services or not. So if somebody from Scotland, a later group, will examine this in more detail. Of course, somebody from Scotland registers with an English practice. They don't say. Are you ordinarily resident in England? No, they don't ask at all.
But if they did ask, they would ask. Are you ordinarily resident in United Kingdom? Because that is the only operative test. Secondly, they do not ask, have you been ordinarily resident for 12 months? Still less? I have to say, with apologies to the noble Lady Baroness Grey-Thompson 60 months. As one of the amendments asks, they don't ask at all because it is a matter of fact, under common law, it's a matter of fact of whether one is ordinarily resident for the time being.
So I don't I don't intend to dwell on a large number of amendments in this group. I simply want to say, from my point of view, when we come to report, my hope is that the noble and learned Lord, the sponsor for whose time in discussion about this I have valued. Thank you. I hope that he, as the sponsor of this Bill, might recognise that we would be better off simply amending the bill to take out the reference to England and Wales to, and likewise in the subsequent clauses eight 1017.
There are consequential changes as well, and make the eligibility test very straightforward, that it is about whether one is ordinarily resident in the United Kingdom, I think necessarily, because that is the only test that we have at the moment in common law, and that that it is as is currently used for the time being. And then we rest on those. The proposition that one is both ordinarily resident and registered with a medical practice, which aligns it with NHS practice.
So from my point of view, I know we will go on and I will be among those who, at a later group, will be looking to strengthen the safeguards that are being applied to the eligibility tests. But I don't regard this question of residence as a safeguard. I regard pretty much all of these amendments other I, I would like to say my own as being devices to create bureaucratic impediments to people's eligibility for this service and whatever we may think in principle for or against the bill.
I do not think we should be depriving people who are accessing NHS services in this country from access to this service, for reasons of bureaucratic differentiation, rather than because they are eligible or otherwise for substantive reasons. So I hope that when we come to report, my amendments might find favour with the sponsor of the Bill.
13:33
-
My Lords, I rise to. >> My Lords, I rise to. >> Speak to my. Amendment to. >> Remind you of the bureaucratic impediment that if you're a resident in England and Wales who lives a few miles from the general practice in Scotland, and you are registered with that practice, you are disqualified from the scope of the Bill. It seems to me there's quite a bit of work on these border issues to be done, which I hope the noble Lord, the Lord might indicate.
He's willing to see done, to try and sort out some of these border issues. And if he is so willing, I wouldn't need to move amendment 17, which will come a little later.
He's willing to see done, to try and sort out some of these border issues. And if he is so willing, I wouldn't need to move amendment 17, which will come a little later.
13:33
Lord Beith (Liberal Democrat)
-
-
Lord Beith (Liberal Democrat)
Address these border issues. I think these border issues are incredibly important. The noble Baroness Baroness Finlay specifically raised them in the context of the Isle of Man patient context of the Isle of Man patient who comes to say Liverpool for treatment. What's going to happen when Scotland and England or Scotland and the Isle of Man have different laws on assisted dying? If, as our this draft says, you've got to be ordinary resident in England and Wales to get the benefit of the exception to the suicide act, then those who say, if I say I'll help you get back to the Isle of Man for an assisted death there, that would be a criminal offence because you wouldn't be ordinarily resident in England and Wales.
The British Medical Association have got a proposal which says we amend the bill to say if you help somebody to go to another part of the country, to have an assisted death in accordance with their laws, that would not be a crime. And I've been to answer the Baroness Finlay point in discussion with the BMA as to how one might introduce an amendment to that effect. Now we need to discuss it, but these cross border issues definitely need to be discussed, and I would very much welcome such a discussion taking place with interested parties.
**** Possible New Speaker ****
Following the noble. What I'm talking about is a group of people talking about is a group of people who live in England, are ordinarily resident in England, but happen to be registered with the general practice in Scotland. This has no impact on what the Scottish situation in other respects would be. That's a matter for the Scottish Parliament, but it does affect the scope of the Bill. Yes.
**** Possible New Speaker ****
I the wider issue, which is the one that Baroness Finlay but it also affects it goes to ordinary resident in Scotland. And then you come to England for your medical advice. And the medical advice says go back to Scotland if you want an assisted death, would that be a crime? But I'm also dealing with the. I would also wish to deal with the GP point. You live in England but have a GP in Scotland, does that debar you from getting it here? And I'm more than happy to include that in the discussion.
**** Possible New Speaker ****
For. Lord Hannett Earl of Stair. Order order order! Excuse me. We'll hear from the
**** Possible New Speaker ****
noble order. Thank you. I rise to speak to my amendment number 14. In this group, amendment number 14. In this group, which seeks to expand eligibility to those of pensionable age who have retired from the UK and gone have retired from the UK and gone to live abroad. It is a probing amendment, of course, and it's not
The British Medical Association have got a proposal which says we amend the bill to say if you help somebody to go to another part of the country, to have an assisted death in accordance with their laws, that would not be a crime. And I've been to answer the Baroness Finlay point in discussion with the BMA as to how one might introduce an amendment to that effect. Now we need to discuss it, but these cross border issues definitely need to be discussed, and I would very much welcome such a discussion taking place with interested parties.
**** Possible New Speaker ****
Following the noble. What I'm talking about is a group of people talking about is a group of people who live in England, are ordinarily resident in England, but happen to be registered with the general practice in Scotland. This has no impact on what the Scottish situation in other respects would be. That's a matter for the Scottish Parliament, but it does affect the scope of the Bill. Yes.
**** Possible New Speaker ****
I the wider issue, which is the one that Baroness Finlay but it also affects it goes to ordinary resident in Scotland. And then you come to England for your medical advice. And the medical advice says go back to Scotland if you want an assisted death, would that be a crime? But I'm also dealing with the. I would also wish to deal with the GP point. You live in England but have a GP in Scotland, does that debar you from getting it here? And I'm more than happy to include that in the discussion.
**** Possible New Speaker ****
For. Lord Hannett Earl of Stair. Order order order! Excuse me. We'll hear from the
**** Possible New Speaker ****
noble order. Thank you. I rise to speak to my amendment number 14. In this group, amendment number 14. In this group, which seeks to expand eligibility to those of pensionable age who have retired from the UK and gone have retired from the UK and gone to live abroad. It is a probing amendment, of course, and it's not
13:36
Lord Moylan (Conservative)
-
-
Lord Moylan (Conservative)
amendment, of course, and it's not my intention particularly to expand eligibility to the bill. I'm trying to raise a question of equity and fairness, but also legal defensibility. So I want to approach this issue from a slightly different angle, and I endorse everything said by my noble friend Lord Lansley and so forth in raising practical issues. And the noble Baroness, Lady Findlay, the noble Lord, Lord Beith, raising these practical issues. But I want to approach it from a on a slightly different basis or intention here.
I think it's fair to say the intention of the sponsor is that in creating this act, we do not turn England and Wales into a sort of international capital to come here for a, for a, for a quick, a quick assisted, a quick assisted death. That would be an appalling thing to happen. And so we try to put some some borders around it, some parameters that say that this service which is here for the use of, for the use domestically of people who are established here.
And one way of looking at that is to is to put these criteria in about having been here for 12 months and, and so forth, and being ordinarily resident and, and all of that. And as I say, I agree that these raise very serious practical issues. But it seems to me and here I, I tread very carefully because I'm not a lawyer. It seems to me they raise legal issues as well. Are we to some extent, fooling ourselves into thinking that we, although we are the legislature, that we can create these boundaries
**** Possible New Speaker ****
and that they will remain firm? Yeah. I am, I'm thinking about what
**** Possible New Speaker ****
I am, I'm thinking about what the noble Baroness, the Minister said in her reply to the first said in her reply to the first group in the first debate we had today, in which she was very careful to draw the attention of careful to draw the attention of noble Lords to the fact that certain amendments in that group might be challenged under human rights law or on the grounds of of the Equalities Act. And she said she couldn't give assurances that they might not be challenged.
That was her being cautious and proper and expressing the government's view while being neutral about the bill. But it raises a flag. How many of these limits that we are discussing now would actually withstand legal challenge? So I chose my own example on precisely those grounds. What if you have lived all your life in this country, you've paid all your taxes in this country, and you've you've reached your pensionable age and you've decided to retire? Let us say to Spain and, and all these unfortunate developments lead you to want to come back.
You qualify under the act for an assisted death in that you have a terminal illness, you have a six month prognosis, and you want to come back to the UK in order to take advantage of that, maybe because it isn't available in Spain, maybe because you want to be with other members of your family. Who knows you want to come back and you want to do that now under the bill, as I understand it, you'd be excluded from doing that. But would a court actually agree that that was a firm parameter? Would a court agree, in other words, that the criteria we have established are sufficiently rational that they have a sufficient basis, either in other legislation or in their understanding of human rights or in practical considerations? There might be all sorts of reasons why courts might say, yes, these are rational limitations, but they could equally, equally be the case that the court would say, no, that's an injustice.
This person has paid their taxes all their life. They've only been gone a few months from this country. Of course, they should be allowed to come back and take advantage of it. It's irrational to exclude them so that that is the point I want to raise. I think it's not simply that the noble Lord, the noble and learned Lord, the sponsor of the bill, has to put in place criteria which sufficiently exclude the possibility that we are going to become an international shop for assisted death, which we'd all agree with him is something we don't want to see happen, but also that they are sufficiently rooted that they are going to be defensible and endurable in a judicial context.
And that is the matter that most concerns me in a way, quite apart from the practical considerations. That's the matter that most concerns me about this whole eligibility debate.
I think it's fair to say the intention of the sponsor is that in creating this act, we do not turn England and Wales into a sort of international capital to come here for a, for a, for a quick, a quick assisted, a quick assisted death. That would be an appalling thing to happen. And so we try to put some some borders around it, some parameters that say that this service which is here for the use of, for the use domestically of people who are established here.
And one way of looking at that is to is to put these criteria in about having been here for 12 months and, and so forth, and being ordinarily resident and, and all of that. And as I say, I agree that these raise very serious practical issues. But it seems to me and here I, I tread very carefully because I'm not a lawyer. It seems to me they raise legal issues as well. Are we to some extent, fooling ourselves into thinking that we, although we are the legislature, that we can create these boundaries
**** Possible New Speaker ****
and that they will remain firm? Yeah. I am, I'm thinking about what
**** Possible New Speaker ****
I am, I'm thinking about what the noble Baroness, the Minister said in her reply to the first said in her reply to the first group in the first debate we had today, in which she was very careful to draw the attention of careful to draw the attention of noble Lords to the fact that certain amendments in that group might be challenged under human rights law or on the grounds of of the Equalities Act. And she said she couldn't give assurances that they might not be challenged.
That was her being cautious and proper and expressing the government's view while being neutral about the bill. But it raises a flag. How many of these limits that we are discussing now would actually withstand legal challenge? So I chose my own example on precisely those grounds. What if you have lived all your life in this country, you've paid all your taxes in this country, and you've you've reached your pensionable age and you've decided to retire? Let us say to Spain and, and all these unfortunate developments lead you to want to come back.
You qualify under the act for an assisted death in that you have a terminal illness, you have a six month prognosis, and you want to come back to the UK in order to take advantage of that, maybe because it isn't available in Spain, maybe because you want to be with other members of your family. Who knows you want to come back and you want to do that now under the bill, as I understand it, you'd be excluded from doing that. But would a court actually agree that that was a firm parameter? Would a court agree, in other words, that the criteria we have established are sufficiently rational that they have a sufficient basis, either in other legislation or in their understanding of human rights or in practical considerations? There might be all sorts of reasons why courts might say, yes, these are rational limitations, but they could equally, equally be the case that the court would say, no, that's an injustice.
This person has paid their taxes all their life. They've only been gone a few months from this country. Of course, they should be allowed to come back and take advantage of it. It's irrational to exclude them so that that is the point I want to raise. I think it's not simply that the noble Lord, the noble and learned Lord, the sponsor of the bill, has to put in place criteria which sufficiently exclude the possibility that we are going to become an international shop for assisted death, which we'd all agree with him is something we don't want to see happen, but also that they are sufficiently rooted that they are going to be defensible and endurable in a judicial context.
And that is the matter that most concerns me in a way, quite apart from the practical considerations. That's the matter that most concerns me about this whole eligibility debate.
13:41
Baroness Whitaker (Labour)
-
-
Baroness Whitaker (Labour)
And when considering this group in particular, perhaps amendments in particular, perhaps amendments 308 and 306, I realised a small number of noble Lords who moved number of noble Lords who moved most of this very large number of amendments to the Bill recognised compassion as their guiding intention. I hope they're being reassured by my noble friend Lord Falconer. Comprehensive and expert assurance reassurance on the many safeguards now inserted into the Bill. More safeguards, I believe, than in the legislation of any other country.
But I am concerned that very extended delays will betray the hope of the woman who nursed both her parents through agonising and protracted deaths, and who now faces the same fate herself. She mourns the fact that her parents were never given the choice. This bill provides. Her words to me as a legislator were have mercy. Mercy is what this bill is about, and noble Lords will surely seek the path to mercy. Surely only those whose motives are ideological would want to prevent this bill from passing, rather than working out the best amendments on a reasonable timetable? I remain profoundly uneasy at the prospect of members of this House abrogating to themselves the right to deny the choice of mercy to that large majority of our fellow citizens who want this choice to be available, as reflected in the decisions of our elected representatives.
Have
**** Possible New Speaker ****
mercy should be our watchword. For the noble Lady sits down.
**** Possible New Speaker ****
For the noble Lady sits down. Since she did refer in her speech to the two amendments that I have on the Order Paper amendment paper, on the Order Paper amendment paper, which I haven't yet spoken to, she seemed to be ascribing motives to seemed to be ascribing motives to them around, trying to deny. Well, let me finish. Motives to the amendment. She she only referred to amendment. She she only referred to two amendments, and they were the two amendments I've got. And she seemed to be suggesting they were designed to stop people accessing this service.
If I hope she'll stay and listen to me when I explain what my amendment is about, and she'll see that is entirely the opposite of what they're designed to do.
But I am concerned that very extended delays will betray the hope of the woman who nursed both her parents through agonising and protracted deaths, and who now faces the same fate herself. She mourns the fact that her parents were never given the choice. This bill provides. Her words to me as a legislator were have mercy. Mercy is what this bill is about, and noble Lords will surely seek the path to mercy. Surely only those whose motives are ideological would want to prevent this bill from passing, rather than working out the best amendments on a reasonable timetable? I remain profoundly uneasy at the prospect of members of this House abrogating to themselves the right to deny the choice of mercy to that large majority of our fellow citizens who want this choice to be available, as reflected in the decisions of our elected representatives.
Have
**** Possible New Speaker ****
mercy should be our watchword. For the noble Lady sits down.
**** Possible New Speaker ****
For the noble Lady sits down. Since she did refer in her speech to the two amendments that I have on the Order Paper amendment paper, on the Order Paper amendment paper, which I haven't yet spoken to, she seemed to be ascribing motives to seemed to be ascribing motives to them around, trying to deny. Well, let me finish. Motives to the amendment. She she only referred to amendment. She she only referred to two amendments, and they were the two amendments I've got. And she seemed to be suggesting they were designed to stop people accessing this service.
If I hope she'll stay and listen to me when I explain what my amendment is about, and she'll see that is entirely the opposite of what they're designed to do.
13:43
Lord Pannick (Crossbench)
-
-
Lord Pannick (Crossbench)
I say to the. Lord Lord Moylan, that nothing is impossible in human rights law, that it would be exceptionally surprising if the courts were to say that a criterion as well established as ordinary residents were not a justifiable criterion to address the difficult problem of which people ought to benefit from the advantages that this bill, if enacted, would confer.
**** Possible New Speaker ****
One other point that I wish to make. I'm very grateful.
**** Possible New Speaker ****
I'm very grateful. I agree that the notion of ordinary residence is very well established. I'm more concerned established. I'm more concerned about subsection D here, which requires a 12 month prior residency, requires a 12 month prior residency, which doesn't apply to anything we do in any other aspect of the NHS. For example, if you get knocked For example, if you get knocked over, you might have been resident here a fortnight. You get knocked over in the street, you're going to be looked after and looked after free.
So it's more the latter than the former that I was concerned with, and I'm grateful to have his legal assurance. But as he says, it's not even, you know, it's not absolutely certain there may be one up.
**** Possible New Speaker ****
If if I were advising Lord Moylan as a client, what I would Moylan as a client, what I would say to him is that a court would recognise that Parliament, when it recognise that Parliament, when it enacts legislation of this sort, has to make a choice and it has to decide what is an appropriate and decide what is an appropriate and reasonable period to require a person to have satisfied, in order to benefit, in order to prevent health tourism that we all wish to avoid in this legislation.
And we should also remember that if Parliament enacts this legislation, the courts would have no power to strike it down in this country. The most they could do is a declaration of incompatibility. But I think that's extremely unlikely in this context. The other point I wanted to make, if I may, is to respond to the noble Lady Baroness Coffey, because she was commending a test of domicile. Now, domicile is one of the most complex legal concepts that we have.
There's domicile of origin, there's domicile of choice, there's domicile of operation of the law. And it would be disastrous, in my opinion, for us to incorporate such a concept into this legislation, not least because I can have domicile in this country simply because it was the domicile of my parents when I was born. And I have lived the entire of my life in the United States, in France or wherever, and I would be able to come back to this country in order to benefit as a health tourist, as take advantage of this bill, if enacted, which is exactly what I think we all want to avoid.
So domicile should be ruled out, and I hope the noble and learned Lord, when he responds, will confirm that.
**** Possible New Speaker ****
One other point that I wish to make. I'm very grateful.
**** Possible New Speaker ****
I'm very grateful. I agree that the notion of ordinary residence is very well established. I'm more concerned established. I'm more concerned about subsection D here, which requires a 12 month prior residency, requires a 12 month prior residency, which doesn't apply to anything we do in any other aspect of the NHS. For example, if you get knocked For example, if you get knocked over, you might have been resident here a fortnight. You get knocked over in the street, you're going to be looked after and looked after free.
So it's more the latter than the former that I was concerned with, and I'm grateful to have his legal assurance. But as he says, it's not even, you know, it's not absolutely certain there may be one up.
**** Possible New Speaker ****
If if I were advising Lord Moylan as a client, what I would Moylan as a client, what I would say to him is that a court would recognise that Parliament, when it recognise that Parliament, when it enacts legislation of this sort, has to make a choice and it has to decide what is an appropriate and decide what is an appropriate and reasonable period to require a person to have satisfied, in order to benefit, in order to prevent health tourism that we all wish to avoid in this legislation.
And we should also remember that if Parliament enacts this legislation, the courts would have no power to strike it down in this country. The most they could do is a declaration of incompatibility. But I think that's extremely unlikely in this context. The other point I wanted to make, if I may, is to respond to the noble Lady Baroness Coffey, because she was commending a test of domicile. Now, domicile is one of the most complex legal concepts that we have.
There's domicile of origin, there's domicile of choice, there's domicile of operation of the law. And it would be disastrous, in my opinion, for us to incorporate such a concept into this legislation, not least because I can have domicile in this country simply because it was the domicile of my parents when I was born. And I have lived the entire of my life in the United States, in France or wherever, and I would be able to come back to this country in order to benefit as a health tourist, as take advantage of this bill, if enacted, which is exactly what I think we all want to avoid.
So domicile should be ruled out, and I hope the noble and learned Lord, when he responds, will confirm that.
13:46
Lord Carlile of Berriew (Crossbench)
-
-
Lord Carlile of Berriew (Crossbench)
My Lords, my Lords, I just my >> My Lords, my Lords, I just my Lords. My Lords, I just like to agree with my noble friend Lord Pannick. The concept of residence is absolutely clearly understood. I'd recommend to Lord Moylan that he might need a criminal lawyer, just in case he was prosecuted for doing something wrong, and I'd be very happy to act for him, of course, and I would recommend that all of us who are considering this matter should have a good look, as I have at the National Health Service Ordinary Residence Tool, as it's called, which was revised in March of this year, and which gives a very clear outline of all the possibilities and where they fall in the ordinary residence.
Judgement. What concerns me and will come to this in another group, possibly even today, about the example that the noble Lord, Lord Moylan gave is that if somebody has been living in Spain and they want to come back to their former country of ordinary residence for an assisted dying, if this bill becomes law, it will prove extremely difficult to detect where there has been undue influence, particularly within a family. It particularly within a family. It would be extraordinarily difficult to investigate that evidence, whether it was done by a court or whether it was done by a court or by a panel.
And I'm afraid I would be opposed to it on that ground, those grounds. those grounds.
Judgement. What concerns me and will come to this in another group, possibly even today, about the example that the noble Lord, Lord Moylan gave is that if somebody has been living in Spain and they want to come back to their former country of ordinary residence for an assisted dying, if this bill becomes law, it will prove extremely difficult to detect where there has been undue influence, particularly within a family. It particularly within a family. It would be extraordinarily difficult to investigate that evidence, whether it was done by a court or whether it was done by a court or by a panel.
And I'm afraid I would be opposed to it on that ground, those grounds. those grounds.
13:48
Baroness Butler-Sloss (Crossbench)
-
-
Baroness Butler-Sloss (Crossbench)
Could I say that I also entirely support including the word disastrous, the points that the noble Lord Pannick have made, as he said, domicile is complex. You'd end up in court if you were going to the issue of domicile. That really is not a good idea. What I really was standing up for is under clause 113. There are two requirements one ordinary residence. And I have to say to the noble Lord Moylan, if I find the case, I wouldn't have any problem at all.
As far as I'm concerned, if it says ordinary resident, that's what I would accept, so long as there was the evidence to support it. And I don't think we need to be caught up. I have to say, in the Human Rights Act in dealing with an issue such as that. But what does worries me is the two requirements one ordinary resident and the other has been resident for at least 12 months, ending with the date of the first declaration. That seems to me to be a complete bar for someone who's in an embassy or living, whether in the embassy or living in.
I think it's very difficult if they're not ordinary resident. It
**** Possible New Speaker ****
looks as though. Lord Carlile to interrupt my noble friend, who I regard as being noble friend, who I regard as being of almost biblical correctness in almost everything, but if she were almost everything, but if she were to take a look at the tool that I referred to, the NHS tool, which referred to, the NHS tool, which sets out all the requirements to prove ordinary residence, she would find that people who work in embassies, for example, are embassies, for example, are excluded because they're given fixed term contracts, which are for a certain time, even though that contract may be extended at some time, for example, it also specifically refers to people who work for charities, who go to work abroad for a temporary period,
**** Possible New Speaker ****
which is fixed by contract. So I don't think the issue she's raised is really very worrying. Well, I'm delighted to hear it
**** Possible New Speaker ****
Well, I'm delighted to hear it in relation to embassies and charities, but the other example that was given was the person that was given was the person living in Spain who wants to come back and die here. It doesn't seem back and die here. It doesn't seem to me that being resident for the last 12 months in this country would allow that person. So I just would allow that person. So I just say to the noble and learned Lord, he might just relook at that particular element of residence.
As far as I'm concerned, if it says ordinary resident, that's what I would accept, so long as there was the evidence to support it. And I don't think we need to be caught up. I have to say, in the Human Rights Act in dealing with an issue such as that. But what does worries me is the two requirements one ordinary resident and the other has been resident for at least 12 months, ending with the date of the first declaration. That seems to me to be a complete bar for someone who's in an embassy or living, whether in the embassy or living in.
I think it's very difficult if they're not ordinary resident. It
**** Possible New Speaker ****
looks as though. Lord Carlile to interrupt my noble friend, who I regard as being noble friend, who I regard as being of almost biblical correctness in almost everything, but if she were almost everything, but if she were to take a look at the tool that I referred to, the NHS tool, which referred to, the NHS tool, which sets out all the requirements to prove ordinary residence, she would find that people who work in embassies, for example, are embassies, for example, are excluded because they're given fixed term contracts, which are for a certain time, even though that contract may be extended at some time, for example, it also specifically refers to people who work for charities, who go to work abroad for a temporary period,
**** Possible New Speaker ****
which is fixed by contract. So I don't think the issue she's raised is really very worrying. Well, I'm delighted to hear it
**** Possible New Speaker ****
Well, I'm delighted to hear it in relation to embassies and charities, but the other example that was given was the person that was given was the person living in Spain who wants to come back and die here. It doesn't seem back and die here. It doesn't seem to me that being resident for the last 12 months in this country would allow that person. So I just would allow that person. So I just say to the noble and learned Lord, he might just relook at that particular element of residence.
13:50
Baroness Andrews (Labour)
-
-
Baroness Andrews (Labour)
Thank you. >> Fascinating debate between our lawyers. I have not any legal experience, but I have in fact investigated the notion of investigated the notion of domiciliary status at some length for different reasons. And I can for different reasons. And I can absolutely agree with the anyone who's tried to work their way through 93 pages of conditionalities and various different criterias. What I wanted to say was, if we could come back to the central point in that excellent contribution by Lord Lansley about the need for consistency with the NHS and the implications of not being consistent.
Terminology is not just domiciliary status. What is the notion of permanence? We could have an equally long and problematic debate over that other element of terminology, and I completely respect the fact that this is a probing amendment. But just as we've had the beginnings of debate on mental capacity and the necessity for consistency and trusting, what we already know works because we see it every day in practice. So the notion of ordinary residence should actually simply, as far as I'm concerned, end the conversation, because I think it is so much a consensus around this House and will welcome consensus, actually, that this is the only definition which is going to be practicable and workable and known and acceptable.
And hopefully, actually, we can move on with the
**** Possible New Speaker ****
debate in that context. Accept that ordinary residence
**** Possible New Speaker ****
Accept that ordinary residence doesn't end the debate, because the Bill goes on to impose an additional qualification about additional qualification about having lived in this country for 12 months prior to the date on signing date of signing the first declaration. And if it were just ordinary residence, then legally no
Terminology is not just domiciliary status. What is the notion of permanence? We could have an equally long and problematic debate over that other element of terminology, and I completely respect the fact that this is a probing amendment. But just as we've had the beginnings of debate on mental capacity and the necessity for consistency and trusting, what we already know works because we see it every day in practice. So the notion of ordinary residence should actually simply, as far as I'm concerned, end the conversation, because I think it is so much a consensus around this House and will welcome consensus, actually, that this is the only definition which is going to be practicable and workable and known and acceptable.
And hopefully, actually, we can move on with the
**** Possible New Speaker ****
debate in that context. Accept that ordinary residence
**** Possible New Speaker ****
Accept that ordinary residence doesn't end the debate, because the Bill goes on to impose an additional qualification about additional qualification about having lived in this country for 12 months prior to the date on signing date of signing the first declaration. And if it were just ordinary residence, then legally no
13:52
13:52
Baroness Andrews (Labour)
-
-
Baroness Andrews (Labour)
The noble Lord is right, and >> The noble Lord is right, and there are specific instances in the noble Lady raised one in relation to the Crown dependencies, where to the Crown dependencies, where these definitions actually will have to be tested in some way. But the purpose of this bill is actually to ensure that people living in this country have a right, actually, to the security, that they will be treated within the NHS, and that the normal rules and behaviours of the NHS will apply to
**** Possible New Speaker ****
the context of this Bill, as it does to everything. I just.
**** Possible New Speaker ****
I just. Ask that just at the point, because my amendments would remove the 12 months and because that that the 12 months and because that that would enable greater alignment with practice within the NHS. But could I just make a plea to noble Lords I just make a plea to noble Lords that we might hear from those who have actually tabled amendments so that we have actually completed the group more quickly? Otherwise, group more quickly? Otherwise, we're I think it's a discourtesy to those who tabled amendments not to hear their explanation for them.
Lords Minister on the subject of intervention, can I just remind the House that a member of House of the House is speaking may be interrupted with a brief question of clarification, a brief question of clarification a member may justifiably refuse to give way. justifiably refuse to give way. Let's just try and stick to the people who've got their names on the amendments and make progress. the amendments and make progress.
**** Possible New Speaker ****
the context of this Bill, as it does to everything. I just.
**** Possible New Speaker ****
I just. Ask that just at the point, because my amendments would remove the 12 months and because that that the 12 months and because that that would enable greater alignment with practice within the NHS. But could I just make a plea to noble Lords I just make a plea to noble Lords that we might hear from those who have actually tabled amendments so that we have actually completed the group more quickly? Otherwise, group more quickly? Otherwise, we're I think it's a discourtesy to those who tabled amendments not to hear their explanation for them.
Lords Minister on the subject of intervention, can I just remind the House that a member of House of the House is speaking may be interrupted with a brief question of clarification, a brief question of clarification a member may justifiably refuse to give way. justifiably refuse to give way. Let's just try and stick to the people who've got their names on the amendments and make progress. the amendments and make progress.
13:53
13:54
Baroness Grey-Thompson (Crossbench)
-
-
Baroness Grey-Thompson (Crossbench)
I, my Lords, I rise to speak to amendment 13 and 309 in my name. These are probing amendments, and I recognise that the 16 months and the 12 months and my two amendments don't quite tally up, but they were tabled at quite different times. Amendment 309 is quite simple. It looks to open a discussion and seek to protect asylum seekers, immigrants without indefinite leave to remain and anyone in the asylum system. Amendment 13. And it was very interesting listening to the noble Lord Lord Lansley, and I recognise the 16 months will have raised some eyebrows.
It was my clumsy attempt to talk about death tourism, but also look at how we can provide consistency within this bill. Now, one of the reasons that we're consistently given for needing this bill is that those who can afford it can go to Dignitas, which promotes inequality. But if we don't get this section of the bill right, then that inequality will still exist. My noble friend Baroness Finlay raised some important points on where someone is able to die. I've got other amendments on certification of those areas, and I do believe this needs some more thought, because many of the letters that I receive from individuals who want the law to change will talk about wanting to end their lives at a time and a place of their choosing.
Now, they may get roughly the time that they want, but they may not get the place. And I was just looking online. We're talking about, you know, people living in different countries, the latest statistics that I could find at any one point, there's between four and a half and 5.5 million British people living abroad. And they need some clarification as well about how this bill could affect them. And I am concerned about the possibility of different processes existing in different parts of the UK and the Crown dependencies, because it could be possible that if you've got money that you could purchase or rent a small property in another jurisdiction to enable you to access this, now that might be totally fine, but people need to understand what this is going to bring and that inequality could still exist.
Now, the phenomenon of death tourism represents a documented concern internationally. The Isle of Man explicitly incorporated a five year residency requirement into its assisted dying legislation, following recommendations from scrutiny committees examining the bill's clauses. And that's why I picked the 16 months. But we have to be careful that not turning jurisdictions into destinations for accessing end of life services, because such relocation could create several problems. It might indicate the person's wish to die is not deeply rooted in their established community context.
It could create practical and ethical difficulties for healthcare systems who are unprepared to provide end of life to transient populations. And it also raises questions about whether individuals are making decisions in isolation from their established support networks. Now, whether we end up with in terms of what residency looks like, I do think we also have to take into account what has happened in other jurisdictions. And I was pleased that the noble and learned Lord said in the previous debate that in this bill, the age will not drop below 18.
And it's really important that we get the residency right, because in other jurisdictions, over time, it has changed. Now, in 2014, Belgium removed any age restriction. And, you know, Vermont lifted its residency requirements in May 2023. So at least 26 people have travelled to Vermont to die who weren't resident there. Now that's Vermont is a tiny US state, but that represented nearly 25% of reported assisted deaths in the state from May 23rd through to June 24th, and that was listed in the Vermont Department of Health data.
In Oregon, the same thing has happened. The residency has been lifted, and around 6% of those choosing to end their lives in Oregon have been from out of state. And that's from the official Oregon Health Authority reports. Oncologist Charles Blanc, whose clinic in Portland is devoted to end of life care, said he thinks Oregon's total is likely an undercount and he does expect the numbers to grow some laws. Adequate residency duration enables meaningful healthcare relationships to develop. I have amendments on relationships with GPS in a later group, and for me it's about providing appropriate healthcare, the right information.
It's about being able to look at patterns of depression, looking at changing wishes, family dynamics, looking at coercion, which we've already debated. And it's about providing stability and authenticity of the person's desire for assisted dying. And it's also about whether the correct and right palliative and psychosocial support is is there. So my Lords, I don't think 60 months is is the right number. But I do think we have to be very careful and very clear about what will happen in terms of people being able to access this service.
And finally, my Lords, longitudinal research on end of life preferences demonstrates significant variability in express wishes over time. And that's why we have to be really clear that we get this right.
It was my clumsy attempt to talk about death tourism, but also look at how we can provide consistency within this bill. Now, one of the reasons that we're consistently given for needing this bill is that those who can afford it can go to Dignitas, which promotes inequality. But if we don't get this section of the bill right, then that inequality will still exist. My noble friend Baroness Finlay raised some important points on where someone is able to die. I've got other amendments on certification of those areas, and I do believe this needs some more thought, because many of the letters that I receive from individuals who want the law to change will talk about wanting to end their lives at a time and a place of their choosing.
Now, they may get roughly the time that they want, but they may not get the place. And I was just looking online. We're talking about, you know, people living in different countries, the latest statistics that I could find at any one point, there's between four and a half and 5.5 million British people living abroad. And they need some clarification as well about how this bill could affect them. And I am concerned about the possibility of different processes existing in different parts of the UK and the Crown dependencies, because it could be possible that if you've got money that you could purchase or rent a small property in another jurisdiction to enable you to access this, now that might be totally fine, but people need to understand what this is going to bring and that inequality could still exist.
Now, the phenomenon of death tourism represents a documented concern internationally. The Isle of Man explicitly incorporated a five year residency requirement into its assisted dying legislation, following recommendations from scrutiny committees examining the bill's clauses. And that's why I picked the 16 months. But we have to be careful that not turning jurisdictions into destinations for accessing end of life services, because such relocation could create several problems. It might indicate the person's wish to die is not deeply rooted in their established community context.
It could create practical and ethical difficulties for healthcare systems who are unprepared to provide end of life to transient populations. And it also raises questions about whether individuals are making decisions in isolation from their established support networks. Now, whether we end up with in terms of what residency looks like, I do think we also have to take into account what has happened in other jurisdictions. And I was pleased that the noble and learned Lord said in the previous debate that in this bill, the age will not drop below 18.
And it's really important that we get the residency right, because in other jurisdictions, over time, it has changed. Now, in 2014, Belgium removed any age restriction. And, you know, Vermont lifted its residency requirements in May 2023. So at least 26 people have travelled to Vermont to die who weren't resident there. Now that's Vermont is a tiny US state, but that represented nearly 25% of reported assisted deaths in the state from May 23rd through to June 24th, and that was listed in the Vermont Department of Health data.
In Oregon, the same thing has happened. The residency has been lifted, and around 6% of those choosing to end their lives in Oregon have been from out of state. And that's from the official Oregon Health Authority reports. Oncologist Charles Blanc, whose clinic in Portland is devoted to end of life care, said he thinks Oregon's total is likely an undercount and he does expect the numbers to grow some laws. Adequate residency duration enables meaningful healthcare relationships to develop. I have amendments on relationships with GPS in a later group, and for me it's about providing appropriate healthcare, the right information.
It's about being able to look at patterns of depression, looking at changing wishes, family dynamics, looking at coercion, which we've already debated. And it's about providing stability and authenticity of the person's desire for assisted dying. And it's also about whether the correct and right palliative and psychosocial support is is there. So my Lords, I don't think 60 months is is the right number. But I do think we have to be very careful and very clear about what will happen in terms of people being able to access this service.
And finally, my Lords, longitudinal research on end of life preferences demonstrates significant variability in express wishes over time. And that's why we have to be really clear that we get this right.
13:59
Lord Frost (Non-affiliated)
-
-
Lord Frost (Non-affiliated)
My Lords, arise to introduce >> My Lords, arise to introduce amendment 23 in my name. And this amendment obviously goes with the amendment obviously goes with the thrust of some of the other amendments that have already been proposed and deals with some of the issues that have come up in this debate. But it takes a slightly different route to the others by simply adding in a new criterion, criterion E to clause one. And it would therefore restrict access to assisted dying support to two well defined and well understood categories of people.
That is, in the first place, British citizens, and second, those with indefinite leave to remain. I think the purpose of couching it in this way is really twofold. It's designed to do two things. The first is to provide a way of cutting through the eligibility problem that we've been discussing, and the ambiguity of some of the definitions by by providing two very clear definitions that avoids the border issues, the potential uncertainties and meaning in some of the, the, the, the, the other definitions.
It could be read as I've drafted it together with the criterion of ordinary residence. In other words, you must satisfy both these criteria to be eligible for assisted dying support. Or we could simply remove the ordinary residence criterion and rest entirely on the fact that you have to be a British citizen or have indefinite indefinite leave to remain. But it is a. Both of those are well understood categories. They're not susceptible to debate, and they're both easily proved.
And I think that's the advantage of those two. Looking at us in this way. I think the other purpose, I guess, is to provide a very clear barrier for similar reasons to, to to to death tourism for people who obtain short term visas or indeed no visa at all for the purpose of obtaining an assisted death, and to stop England and Wales becoming destinations for this. And I think I just want briefly to summarise why we want to avoid that, because I think the reasons have been taken slightly as read in this discussion.
But I do just want to, to recall not a not a great depth, but but in a little and first without such a provision of the nature that my amendment would provide, it becomes more difficult to enforce the safeguards, whatever they are, that end up in this bill. For example, on past medical history, on mental health capacity, because it can be difficult to obtain international medical records, they aren't always written in exactly the same way they can from some countries indeed be relatively easily forged or faked.
It's also difficult to confirm that somebody who's got a short term relationship or no relationship with the UK is not being coerced by people abroad or has consistent capacity. So there is there is that angle to it. Second, there's the risk of, I suppose, diplomatic complication taking in non permanently resident foreign citizens to commit what may be an offence in their home jurisdiction. Now, some countries are going to feel more strongly about that than others. Probably. But but the risk exists and this would exclude it.
Third, there's a pull factors. That's an obvious problem that we're very familiar with in the UK. The global appeal of the English language, the ease of registration with a GP. And as I've said, the lax definition of some of the definitions. Fourth, resource constraints. Our healthcare system has finite capacity for end of life care. Whoever ends up precisely, precisely providing it. And this amendment ensures that people, those who end up being eligible, are those with a very clear connection to the UK, either citizenship or the clear right to remain here for as long as they wish.
Finally, my Lords, yeah, my noble friend is making interesting points, but I'm somewhat worried. Does he? He's particularly well equipped to recognise that there are possibly as many as 1.5 million people in this country with pre-settled status from the European Union, who are neither British citizens nor have indefinite leave to remain. And there are also probably somewhere between 3 and 400,000 Irish citizens living in this country who equally have neither of these qualifications. That is true. That is certainly true.
The noble Lord makes good points, and I think the principle that's in my amendment could be expanded to take in other well defined categories. I mean, personally, I'd be more convinced about the the Irish category than the EU pre-settled status, given this issue was not anything like an issue when we negotiated the EU treaties that created that status. But I think that's for discussion. If the principle is agreed. Finally, I'll just just note that the amendment I put forward reflects norms elsewhere, notably in Australia and New Zealand.
And actually it's quite closely based on section nine of the Victoria Voluntary Assisted Dying Act 2017, which, whatever its manifold other weaknesses, is at least clear on this point. So, my Lords, I'll stop there and I look forward to the discussion and the views of the sponsor. But I just offer this amendment as a potential way of providing more clarity and reducing the level of ambiguity in what is obviously going to be very important provision in this bill. So I will speak very briefly in support of amendment 23, moved by Lord Frost, bearing in mind that
That is, in the first place, British citizens, and second, those with indefinite leave to remain. I think the purpose of couching it in this way is really twofold. It's designed to do two things. The first is to provide a way of cutting through the eligibility problem that we've been discussing, and the ambiguity of some of the definitions by by providing two very clear definitions that avoids the border issues, the potential uncertainties and meaning in some of the, the, the, the, the other definitions.
It could be read as I've drafted it together with the criterion of ordinary residence. In other words, you must satisfy both these criteria to be eligible for assisted dying support. Or we could simply remove the ordinary residence criterion and rest entirely on the fact that you have to be a British citizen or have indefinite indefinite leave to remain. But it is a. Both of those are well understood categories. They're not susceptible to debate, and they're both easily proved.
And I think that's the advantage of those two. Looking at us in this way. I think the other purpose, I guess, is to provide a very clear barrier for similar reasons to, to to to death tourism for people who obtain short term visas or indeed no visa at all for the purpose of obtaining an assisted death, and to stop England and Wales becoming destinations for this. And I think I just want briefly to summarise why we want to avoid that, because I think the reasons have been taken slightly as read in this discussion.
But I do just want to, to recall not a not a great depth, but but in a little and first without such a provision of the nature that my amendment would provide, it becomes more difficult to enforce the safeguards, whatever they are, that end up in this bill. For example, on past medical history, on mental health capacity, because it can be difficult to obtain international medical records, they aren't always written in exactly the same way they can from some countries indeed be relatively easily forged or faked.
It's also difficult to confirm that somebody who's got a short term relationship or no relationship with the UK is not being coerced by people abroad or has consistent capacity. So there is there is that angle to it. Second, there's the risk of, I suppose, diplomatic complication taking in non permanently resident foreign citizens to commit what may be an offence in their home jurisdiction. Now, some countries are going to feel more strongly about that than others. Probably. But but the risk exists and this would exclude it.
Third, there's a pull factors. That's an obvious problem that we're very familiar with in the UK. The global appeal of the English language, the ease of registration with a GP. And as I've said, the lax definition of some of the definitions. Fourth, resource constraints. Our healthcare system has finite capacity for end of life care. Whoever ends up precisely, precisely providing it. And this amendment ensures that people, those who end up being eligible, are those with a very clear connection to the UK, either citizenship or the clear right to remain here for as long as they wish.
Finally, my Lords, yeah, my noble friend is making interesting points, but I'm somewhat worried. Does he? He's particularly well equipped to recognise that there are possibly as many as 1.5 million people in this country with pre-settled status from the European Union, who are neither British citizens nor have indefinite leave to remain. And there are also probably somewhere between 3 and 400,000 Irish citizens living in this country who equally have neither of these qualifications. That is true. That is certainly true.
The noble Lord makes good points, and I think the principle that's in my amendment could be expanded to take in other well defined categories. I mean, personally, I'd be more convinced about the the Irish category than the EU pre-settled status, given this issue was not anything like an issue when we negotiated the EU treaties that created that status. But I think that's for discussion. If the principle is agreed. Finally, I'll just just note that the amendment I put forward reflects norms elsewhere, notably in Australia and New Zealand.
And actually it's quite closely based on section nine of the Victoria Voluntary Assisted Dying Act 2017, which, whatever its manifold other weaknesses, is at least clear on this point. So, my Lords, I'll stop there and I look forward to the discussion and the views of the sponsor. But I just offer this amendment as a potential way of providing more clarity and reducing the level of ambiguity in what is obviously going to be very important provision in this bill. So I will speak very briefly in support of amendment 23, moved by Lord Frost, bearing in mind that
14:06
Lord Goodman of Wycombe (Conservative)
-
-
Lord Goodman of Wycombe (Conservative)
amendments in committee very often are probing amendments to test the are probing amendments to test the view of the sponsor, it's important to recognise at the start that it to recognise at the start that it is not clear from the Bill whether or not the NHS will provide voluntary assisted dying services, and this was a point in relation to which the bill was criticised very which the bill was criticised very heavily by the Delegated Powers Committee, on which I said but it clearly is the intention of the noble Lord Faulkner that it should.
And I want to assume, for the purposes of this debate very briefly, that it will. Now, my noble friend Baroness Coffey raised at the start of this debate a problem which was the question of whether someone might seek to obtain residency under the terms of the bill in order to obtain what has been referred to as death shopping. This is clearly a problem, and the virtue of Lord noble Lord Frost amendment is that it would deal with it.
Imperfect though the amendment may be. What I would like to hear from the sponsor of the bill, Lord Faulkner, is what his view is of the problem raised by my noble friend Baroness Coffey. I think he accepts that death tourism is a problem. Is his view like that of my noble friend Lord Lord Lansley? That residency really is the only sensible way of determining these matters. If it is why the additional safeguard that he's put into clause one of the bill, or if he thinks residency is not sufficient, what additional safeguards might he be able to offer? I look forward to hearing from him when he responds to this debate.
And I want to assume, for the purposes of this debate very briefly, that it will. Now, my noble friend Baroness Coffey raised at the start of this debate a problem which was the question of whether someone might seek to obtain residency under the terms of the bill in order to obtain what has been referred to as death shopping. This is clearly a problem, and the virtue of Lord noble Lord Frost amendment is that it would deal with it.
Imperfect though the amendment may be. What I would like to hear from the sponsor of the bill, Lord Faulkner, is what his view is of the problem raised by my noble friend Baroness Coffey. I think he accepts that death tourism is a problem. Is his view like that of my noble friend Lord Lord Lansley? That residency really is the only sensible way of determining these matters. If it is why the additional safeguard that he's put into clause one of the bill, or if he thinks residency is not sufficient, what additional safeguards might he be able to offer? I look forward to hearing from him when he responds to this debate.
14:07
Lord Harper (Conservative)
-
-
Lord Harper (Conservative)
My Lords, before I speak to my amendments 300 A and 306, let me just pick up a couple of issues just pick up a couple of issues that have been raised in the debate briefly. First of all, I was very pleased that the noble and learned pleased that the noble and learned Lord, Lord Falconer said it was very important in response to the noble Lord Lord Booth, that we dealt with these border issues. He will remember I spoke on that on the first day of debate, using my experience as a former Member of Parliament for a border constituency, and raised some of the very practical issues that there will be if we don't get that right.
So I was very pleased to hear his his answer and response to deal with both the and the noble Lord will remember when I was raising these issues, there were people on the other side of the argument who tried to shout me down before I'd even finished, and I'm pleased, therefore, that he recognises that the issues I was raising are important and valid ones. So we've got both the England Scotland border to worry about, but also the England Wales border to make sure these issues work properly.
The second thing, I'm very grateful to the noble Lord Lord Pannick for the free legal advice he provided to me in answering the question about what the courts could do about a human rights challenge, an answer that I didn't get from the Minister. So I'm grateful to have had it from from him. On the third point that came up in the debate about Crown servants, it is the case that if you're a Crown servant, you can retain your ordinary resident status when you're posted overseas.
So as that applies to diplomats, members of the armed forces and civil servants, it doesn't usually apply, though, to people who work for the NHS, local government and so forth. But but we don't have to worry about people who work in embassies. Let me deal with the the the issues in Lord Lansley amendments, because this is a point which is very relevant actually to the nature of this service. So he's absolutely right that for primary care, we don't have the same test on residents that we do for secondary care.
And there's a reason for that. When we were putting in place the changes in the Immigration Act on secondary care, we did consider whether we should implement similar changes for primary care. This was after the period when he was the Secretary of State for health, and the reason why we we didn't change that position was because there's a very significant community benefit for allowing people to have access who are physically in the United Kingdom to primary care, so they access all sorts of services, particularly if they are if they have a disease or an illness which is communicable and you absolutely want them to seek early treatment, not just for their own benefit, for the benefit of everyone else.
So that's why for primary care, we absolutely have that that more wider access than for secondary care, where we limit it to those people who are ordinarily residents, we allow others to access it, but only if they pay for it. So I would and I would argue that this if this is provided on the NHS, this service should be treated more in the same way that we provide secondary care rather than the way we provide primary care. It's more akin to that sort of treatment rather than primary care.
So that's where I would respectfully disagree with you. Of course, I don't think we are disagreeing because my amendments would have the effect of, of of applying an ordinary residence test, but that that ordinary residence test in relation to the assisted dying service would be exactly the same test as if one was going for planned secondary care. Good, good. In which case I've understood him. I when he was talking about primary care, I thought he was suggesting we had a wider case.
So I'm very pleased to hear that. So let me address now my amendments and the purpose of them. It's really to deal with the fact that at the moment, as the bill is drafted, as I understand it, it would be the job of the doctor, the coordinating doctor. So a clinician to make the determination about somebody's ordinary residence. And the Medical Defence Union has expressed concern that requiring medical professionals to do that could put them at legal risk. And indeed, as my the way my noble friend suggested, it sort of turns them into immigration officers.
And that was a concern that was was made when we were making the changes in the Immigration Act, which is why the people that make those decisions are not clinicians, but they are overseas. The overseas visitor managers who do that, administrators in the health service. And so my amendments would shift the responsibility back to for assessing residency from clinicians to administrators. And so if NHS trusts were providing this service, they would use their overseas visitors managers to do it.
That's an existing structure. People who know how these rules work. And as I think the the noble Lord, Lord Carlile mentioned, there is a tool that exists that's well understood for enabling people to check people's eligibility. And I think it's already come up in the debate, so I won't dwell on it at length. But ordinary residency isn't that straightforward. It's designed in case law, not in statute. And when we were bringing forward the Immigration Act, there was a review that took place, the Overseas Visitors Charging Review in 2012, which concluded that the vagueness of the definition means that ordinary residency is difficult to interpret and apply on an individual case basis.
And as I've, I've already been slightly quoted, I think, by the noble Baroness Finlay, I'm, I'm slightly in danger of quoting myself. But when I was taking that legislation through, I said that the existing rules were complex. And one of the things that came through from the audit was that front line health professionals find them complex. And the evidence we got wasn't just the front line professionals, actually, it was that they were actually complex, and we tried to make them more straightforward.
And it was one of the reasons, actually why we why we introduced the the health surcharge, rather than trying to have to make it more complex for the health service to not treat people or test whether they were treating people. We charged people coming into the country and then let them have access to the health service, and that seemed to be a more sensible way of doing it. So that, I think, is the essence of my amendment. So I would suggest to the noble Lord, noble Lord, Lord Falconer, that that he looks at that perhaps, and I think at Report stage it would be helpful if the bill was amended to take away from the the doctor that's in charge of this, the the test for ordinary residents, and that goes to the organisation that's providing it.
And then that can be done as part of an administrative function. And I know from the conversations we had at the time, clinicians and medical professionals, both for legal reasons as set out by the Medical Defence Union, but also as as my noble friend Lord Darzi said, their job is not to do gatekeeping for access to these services. We already have professionals in the health service whose job is to do that, and it would be better if if they were given that task rather than clinicians.
And that is the purpose of my amendments. Very good.
So I was very pleased to hear his his answer and response to deal with both the and the noble Lord will remember when I was raising these issues, there were people on the other side of the argument who tried to shout me down before I'd even finished, and I'm pleased, therefore, that he recognises that the issues I was raising are important and valid ones. So we've got both the England Scotland border to worry about, but also the England Wales border to make sure these issues work properly.
The second thing, I'm very grateful to the noble Lord Lord Pannick for the free legal advice he provided to me in answering the question about what the courts could do about a human rights challenge, an answer that I didn't get from the Minister. So I'm grateful to have had it from from him. On the third point that came up in the debate about Crown servants, it is the case that if you're a Crown servant, you can retain your ordinary resident status when you're posted overseas.
So as that applies to diplomats, members of the armed forces and civil servants, it doesn't usually apply, though, to people who work for the NHS, local government and so forth. But but we don't have to worry about people who work in embassies. Let me deal with the the the issues in Lord Lansley amendments, because this is a point which is very relevant actually to the nature of this service. So he's absolutely right that for primary care, we don't have the same test on residents that we do for secondary care.
And there's a reason for that. When we were putting in place the changes in the Immigration Act on secondary care, we did consider whether we should implement similar changes for primary care. This was after the period when he was the Secretary of State for health, and the reason why we we didn't change that position was because there's a very significant community benefit for allowing people to have access who are physically in the United Kingdom to primary care, so they access all sorts of services, particularly if they are if they have a disease or an illness which is communicable and you absolutely want them to seek early treatment, not just for their own benefit, for the benefit of everyone else.
So that's why for primary care, we absolutely have that that more wider access than for secondary care, where we limit it to those people who are ordinarily residents, we allow others to access it, but only if they pay for it. So I would and I would argue that this if this is provided on the NHS, this service should be treated more in the same way that we provide secondary care rather than the way we provide primary care. It's more akin to that sort of treatment rather than primary care.
So that's where I would respectfully disagree with you. Of course, I don't think we are disagreeing because my amendments would have the effect of, of of applying an ordinary residence test, but that that ordinary residence test in relation to the assisted dying service would be exactly the same test as if one was going for planned secondary care. Good, good. In which case I've understood him. I when he was talking about primary care, I thought he was suggesting we had a wider case.
So I'm very pleased to hear that. So let me address now my amendments and the purpose of them. It's really to deal with the fact that at the moment, as the bill is drafted, as I understand it, it would be the job of the doctor, the coordinating doctor. So a clinician to make the determination about somebody's ordinary residence. And the Medical Defence Union has expressed concern that requiring medical professionals to do that could put them at legal risk. And indeed, as my the way my noble friend suggested, it sort of turns them into immigration officers.
And that was a concern that was was made when we were making the changes in the Immigration Act, which is why the people that make those decisions are not clinicians, but they are overseas. The overseas visitor managers who do that, administrators in the health service. And so my amendments would shift the responsibility back to for assessing residency from clinicians to administrators. And so if NHS trusts were providing this service, they would use their overseas visitors managers to do it.
That's an existing structure. People who know how these rules work. And as I think the the noble Lord, Lord Carlile mentioned, there is a tool that exists that's well understood for enabling people to check people's eligibility. And I think it's already come up in the debate, so I won't dwell on it at length. But ordinary residency isn't that straightforward. It's designed in case law, not in statute. And when we were bringing forward the Immigration Act, there was a review that took place, the Overseas Visitors Charging Review in 2012, which concluded that the vagueness of the definition means that ordinary residency is difficult to interpret and apply on an individual case basis.
And as I've, I've already been slightly quoted, I think, by the noble Baroness Finlay, I'm, I'm slightly in danger of quoting myself. But when I was taking that legislation through, I said that the existing rules were complex. And one of the things that came through from the audit was that front line health professionals find them complex. And the evidence we got wasn't just the front line professionals, actually, it was that they were actually complex, and we tried to make them more straightforward.
And it was one of the reasons, actually why we why we introduced the the health surcharge, rather than trying to have to make it more complex for the health service to not treat people or test whether they were treating people. We charged people coming into the country and then let them have access to the health service, and that seemed to be a more sensible way of doing it. So that, I think, is the essence of my amendment. So I would suggest to the noble Lord, noble Lord, Lord Falconer, that that he looks at that perhaps, and I think at Report stage it would be helpful if the bill was amended to take away from the the doctor that's in charge of this, the the test for ordinary residents, and that goes to the organisation that's providing it.
And then that can be done as part of an administrative function. And I know from the conversations we had at the time, clinicians and medical professionals, both for legal reasons as set out by the Medical Defence Union, but also as as my noble friend Lord Darzi said, their job is not to do gatekeeping for access to these services. We already have professionals in the health service whose job is to do that, and it would be better if if they were given that task rather than clinicians.
And that is the purpose of my amendments. Very good.
14:15
Baroness Stroud (Conservative)
-
-
Baroness Stroud (Conservative)
My Lords. I want to rise just to >> My Lords. I want to rise just to seek clarity on a point raised through precisely this exchange between Lord Harper and Lord between Lord Harper and Lord Lansley, particularly on the issue of ordinarily resident. Following the enthusiasm expressed for aligning the language of this bill with the usual terms of the NHS. If we take aligning ordinarily resident with NHS maternity care, for example, it acts as a definition for who pays and not for who receives the service.
So all pregnant women are entitled to the service of NHS maternity care. It is only whether it's free that depends on your residency, nationality and immigration status. Those ordinarily resident get free care while overseas visitors and those not settled may have to pay charges, though care is never refused and payment plans are available, so could the noble and learned Lord confirm that the enthusiasm for aligning with NHS existing terms would not extend to a widening of service eligibility, and thereby the UK becoming a destination venue?
So all pregnant women are entitled to the service of NHS maternity care. It is only whether it's free that depends on your residency, nationality and immigration status. Those ordinarily resident get free care while overseas visitors and those not settled may have to pay charges, though care is never refused and payment plans are available, so could the noble and learned Lord confirm that the enthusiasm for aligning with NHS existing terms would not extend to a widening of service eligibility, and thereby the UK becoming a destination venue?
14:16
Lord Meston (Crossbench)
-
-
Lord Meston (Crossbench)
I would seriously question whether amendments 11 and 11 A are either necessary or useful, following from what has just been said, my experience in the courts is that the concept of ordinary residents stated in the Bill is well established in our law, workable in practice and well understood by practitioners and judiciary, particularly in family law, where it most often appears it is a tried and tested expression to impose the more stringent precondition of permanent residence, effectively requiring unbroken physical presence could unnecessarily, and, I suggest unkindly, restrict the mobility of those who are seriously ill or becoming seriously ill, who might be entitled to the benefit of this bill if it is enacted.
Such people, particularly those who have a clear, stable and lasting residential connection to England and Wales, should not be left to fear that they cannot make even a brief visit away from home fully intending to return, in case that visit away is said to have changed or interrupted their permanent residence, and thereby stop the clock on their eligibility for assistance. Under the bill's provisions and requiring the qualifying period of 12 months to restart from the beginning. That, I suggest, would be a great disservice to such people and would not be any improvement to the bill.
As for domicile, as others have already said, it is in reality a notoriously difficult concept to define. You can only have one domicile at any one time. It can be a domicile of origin or domicile of dependency or domicile of choice. It is suggested in the explanatory memorandum to the amendment, seeking to introduce the concept domicile, that it would tighten the eligibility requirements. In reality, it would do little more than complicate them and indeed in some situations could loosen them.
You can retain your domicile of origin in this country, even if you have not lived here for years. You can also acquire domicile of choice or revive a domicile of origin immediately on arrival in this country, with no minimum period of residence. I therefore suggest that the substitution of domicile for ordinary residence would not be helpful to anyone. I suggest we should adhere to the concept of ordinary residence.
Such people, particularly those who have a clear, stable and lasting residential connection to England and Wales, should not be left to fear that they cannot make even a brief visit away from home fully intending to return, in case that visit away is said to have changed or interrupted their permanent residence, and thereby stop the clock on their eligibility for assistance. Under the bill's provisions and requiring the qualifying period of 12 months to restart from the beginning. That, I suggest, would be a great disservice to such people and would not be any improvement to the bill.
As for domicile, as others have already said, it is in reality a notoriously difficult concept to define. You can only have one domicile at any one time. It can be a domicile of origin or domicile of dependency or domicile of choice. It is suggested in the explanatory memorandum to the amendment, seeking to introduce the concept domicile, that it would tighten the eligibility requirements. In reality, it would do little more than complicate them and indeed in some situations could loosen them.
You can retain your domicile of origin in this country, even if you have not lived here for years. You can also acquire domicile of choice or revive a domicile of origin immediately on arrival in this country, with no minimum period of residence. I therefore suggest that the substitution of domicile for ordinary residence would not be helpful to anyone. I suggest we should adhere to the concept of ordinary residence.
14:19
Lord Mackinlay of Richborough (Conservative)
-
-
Lord Mackinlay of Richborough (Conservative)
My Lords. legislation come out of our houses of Parliament. There are too often words like shall give regard to. And I remember speakers counsel examine this at some length when I was on the speaker's Committee for the Electoral Commission, and he, in rather easy speak, said it doesn't really mean much. And the other term we hear is reasonable. Now, I'm sorry, in this bill, we have the term in clause one about ordinary residents. Now, what does ordinarily residence mean? And I must say, I'm rather disappointed that the bill has had seemingly a lot of investigation and clarification in the other place and comes here with that rather vague phase phrase within it.
And that has been examined at some length here. The reason for the multitude of amendments now, is it a common law case law interpretation, which Baroness Finlay, I think opened this debate very, very eloquently, saying that is a vague term offered some case law that the Barnett case, where it was far from very, very clear, the I've come up with five different types of ordinarily resident where there are different rules. The case law one now, the one that's been mentioned widely today and it should be is the issue of the tour, the residence tool that is advanced by the Department for health.
I think that gives us the closest attempt at explaining what ordinarily residence means in terms of health care. But it's peculiar because the purpose of it is to actually keep people away from health care if they are not resident, and hence we charge them, quite rightly, for their services. Now, one wonders whether that actually operates as effectively as it might, but at least it goes to to try to actually codify with with guidance as to what that actually means.
The noble Lord Carlile said that it was easy, and I'm afraid looking at it, I have it here, strangely enough, 14 pages blissfully short compared to some guidance. But it has in there the golden phrases. This list is not exhaustive, so I'm afraid that in itself is is not that clear. But at least it attempts. Now, of course, this legislation before us is restricting the availability of assisted dying to England and Wales. And so I have great support for what my noble friend Lord Lansley had to say about the UK is mentioned in the residency tool, so why not keep that concurrency in considering whether people are validly able to access secondary care? Now, the third one would be availability of DWP benefits.
Now that is restricted and a wholly different legislative way. If people that were fully domiciled just fairly briefly away from the country returned to the country, they would face another mountain of rules to be able to claim Universal Credit, for instance. And so that is a whole new raft of interpretation about what is ordinarily resident. Now, voting. Voting has a whole different ballgame, a whole different ball game to it. And I think this came to light most graphically in the 2014 Scottish referendum on independence.
You may have noticed that my name is McKinley. Which one would think has some Scottish connotation, but long, long gone in the midst of time. And yeah, I had no part in that election. But you could have a family that has had generations of attachments to Scotland, and merely by dint of they are living in England for a very short period, would have disqualified them from having a say in that rather extensive constitutional referendum, whereas had, well, anybody in England decided to go and live in Scotland for the briefest of periods within a very short time, would have gained a qualification to take part in that very constitutional referendum.
So in election law, we have a whole new raft of interpretation as to what ordinarily residents is, and we see that in live action quite regularly. Whenever there seems to be a parliamentary by election, parties seem to aim the finger at other parties and say, well, your candidate has only lived here for five minutes. He's renting his aunty's flat and he's not properly resident. So indeed, even in electoral law there is complication. But if we're really looking for complication now, that would be in tax law.
I am supportive of my noble friend Baroness Coffey attempts to assist us by adding domicile into the interpretation position that the noble Lord Pannick does not seem to agree with, saying that is infinitely complex. Well, if we look at tax, then I'm afraid the whole issue of ordinary residents, ordinary residents is a stuff of of true complication. Now, there was an attempt to codify it in the 2013 Finance Act, where we introduced the statutory residence basis. And even that is not without complication.
I should know, sir, because I have exactly a case on my desk professionally as a chartered accountant at the moment where the HMRC is trying to claim that somebody who's been out of the country for ten years has suddenly reacquired UK ordinary, ordinarily resident status and hence tax status. So we have conflicts across those five different interpretations, and it all depends on whether the state is trying to deny money i.e DWP benefits deny healthcare i.e.
by qualification for secondary care only or to try and get them into the UK as resident because they will then be able to claim a lot more tax out of them. So I'm afraid to. I say to the noble and learned Lord, Lord Faulkner, my gross disappointment that we have legislation to this state where we've had an hour and a half of debate about one concept of what ordinarily resident actually means, because having listened to a wide range of of debate from people who have infinitely more experience in the law than I do, we are still all at sea as to what this actually means.
So when we come back at report, we need we have to have a proper defined qualification for assisted dying under this act and whether that is a helpful amendment as proposed by my noble friends Goodman and Frost, which adds a little bit more to at least determine the qualification or whether people who are properly and absolutely and very clearly under a case law interpretation, which I think my my noble friend Lord Moylan has tried to put to, you know, advance and examine.
But as it stands at the moment, I am none the wiser. After this expansive debate in your Lordships' House, as to what that phrase actually means. So I would appreciate in the summing up whether the my noble and learned Lord Faulkner can actually say which of those five interpretations is meant by this bill. I've got a sneaking suspicion that it is the healthcare attempt to copy what ordinarily residents means. If that is the case, let us have that explicitly on the face of the bill, so that we at least know what we're talking about.
**** Possible New Speaker ****
My noble friend Lord McKinley, of which is all at sea. Let me try of which is all at sea. Let me try and provide a little tabula in naufragio. As we say, these these amendments, we say that frequently amendments, we say that frequently in Liverpool. The these amendments all relate to the eligibility of persons accessing assistance under
And that has been examined at some length here. The reason for the multitude of amendments now, is it a common law case law interpretation, which Baroness Finlay, I think opened this debate very, very eloquently, saying that is a vague term offered some case law that the Barnett case, where it was far from very, very clear, the I've come up with five different types of ordinarily resident where there are different rules. The case law one now, the one that's been mentioned widely today and it should be is the issue of the tour, the residence tool that is advanced by the Department for health.
I think that gives us the closest attempt at explaining what ordinarily residence means in terms of health care. But it's peculiar because the purpose of it is to actually keep people away from health care if they are not resident, and hence we charge them, quite rightly, for their services. Now, one wonders whether that actually operates as effectively as it might, but at least it goes to to try to actually codify with with guidance as to what that actually means.
The noble Lord Carlile said that it was easy, and I'm afraid looking at it, I have it here, strangely enough, 14 pages blissfully short compared to some guidance. But it has in there the golden phrases. This list is not exhaustive, so I'm afraid that in itself is is not that clear. But at least it attempts. Now, of course, this legislation before us is restricting the availability of assisted dying to England and Wales. And so I have great support for what my noble friend Lord Lansley had to say about the UK is mentioned in the residency tool, so why not keep that concurrency in considering whether people are validly able to access secondary care? Now, the third one would be availability of DWP benefits.
Now that is restricted and a wholly different legislative way. If people that were fully domiciled just fairly briefly away from the country returned to the country, they would face another mountain of rules to be able to claim Universal Credit, for instance. And so that is a whole new raft of interpretation about what is ordinarily resident. Now, voting. Voting has a whole different ballgame, a whole different ball game to it. And I think this came to light most graphically in the 2014 Scottish referendum on independence.
You may have noticed that my name is McKinley. Which one would think has some Scottish connotation, but long, long gone in the midst of time. And yeah, I had no part in that election. But you could have a family that has had generations of attachments to Scotland, and merely by dint of they are living in England for a very short period, would have disqualified them from having a say in that rather extensive constitutional referendum, whereas had, well, anybody in England decided to go and live in Scotland for the briefest of periods within a very short time, would have gained a qualification to take part in that very constitutional referendum.
So in election law, we have a whole new raft of interpretation as to what ordinarily residents is, and we see that in live action quite regularly. Whenever there seems to be a parliamentary by election, parties seem to aim the finger at other parties and say, well, your candidate has only lived here for five minutes. He's renting his aunty's flat and he's not properly resident. So indeed, even in electoral law there is complication. But if we're really looking for complication now, that would be in tax law.
I am supportive of my noble friend Baroness Coffey attempts to assist us by adding domicile into the interpretation position that the noble Lord Pannick does not seem to agree with, saying that is infinitely complex. Well, if we look at tax, then I'm afraid the whole issue of ordinary residents, ordinary residents is a stuff of of true complication. Now, there was an attempt to codify it in the 2013 Finance Act, where we introduced the statutory residence basis. And even that is not without complication.
I should know, sir, because I have exactly a case on my desk professionally as a chartered accountant at the moment where the HMRC is trying to claim that somebody who's been out of the country for ten years has suddenly reacquired UK ordinary, ordinarily resident status and hence tax status. So we have conflicts across those five different interpretations, and it all depends on whether the state is trying to deny money i.e DWP benefits deny healthcare i.e.
by qualification for secondary care only or to try and get them into the UK as resident because they will then be able to claim a lot more tax out of them. So I'm afraid to. I say to the noble and learned Lord, Lord Faulkner, my gross disappointment that we have legislation to this state where we've had an hour and a half of debate about one concept of what ordinarily resident actually means, because having listened to a wide range of of debate from people who have infinitely more experience in the law than I do, we are still all at sea as to what this actually means.
So when we come back at report, we need we have to have a proper defined qualification for assisted dying under this act and whether that is a helpful amendment as proposed by my noble friends Goodman and Frost, which adds a little bit more to at least determine the qualification or whether people who are properly and absolutely and very clearly under a case law interpretation, which I think my my noble friend Lord Moylan has tried to put to, you know, advance and examine.
But as it stands at the moment, I am none the wiser. After this expansive debate in your Lordships' House, as to what that phrase actually means. So I would appreciate in the summing up whether the my noble and learned Lord Faulkner can actually say which of those five interpretations is meant by this bill. I've got a sneaking suspicion that it is the healthcare attempt to copy what ordinarily residents means. If that is the case, let us have that explicitly on the face of the bill, so that we at least know what we're talking about.
**** Possible New Speaker ****
My noble friend Lord McKinley, of which is all at sea. Let me try of which is all at sea. Let me try and provide a little tabula in naufragio. As we say, these these amendments, we say that frequently amendments, we say that frequently in Liverpool. The these amendments all relate to the eligibility of persons accessing assistance under
14:28
Lord Wolfson of Tredegar (Conservative)
-
-
Lord Wolfson of Tredegar (Conservative)
persons accessing assistance under the bill. And noble Lady Baroness Finlay of Llandaff amendment 11 seeks to introduce a requirement that the person must be permanently residing in England and Wales to be eligible under the Bill, whereas the Bill currently has a requirement of ordinary residents. And there are two questions, I think, that arise from the current definition of eligibility, which I hope the noble Lord, Lord Falconer of Thoroton, will pick up as he said he would. First of all, will persons resident in Scotland or Northern Ireland who have moved to England or Wales be able to access assistance under the Bill? And secondly, will persons resident abroad who are UK citizens be able to return to the UK early, so to speak, in a terminal illness to access assistance during their last six months? Those questions, I think, then lead on to the amendments to the name of my noble friend Lord Moylan, amendment 14, to whom I am not proposing to provide any free legal advice.
That amendment relates to UK citizens who are pensioners living abroad, and the question of access to assistance under the act is obviously an important one, and it would be helpful to know how the noble and learned Lord expects the eligibility criteria to affect UK citizens who are terminally ill and living abroad. In particular, what steps would they have to take in order to make use of their rights under the bill? My noble friend Lord Lord Mance amendments in the group raised an important point and as my noble friend has said, these amendments propose that where the bill currently refers to a person ordinarily resident in England and Wales, it should refer instead to being ordinarily resident in the United Kingdom.
As I understand it, they don't change the policy intention of the bill, but they seek to align the language with long established practice. And that does seem, if I may say respectfully, to be a sensible amendment, and I look forward to
**** Possible New Speaker ****
sorry. I my amendments. Do intend to change the.
**** Possible New Speaker ****
Policy in that it would remove the 12 month residence requirement. Is absolutely right on that point. It does change the policy intention. I'm grateful and I would welcome the thoughts of the noble welcome the thoughts of the noble Lord, Lord Falconer of Thoroton on that. Finally, in the absence of my that. Finally, in the absence of my noble friend, the Earl Howe, I've been asked on his behalf to formally speak on his amendments 301 A and 305 A, and in speaking to those amendments, I would like to highlight the threshold which is set for determining whether an individual is in England and Wales at the time of the first assessment.
I hope the noble Lord, Lord will be able to pick up this point as the bill is currently drafted. The question as to whether somebody is in England and Wales is ordinarily resident in England and Wales rests on what's called the opinion of the coordinating doctor. My concern is that an opinion without any further evidential requirement may be too low a bar, particularly given the need to guard against the risk of what has been called death tourism. Now, in other parts of the Bill, the word satisfied has been used by the noble Leonard Lord, and I think we would agree that satisfied entails a higher evidential bar than merely opinion, and indeed that is also higher than believes or reasonably believes.
Satisfied is a higher standard. And so when the noble Lord replies, I wonder whether he could use that opportunity to explain why the test here is only opinion and not satisfied, as that test is used in other parts of the bill.
**** Possible New Speaker ****
My Lords, I would like to first of all, thank all noble Lords for of all, thank all noble Lords for their contributions on this debate on the issue of residency and on the issue of residency and eligibility criteria, as I've already made clear and and repeating, I will confine my comments limited to those amendments on which the government has major legal, technical or has major legal, technical or operational workability concerns. So firstly, I'm turning to the amendments which narrow the residence criteria in respect of eligibility for assistance under the bill.
Amendment 11, tabled by the noble Lady Baroness Findlay, change would change the residence criteria for assistance under the bill from requiring a person to be ordinarily resident to permanently
That amendment relates to UK citizens who are pensioners living abroad, and the question of access to assistance under the act is obviously an important one, and it would be helpful to know how the noble and learned Lord expects the eligibility criteria to affect UK citizens who are terminally ill and living abroad. In particular, what steps would they have to take in order to make use of their rights under the bill? My noble friend Lord Lord Mance amendments in the group raised an important point and as my noble friend has said, these amendments propose that where the bill currently refers to a person ordinarily resident in England and Wales, it should refer instead to being ordinarily resident in the United Kingdom.
As I understand it, they don't change the policy intention of the bill, but they seek to align the language with long established practice. And that does seem, if I may say respectfully, to be a sensible amendment, and I look forward to
**** Possible New Speaker ****
sorry. I my amendments. Do intend to change the.
**** Possible New Speaker ****
Policy in that it would remove the 12 month residence requirement. Is absolutely right on that point. It does change the policy intention. I'm grateful and I would welcome the thoughts of the noble welcome the thoughts of the noble Lord, Lord Falconer of Thoroton on that. Finally, in the absence of my that. Finally, in the absence of my noble friend, the Earl Howe, I've been asked on his behalf to formally speak on his amendments 301 A and 305 A, and in speaking to those amendments, I would like to highlight the threshold which is set for determining whether an individual is in England and Wales at the time of the first assessment.
I hope the noble Lord, Lord will be able to pick up this point as the bill is currently drafted. The question as to whether somebody is in England and Wales is ordinarily resident in England and Wales rests on what's called the opinion of the coordinating doctor. My concern is that an opinion without any further evidential requirement may be too low a bar, particularly given the need to guard against the risk of what has been called death tourism. Now, in other parts of the Bill, the word satisfied has been used by the noble Leonard Lord, and I think we would agree that satisfied entails a higher evidential bar than merely opinion, and indeed that is also higher than believes or reasonably believes.
Satisfied is a higher standard. And so when the noble Lord replies, I wonder whether he could use that opportunity to explain why the test here is only opinion and not satisfied, as that test is used in other parts of the bill.
**** Possible New Speaker ****
My Lords, I would like to first of all, thank all noble Lords for of all, thank all noble Lords for their contributions on this debate on the issue of residency and on the issue of residency and eligibility criteria, as I've already made clear and and repeating, I will confine my comments limited to those amendments on which the government has major legal, technical or has major legal, technical or operational workability concerns. So firstly, I'm turning to the amendments which narrow the residence criteria in respect of eligibility for assistance under the bill.
Amendment 11, tabled by the noble Lady Baroness Findlay, change would change the residence criteria for assistance under the bill from requiring a person to be ordinarily resident to permanently
14:33
Baroness Merron, The Parliamentary Under-Secretary for Health and Social Care (Labour)
-
-
Baroness Merron, The Parliamentary Under-Secretary for Health and Social Care (Labour)
resident. Unlike the term ordinarily residence, permanently resident does not have a set resident does not have a set definition in the context of UK immigration law, it is possible that it would be taken as referring that it would be taken as referring only to those who have citizenship or indefinite leave to remain, or indefinite leave to remain, which is a much narrower scope than the current current wording of ordinarily resident. Similarly, amendments 23, 309, 308 and 306 would restrict access to assisted dying support to only British citizens or people with an indefinite leave to remain.
This may result in migrants on long term work or study visas who have resided in England and Wales for longer than 12 months, being denied access to an assisted death, thereby potentially giving rise to indirect discrimination based on race. Under the ECHR, these amendments may be subject to challenge under article 14 of the EC when read with article eight on the basis that it may amount to unjustified discrimination. This differential treatment would require an objective and reasonable justification.
In addition, under various international agreements, the UK has an obligation not to discriminate against EU, EEA and Swiss nationals on the basis of nationality, though the agreements do not prevent restrictions on the basis of residency, since these amendments would prevent individuals from those countries from accessing these services on an equal basis to UK citizens in the same circumstances, they are likely to be contrary to the UK's international obligations under these agreements. Amendments 11 258306B and 449A table by the noble Lady Baroness Coffey seek to change the residence requirement residency requirement from ordinarily resident to domiciled.
These would add complexity and and add potential uncertainty into the eligibility requirements. Domicile refers to the determination of a person's permanent home, largely for tax purposes, meaning that a person can be domiciled in a place without being resident there. It is not a familiar concept in domestic law outside of taxation, so it's unclear how it would apply in this context. Further elaboration in guidance would be needed to make these amendments workable. It is also unclear what practical impact this change would have, when the bill would still require people to be physically present in England and Wales in respect of the steps under clauses eight, ten, 11 and 19.
I will next turn to amendment 14, in the name of the noble Lord, Lord Moylan.
**** Possible New Speaker ****
Beta specifically introduced this concept of England and Wales, and Stephen Kinnock did not raise and Stephen Kinnock did not raise any issues about that during the Committee stage at all in terms of either operation, ability or similar. But I'm astonished to hear some of the other elements that are now coming out for the first time
**** Possible New Speaker ****
now coming out for the first time important. I'm sorry to hear the noble Lady
**** Possible New Speaker ****
I'm sorry to hear the noble Lady is surprised. I'm simply setting out where the government has particular concerns in the scope that I was referring to. My noble friend Lord Faulkner may be able to more appropriately comment if he wishes to do so. In respect of the the points the noble Lady is raising. Turning to amendment 14, in the name of the noble Lord, Lord Moylan, which would widen the eligibility criteria to include UK citizens of pensionable age who are living abroad.
There are two main issues with this amendment. The first is that the UK has obligations under international agreements, which enable residents of partner countries to receive in the UK certain benefits, including some health service provision. These agreements are, as I've previously mentioned, with the EU, EEA states and Switzerland. As I have set out, these agreements prevent restrictions based on nationality, though they do permit those based on residency. Therefore, the amendment would have the effect of opening access to provision of assistance under the Bill to EU, Swiss and residents of pensionable age, provided they satisfy other eligibility criteria.
Widening access to only UK nationals of pensionable age would be contrary to the UK's obligations under those agreements. Secondly, by including those who, and I quote, move to live abroad. Close quote the amendment would enable pensionable age citizens from Northern Ireland or Scotland who have moved abroad to access the provision of assistance in accordance with the Bill, if they satisfy the other eligibility criteria. So, for all the other amendments in this group, I make no comment. Any workability concerns are less significant.
For example, amendment ten removes two eligibility criteria from clause one. An amendment 13 changes the requirements relating to ordinary residents in England and Wales. As clause one is largely descriptive, these amendments will have limited legal effect without corresponding amendments being made to operative provisions later in the bill. While these are indeed choices for noble Lords, these amendments may introduce inconsistencies and ambiguity into the Bill. As noble Lords will be aware, these amendments have not had technical drafting support from officials, and so the way they are currently drafted means that they may not be fully workable, effective or enforceable.
But of course, the issues raised are rightly a matter
**** Possible New Speaker ****
for noble Lords to consider and to decide. Could I just ask, given that
**** Possible New Speaker ****
Could I just ask, given that Jersey and the Isle of Man, if I'm correct and not e countries, how is the contract for health service delivery affected by this bill? In delivery affected by this bill? In the light of the problems that I highlighted right at the beginning of this, what's turned into quite a lengthy debate, because I was trying to look at a carve out for those countries so that those contracts could continue, but I was told that it was deemed out of scope of the bill.
**** Possible New Speaker ****
I'm sure the noble Lady will understand. I'm restricted to the comments that I can appropriately comments that I can appropriately make here. And I did hear my noble friend Lord Faulkner say that all friend Lord Faulkner say that all of these matters did need consideration, and I'm sure that he
**** Possible New Speaker ****
will expand further on that very point. Can I come to that question.
**** Possible New Speaker ****
When I go through? Thanks.
**** Possible New Speaker ****
First of all, the purpose of 11C. Namely, in order to qualify, you've got to be ordinarily resident in got to be ordinarily resident in England and Wales and have been so resident for at least 12 months, is, as noble Lords have said, to avoid people coming here specifically for the purpose of having an assisted the purpose of having an assisted death. It therefore would not be adequate to say ordinary resident adequate to say ordinary resident at the moment you apply, because you would have come specifically for that period.
Hence you need a period. 12 months is taken as a reasonable period in relation to that. In relation to the phrase ordinary, ordinary, resident. It is a phrase that appears right throughout the statute book in a whole range of settings, and reflects the policy choice made by regulations or statutes which say, we want to give this right to people who permanently live using the word permanently. Not in a legal sense, but in an ordinary sense, who permanently live in this country.
In applying that phrase, the courts have not generally had any real difficulty as to what it means. It is a reflection of this Parliament saying, we want to give
This may result in migrants on long term work or study visas who have resided in England and Wales for longer than 12 months, being denied access to an assisted death, thereby potentially giving rise to indirect discrimination based on race. Under the ECHR, these amendments may be subject to challenge under article 14 of the EC when read with article eight on the basis that it may amount to unjustified discrimination. This differential treatment would require an objective and reasonable justification.
In addition, under various international agreements, the UK has an obligation not to discriminate against EU, EEA and Swiss nationals on the basis of nationality, though the agreements do not prevent restrictions on the basis of residency, since these amendments would prevent individuals from those countries from accessing these services on an equal basis to UK citizens in the same circumstances, they are likely to be contrary to the UK's international obligations under these agreements. Amendments 11 258306B and 449A table by the noble Lady Baroness Coffey seek to change the residence requirement residency requirement from ordinarily resident to domiciled.
These would add complexity and and add potential uncertainty into the eligibility requirements. Domicile refers to the determination of a person's permanent home, largely for tax purposes, meaning that a person can be domiciled in a place without being resident there. It is not a familiar concept in domestic law outside of taxation, so it's unclear how it would apply in this context. Further elaboration in guidance would be needed to make these amendments workable. It is also unclear what practical impact this change would have, when the bill would still require people to be physically present in England and Wales in respect of the steps under clauses eight, ten, 11 and 19.
I will next turn to amendment 14, in the name of the noble Lord, Lord Moylan.
**** Possible New Speaker ****
Beta specifically introduced this concept of England and Wales, and Stephen Kinnock did not raise and Stephen Kinnock did not raise any issues about that during the Committee stage at all in terms of either operation, ability or similar. But I'm astonished to hear some of the other elements that are now coming out for the first time
**** Possible New Speaker ****
now coming out for the first time important. I'm sorry to hear the noble Lady
**** Possible New Speaker ****
I'm sorry to hear the noble Lady is surprised. I'm simply setting out where the government has particular concerns in the scope that I was referring to. My noble friend Lord Faulkner may be able to more appropriately comment if he wishes to do so. In respect of the the points the noble Lady is raising. Turning to amendment 14, in the name of the noble Lord, Lord Moylan, which would widen the eligibility criteria to include UK citizens of pensionable age who are living abroad.
There are two main issues with this amendment. The first is that the UK has obligations under international agreements, which enable residents of partner countries to receive in the UK certain benefits, including some health service provision. These agreements are, as I've previously mentioned, with the EU, EEA states and Switzerland. As I have set out, these agreements prevent restrictions based on nationality, though they do permit those based on residency. Therefore, the amendment would have the effect of opening access to provision of assistance under the Bill to EU, Swiss and residents of pensionable age, provided they satisfy other eligibility criteria.
Widening access to only UK nationals of pensionable age would be contrary to the UK's obligations under those agreements. Secondly, by including those who, and I quote, move to live abroad. Close quote the amendment would enable pensionable age citizens from Northern Ireland or Scotland who have moved abroad to access the provision of assistance in accordance with the Bill, if they satisfy the other eligibility criteria. So, for all the other amendments in this group, I make no comment. Any workability concerns are less significant.
For example, amendment ten removes two eligibility criteria from clause one. An amendment 13 changes the requirements relating to ordinary residents in England and Wales. As clause one is largely descriptive, these amendments will have limited legal effect without corresponding amendments being made to operative provisions later in the bill. While these are indeed choices for noble Lords, these amendments may introduce inconsistencies and ambiguity into the Bill. As noble Lords will be aware, these amendments have not had technical drafting support from officials, and so the way they are currently drafted means that they may not be fully workable, effective or enforceable.
But of course, the issues raised are rightly a matter
**** Possible New Speaker ****
for noble Lords to consider and to decide. Could I just ask, given that
**** Possible New Speaker ****
Could I just ask, given that Jersey and the Isle of Man, if I'm correct and not e countries, how is the contract for health service delivery affected by this bill? In delivery affected by this bill? In the light of the problems that I highlighted right at the beginning of this, what's turned into quite a lengthy debate, because I was trying to look at a carve out for those countries so that those contracts could continue, but I was told that it was deemed out of scope of the bill.
**** Possible New Speaker ****
I'm sure the noble Lady will understand. I'm restricted to the comments that I can appropriately comments that I can appropriately make here. And I did hear my noble friend Lord Faulkner say that all friend Lord Faulkner say that all of these matters did need consideration, and I'm sure that he
**** Possible New Speaker ****
will expand further on that very point. Can I come to that question.
**** Possible New Speaker ****
When I go through? Thanks.
**** Possible New Speaker ****
First of all, the purpose of 11C. Namely, in order to qualify, you've got to be ordinarily resident in got to be ordinarily resident in England and Wales and have been so resident for at least 12 months, is, as noble Lords have said, to avoid people coming here specifically for the purpose of having an assisted the purpose of having an assisted death. It therefore would not be adequate to say ordinary resident adequate to say ordinary resident at the moment you apply, because you would have come specifically for that period.
Hence you need a period. 12 months is taken as a reasonable period in relation to that. In relation to the phrase ordinary, ordinary, resident. It is a phrase that appears right throughout the statute book in a whole range of settings, and reflects the policy choice made by regulations or statutes which say, we want to give this right to people who permanently live using the word permanently. Not in a legal sense, but in an ordinary sense, who permanently live in this country.
In applying that phrase, the courts have not generally had any real difficulty as to what it means. It is a reflection of this Parliament saying, we want to give
14:42
Lord Falconer of Thoroton (Labour)
-
-
Lord Falconer of Thoroton (Labour)
particular rights to the people who live here, and sometimes we say, as we are suggesting here, we don't we are suggesting here, we don't care what your citizenship status is. If you live here permanently, you get that right. So, for example, in relation to the National Health in relation to the National Health Service, we say if you live here permanently, then you get that right. We also have what it is right. We also have what it is worth. And I say this with the greatest respect.
Can I just finish this point? I also say with the
Can I just finish this point? I also say with the
14:42
Bill Sponsor
Lord Falconer of Thoroton (Labour)
-
Bill Sponsor
Lord Falconer of Thoroton (Labour)
greatest respect to the Baroness Butler-Sloss, the cases have made it pretty clear that you can be ordinarily resident here, but have ordinarily resident here, but have temporary absences abroad. So if you go to work as a diplomat abroad, or work or serve in the armed or work or serve in the armed forces, or take a job that takes you away for two months, the big you away for two months, the big case is somebody whose family lived here, and they went to be educated in India for a period of time, held still ordinarily resident here.
I, with the greatest respect to Lord Mackinlay don't think adopting the phrase ordinary residence gives rise either to injustice or in relation to legal difficulties. Now, could I deal with the points that have been made by individual peers, first of all? But can I can I just go through it, then come in at the end? Because we have I've got a time limitation. First of all, as far as Baroness Finlay is concerned, I am very sympathetic to her point, as I made clear in relation to my intervention, there is the issue which I think she wanted raised by putting in the word permanent.
I don't think she was putting in permanent except a probe on the question of the of the person who lives in the Isle of Man or Jersey and gets all their medical treatment habitually in England, when the person the doctor in England says, I'll help you go home to the Isle of Man to get a assisted death, assume it's going to become legal in the Isle of Man. The doctor there would be committing a criminal offence under this bill unless there is an amendment.
The BMA have proposed an amendment that if you help somebody to go home for an assisted death, going home being to say the Isle of Man or Jersey, and it's legal there, that should not be a criminal offence. And we I've talked the BMA about that and we need to work together to see whether or not we can get an amendment that satisfies the point that the noble Baroness Finlay has made. And I welcome her input in relation to this. Connected with that is the point made by Lord Beith, which will come to later, which is why do we say the general practice has got to be in England? You could have a general practice in Scotland as somebody who lives in England.
And again, I think that point merits a looking at. I can't see why the general practice has got to be in England and Wales, because the purpose of having the general practice in England and Wales is to feed in records to various places, because it doesn't depend upon how often you see your GP and if it's in Scotland, it achieves that. So I hope that helps and I'm more than happy to talk about those particular issues. Baroness Coffey suggests that ordinary residents be replaced by domicile.
I couldn't have put it better than the various interventions in relation to it. Namely, domicile is a complicated, legally driven. I don't say it's only in relation to tax, but tax is the area which has driven definitions of domicile. It would be an inappropriate test in my view, and therefore I would be against that. The noble Lord Lord Lansley, who I am grateful to for taking time to explain his amendments to me, said to me and said it again to the House.
We don't want we don't want the, the, the doctors to become immigration enforcement officers. Broadly, the test in the National Health Service is, if you are resident anywhere in the UK, you can access any NHS facilities in the UK. So if you're a resident in the island of Orkney and you end up in Belfast with a with a health problem, there's absolutely no problem in relation to it. I'm, I'm quite sympathetic to that, that approach, except for two reasons. First of all, it doesn't obviate the need to make a decision about whether or not you live in the UK or England and Wales.
It gets rid of the problem. Which bit of the UK do you live in? But it doesn't obviate the problem about. Are you ordinarily resident in the UK, which currently exists? On the second aspect of it, I am worried about the devolution aspects, which means that you are giving rights to people in Scotland, which Scotland, not England, has got to decide. So I recognise what he is saying. But and I would be sympathetic, but I think there are those two problems.
I also should point out that the noble Lord Lord Lansley says get rid of the 12 months. Just take it as at the moment you make the declaration. The problem about that is you invite the possibility of just finish this sentence and then deal with me. As far as the the tourism point, if you can come just to have a you can come and genuinely to live here till you die
**** Possible New Speaker ****
in order to get a assisted death. And we don't want that. But I think, I think the noble
**** Possible New Speaker ****
But I think, I think the noble but I think the noble Lord knows that the definition of ordinarily resident that is used in the resident that is used in the National Health Service is one which is defined in common law, and it's about living here as part of it's about living here as part of your normal pattern of life for a settled and continuing purpose. It is not at a moment in time. That's is not at a moment in time. That's why the 12 months is particularly inappropriate, because there is no it's a matter of judgement at the point at which a test of ordinary residence happens, and one has to demonstrate that one is here for a
**** Possible New Speaker ****
completely. The reason why the 12 months is
**** Possible New Speaker ****
The reason why the 12 months is in is to give some degree of assurance that the reason you are living here is not because of the living here is not because of the assisted death, but because it is your genuine home. Could I come to the noble Lord? Lord Frost's the noble Lord? Lord Frost's proposal the way it's drafted though I can't believe he meant this in the way that he put it, is this in the way that he put it, is you have to be ordinarily resident in England and Wales, and you've got to be a British citizen and definite leave to remain.
The reason I put that, that, that, that surprise is because he was saying it would, it would be an easier test to apply. It wouldn't be an easier test to apply because you'd have to apply both ordinary residents and whether you were a citizen or had indefinite leave to remain. I don't think his proposal even assume it is the more limited one. Namely, you only have to be a British citizen or have indefinite leave to remain. And you don't have to be ordinarily resident here.
I don't think that would be appropriate for two reasons. First of all, the policy choice that the sponsors of the bill, myself and Kim Leadbeater have made is that if you live here, if you are ordinarily resident here, whatever your citizenship, whatever your status, you should be entitled to it. And secondly, and separately, I do not think it is appropriate to make it available for people who, for example, have not lived in this country for 50 or 60 years and have no intention of returning, that would invite death tourism, to use the phrase.
Lord Harper said doctors should not be required to make the assessment. If the position is that there has to be some residence requirement, then I think it's perfectly okay for the two doctors who are concerned with this to make inquiries. Where do you live? How long have you lived here? It's not difficult. And in 99.99% of cases, it won't give rise to any problems. Because suppose I say to the doctor and assume most people are honest. I actually live in France, but I'm coming here because I want this, and the doctor will say, I'm afraid that's not available.
So although I hear what the noble. Let me finish what the noble Lord says. I don't think it gives rise to particular problems if there are particular problematic cases, then they can ultimately be
**** Possible New Speaker ****
resolved by the panel. I don't think that is the. Experience of the National Health Experience of the National Health Service. And there's a whole cadre of staff, the overseas visitors, managers, about people who are trying to access a service. I don't think it is the case that this is very straightforward, and in the vast majority of cases, there won't vast majority of cases, there won't be an issue that is not the NHS experience, and I don't think it would be the experience of this service either.
Yeah, exactly.
**** Possible New Speaker ****
service either. Yeah, exactly. Nice to hear that. And obviously I'll make enquiries, but I'm almost sure that won't be right in this. In in relation to Lord McKinley's point, he, he he gave us a rather interesting tour of the law and said how ordinary residents applies in various areas. Ordinary residents means the same thing. In all of these reasons, and for the reasons I've already said, I do not think it will. It will prove a difficult thing to apply in practice.
I am grateful to Lord Meston for his endorsement of the approach to ordinary residents. The noble Lord, Lord, the noble, the noble Lord, Lord Wolfson. Sorry, almost slipped again there. The noble Lord. Lord Wolfson asked me a number of questions. What about the citizen who was ordinarily resident here, and then went to live abroad? And I think that's the noble Lord, Lord Moylan's case. So the person who decided I'm going to move my house to Spain and live the rest of my days there, then when I become ill, I want to come back and have an assisted death.
Under the terms of this bill, you wouldn't be eligible under the bill because you would not have been ordinarily resident in this country for 12 months, this country being England and Wales. And your second question was in relation to what happens to somebody from Northern Ireland who comes here and asks one again, not eligible, because the assumption under your question was you, your ordinary residence is in relation to, in Northern Ireland. Your third question was why opinion not satisfied? Because there may be opinion is enough.
It seemed to us in relation to this, because it would be done basically on the asking of a number of questions, and you would be assuming that the answers that you had would be honest. My Lord, I think that deals with all things that are Baroness Coffey I apologise you.
**** Possible New Speaker ****
I noticed you've taken interventions from other noble Lord Porter and Leonard Lord Caine in interventions, so I don't believe interventions, so I don't believe that the noble Lord has addressed my issue actually, about the risk my issue actually, about the risk of tourism. And the reason I say that he's used interchangeably that he's used interchangeably during his explanations permanently is what ordinarily resident is. No is what ordinarily resident is. No distinguished lawyer here has actually countered the view that you can be ordinarily resident in more than one country at the same time.
And we have this broader issue that case law can change this, the NHS guidance can change this, and I think it really does need revisiting. But could he really address my issues about tourism in
**** Possible New Speaker ****
think. That's a smokescreen.
**** Possible New Speaker ****
That's a smokescreen. What this bill is doing in a way that the law has recognised time and time again, because this Parliament has to make choices from time to time about who gets time to time about who gets benefits. And it's saying the benefits of this bill should be given to those and only to those who ordinarily live in this country. That phrase has not given rise to problems. The courts understand it, doctors understand it, the panels will understand it.
And if we can't in this Parliament say we're going to give rights only to those who are ordinarily resident, which is a phrase that means something, then we are never going to be able to determine who is entitled to our rights. So with the greatest of respect to the Baroness Coffey, I think what we're trying to do in this bill is clear. I invite noble
**** Possible New Speaker ****
amendments. I sum up now at the end of this
**** Possible New Speaker ****
I sum up now at the end of this very interesting debate. I am relieved to hear that people don't want doctors to be the immigration officers, and I'm a little disappointed, actually, that the disappointed, actually, that the noble Lord, Lord Faulkner, hasn't accepted the noble House amendment accepted the noble House amendment that was spoken to because it's so straightforward. And by having the term satisfied in there, if, as he says, for over 90, I think he said 98%, but I oh, sorry, 99% of patients, it wouldn't be a problem then to be satisfied won't be a problem.
But I think it adds a degree of security for doctors who are being asked to provide these assessments of eligibility. I was also glad to hear from the noble Lord Lord Harper that those who are working for the Foreign and Commonwealth Office in embassies or whatever are actually covered, okay, and that isn't a problem. I note the noble, the noble Lord. Sorry, I've promoted him Lord Carlile it is a Lord, not an Earl, that he raised the issue about those working as volunteers abroad for a very long time, and I hope that that that ability, which applies to foreign, common, foreign and Commonwealth Office workers could also apply to those working for charities like some of the really major charities who may be abroad for very, very long time but view their permanent home as in the UK.
I still remain concerned about Jersey and the Isle of Man. I would like to ask the noble Lord what conversations has he had with the public Bill office about how to get this in scope? Because my attempts have failed and I understood that here in the House of Lords, we are not able to widen the scope of the Bill. And I have a worry that without widening the scope of the bill, we won't address it. And those doctors treating patients with all kinds of really serious illnesses, particularly in Liverpool, which has already been referred to by the frontbench and in Southampton, could inadvertently find themselves in a very difficult position, and it would just be an legislation.
**** Possible New Speaker ****
Well, I don't. Know if the noble Baroness has discussed with the public Bill discussed with the public Bill office the BMA's proposal in relation to this, what the BMA's proposal is that it's not a crime under the suicide act, if the under the suicide act, if the assistance you give is not unlawful in the Isle of Man or Jersey, the idea that that is out of scope idea that that is out of scope seems to me to be beyond.
That's obviously wrong, because what this bill is doing is crafting an exception to the suicide act. So if the Baroness Finlay and myself go and see the public bill office and explain that, I would have thought
**** Possible New Speaker ****
there would be no difficulty about the scope. I would be delighted. To go with the noble Lord, because he may have a little bit because he may have a little bit more success, and the public Bill office have been unfailingly helpful. It is no criticism helpful. It is no criticism whatsoever of them. They really have worked incredibly hard. But have worked incredibly hard. But with that, and with the promise of going to see them with it, a matter of urgency, I beg leave to withdraw
**** Possible New Speaker ****
the amendment. President, the amendment be withdrawn. Amendment by leave withdrawn. Amendment 11 Baroness Finlay not moved. Amendments 11 a Baroness Coffey not moved 11 B Lord Lansley not moved. Amendment 12 already debated. Baroness Coffey not moved. Amendment 13 Baroness Grey-Thompson not moved. Amendment 14 Lord Moylan not moved. Amendment
**** Possible New Speaker ****
15 was withdrawn. So I think I'm going. My Lords, we have completed
**** Possible New Speaker ****
My Lords, we have completed three groups of amendments, which is less than I'd hoped for when I is less than I'd hoped for when I spoke in the House this morning. I think that all noble Lords need to reflect on that before we resume
**** Possible New Speaker ****
reflect on that before we resume consideration of this bill next Friday. With that, I beg to move the House. Be now resumed. Adjourned.
**** Possible New Speaker ****
Adjourned. Proceedings were there. He would give anxious to consideration to how we are going to complete this Committee stage of an enormously important bill, which this House may well want to amend, and may well wish to disagree with at Third Reading. But it surely essential that this House is provided with the time that enables us to do our job. Because if we don't do our job, it's going to be enormously damaging to the reputation of this House.
And is there any way in
**** Possible New Speaker ****
which he can give thought to this over the next few days? Yeah.
**** Possible New Speaker ****
Yeah. I'm very happy to give thought to that. When I came to this Dispatch Box a couple of weeks and announced the extra days, I was announced the extra days, I was hoping that was going to assist the House. But at this rate of progress then I think we may still be then I think we may still be struggling, but I'm very happy to consideration that and my door remains open to anybody if I can give assistance on that. But as I give assistance on that.
But as I keep making note, at the end of the day, this is a private member's bill and the government remains
**** Possible New Speaker ****
neutral on the bill itself. Prime Minister. Okay, I'm.
**** Possible New Speaker ****
Okay, I'm. The question is that the House be resumed, as many of that opinion will say content the contrary, not contents. The contents have it.
**** Possible New Speaker ****
contents. The contents have it. Order order order order order order!
**** Possible New Speaker ****
order! Order! Back to the House. Do now adjourn.
I, with the greatest respect to Lord Mackinlay don't think adopting the phrase ordinary residence gives rise either to injustice or in relation to legal difficulties. Now, could I deal with the points that have been made by individual peers, first of all? But can I can I just go through it, then come in at the end? Because we have I've got a time limitation. First of all, as far as Baroness Finlay is concerned, I am very sympathetic to her point, as I made clear in relation to my intervention, there is the issue which I think she wanted raised by putting in the word permanent.
I don't think she was putting in permanent except a probe on the question of the of the person who lives in the Isle of Man or Jersey and gets all their medical treatment habitually in England, when the person the doctor in England says, I'll help you go home to the Isle of Man to get a assisted death, assume it's going to become legal in the Isle of Man. The doctor there would be committing a criminal offence under this bill unless there is an amendment.
The BMA have proposed an amendment that if you help somebody to go home for an assisted death, going home being to say the Isle of Man or Jersey, and it's legal there, that should not be a criminal offence. And we I've talked the BMA about that and we need to work together to see whether or not we can get an amendment that satisfies the point that the noble Baroness Finlay has made. And I welcome her input in relation to this. Connected with that is the point made by Lord Beith, which will come to later, which is why do we say the general practice has got to be in England? You could have a general practice in Scotland as somebody who lives in England.
And again, I think that point merits a looking at. I can't see why the general practice has got to be in England and Wales, because the purpose of having the general practice in England and Wales is to feed in records to various places, because it doesn't depend upon how often you see your GP and if it's in Scotland, it achieves that. So I hope that helps and I'm more than happy to talk about those particular issues. Baroness Coffey suggests that ordinary residents be replaced by domicile.
I couldn't have put it better than the various interventions in relation to it. Namely, domicile is a complicated, legally driven. I don't say it's only in relation to tax, but tax is the area which has driven definitions of domicile. It would be an inappropriate test in my view, and therefore I would be against that. The noble Lord Lord Lansley, who I am grateful to for taking time to explain his amendments to me, said to me and said it again to the House.
We don't want we don't want the, the, the doctors to become immigration enforcement officers. Broadly, the test in the National Health Service is, if you are resident anywhere in the UK, you can access any NHS facilities in the UK. So if you're a resident in the island of Orkney and you end up in Belfast with a with a health problem, there's absolutely no problem in relation to it. I'm, I'm quite sympathetic to that, that approach, except for two reasons. First of all, it doesn't obviate the need to make a decision about whether or not you live in the UK or England and Wales.
It gets rid of the problem. Which bit of the UK do you live in? But it doesn't obviate the problem about. Are you ordinarily resident in the UK, which currently exists? On the second aspect of it, I am worried about the devolution aspects, which means that you are giving rights to people in Scotland, which Scotland, not England, has got to decide. So I recognise what he is saying. But and I would be sympathetic, but I think there are those two problems.
I also should point out that the noble Lord Lord Lansley says get rid of the 12 months. Just take it as at the moment you make the declaration. The problem about that is you invite the possibility of just finish this sentence and then deal with me. As far as the the tourism point, if you can come just to have a you can come and genuinely to live here till you die
**** Possible New Speaker ****
in order to get a assisted death. And we don't want that. But I think, I think the noble
**** Possible New Speaker ****
But I think, I think the noble but I think the noble Lord knows that the definition of ordinarily resident that is used in the resident that is used in the National Health Service is one which is defined in common law, and it's about living here as part of it's about living here as part of your normal pattern of life for a settled and continuing purpose. It is not at a moment in time. That's is not at a moment in time. That's why the 12 months is particularly inappropriate, because there is no it's a matter of judgement at the point at which a test of ordinary residence happens, and one has to demonstrate that one is here for a
**** Possible New Speaker ****
completely. The reason why the 12 months is
**** Possible New Speaker ****
The reason why the 12 months is in is to give some degree of assurance that the reason you are living here is not because of the living here is not because of the assisted death, but because it is your genuine home. Could I come to the noble Lord? Lord Frost's the noble Lord? Lord Frost's proposal the way it's drafted though I can't believe he meant this in the way that he put it, is this in the way that he put it, is you have to be ordinarily resident in England and Wales, and you've got to be a British citizen and definite leave to remain.
The reason I put that, that, that, that surprise is because he was saying it would, it would be an easier test to apply. It wouldn't be an easier test to apply because you'd have to apply both ordinary residents and whether you were a citizen or had indefinite leave to remain. I don't think his proposal even assume it is the more limited one. Namely, you only have to be a British citizen or have indefinite leave to remain. And you don't have to be ordinarily resident here.
I don't think that would be appropriate for two reasons. First of all, the policy choice that the sponsors of the bill, myself and Kim Leadbeater have made is that if you live here, if you are ordinarily resident here, whatever your citizenship, whatever your status, you should be entitled to it. And secondly, and separately, I do not think it is appropriate to make it available for people who, for example, have not lived in this country for 50 or 60 years and have no intention of returning, that would invite death tourism, to use the phrase.
Lord Harper said doctors should not be required to make the assessment. If the position is that there has to be some residence requirement, then I think it's perfectly okay for the two doctors who are concerned with this to make inquiries. Where do you live? How long have you lived here? It's not difficult. And in 99.99% of cases, it won't give rise to any problems. Because suppose I say to the doctor and assume most people are honest. I actually live in France, but I'm coming here because I want this, and the doctor will say, I'm afraid that's not available.
So although I hear what the noble. Let me finish what the noble Lord says. I don't think it gives rise to particular problems if there are particular problematic cases, then they can ultimately be
**** Possible New Speaker ****
resolved by the panel. I don't think that is the. Experience of the National Health Experience of the National Health Service. And there's a whole cadre of staff, the overseas visitors, managers, about people who are trying to access a service. I don't think it is the case that this is very straightforward, and in the vast majority of cases, there won't vast majority of cases, there won't be an issue that is not the NHS experience, and I don't think it would be the experience of this service either.
Yeah, exactly.
**** Possible New Speaker ****
service either. Yeah, exactly. Nice to hear that. And obviously I'll make enquiries, but I'm almost sure that won't be right in this. In in relation to Lord McKinley's point, he, he he gave us a rather interesting tour of the law and said how ordinary residents applies in various areas. Ordinary residents means the same thing. In all of these reasons, and for the reasons I've already said, I do not think it will. It will prove a difficult thing to apply in practice.
I am grateful to Lord Meston for his endorsement of the approach to ordinary residents. The noble Lord, Lord, the noble, the noble Lord, Lord Wolfson. Sorry, almost slipped again there. The noble Lord. Lord Wolfson asked me a number of questions. What about the citizen who was ordinarily resident here, and then went to live abroad? And I think that's the noble Lord, Lord Moylan's case. So the person who decided I'm going to move my house to Spain and live the rest of my days there, then when I become ill, I want to come back and have an assisted death.
Under the terms of this bill, you wouldn't be eligible under the bill because you would not have been ordinarily resident in this country for 12 months, this country being England and Wales. And your second question was in relation to what happens to somebody from Northern Ireland who comes here and asks one again, not eligible, because the assumption under your question was you, your ordinary residence is in relation to, in Northern Ireland. Your third question was why opinion not satisfied? Because there may be opinion is enough.
It seemed to us in relation to this, because it would be done basically on the asking of a number of questions, and you would be assuming that the answers that you had would be honest. My Lord, I think that deals with all things that are Baroness Coffey I apologise you.
**** Possible New Speaker ****
I noticed you've taken interventions from other noble Lord Porter and Leonard Lord Caine in interventions, so I don't believe interventions, so I don't believe that the noble Lord has addressed my issue actually, about the risk my issue actually, about the risk of tourism. And the reason I say that he's used interchangeably that he's used interchangeably during his explanations permanently is what ordinarily resident is. No is what ordinarily resident is. No distinguished lawyer here has actually countered the view that you can be ordinarily resident in more than one country at the same time.
And we have this broader issue that case law can change this, the NHS guidance can change this, and I think it really does need revisiting. But could he really address my issues about tourism in
**** Possible New Speaker ****
think. That's a smokescreen.
**** Possible New Speaker ****
That's a smokescreen. What this bill is doing in a way that the law has recognised time and time again, because this Parliament has to make choices from time to time about who gets time to time about who gets benefits. And it's saying the benefits of this bill should be given to those and only to those who ordinarily live in this country. That phrase has not given rise to problems. The courts understand it, doctors understand it, the panels will understand it.
And if we can't in this Parliament say we're going to give rights only to those who are ordinarily resident, which is a phrase that means something, then we are never going to be able to determine who is entitled to our rights. So with the greatest of respect to the Baroness Coffey, I think what we're trying to do in this bill is clear. I invite noble
**** Possible New Speaker ****
amendments. I sum up now at the end of this
**** Possible New Speaker ****
I sum up now at the end of this very interesting debate. I am relieved to hear that people don't want doctors to be the immigration officers, and I'm a little disappointed, actually, that the disappointed, actually, that the noble Lord, Lord Faulkner, hasn't accepted the noble House amendment accepted the noble House amendment that was spoken to because it's so straightforward. And by having the term satisfied in there, if, as he says, for over 90, I think he said 98%, but I oh, sorry, 99% of patients, it wouldn't be a problem then to be satisfied won't be a problem.
But I think it adds a degree of security for doctors who are being asked to provide these assessments of eligibility. I was also glad to hear from the noble Lord Lord Harper that those who are working for the Foreign and Commonwealth Office in embassies or whatever are actually covered, okay, and that isn't a problem. I note the noble, the noble Lord. Sorry, I've promoted him Lord Carlile it is a Lord, not an Earl, that he raised the issue about those working as volunteers abroad for a very long time, and I hope that that that ability, which applies to foreign, common, foreign and Commonwealth Office workers could also apply to those working for charities like some of the really major charities who may be abroad for very, very long time but view their permanent home as in the UK.
I still remain concerned about Jersey and the Isle of Man. I would like to ask the noble Lord what conversations has he had with the public Bill office about how to get this in scope? Because my attempts have failed and I understood that here in the House of Lords, we are not able to widen the scope of the Bill. And I have a worry that without widening the scope of the bill, we won't address it. And those doctors treating patients with all kinds of really serious illnesses, particularly in Liverpool, which has already been referred to by the frontbench and in Southampton, could inadvertently find themselves in a very difficult position, and it would just be an legislation.
**** Possible New Speaker ****
Well, I don't. Know if the noble Baroness has discussed with the public Bill discussed with the public Bill office the BMA's proposal in relation to this, what the BMA's proposal is that it's not a crime under the suicide act, if the under the suicide act, if the assistance you give is not unlawful in the Isle of Man or Jersey, the idea that that is out of scope idea that that is out of scope seems to me to be beyond.
That's obviously wrong, because what this bill is doing is crafting an exception to the suicide act. So if the Baroness Finlay and myself go and see the public bill office and explain that, I would have thought
**** Possible New Speaker ****
there would be no difficulty about the scope. I would be delighted. To go with the noble Lord, because he may have a little bit because he may have a little bit more success, and the public Bill office have been unfailingly helpful. It is no criticism helpful. It is no criticism whatsoever of them. They really have worked incredibly hard. But have worked incredibly hard. But with that, and with the promise of going to see them with it, a matter of urgency, I beg leave to withdraw
**** Possible New Speaker ****
the amendment. President, the amendment be withdrawn. Amendment by leave withdrawn. Amendment 11 Baroness Finlay not moved. Amendments 11 a Baroness Coffey not moved 11 B Lord Lansley not moved. Amendment 12 already debated. Baroness Coffey not moved. Amendment 13 Baroness Grey-Thompson not moved. Amendment 14 Lord Moylan not moved. Amendment
**** Possible New Speaker ****
15 was withdrawn. So I think I'm going. My Lords, we have completed
**** Possible New Speaker ****
My Lords, we have completed three groups of amendments, which is less than I'd hoped for when I is less than I'd hoped for when I spoke in the House this morning. I think that all noble Lords need to reflect on that before we resume
**** Possible New Speaker ****
reflect on that before we resume consideration of this bill next Friday. With that, I beg to move the House. Be now resumed. Adjourned.
**** Possible New Speaker ****
Adjourned. Proceedings were there. He would give anxious to consideration to how we are going to complete this Committee stage of an enormously important bill, which this House may well want to amend, and may well wish to disagree with at Third Reading. But it surely essential that this House is provided with the time that enables us to do our job. Because if we don't do our job, it's going to be enormously damaging to the reputation of this House.
And is there any way in
**** Possible New Speaker ****
which he can give thought to this over the next few days? Yeah.
**** Possible New Speaker ****
Yeah. I'm very happy to give thought to that. When I came to this Dispatch Box a couple of weeks and announced the extra days, I was announced the extra days, I was hoping that was going to assist the House. But at this rate of progress then I think we may still be then I think we may still be struggling, but I'm very happy to consideration that and my door remains open to anybody if I can give assistance on that. But as I give assistance on that.
But as I keep making note, at the end of the day, this is a private member's bill and the government remains
**** Possible New Speaker ****
neutral on the bill itself. Prime Minister. Okay, I'm.
**** Possible New Speaker ****
Okay, I'm. The question is that the House be resumed, as many of that opinion will say content the contrary, not contents. The contents have it.
**** Possible New Speaker ****
contents. The contents have it. Order order order order order order!
**** Possible New Speaker ****
order! Order! Back to the House. Do now adjourn.