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Friday 9th January 2026
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10:18
Lord Carlile of Berriew (Crossbench)
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Lord Carlile of Berriew (Crossbench)
Applications they Applications they expect, Applications they expect, and Applications they expect, and the court in question at that stage was simply the High Court of Justice Family Division judges. And secondly, that it might prove more difficult to obtain permission from a court than from the panel as now described. As to the judge's amendment, 120 offers a simple and sound solution, which I'm surprised hadn't been thought of before. It broadens the range of judiciary who would be designated to reach these decisions.
These momentous decisions, which involve the deliberate participation of one individual in bringing about the death of another, that a judge should be involved, is, I would suggest, your Lordship, self-evidently appropriate. And what we should expect, given that third party participation in a death would otherwise involve the offence of murder. And I remind your Lordships that murder is defined as being involved in bringing about the death of another with the intent to kill or do grievous bodily harm. Decisions as to whether life support should be switched off are regularly heard by judges of the Family Division of the High Court, as are other extremely important decisions concerning family life, including matters affecting contact between parents and their own children.
There are, however, only 20 High Court judges in the Family Division, including the president. But my Lords, around the country, there are more than 40 designated family judges. Specialist circuit judges who deal with the most difficult and important cases by adding those 40 plus designated judges into the cohort of judges who would decide cases envisaged by this bill, who were not envisaged as part of the process. Originally, there would, I would suggest, be an ample supply of skilled and diverse expert judiciary who would provide confidence inspiring judgement in this important and difficult new area of the law.
I should add that the training of judges is very important in this context. The Judicial College provides expert training for all judges, including in specialist jurisdictions, and there are those in this chamber who have acted both as students and tutors in the work of the Judicial College. And I would also add that there's also a team of a cohort of recorders who are part time judges, who could fill any listing gaps caused by this new jurisdiction. As to the second objection, that it might prove more difficult to obtain permission from a court than from a panel I would make.
What I would suggest are four cardinal points. First, it should not be easy to permit third party involvement in someone's death, nor should it be impossible, which is not the aim of these amendments. These amendments are predicated on the assumption that assisted suicide becomes lawful. It should be the subject of a procedure proportionate to the great legal change involved. In some cases, that may make an application more challenging. But those are exactly the cases in need of increased increased scrutiny and protection.
Where do second point, where do we expect difficult issues of this level of seriousness and complexity to be tested and adjudicated upon? Generally, the answer is in the courts. Of course, there is no comparable precedent in which a matter affecting life and death is handed to a panel, even one chaired by a senior or retired lawyer. There are good reasons for that expectation. The court has special powers and they include, importantly, ordering the disclosure of documents such as relevant correspondence and medical records.
Power to examine in a balanced way the arguments and evidence of both sides of a question, and to make a reasoned decision as to what evidence to accept or reject. An example of such an issue might be whether, for example, an applicant is ordinarily resident in England and Wales or the UK. Not necessarily an easy question to answer. And also the court procedure allows the intervention of what are called interested parties. For example, close relatives between whom there may be important and relevant issues.
If the court regards the interventions as of potential value and every day of the week, courts consider whether interveners should be allowed in a particular case or not on the merits. And another thing that courts do is produce reasoned judgements in which clear findings of fact and law are set out. This is the part of the everyday work of judges in every court around the country. My third cardinal point is the appeal process. An appeal process is well understood and would be available if through the courts.
The court has a very good reputation for efficiency and prompt action in cases that clearly require it, where real urgency is required, the courts respond in a familiar jurisdiction, which does not have to be designed from scratch, and commands as much public confidence as any process that we have in our in our polity in this country. Also, my fourth cardinal point is that courts are familiar with the concept of individual capacity, with hearing and deciding upon expert evidence, and above all, in this context of dealing with allegations of due undue influence.
The greatest worry I have about this new jurisdiction is that undue influence, often financially motivated, may feature heavily in some cases. There is some evidence, for example, from Canada, that that has been a real issue in a significant number of cases, rooting out undue influence after the event offers absolutely nothing in this jurisdiction, because the individual whose life is being discussed will already be dead. The experience of judges all honed in practice, in which, from time to time, they all encounter examples of the most egregious and devious behaviour, together with the forensic nature of the court process, promise a reasonable prospect of fair and proper decision making.
And it may be of interest to note that yesterday we welcomed into our house a new member, Lord John, who has spent his legal practice dealing with just that issue of undue influence as a distinguished probate lawyer. Just an example of the way in which lawyers and the courts deal with these issues. In addition, of course, my Lords, the recruitment of judges is statutory, well tested and very successful. The recruitment process suggested for the panels has none of those known qualities.
Qualities, indeed is an unknown quantity. My Lords, I promise your Lordships that I do not move these amendments in a way that is intended to undermine the Bill. My aim is based on the presumption that a bill of this kind will be passed. My amendments are intended to make it safe and ask. Preparation, I know, is shared by the noble and learned Lord, Lord Falconer. Confidence in his proposals would greatly be increased by his acceptance. Acceptance of the principles behind
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these amendments. Well done.
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Move his amendment. Most grateful. I beg to move. Amendment. Proposed. Clause one,
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Amendment. Proposed. Clause one, page one. Line 12. At end. Insert the words as printed on the Marshalled List. My Lords Lord Marshalled List. My Lords Lord Shinkwin is taking part remotely. I invite Lord Shinkwin to speak.
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invite Lord Shinkwin to speak. My votes. I rise to speak to amendment 120 and the amendments
These momentous decisions, which involve the deliberate participation of one individual in bringing about the death of another, that a judge should be involved, is, I would suggest, your Lordship, self-evidently appropriate. And what we should expect, given that third party participation in a death would otherwise involve the offence of murder. And I remind your Lordships that murder is defined as being involved in bringing about the death of another with the intent to kill or do grievous bodily harm. Decisions as to whether life support should be switched off are regularly heard by judges of the Family Division of the High Court, as are other extremely important decisions concerning family life, including matters affecting contact between parents and their own children.
There are, however, only 20 High Court judges in the Family Division, including the president. But my Lords, around the country, there are more than 40 designated family judges. Specialist circuit judges who deal with the most difficult and important cases by adding those 40 plus designated judges into the cohort of judges who would decide cases envisaged by this bill, who were not envisaged as part of the process. Originally, there would, I would suggest, be an ample supply of skilled and diverse expert judiciary who would provide confidence inspiring judgement in this important and difficult new area of the law.
I should add that the training of judges is very important in this context. The Judicial College provides expert training for all judges, including in specialist jurisdictions, and there are those in this chamber who have acted both as students and tutors in the work of the Judicial College. And I would also add that there's also a team of a cohort of recorders who are part time judges, who could fill any listing gaps caused by this new jurisdiction. As to the second objection, that it might prove more difficult to obtain permission from a court than from a panel I would make.
What I would suggest are four cardinal points. First, it should not be easy to permit third party involvement in someone's death, nor should it be impossible, which is not the aim of these amendments. These amendments are predicated on the assumption that assisted suicide becomes lawful. It should be the subject of a procedure proportionate to the great legal change involved. In some cases, that may make an application more challenging. But those are exactly the cases in need of increased increased scrutiny and protection.
Where do second point, where do we expect difficult issues of this level of seriousness and complexity to be tested and adjudicated upon? Generally, the answer is in the courts. Of course, there is no comparable precedent in which a matter affecting life and death is handed to a panel, even one chaired by a senior or retired lawyer. There are good reasons for that expectation. The court has special powers and they include, importantly, ordering the disclosure of documents such as relevant correspondence and medical records.
Power to examine in a balanced way the arguments and evidence of both sides of a question, and to make a reasoned decision as to what evidence to accept or reject. An example of such an issue might be whether, for example, an applicant is ordinarily resident in England and Wales or the UK. Not necessarily an easy question to answer. And also the court procedure allows the intervention of what are called interested parties. For example, close relatives between whom there may be important and relevant issues.
If the court regards the interventions as of potential value and every day of the week, courts consider whether interveners should be allowed in a particular case or not on the merits. And another thing that courts do is produce reasoned judgements in which clear findings of fact and law are set out. This is the part of the everyday work of judges in every court around the country. My third cardinal point is the appeal process. An appeal process is well understood and would be available if through the courts.
The court has a very good reputation for efficiency and prompt action in cases that clearly require it, where real urgency is required, the courts respond in a familiar jurisdiction, which does not have to be designed from scratch, and commands as much public confidence as any process that we have in our in our polity in this country. Also, my fourth cardinal point is that courts are familiar with the concept of individual capacity, with hearing and deciding upon expert evidence, and above all, in this context of dealing with allegations of due undue influence.
The greatest worry I have about this new jurisdiction is that undue influence, often financially motivated, may feature heavily in some cases. There is some evidence, for example, from Canada, that that has been a real issue in a significant number of cases, rooting out undue influence after the event offers absolutely nothing in this jurisdiction, because the individual whose life is being discussed will already be dead. The experience of judges all honed in practice, in which, from time to time, they all encounter examples of the most egregious and devious behaviour, together with the forensic nature of the court process, promise a reasonable prospect of fair and proper decision making.
And it may be of interest to note that yesterday we welcomed into our house a new member, Lord John, who has spent his legal practice dealing with just that issue of undue influence as a distinguished probate lawyer. Just an example of the way in which lawyers and the courts deal with these issues. In addition, of course, my Lords, the recruitment of judges is statutory, well tested and very successful. The recruitment process suggested for the panels has none of those known qualities.
Qualities, indeed is an unknown quantity. My Lords, I promise your Lordships that I do not move these amendments in a way that is intended to undermine the Bill. My aim is based on the presumption that a bill of this kind will be passed. My amendments are intended to make it safe and ask. Preparation, I know, is shared by the noble and learned Lord, Lord Falconer. Confidence in his proposals would greatly be increased by his acceptance. Acceptance of the principles behind
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these amendments. Well done.
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Move his amendment. Most grateful. I beg to move. Amendment. Proposed. Clause one,
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Amendment. Proposed. Clause one, page one. Line 12. At end. Insert the words as printed on the Marshalled List. My Lords Lord Marshalled List. My Lords Lord Shinkwin is taking part remotely. I invite Lord Shinkwin to speak.
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invite Lord Shinkwin to speak. My votes. I rise to speak to amendment 120 and the amendments
10:27
Lord Shinkwin (Conservative)
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Lord Shinkwin (Conservative)
consequential to it. I shall explain that at the outset that my explain that at the outset that my remarks today incorporate the concerns of my noble friend Lord concerns of my noble friend Lord Farmer, who regrets that he is unable to be in the house. We're unable to be in the house. We're both worried, as I know, are many other noble Lords, about talent, other noble Lords, about talent, capacity and other pressures on the family. Courts were particularly concerned that the effect of these amendments would be to increase capacity pressures still further by placing decision making and sign off for applications for assisted dying orders into the Family Division of the High Court.
And the noble Lord Lord Carlile mentioned safety. Notwithstanding his reference to 40 plus circuit judges and a cohort of recorders, I fear that what is before us is a recipe for overwhelming a system which already shows grave signs of being overloaded. Noble Lords will know that for some considerable time. My noble friend Lord Farmer has been pressing this and previous governments to cite early legal advice and support. When families separate in family hubs to ease pressure precisely because of existing capacity issues.
Moreover, the National Audit Office recently said of the family justice system and I quote, the government does not have an overall assessment of the main drivers of delays or the capacity required to manage the system efficiently and reduce delay. The MoJ, DfE and others have carried out several reviews to identify causes of delay in family justice, identifying more than 25 different contributing factors. Most of the reviews could not quantify the scale and impact of each issue on overall performance, or the resources required to deal with these causes efficiently.
Due to data limitations and quote. Given this, my liberal friends and I don't really understand how placing these new requirements under amendment 120 onto the overall, the already overburdened shoulders of the family judiciary is either helpful, oriented, realistic. Our concern is exacerbated because without access to the government's assessment of the spill's impacts on time on the Family court system, we cannot know for certain. Yet Parliament is being asked to legislate.
Regardless, my Lords, I struggle to see how that is meant to engender faith, either in your Lordships' House or indeed the parliamentary system. Surely this illustrates once again the inappropriateness of the private member's bill for such a complex and momentous piece of legislation. Now, I appreciate it could be argued that only High Court judges therein, or senior circuit judges who are designated family judges, will hear and give direction on assisted suicide cases.
And I note again what the noble Lord Lord Carlile said about circuit judges. For example, anthologies. But even if only these echelons of family judiciary are involved, this would still put immense strain on an overall on an already overloaded system. I understand that projections per annum suggest about 2000 assisted dying cases. In year six. Each case would, we assume, require substantial thought time and judges out of torts attention. So I'd be very interested to hear from the family justice Minister what the government's own position is on this, because previous incumbents with whom my noble friend Lord Farmer has spoken, have emphasised the backlogs and delays which families in very many circumstances, already face.
My Lords, I focus my remarks on the impact of amendment 120 and consequential amendments on the judiciary. But of course, that overlooks the human cost in terms of the impact on families. What about them, my Lords? Assisted dying cases would be very time sensitive. So many hard pressed families would inevitably be pushed further back in the queue, including those with complicated circumstances that also require senior judges expertise. Do we think that that is fair? My friend Lord Farmer had a particular question.
For a noble Lord Lord Carlile, relating to the word may, in subsection two of the new clause proposed an amendment 2120 and how this could be interpreted. This currently says to the president of the court may direct that the application may be heard and directions given by a judge of the Family Division, or by circuit judge, who designated family judge. My friend asked for public bills office. Now the word may could be interpreted because in commercial contracts, which is where his experience lies, may is an ambiguous word implying optionality.
So it's always a red flag for him, and he accepts that in this context, it might simply mean this law would permit. I know that had he been able to be present, he would have wanted to ascertain how it would be interpreted outside of the commercial environment. Because my my Lords, when he asked the public Bills office as to whether it was allowed the precedent a simply to grant the order, apply for circumventing the process outlined in the rest of clause and or b to direct other judges and or C to adjudicate whether the application should be heard or not.
The Public Bills Office was unable to provide advice as to exactly how the courts would interpret this, so my noble friend Lord Farmer would be very grateful if a noble Lord Lord Carlile to explain in his closing remarks, the use of the word may. And I understand that if interpretation needs to be clearer, my noble friend Lord Farmer might consider tabling an amendment to this amendment at report. Although amendment 67, in the name of the noble Baroness Thompson, might at least prevent option A, where the president simply grants law to apply for.
I'm sure I'm not alone in believing that the slightest risk of assisted dying. Actions being nodded through over time has to be strenuously guarded against. Not least given that Sir Nicholas Lord Austin cautions against the High Court's involvement in a previous incarnation of this bill being no more than a symbolic rubber stamp. My Lords, I look forward to hearing from the noble Lord Lord Carlile. And as I said earlier from the family Justice earlier from the family Justice Minister, if she is in her place.
And the noble Lord Lord Carlile mentioned safety. Notwithstanding his reference to 40 plus circuit judges and a cohort of recorders, I fear that what is before us is a recipe for overwhelming a system which already shows grave signs of being overloaded. Noble Lords will know that for some considerable time. My noble friend Lord Farmer has been pressing this and previous governments to cite early legal advice and support. When families separate in family hubs to ease pressure precisely because of existing capacity issues.
Moreover, the National Audit Office recently said of the family justice system and I quote, the government does not have an overall assessment of the main drivers of delays or the capacity required to manage the system efficiently and reduce delay. The MoJ, DfE and others have carried out several reviews to identify causes of delay in family justice, identifying more than 25 different contributing factors. Most of the reviews could not quantify the scale and impact of each issue on overall performance, or the resources required to deal with these causes efficiently.
Due to data limitations and quote. Given this, my liberal friends and I don't really understand how placing these new requirements under amendment 120 onto the overall, the already overburdened shoulders of the family judiciary is either helpful, oriented, realistic. Our concern is exacerbated because without access to the government's assessment of the spill's impacts on time on the Family court system, we cannot know for certain. Yet Parliament is being asked to legislate.
Regardless, my Lords, I struggle to see how that is meant to engender faith, either in your Lordships' House or indeed the parliamentary system. Surely this illustrates once again the inappropriateness of the private member's bill for such a complex and momentous piece of legislation. Now, I appreciate it could be argued that only High Court judges therein, or senior circuit judges who are designated family judges, will hear and give direction on assisted suicide cases.
And I note again what the noble Lord Lord Carlile said about circuit judges. For example, anthologies. But even if only these echelons of family judiciary are involved, this would still put immense strain on an overall on an already overloaded system. I understand that projections per annum suggest about 2000 assisted dying cases. In year six. Each case would, we assume, require substantial thought time and judges out of torts attention. So I'd be very interested to hear from the family justice Minister what the government's own position is on this, because previous incumbents with whom my noble friend Lord Farmer has spoken, have emphasised the backlogs and delays which families in very many circumstances, already face.
My Lords, I focus my remarks on the impact of amendment 120 and consequential amendments on the judiciary. But of course, that overlooks the human cost in terms of the impact on families. What about them, my Lords? Assisted dying cases would be very time sensitive. So many hard pressed families would inevitably be pushed further back in the queue, including those with complicated circumstances that also require senior judges expertise. Do we think that that is fair? My friend Lord Farmer had a particular question.
For a noble Lord Lord Carlile, relating to the word may, in subsection two of the new clause proposed an amendment 2120 and how this could be interpreted. This currently says to the president of the court may direct that the application may be heard and directions given by a judge of the Family Division, or by circuit judge, who designated family judge. My friend asked for public bills office. Now the word may could be interpreted because in commercial contracts, which is where his experience lies, may is an ambiguous word implying optionality.
So it's always a red flag for him, and he accepts that in this context, it might simply mean this law would permit. I know that had he been able to be present, he would have wanted to ascertain how it would be interpreted outside of the commercial environment. Because my my Lords, when he asked the public Bills office as to whether it was allowed the precedent a simply to grant the order, apply for circumventing the process outlined in the rest of clause and or b to direct other judges and or C to adjudicate whether the application should be heard or not.
The Public Bills Office was unable to provide advice as to exactly how the courts would interpret this, so my noble friend Lord Farmer would be very grateful if a noble Lord Lord Carlile to explain in his closing remarks, the use of the word may. And I understand that if interpretation needs to be clearer, my noble friend Lord Farmer might consider tabling an amendment to this amendment at report. Although amendment 67, in the name of the noble Baroness Thompson, might at least prevent option A, where the president simply grants law to apply for.
I'm sure I'm not alone in believing that the slightest risk of assisted dying. Actions being nodded through over time has to be strenuously guarded against. Not least given that Sir Nicholas Lord Austin cautions against the High Court's involvement in a previous incarnation of this bill being no more than a symbolic rubber stamp. My Lords, I look forward to hearing from the noble Lord Lord Carlile. And as I said earlier from the family Justice earlier from the family Justice Minister, if she is in her place.
10:38
Baroness Hollins (Crossbench)
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Baroness Hollins (Crossbench)
I added my name to several of my >> I added my name to several of my noble friend's amendments, and I'd like to congratulate my noble friend for finding a solution which friend for finding a solution which could allow the bill to meet one of the sponsors original aspirations the sponsors original aspirations and the impact of amendments 25 120 are many, and one which may be attractive, of course, to your Lordships House would be that it would considerably shorten the bill, as several clauses would be removed, and as of date debate probably become unnecessary.
However, Bill states that it will allow adults who are terminally ill to request and be provided with assistance to end their own life, and it refers to eligibility for lawful assistance to voluntary end their own life. The office for National. The Oxford Concise Medical Dictionary defines suicide as deliberately causing one's own death, and assisted suicide as the act of helping a patient to commit suicide by giving them the means to do so. And the office for National Statistics similarly defines suicide as deaths resulting from an intentional self-harm for persons age ten and over.
Clause 32 on the criminal liability for providing assistance explicitly. References. The Suicide Act 1961, providing that assistance carried out in accordance with this Bill will be exempt from that acts offence of assisting suicide, and this reinforces that the legislation under consideration is assisted suicide. I am aware that many people would prefer the term assisted dying because of the stigma associated with the term suicide. The bill rather contradicts itself by adopting the term assisted dying while attempting to modify these other statutory provisions concern assisted suicide, and it creates both conceptual and legal ambiguity.
Parliament is being asked to authorise assisted suicide. Then it follows that such decisions fall within the proper domain of the courts, and for that for this reason, among others, I support Lord Farmer amendment replacing the Assisted Dying Review Panel with a court supervised process. Amendment 120 appropriately moves decision making from the medical to the legal sphere. Assisted dying is not a medical treatment. It's an act with profound societal implications and therefore, I suggest, requires judicial rather than clinical oversight.
And for this reason I believe it does not belong in the National Health Service. Under the proposed model, doctors would continue to provide expert medical evidence confirming diagnosis and prognosis, but the final authorisation would rest with the judge. This judicial scrutiny provides a stronger safeguard against errors. It enhances transparency and public confidence in the system by placing responsibility for these irreversible decisions in the courts, where I believe they properly belong, and concerns about capacity in the court. Potential delay or cost do not outweigh the need for robust safeguards when decisions of life and death are involved, the appropriate response is to streamline court processes, not to lower the level of scrutiny and the same issues of capacity, of course, and would to take on a new stream of work would, of course, apply in the NHS.
A judge would provide, I believe, a more independent assessment of an individual application than a panel which is likely to comprise people who've chosen to do this work and have no track record of dealing with issues such as undue influence. It is regrettable that the Other place abandoned judicial oversight in favour of assisted dying. View panel and Commissioner. Thus, I believe, seriously weakening safeguards originally envisaged. The Assisted Dying Review Panel in its current form is not fit for purpose. Its composition does not provide sufficient safeguards for vulnerable individuals, and there is insufficient clarity on how it includes expertise in palliative care, safeguarding and decision making capacity.
A court model would be preferable. Without it, the panel would need to be substantially strengthened. But I also strongly believe that without guaranteed access to a comprehensive, multidisciplinary, specialist assessment of palliative, psychological and social care needs, neither judicial scrutiny nor an expert panel would be able to reliably identify inappropriate requests for an assisted death. These preliminary assessments are the most essential safeguards to ensure that treatable sources of distress or modifiable psychosocial factors are considered before an informed decision can be made, both by the individual concerned and by the decision makers.
My Lords, we will debate specialist multidisciplinary assessments in the next group and I look forward to returning to that. My Lords, I also support the amendments tabled by Lord Carlile, which seek to broaden the scope of safeguards referred to in clause one. At present, the Bill limits these safeguards to sections 8 to 30, which cover only the procedural steps. My noble friend's amendment would extend the safeguard requirements, the whole of the act, ensuring that every substantive provision, not just the procedural elements, must be complied with before assistance to die can be provided.
I also support my noble friend's amendment to strengthen the definition of a terminal illness, and the amendment clarifies that a terminal illness must be an inevitably prevent progressive disease, which cannot be halted. The inclusion of halted is important ensures that eligibility is limited to conditions where the disease trajectory cannot be stabilised or slowed through available interventions.
However, Bill states that it will allow adults who are terminally ill to request and be provided with assistance to end their own life, and it refers to eligibility for lawful assistance to voluntary end their own life. The office for National. The Oxford Concise Medical Dictionary defines suicide as deliberately causing one's own death, and assisted suicide as the act of helping a patient to commit suicide by giving them the means to do so. And the office for National Statistics similarly defines suicide as deaths resulting from an intentional self-harm for persons age ten and over.
Clause 32 on the criminal liability for providing assistance explicitly. References. The Suicide Act 1961, providing that assistance carried out in accordance with this Bill will be exempt from that acts offence of assisting suicide, and this reinforces that the legislation under consideration is assisted suicide. I am aware that many people would prefer the term assisted dying because of the stigma associated with the term suicide. The bill rather contradicts itself by adopting the term assisted dying while attempting to modify these other statutory provisions concern assisted suicide, and it creates both conceptual and legal ambiguity.
Parliament is being asked to authorise assisted suicide. Then it follows that such decisions fall within the proper domain of the courts, and for that for this reason, among others, I support Lord Farmer amendment replacing the Assisted Dying Review Panel with a court supervised process. Amendment 120 appropriately moves decision making from the medical to the legal sphere. Assisted dying is not a medical treatment. It's an act with profound societal implications and therefore, I suggest, requires judicial rather than clinical oversight.
And for this reason I believe it does not belong in the National Health Service. Under the proposed model, doctors would continue to provide expert medical evidence confirming diagnosis and prognosis, but the final authorisation would rest with the judge. This judicial scrutiny provides a stronger safeguard against errors. It enhances transparency and public confidence in the system by placing responsibility for these irreversible decisions in the courts, where I believe they properly belong, and concerns about capacity in the court. Potential delay or cost do not outweigh the need for robust safeguards when decisions of life and death are involved, the appropriate response is to streamline court processes, not to lower the level of scrutiny and the same issues of capacity, of course, and would to take on a new stream of work would, of course, apply in the NHS.
A judge would provide, I believe, a more independent assessment of an individual application than a panel which is likely to comprise people who've chosen to do this work and have no track record of dealing with issues such as undue influence. It is regrettable that the Other place abandoned judicial oversight in favour of assisted dying. View panel and Commissioner. Thus, I believe, seriously weakening safeguards originally envisaged. The Assisted Dying Review Panel in its current form is not fit for purpose. Its composition does not provide sufficient safeguards for vulnerable individuals, and there is insufficient clarity on how it includes expertise in palliative care, safeguarding and decision making capacity.
A court model would be preferable. Without it, the panel would need to be substantially strengthened. But I also strongly believe that without guaranteed access to a comprehensive, multidisciplinary, specialist assessment of palliative, psychological and social care needs, neither judicial scrutiny nor an expert panel would be able to reliably identify inappropriate requests for an assisted death. These preliminary assessments are the most essential safeguards to ensure that treatable sources of distress or modifiable psychosocial factors are considered before an informed decision can be made, both by the individual concerned and by the decision makers.
My Lords, we will debate specialist multidisciplinary assessments in the next group and I look forward to returning to that. My Lords, I also support the amendments tabled by Lord Carlile, which seek to broaden the scope of safeguards referred to in clause one. At present, the Bill limits these safeguards to sections 8 to 30, which cover only the procedural steps. My noble friend's amendment would extend the safeguard requirements, the whole of the act, ensuring that every substantive provision, not just the procedural elements, must be complied with before assistance to die can be provided.
I also support my noble friend's amendment to strengthen the definition of a terminal illness, and the amendment clarifies that a terminal illness must be an inevitably prevent progressive disease, which cannot be halted. The inclusion of halted is important ensures that eligibility is limited to conditions where the disease trajectory cannot be stabilised or slowed through available interventions.
10:44
Baroness Berridge (Conservative)
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Baroness Berridge (Conservative)
I rise to speak briefly to two of the amendments in the group, and of the amendments in the group, and I'm grateful to the noble Lord Lord Carlile for meeting with me in relation to his proposals under relation to his proposals under amendment 120 but also in this group is the amendment of amendment 116, which introduces the capacity test that the noble Lord expects the court to use within that amendment, within the clear and settled intention. Part of that capacity test, there is the introduction of the phrase undue influence or coercion.
Now, my Lords, that is a different test to the rest of the bill, which uses dishonesty, coercion and pressure. So I'm also sure that the noble Lords, as he's outlined, is aware that undue influence in civil law has a particular meaning and is presumed within certain relationships. And in the course of sitting on your Lordship's select committee, I was aware of a series of correspondence between Ministry of Justice Ministers in the other place and Rebecca Paul MP, which raised issues outlining why undue influence is not used in the bill.
So why is this test in amendment 116 not consistent with the rest of the wording in the bill? I'd also be grateful to hear from the noble Lady, the Minister, about whether the government has changed its mind. And my recollection is the reasoning was a it was not necessary to use undue influence. And there was concern about bringing in that concept precisely because of presumed relationships where there is undue influence. And I wait to hear from the noble Lord, Lord Lord John, when he has done his maiden speech.
But I'm also concerned by the removal of the word pressure, because that is significant from the evidence we heard in select committee, particularly for those with terminal illnesses suffering domestic abuse. Pressure, it seems to me, is a lower bar than coercion. And that matter again receives much scrutiny and support. I would say in the Commons, it seems we might be inadvertently, inadvertently lowering the protections within the bill. Pressure and dishonesty as well remain part of the criminal law test in clause 32.
This inconsistency would mean that there's a serious criminal offences which can result in life imprisonment, but they're not part of the test that the High Court would be applying to grant assisted dying. I would be grateful for some clarification on this. A particular is the noble and learned Lord said to the Select Committee, and I quote the offence that is under clause 32 is completed when there is pressure. So conduct that is now irrelevant to the test to apply for assisted dying.
And I would be grateful for the explanation. Also, I'd be grateful to know from the noble Lord Lord Carlile has this capacity test been consulted on? Has the noble Lord spoken to the Royal College of Psychiatrists or Alex KC of the clad group with expertise in mental capacity law? How does that test as well sit with the mental capacity law which survives the clause? Stamp parts? There are 16 of them that are affected. How do they now sit together? I'm very pleased to see that amendment 116D in the clear and settled intention mentions the court requiring evidence of living conditions, palliative care and social care.
But could the noble Lord outline what remedies is he intending that the Family Court should have here? Is he envisaging that you'll be able to order a local authority or an NHS trust to provide such care when you assess that evidence? Possibly adjourning the application to allow this to happen. Perhaps he could update the House as to whether the courts are would be happy with that kind of remedy, as I do believe they are unsure. They are reluctant of remedies, of compelling the spending of public money like this.
But moving on to amendment 120, this is the third version we now have in relation to a foundational issue in the bill, who will determine applications for assisted dying for for noble Lords to be faced with this kind of change? I'm sorry, I'm not surprised because of the lack of pre-legislative work on the bill, but it's important to note that the impact assessment that your Lordships' House has has been prepared on the basis of the panel, your Lordship Select Committee took evidence on the basis of a panel, not on a judicial route.
We would have chosen, obviously, and asked different witnesses to come. My Lords, due to separation of powers in my over nearly 15 years in your Lordships House, I have been been continually bemused by the difficulty to obtain the views of the judiciary, which is precisely what we need here, it seems. What happens seems to me what happens is that retired members of the judiciary write articles in the media that one suspects, might be the views of the current judiciary. Sir James Munby, retired president of the Family Division, has written numerous articles over the last couple of years on why this is not a judicial function and about judicial capacity, which I believe were persuasive.
In the other place, noble Lords, when considering such a fundamental change against this bill, are now without his wisdom, as sadly, he died suddenly on New Year's Day. And I regret that your Lordships House never had the benefit of his wisdom, as I believe you can never have too many retired presidents of the Family Division in your Lordships' House noble Lords. The noble Lord says, though, that the designated family judges have ample judicial time. But I do hope the noble Lady, the Minister or the noble Lord has met with the current president of the of the Family Division to give us evidence to that effect.
On Friday, the 19th of December, the Lady Chief Justice gave her first formal interview in the Times newspaper. Judicial morale is, quote, fragile and reminded the journalist, quote, these are real people. Where is the evidence that there is spare judicial time in the family court to hear between just over 500 or just over 2000 applications, as per the impact assessment? Some will be straightforward, but many will not be due to the lack of scrutiny of the process. I do need to ask the noble Lord and the noble Lady, the Minister, some questions about involving the designated family judges.
As I understand it, that's the phrase because we're not quite sure what the judicial situation is. The cases of life and death decisions in the High Court are only done by full time High Court judges. There are, I understand, three grades of High Court judge. These decisions are made by the Court of Protection. I'm looking to the noble Lady. Lady Butler-sloss. It's only the top grade of those in the Court of Protection who do switching off life support machines and the Charlie Gard type situation.
Life and death decisions are not currently done, as I understand it, by section nine for Deputy High Court judges or as I understand it, by designated family judges with what's called a section 91 ticket, is there going to be additional budget to pay designated family judges when they sit as deputy High court judges to do these cases currently are not paid for that. There may be further implications for the Ministry of Justice budget, because if you pay those judges to do section 91, in this scenario, they'll want it for all of the work they do as section 91.
The impact assessment, as I say, is done on the basis of the costs of the panel. But moving, I would say more importantly, on from the finances of judges, the system is at capacity, as I understand it, designated family judges lists are full and they are full of the most serious and difficult and horrid care cases. That is, as I understand it, the daily diet of a designated family judge. So not only is the system at capacity, but what about the individual capacity of each judge emotionally and psychologically in relation to now giving them an extra caseload? So I do hope that the noble Lord or the noble Lady, the Minister will arrange.
I believe this is the form of meeting Her Majesty's Courts and Tribunals Service with the Ministry of Justice and the president of the Family Division to discuss this this matter. I was really pleased to see the enthusiasm that the noble Lord Lord Carlile had for potentially discovering extra judicial time, but I believe that assertion needs investigating. As the Lady Chief Justice has said, these are real people. Finally, removing 16 clauses from a bill which is about 30% of the bill makes this in, in my view, potentially a new bill if it were not so serious.
My Lords, I now feel it's like saving a PDF, PDF, version one, version two, and version three. We are continually reassured that the bill in the form it came to your Lordships' House by the sponsor in the other place, had the strictest safeguards in the world. But now we are making a fundamental change at to to the Bill.
Now, my Lords, that is a different test to the rest of the bill, which uses dishonesty, coercion and pressure. So I'm also sure that the noble Lords, as he's outlined, is aware that undue influence in civil law has a particular meaning and is presumed within certain relationships. And in the course of sitting on your Lordship's select committee, I was aware of a series of correspondence between Ministry of Justice Ministers in the other place and Rebecca Paul MP, which raised issues outlining why undue influence is not used in the bill.
So why is this test in amendment 116 not consistent with the rest of the wording in the bill? I'd also be grateful to hear from the noble Lady, the Minister, about whether the government has changed its mind. And my recollection is the reasoning was a it was not necessary to use undue influence. And there was concern about bringing in that concept precisely because of presumed relationships where there is undue influence. And I wait to hear from the noble Lord, Lord Lord John, when he has done his maiden speech.
But I'm also concerned by the removal of the word pressure, because that is significant from the evidence we heard in select committee, particularly for those with terminal illnesses suffering domestic abuse. Pressure, it seems to me, is a lower bar than coercion. And that matter again receives much scrutiny and support. I would say in the Commons, it seems we might be inadvertently, inadvertently lowering the protections within the bill. Pressure and dishonesty as well remain part of the criminal law test in clause 32.
This inconsistency would mean that there's a serious criminal offences which can result in life imprisonment, but they're not part of the test that the High Court would be applying to grant assisted dying. I would be grateful for some clarification on this. A particular is the noble and learned Lord said to the Select Committee, and I quote the offence that is under clause 32 is completed when there is pressure. So conduct that is now irrelevant to the test to apply for assisted dying.
And I would be grateful for the explanation. Also, I'd be grateful to know from the noble Lord Lord Carlile has this capacity test been consulted on? Has the noble Lord spoken to the Royal College of Psychiatrists or Alex KC of the clad group with expertise in mental capacity law? How does that test as well sit with the mental capacity law which survives the clause? Stamp parts? There are 16 of them that are affected. How do they now sit together? I'm very pleased to see that amendment 116D in the clear and settled intention mentions the court requiring evidence of living conditions, palliative care and social care.
But could the noble Lord outline what remedies is he intending that the Family Court should have here? Is he envisaging that you'll be able to order a local authority or an NHS trust to provide such care when you assess that evidence? Possibly adjourning the application to allow this to happen. Perhaps he could update the House as to whether the courts are would be happy with that kind of remedy, as I do believe they are unsure. They are reluctant of remedies, of compelling the spending of public money like this.
But moving on to amendment 120, this is the third version we now have in relation to a foundational issue in the bill, who will determine applications for assisted dying for for noble Lords to be faced with this kind of change? I'm sorry, I'm not surprised because of the lack of pre-legislative work on the bill, but it's important to note that the impact assessment that your Lordships' House has has been prepared on the basis of the panel, your Lordship Select Committee took evidence on the basis of a panel, not on a judicial route.
We would have chosen, obviously, and asked different witnesses to come. My Lords, due to separation of powers in my over nearly 15 years in your Lordships House, I have been been continually bemused by the difficulty to obtain the views of the judiciary, which is precisely what we need here, it seems. What happens seems to me what happens is that retired members of the judiciary write articles in the media that one suspects, might be the views of the current judiciary. Sir James Munby, retired president of the Family Division, has written numerous articles over the last couple of years on why this is not a judicial function and about judicial capacity, which I believe were persuasive.
In the other place, noble Lords, when considering such a fundamental change against this bill, are now without his wisdom, as sadly, he died suddenly on New Year's Day. And I regret that your Lordships House never had the benefit of his wisdom, as I believe you can never have too many retired presidents of the Family Division in your Lordships' House noble Lords. The noble Lord says, though, that the designated family judges have ample judicial time. But I do hope the noble Lady, the Minister or the noble Lord has met with the current president of the of the Family Division to give us evidence to that effect.
On Friday, the 19th of December, the Lady Chief Justice gave her first formal interview in the Times newspaper. Judicial morale is, quote, fragile and reminded the journalist, quote, these are real people. Where is the evidence that there is spare judicial time in the family court to hear between just over 500 or just over 2000 applications, as per the impact assessment? Some will be straightforward, but many will not be due to the lack of scrutiny of the process. I do need to ask the noble Lord and the noble Lady, the Minister, some questions about involving the designated family judges.
As I understand it, that's the phrase because we're not quite sure what the judicial situation is. The cases of life and death decisions in the High Court are only done by full time High Court judges. There are, I understand, three grades of High Court judge. These decisions are made by the Court of Protection. I'm looking to the noble Lady. Lady Butler-sloss. It's only the top grade of those in the Court of Protection who do switching off life support machines and the Charlie Gard type situation.
Life and death decisions are not currently done, as I understand it, by section nine for Deputy High Court judges or as I understand it, by designated family judges with what's called a section 91 ticket, is there going to be additional budget to pay designated family judges when they sit as deputy High court judges to do these cases currently are not paid for that. There may be further implications for the Ministry of Justice budget, because if you pay those judges to do section 91, in this scenario, they'll want it for all of the work they do as section 91.
The impact assessment, as I say, is done on the basis of the costs of the panel. But moving, I would say more importantly, on from the finances of judges, the system is at capacity, as I understand it, designated family judges lists are full and they are full of the most serious and difficult and horrid care cases. That is, as I understand it, the daily diet of a designated family judge. So not only is the system at capacity, but what about the individual capacity of each judge emotionally and psychologically in relation to now giving them an extra caseload? So I do hope that the noble Lord or the noble Lady, the Minister will arrange.
I believe this is the form of meeting Her Majesty's Courts and Tribunals Service with the Ministry of Justice and the president of the Family Division to discuss this this matter. I was really pleased to see the enthusiasm that the noble Lord Lord Carlile had for potentially discovering extra judicial time, but I believe that assertion needs investigating. As the Lady Chief Justice has said, these are real people. Finally, removing 16 clauses from a bill which is about 30% of the bill makes this in, in my view, potentially a new bill if it were not so serious.
My Lords, I now feel it's like saving a PDF, PDF, version one, version two, and version three. We are continually reassured that the bill in the form it came to your Lordships' House by the sponsor in the other place, had the strictest safeguards in the world. But now we are making a fundamental change at to to the Bill.
10:53
Lord Pannick (Crossbench)
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Lord Pannick (Crossbench)
A very powerful case, if I may >> A very powerful case, if I may say so, for judicial control to provide the independent scrutiny, provide the independent scrutiny, which we all agree is required in some form to ensure that the criteria of the bill are satisfied in individual cases. But can I offer a contrasting view? Because although I have the greatest of admiration for His Majesty's judges, some of my best friends are judges. I. I do not think that judges are the only people, or indeed the best people alone, to decide the grave issues which we all agree are raised by this bill.
And it is, I think, in response to Lord Carl, necessary just to bear in mind, the Committee should bear in mind what the Bill actually provides and what it provides, and it set out in schedule two that before anyone is able to take advantage of the provisions of this bill, they have to satisfy the panel that the criteria in the bill are met and who is on the panel. It's not simply a judge, it's a panel of three people who have a range of expertise that, in my view, is highly desirable.
In this sensitive context. You need, first of all, a legal member. And it's right that there should be a legal member because some of the issues are very much legal issues, and judges do have particular expertise, and the legal member must either hold or have held high judicial office. Judge of the Supreme Court, Court of Appeal, judge or Deputy Judge of the High Court, or be one of His Majesty's Counsel, or been requested to act as a judge of the Court of Appeal or the High Court.
So you need a legal member, but you also have on this panel someone who is a psychiatrist member. And that's highly desirable in this sensitive context. You have someone who is a registered medical practitioner and a practising psychiatrist, and is registered in one of the psychiatrist's specialisms in the specialist register. So you have that person sitting alongside the legal member, and then also you have someone who's registered as a social worker to add their perspective on the difficult issues, and they are difficult issues raised by eligibility under this bill.
So you've got three people, you've got a range of expertise, and the schedule two provides it's paragraph.
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I'm interested in his view of the panel and I appreciate his discussing schedule two. But there are parts of this bill where it are parts of this bill where it doesn't need a unanimous decision of that panel. So it's quite possible the person from the
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possible the person from the medical person could be overruled by the others. That's not my understanding. Great respect, because as the next Great respect, because as the next point, I was going to make, if you look at schedule two, paragraph look at schedule two, paragraph five, subparagraph three, it answers, I think the very point that the noble Baroness Baroness Coffey just just raised, because what paragraph five, subparagraph three says is the panel is to be treated as having decided to refuse to grant a certificate of eligibility if any member, any member A votes against a decision to grant such a certificate, or b abstains from voting on such a decision.
So my understanding, the noble and learned Lord, Lord Falconer, will say if I'm wrong. But my understanding is that with great respect to the noble Lady, she's wrong. You need the unanimous view of all three members of this panel before the provisions of this
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noble. Lord, allow a little bit further in committee. In the select in committee. In the select committee, it was actually the evidence by witnesses that it should not be allowed, that should not be allowed, that somebody could simply abstain, that if these people are being appointed as professionals to these panels,
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they should express a view. At the moment, expressing no view is deemed to be in favour. I'm sorry.
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I'm sorry. The noble Baroness has not listened to what has not read. I say this with the greatest respect. She's not listened. She's not read what is in the bill. Because if any of the three abstains and I agree highly undesirable, they should. But if they are unwise enough to abstain, they're not satisfied that the case is made out, eligibility is not satisfied, and therefore the person concerned cannot take advantage of the provisions of this bill.
Again, if Lord Faulkner noble and learned Lord thinks I've misunderstood this, he will say so. But he's he's nodding. So the noble Baroness really needs to read the bill. assessment.
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And your your concern will be addressed. Then we need to look at paragraph eight of schedule two, because paragraph eight tells the Commissioner that he or she may Commissioner that he or she may give guidance about practice and procedure. And I would be very surprised indeed if the practice surprised indeed if the practice and procedure does not allow for interested parties to be heard. I'd interested parties to be heard. I'd be very surprised indeed if the practice and procedure does not provide another of Lord Carlile's points for documents to be requested if they're not requested.
If a person does not supply relevant documents, then I would imagine I would expect that the panel will not be satisfied. One of the three members will not be
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satisfied. Then. Paragraph nine panels. I'm very grateful to the noble Lord. If you just looks again at schedule two, paragraph five, it may be that there's a wholesale may be that there's a wholesale ambiguity, but paragraph two says decisions of the panel may be taken by a majority vote, but this is subject to subparagraph three, which is read out. Do those two
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which is read out. Do those two paragraphs contradict one another? No they don't, because the majority vote does not apply to the question of whether a certificate of eligibility applies. There may be a majority vote on other issues, for example, whether to have a hearing, whether or not to require documents, something of that sort. But on the fundamental issue, noble Lords shaking his head. But that's what it says. A majority vote is not permitted on the crucial core issue of whether a certificate of eligibility is required.
Paragraph nine addresses another of the noble Lord, Lord Carlile's concerns because it says paragraph nine one panels must, I emphasise, must give reasons in writing for their decision. Finally, it is not irrelevant. And these were points I thought very powerfully made, if I may say so, by the noble Lady Baroness Berridge. It's not irrelevant that our courts, our courts, are currently massively overburdened. Of course, judges do their best to hear urgent cases as speedily as they can, but delays are a serious problem in our court system.
The Minister no doubt will have something to say about this. And when the committee considers what is the best, most effective, most efficient way to address the real issues of independent assessment, it is important, is it not, to bear in mind that these provisions, this bill, the legislation, will only apply to those with six months or less to live and to have a system that builds in delays is going to damage the whole purpose of this bill.
And it is, I think, in response to Lord Carl, necessary just to bear in mind, the Committee should bear in mind what the Bill actually provides and what it provides, and it set out in schedule two that before anyone is able to take advantage of the provisions of this bill, they have to satisfy the panel that the criteria in the bill are met and who is on the panel. It's not simply a judge, it's a panel of three people who have a range of expertise that, in my view, is highly desirable.
In this sensitive context. You need, first of all, a legal member. And it's right that there should be a legal member because some of the issues are very much legal issues, and judges do have particular expertise, and the legal member must either hold or have held high judicial office. Judge of the Supreme Court, Court of Appeal, judge or Deputy Judge of the High Court, or be one of His Majesty's Counsel, or been requested to act as a judge of the Court of Appeal or the High Court.
So you need a legal member, but you also have on this panel someone who is a psychiatrist member. And that's highly desirable in this sensitive context. You have someone who is a registered medical practitioner and a practising psychiatrist, and is registered in one of the psychiatrist's specialisms in the specialist register. So you have that person sitting alongside the legal member, and then also you have someone who's registered as a social worker to add their perspective on the difficult issues, and they are difficult issues raised by eligibility under this bill.
So you've got three people, you've got a range of expertise, and the schedule two provides it's paragraph.
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I'm interested in his view of the panel and I appreciate his discussing schedule two. But there are parts of this bill where it are parts of this bill where it doesn't need a unanimous decision of that panel. So it's quite possible the person from the
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possible the person from the medical person could be overruled by the others. That's not my understanding. Great respect, because as the next Great respect, because as the next point, I was going to make, if you look at schedule two, paragraph look at schedule two, paragraph five, subparagraph three, it answers, I think the very point that the noble Baroness Baroness Coffey just just raised, because what paragraph five, subparagraph three says is the panel is to be treated as having decided to refuse to grant a certificate of eligibility if any member, any member A votes against a decision to grant such a certificate, or b abstains from voting on such a decision.
So my understanding, the noble and learned Lord, Lord Falconer, will say if I'm wrong. But my understanding is that with great respect to the noble Lady, she's wrong. You need the unanimous view of all three members of this panel before the provisions of this
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noble. Lord, allow a little bit further in committee. In the select in committee. In the select committee, it was actually the evidence by witnesses that it should not be allowed, that should not be allowed, that somebody could simply abstain, that if these people are being appointed as professionals to these panels,
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they should express a view. At the moment, expressing no view is deemed to be in favour. I'm sorry.
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I'm sorry. The noble Baroness has not listened to what has not read. I say this with the greatest respect. She's not listened. She's not read what is in the bill. Because if any of the three abstains and I agree highly undesirable, they should. But if they are unwise enough to abstain, they're not satisfied that the case is made out, eligibility is not satisfied, and therefore the person concerned cannot take advantage of the provisions of this bill.
Again, if Lord Faulkner noble and learned Lord thinks I've misunderstood this, he will say so. But he's he's nodding. So the noble Baroness really needs to read the bill. assessment.
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And your your concern will be addressed. Then we need to look at paragraph eight of schedule two, because paragraph eight tells the Commissioner that he or she may Commissioner that he or she may give guidance about practice and procedure. And I would be very surprised indeed if the practice surprised indeed if the practice and procedure does not allow for interested parties to be heard. I'd interested parties to be heard. I'd be very surprised indeed if the practice and procedure does not provide another of Lord Carlile's points for documents to be requested if they're not requested.
If a person does not supply relevant documents, then I would imagine I would expect that the panel will not be satisfied. One of the three members will not be
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satisfied. Then. Paragraph nine panels. I'm very grateful to the noble Lord. If you just looks again at schedule two, paragraph five, it may be that there's a wholesale may be that there's a wholesale ambiguity, but paragraph two says decisions of the panel may be taken by a majority vote, but this is subject to subparagraph three, which is read out. Do those two
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which is read out. Do those two paragraphs contradict one another? No they don't, because the majority vote does not apply to the question of whether a certificate of eligibility applies. There may be a majority vote on other issues, for example, whether to have a hearing, whether or not to require documents, something of that sort. But on the fundamental issue, noble Lords shaking his head. But that's what it says. A majority vote is not permitted on the crucial core issue of whether a certificate of eligibility is required.
Paragraph nine addresses another of the noble Lord, Lord Carlile's concerns because it says paragraph nine one panels must, I emphasise, must give reasons in writing for their decision. Finally, it is not irrelevant. And these were points I thought very powerfully made, if I may say so, by the noble Lady Baroness Berridge. It's not irrelevant that our courts, our courts, are currently massively overburdened. Of course, judges do their best to hear urgent cases as speedily as they can, but delays are a serious problem in our court system.
The Minister no doubt will have something to say about this. And when the committee considers what is the best, most effective, most efficient way to address the real issues of independent assessment, it is important, is it not, to bear in mind that these provisions, this bill, the legislation, will only apply to those with six months or less to live and to have a system that builds in delays is going to damage the whole purpose of this bill.
11:02
Lord Harries of Pentregarth (Crossbench)
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Lord Harries of Pentregarth (Crossbench)
I wish to speak to amendments 25 >> I wish to speak to amendments 25 and 120. In the name of the noble Lord Lord Carlile of Berriew, to Lord Lord Carlile of Berriew, to which my name is attached. Amendments which I believe go to the very heart of this bill. I do so because it's vital that if this bill eventually comes into law, the system set up for approving requests for assisted dying should have the trust of the general public.
And what we have to bear in mind is that although people generally trust one another, trust in institutions is now at a record low. Or to put it another way, there is in our society now a deep distrust of official bodies. Having said that, there is one exception the judiciary. Between 70 and 73% of the public trust judges trust them to tell the truth. And that is why we need a court based system. The member and the other place, when she first introduced the bill, argued that having a High Court judge would give the system an extra layer of protection against coercion and pressure and make it the most robust and safest system in the world.
My Lords, she was right in saying that, well, as we know, she changed her mind. And the bill comes to us now in a very different form with panels instead of a judge. And the main reason for the change, of course, was the view that the High Court did not have the capacity to meet another set of demands. Hence the noble Lord, Lord Karl's amendment that requests should be dealt with by the family division. And as he pointed out, although there are only 20 High Court judges in the family edition, there are 40 other designated judges trained to hear serious cases, and with this cohort, there would be enough people available to hear requests for assisted dying.
My Lords, the other reason for having a court based system, which I find persuasive, is that a court has the legal powers to summon witnesses and order documents. Suppose a judge has a concern about financial pressure being involved in some way. He could summon relatives or others involved to help him or her reach a decision. I'm not aware that the proposed panel in the bill, as we now have it, will have a similar power in clause 17 four of the bill determination by panel.
The word may is mentioned eight times. It may call for this or that, but so far I can see it has actually no powers to make people comply. Now we heard a very powerful defence from my friend, the noble Lord panic in favour of the panel system, of course, with his breast and his other people. But I would like to remind him, if I may, that in 2014 the Second Reading of Lord Falconer as assisted dying Bill, the Lord Falconer accepted an amendment from the noble Lord Lord Pannick to add a review of the family division of the High Court.
He pointed out, rightly, that the Family Division deals with very difficult cases, like the bland case, like the separating of the Siamese twins, and he argued that they could deal with very, very difficult cases speedily and in time. And Lord Falconer also told the House that he disagreed with alternative proposals of a panel, a panel at that time being a panel of magistrates, not the kind of panel we have at the moment, he said. Then I think that you need the highest quality judges to decide these issues.
And the times, in its main leader on December the 15th, described the move away from a court based system to a panel as an ill advised about turn. And it was now the noble Lord Lord Shinkwin and also the noble Lord lady. Lady Berridge, of course, pointed out quite rightly, the extra pressure that will be put upon the the Family Court division. But, my Lords, on the assumption that this Bill will go go through it, after all, has been voted on by the by the elected House.
We have to ask ourselves, which is actually safer if it's going to through, is it safer to have a court based system or to have the panel? I believe, my Lords, that given the fact that it is judges who are trusted in society, we should go for a court based system. And I strongly support the noble Lord. Lord Carey use amendments.
And what we have to bear in mind is that although people generally trust one another, trust in institutions is now at a record low. Or to put it another way, there is in our society now a deep distrust of official bodies. Having said that, there is one exception the judiciary. Between 70 and 73% of the public trust judges trust them to tell the truth. And that is why we need a court based system. The member and the other place, when she first introduced the bill, argued that having a High Court judge would give the system an extra layer of protection against coercion and pressure and make it the most robust and safest system in the world.
My Lords, she was right in saying that, well, as we know, she changed her mind. And the bill comes to us now in a very different form with panels instead of a judge. And the main reason for the change, of course, was the view that the High Court did not have the capacity to meet another set of demands. Hence the noble Lord, Lord Karl's amendment that requests should be dealt with by the family division. And as he pointed out, although there are only 20 High Court judges in the family edition, there are 40 other designated judges trained to hear serious cases, and with this cohort, there would be enough people available to hear requests for assisted dying.
My Lords, the other reason for having a court based system, which I find persuasive, is that a court has the legal powers to summon witnesses and order documents. Suppose a judge has a concern about financial pressure being involved in some way. He could summon relatives or others involved to help him or her reach a decision. I'm not aware that the proposed panel in the bill, as we now have it, will have a similar power in clause 17 four of the bill determination by panel.
The word may is mentioned eight times. It may call for this or that, but so far I can see it has actually no powers to make people comply. Now we heard a very powerful defence from my friend, the noble Lord panic in favour of the panel system, of course, with his breast and his other people. But I would like to remind him, if I may, that in 2014 the Second Reading of Lord Falconer as assisted dying Bill, the Lord Falconer accepted an amendment from the noble Lord Lord Pannick to add a review of the family division of the High Court.
He pointed out, rightly, that the Family Division deals with very difficult cases, like the bland case, like the separating of the Siamese twins, and he argued that they could deal with very, very difficult cases speedily and in time. And Lord Falconer also told the House that he disagreed with alternative proposals of a panel, a panel at that time being a panel of magistrates, not the kind of panel we have at the moment, he said. Then I think that you need the highest quality judges to decide these issues.
And the times, in its main leader on December the 15th, described the move away from a court based system to a panel as an ill advised about turn. And it was now the noble Lord Lord Shinkwin and also the noble Lord lady. Lady Berridge, of course, pointed out quite rightly, the extra pressure that will be put upon the the Family Court division. But, my Lords, on the assumption that this Bill will go go through it, after all, has been voted on by the by the elected House.
We have to ask ourselves, which is actually safer if it's going to through, is it safer to have a court based system or to have the panel? I believe, my Lords, that given the fact that it is judges who are trusted in society, we should go for a court based system. And I strongly support the noble Lord. Lord Carey use amendments.
11:06
Baroness Butler-Sloss (Crossbench)
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Baroness Butler-Sloss (Crossbench)
My Lord. >> My Lord. >> I'm the only person in this House who was president of the Family Division. I did actually do the final part of the bland case to allow him to die. I would I very much prefer the idea that we should have a court based decision for the reasons that have already been given, and I'm only rising, really, to answer some of the points made by Lord Shinkwin and also the noble Lady, the Baroness Berridge.
First of all, judges try extremely difficult and emotional cases. I really don't think it's necessary for this House to consider the emotional impact of those cases, because that's our job, and if it's our job, we do it, and then we hope that we can cope with it. And I tried endless life and death cases. I have to tell you, Lordships, that deciding that a baby should die was even worse than deciding that an adult should die. But it has to be done.
Secondly, I think the proposal of the noble Lord Lord Carlile that not only the 20 family division judges should do it, but also Deputy High Court judges and the designated family judges, or indeed there are other judges in the family centres who are equally good with the designated family judge. And it seems to me when I was president, I actually ticketed those judges who were family judges who were suited to try adoption cases. I see no problem in the president of the Family division deciding on those judges.
And indeed silk cases who are acting as section nine deputy High court judges. I see no difficulty in the Family Division president working out who it would be suitable to try these cases, and that would increase the number from the 20 to the part time judges and other judges around the country. That's not the best solution, the best solution of the 20 judges. But the reality is it would be necessary. And may I just make the final point? If Parliament passes this legislation, if Parliament tells the Family division and the other family judges that this is their job and it is to deal with somebody who is likely to die within six months, although we all know how inaccurate the last six months actually is.
But if that is so, the judges will do it, and they will then have to give priority to life and death cases, which they do anyway, and other urgent cases, even if it means that other important cases are kept waiting. So the delays and all the other have to give way to the requirement of Parliament that judges try the cases.
First of all, judges try extremely difficult and emotional cases. I really don't think it's necessary for this House to consider the emotional impact of those cases, because that's our job, and if it's our job, we do it, and then we hope that we can cope with it. And I tried endless life and death cases. I have to tell you, Lordships, that deciding that a baby should die was even worse than deciding that an adult should die. But it has to be done.
Secondly, I think the proposal of the noble Lord Lord Carlile that not only the 20 family division judges should do it, but also Deputy High Court judges and the designated family judges, or indeed there are other judges in the family centres who are equally good with the designated family judge. And it seems to me when I was president, I actually ticketed those judges who were family judges who were suited to try adoption cases. I see no problem in the president of the Family division deciding on those judges.
And indeed silk cases who are acting as section nine deputy High court judges. I see no difficulty in the Family Division president working out who it would be suitable to try these cases, and that would increase the number from the 20 to the part time judges and other judges around the country. That's not the best solution, the best solution of the 20 judges. But the reality is it would be necessary. And may I just make the final point? If Parliament passes this legislation, if Parliament tells the Family division and the other family judges that this is their job and it is to deal with somebody who is likely to die within six months, although we all know how inaccurate the last six months actually is.
But if that is so, the judges will do it, and they will then have to give priority to life and death cases, which they do anyway, and other urgent cases, even if it means that other important cases are kept waiting. So the delays and all the other have to give way to the requirement of Parliament that judges try the cases.
11:09
Lord Garnier (Conservative)
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Lord Garnier (Conservative)
Definitely following the noble and learned Lady with her experience both as a legislator and as a very senior judge. And I'm very pleased that she intervened when she did, because I think her contribution has been most helpful. There is always a difficulty for someone like me who is not a family law practitioner, to draw a distinction between the arguments of the noble Lord. Lord Carlile and I broadly support what he advanced and the analysis of the noble Lord Pannick in his construction of the bill.
As it currently stands. There's merit in both, but what we've got to try and do as a house is to produce a practical solution, irrespective of whether one supports the principle behind the bill or not. If it goes through, it might as well go through in a way that works. Now, it seems to me that one of the advantages of the arguments put forward by the noble Lord Lord Carlile. And I put to one side for the moment the very sensible arguments made by the noble Lord Pannick.
But one of the advantages of the arguments put forward by the noble Lord Carlile is that we will be producing answers through a court of record, and it will create a form of precedent I have. I have a suspicion, I don't know. It may be that the noble and learned Lady will tell me different, but I have a suspicion that there will be, to start with a rush of factually different types of case under this application system. They will, or at least 1 or 2 of the lead cases will be grouped and go to the Court of Appeal, where perhaps the president, with two other highly experienced Lords of Appeal, Lord Justices of Appeal, will set out a rubric, a legal rubric for judges of first instance to deal with.
And it will be interesting if the noble Lord Lord Meston has a moment to hear what he has to say. As an experienced family law circuit judge and from the Court of Appeal, a case or a group of cases will go to the Supreme Court and that will all happen, I suspect, reasonably quickly, within the early part of the life of this enacted bill. And once we've done that, the system will settle and circuit judges, senior circuit judges, family division judges will be able to deal with these cases, difficult as they may be hideous as some of them will be, may well be contentious, as some of them may well be, but we'll be able to deal with them with the permission of Parliament, of course, but with the guidance of the Court of Appeal and the Supreme Court.
So that, I think, is a system to be preferred, because I think the panel system, which the noble Lord Lord Pannick described from the face of the bill, does not necessarily provide that legal authority, albeit that there is a or could be a judge on, on the panel, and it won't have the imprimatur of the Court of Appeal. The Supreme Court, in its in its assessment of what what has happened. I may be wrong about that, but it seems.
**** Possible New Speaker ****
To pick up on what the noble Lord Garnier has just said. He's absolutely right. I just wanted to absolutely right. I just wanted to say in the bland case, that was exactly what happened. This was a permanent vegetative state. No one permanent vegetative state. No one had ever had that case come before the courts. A High Court judge dealt with it. I was in the Court dealt with it. I was in the Court of Appeal where we approved it. The Supreme Court, then the Judicial Committee approved it.
I then tried the first case, and then it was understood by other judges how it should be dealt with. So Lord Garnier is absolutely right.
**** Possible New Speaker ****
I'm very grateful to the noble and learned Lady for her. A and learned Lady for her. A provision of Roger said one final point. If there is a distinct if there is a lack of High Court judges in the family, we're told there are 20 and there are 40 there are 20 and there are 40 circuit judges who specialise in family work. There was a time, and it may well be that when the Nolan lady was either in the Court of Appeal or in the Supreme Court, that a commercial judge from the Queen's Bench Division was appointed as the president of the court of the Family Division.
There are plenty of very, very bright and capable judges in the other divisions who, if required, could apply themselves to these sorts of cases. So I don't think we're going to be short of personnel. What we are short of is a decision of this House to agree with the noble Lord, Lord Karl, or something like that. And it may well be that noble and learned Lord, Lord Faulkner will come up with a way of dealing with the gap between him and the noble Lord Lord Carlile as one of these ten thematic discussions, so that we get a workable, just and respected, publicly respected system, which, if we are to have a bill, allows the public to feel confident that the system will work properly.
Very good.
As it currently stands. There's merit in both, but what we've got to try and do as a house is to produce a practical solution, irrespective of whether one supports the principle behind the bill or not. If it goes through, it might as well go through in a way that works. Now, it seems to me that one of the advantages of the arguments put forward by the noble Lord Lord Carlile. And I put to one side for the moment the very sensible arguments made by the noble Lord Pannick.
But one of the advantages of the arguments put forward by the noble Lord Carlile is that we will be producing answers through a court of record, and it will create a form of precedent I have. I have a suspicion, I don't know. It may be that the noble and learned Lady will tell me different, but I have a suspicion that there will be, to start with a rush of factually different types of case under this application system. They will, or at least 1 or 2 of the lead cases will be grouped and go to the Court of Appeal, where perhaps the president, with two other highly experienced Lords of Appeal, Lord Justices of Appeal, will set out a rubric, a legal rubric for judges of first instance to deal with.
And it will be interesting if the noble Lord Lord Meston has a moment to hear what he has to say. As an experienced family law circuit judge and from the Court of Appeal, a case or a group of cases will go to the Supreme Court and that will all happen, I suspect, reasonably quickly, within the early part of the life of this enacted bill. And once we've done that, the system will settle and circuit judges, senior circuit judges, family division judges will be able to deal with these cases, difficult as they may be hideous as some of them will be, may well be contentious, as some of them may well be, but we'll be able to deal with them with the permission of Parliament, of course, but with the guidance of the Court of Appeal and the Supreme Court.
So that, I think, is a system to be preferred, because I think the panel system, which the noble Lord Lord Pannick described from the face of the bill, does not necessarily provide that legal authority, albeit that there is a or could be a judge on, on the panel, and it won't have the imprimatur of the Court of Appeal. The Supreme Court, in its in its assessment of what what has happened. I may be wrong about that, but it seems.
**** Possible New Speaker ****
To pick up on what the noble Lord Garnier has just said. He's absolutely right. I just wanted to absolutely right. I just wanted to say in the bland case, that was exactly what happened. This was a permanent vegetative state. No one permanent vegetative state. No one had ever had that case come before the courts. A High Court judge dealt with it. I was in the Court dealt with it. I was in the Court of Appeal where we approved it. The Supreme Court, then the Judicial Committee approved it.
I then tried the first case, and then it was understood by other judges how it should be dealt with. So Lord Garnier is absolutely right.
**** Possible New Speaker ****
I'm very grateful to the noble and learned Lady for her. A and learned Lady for her. A provision of Roger said one final point. If there is a distinct if there is a lack of High Court judges in the family, we're told there are 20 and there are 40 there are 20 and there are 40 circuit judges who specialise in family work. There was a time, and it may well be that when the Nolan lady was either in the Court of Appeal or in the Supreme Court, that a commercial judge from the Queen's Bench Division was appointed as the president of the court of the Family Division.
There are plenty of very, very bright and capable judges in the other divisions who, if required, could apply themselves to these sorts of cases. So I don't think we're going to be short of personnel. What we are short of is a decision of this House to agree with the noble Lord, Lord Karl, or something like that. And it may well be that noble and learned Lord, Lord Faulkner will come up with a way of dealing with the gap between him and the noble Lord Lord Carlile as one of these ten thematic discussions, so that we get a workable, just and respected, publicly respected system, which, if we are to have a bill, allows the public to feel confident that the system will work properly.
Very good.
11:15
Baroness O'Loan (Crossbench)
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Baroness O'Loan (Crossbench)
The 79 amendments in this group, as the noble Lord Lord Carlile said, as the noble Lord Lord Carlile said, there was initially provision for judicial management of these cases. Given the magnitude of the risk. The assisted dying panel was substituted as a consequence of the difficulties which were identified. So what is unsatisfactory about the assisted dying panel process and why is change necessary? My Lords, despite Lord Pannick remarks, the bill does not provide for family knowledge or or involvement as of right.
And surely we do not want our people to end up in the position of the woman who heard of her mother's death in Switzerland when she was told the ashes were in the post to her. We do not want families to discover after the event that their child, whom they're trying to support after a diagnosis of a terminal illness, having reached the grand old age of 18, has opted for physician assisted death, leaving them no chance to intervene. Inevitably, there will be major difficulties providing professionals to act as panel members.
My Lords, we know that the lowest level of assisted dying deaths is in Oregon, where it's nearly 1%. But in Canada and the Netherlands, it's around five, nearly 6%. If only 1% of deaths were assisted deaths here, it would be 6000 deaths. And this is the figure referred to by Lord Sir Nicholas Mostyn. Addressing the Public Commons Public Bill Committee. There are only 29,500 social workers in England and Wales, according to the impact assessment. There are quite simply not enough of them to care for and protect children and vulnerable adults now.
So what element of the crucial and challenging work of child and vulnerable adult protection would be sacrificed to support the existence of assisted death panels? This is a very real question, my Lord. The Royal College of Psychiatrists has said consistently that it can't support the bill, and there is a major shortage of registered psychiatrists. And as the noble Lord Lord Pannick and indeed noble Lord Lord Carlile said, the. The bill requires that the members of the the legal member of the panel hold high judicial offices at KC, etc.
but my Lords, there are only 107 High Court judges country currently 20 Family Division judges, 41 designated judges and our cases do seem to be tend do seem to tend to be fairly well occupied. My Lords. Nearly 104,000 children were trapped in family Court backlog over 2023. The average time for dealing with cases involving children. Very, very important cases is 43 weeks, and there are currently thousands of couples and nearly 20,000 children waiting for hearings. Now, given the delays, I do not believe despite the noble and learned Lady Butler-sloss intervention, that that family court judges would be available to act as legal members.
Yet the decisions by the panel required by this bill must be subject to time pressure, because there is that requirement of death within six months. And even if we only allowed three hours a case at the lowest figure of 6000, we'd need 54,000 hours of professional time members. If it was 5%, it would rise to 270,000 hours. How is this to be funded? How are these professionals to be trained, supervised? Managed? What is going to be the cost of the panel members and the administration of the panels? The impact assessment provides no answers to these questions.
Where's the money coming from? It's not coming from savings in care, because most of the palliative care is actually provided by donations by the public. Only 30% funded by the state. So, my Lord, the system now in the bill is simply unsafe. It provides virtually no protection for the weak and vulnerable. It isn't workable. So the very extensive amendments tabled by Lord Carlile and others are complex. I like lady, noble Lady, Lady Hollins. I welcome the introduction of the change in the terminology of of a terminal illness and the change of terminology to lethal drugs, for example.
But the bill's current panel provision would be replaced by this new system. Judges would be able and would be most likely, I think, to appoint a financial and medical adviser in each case, as provided for in amendment 4 to 6 Subclause five, and that would provide additional assurance. My Lords, noble Lord Carlile's Amendment 116 sets out an excellent framework for judicial decision making, includes consideration of six complex reports, including submissions by the applicant, evidence about diagnosis and prognosis of the illness, evidence of a specialist medical practitioner's assessment of a mental condition.
Evidence about living conditions. Evidence about availability of suitable housing and effective palliative care and social care. Evidence of a specialist palliative care practitioner, and evidence of people who are familiar with the applicant's character and personality. My Lords, this is the kind of evidence that would enable proper consideration to be given to this momentous decision to apply to end one's own life with the assistance of the state, a state which has previously devoted all its resources to protecting and saving life. If such proper evidence is to be considered.
In each case in which an assisted death is sought, there would be a requirement for some further 30,000 reports from specialists of various kinds, as well as social work reports on a person's living conditions. Where Lords. Without this type of evidence, there could be no assurance that an applicant actually satisfies every requirement of the bill, that there has been no coercion or undue influence, or that the person has simply lost all hope of anyone helping them to live out their lives in peace and dignity.
There is also a major shortage of specialists in virtually every area of NHS work. So although the system proposed in the amendments in Group one, don't immediately, sir, don't immediately provide a definite route for family friends who fear coercion, etc. and I think that would be required if there were 6000 applications for assisted death a year. And if a judge had to gather and consider all the evidence and reach a conclusion, it would probably take him at least four hours, at least four hours, about 24,000 hours of judicial time required.
My Lords family courts have frequently been described as complex, inefficient and difficult to navigate for families without legal support. The PAC heard concern. The PAC committee heard concerns that court staff, legal advisers and Kafka staff are poorly resourced or trained to support domestic abuse victims and that their needs are not being met by the family justice process. Moreover, my Lords of those courts can't identify and provided for abuse arising in the current context of current cases. How will they identify abuse in cases where a person seeking an assisted death has been subject to coercion or abuse, yet failure to do so may well result in the state dispensing death to someone who is not making an independent, informed decision.
My Lords, there's also a problem about the cost of lawyers. The current fees for the Family Court range from £579 to £200 per solicito per my Lord. You can do the calculations as to what this would cost a family seeking to be represented in the court, and the assumption must be that this is not going to be publicly funded. The PAC recently published a report about access to legal aid. It states that about 24% of the population, often those most in need of legal assistance.
Disabled people or those living in poverty are excluded from the remote access now provided by digital means. My Lords, these matters should have been considered in public consultation. There was none. There should have been an assessment of risk and cost. There was none. If judges make these decisions, we do need more judges. And it is not enough to say that judges will deliver if we tell them to. The reality is, we know from examining and observing the operation of the courts is that cases are delayed.
I believe there are 80,000 cases alone waiting in the criminal justice system for trial rate. Cases are being listed for hearing in 2029. And how do rape victims and other litigants, how are we to care for them when we're also providing this extra urgent need to make determine applications for assisted death? So I think that I would ask the noble Lord, the Minister, how the government proposes to resource. Even the panel's work is the intention to designate other judges who sit loudly in the Crown Court.
A person making an application will have six months to live, so it's going to be urgent in any situation. The noble Lord, Lord Carlile's amendments are necessary and would provide far greater protection. But if the original proposal, which gave very little protection was secret, could not be delivered, it's difficult to envisage how judicial capacity could be found to deliver the service in the timely manner. An impact assessment is urgently needed before your Lordships could rationally make a decision on these cases.
And surely we do not want our people to end up in the position of the woman who heard of her mother's death in Switzerland when she was told the ashes were in the post to her. We do not want families to discover after the event that their child, whom they're trying to support after a diagnosis of a terminal illness, having reached the grand old age of 18, has opted for physician assisted death, leaving them no chance to intervene. Inevitably, there will be major difficulties providing professionals to act as panel members.
My Lords, we know that the lowest level of assisted dying deaths is in Oregon, where it's nearly 1%. But in Canada and the Netherlands, it's around five, nearly 6%. If only 1% of deaths were assisted deaths here, it would be 6000 deaths. And this is the figure referred to by Lord Sir Nicholas Mostyn. Addressing the Public Commons Public Bill Committee. There are only 29,500 social workers in England and Wales, according to the impact assessment. There are quite simply not enough of them to care for and protect children and vulnerable adults now.
So what element of the crucial and challenging work of child and vulnerable adult protection would be sacrificed to support the existence of assisted death panels? This is a very real question, my Lord. The Royal College of Psychiatrists has said consistently that it can't support the bill, and there is a major shortage of registered psychiatrists. And as the noble Lord Lord Pannick and indeed noble Lord Lord Carlile said, the. The bill requires that the members of the the legal member of the panel hold high judicial offices at KC, etc.
but my Lords, there are only 107 High Court judges country currently 20 Family Division judges, 41 designated judges and our cases do seem to be tend do seem to tend to be fairly well occupied. My Lords. Nearly 104,000 children were trapped in family Court backlog over 2023. The average time for dealing with cases involving children. Very, very important cases is 43 weeks, and there are currently thousands of couples and nearly 20,000 children waiting for hearings. Now, given the delays, I do not believe despite the noble and learned Lady Butler-sloss intervention, that that family court judges would be available to act as legal members.
Yet the decisions by the panel required by this bill must be subject to time pressure, because there is that requirement of death within six months. And even if we only allowed three hours a case at the lowest figure of 6000, we'd need 54,000 hours of professional time members. If it was 5%, it would rise to 270,000 hours. How is this to be funded? How are these professionals to be trained, supervised? Managed? What is going to be the cost of the panel members and the administration of the panels? The impact assessment provides no answers to these questions.
Where's the money coming from? It's not coming from savings in care, because most of the palliative care is actually provided by donations by the public. Only 30% funded by the state. So, my Lord, the system now in the bill is simply unsafe. It provides virtually no protection for the weak and vulnerable. It isn't workable. So the very extensive amendments tabled by Lord Carlile and others are complex. I like lady, noble Lady, Lady Hollins. I welcome the introduction of the change in the terminology of of a terminal illness and the change of terminology to lethal drugs, for example.
But the bill's current panel provision would be replaced by this new system. Judges would be able and would be most likely, I think, to appoint a financial and medical adviser in each case, as provided for in amendment 4 to 6 Subclause five, and that would provide additional assurance. My Lords, noble Lord Carlile's Amendment 116 sets out an excellent framework for judicial decision making, includes consideration of six complex reports, including submissions by the applicant, evidence about diagnosis and prognosis of the illness, evidence of a specialist medical practitioner's assessment of a mental condition.
Evidence about living conditions. Evidence about availability of suitable housing and effective palliative care and social care. Evidence of a specialist palliative care practitioner, and evidence of people who are familiar with the applicant's character and personality. My Lords, this is the kind of evidence that would enable proper consideration to be given to this momentous decision to apply to end one's own life with the assistance of the state, a state which has previously devoted all its resources to protecting and saving life. If such proper evidence is to be considered.
In each case in which an assisted death is sought, there would be a requirement for some further 30,000 reports from specialists of various kinds, as well as social work reports on a person's living conditions. Where Lords. Without this type of evidence, there could be no assurance that an applicant actually satisfies every requirement of the bill, that there has been no coercion or undue influence, or that the person has simply lost all hope of anyone helping them to live out their lives in peace and dignity.
There is also a major shortage of specialists in virtually every area of NHS work. So although the system proposed in the amendments in Group one, don't immediately, sir, don't immediately provide a definite route for family friends who fear coercion, etc. and I think that would be required if there were 6000 applications for assisted death a year. And if a judge had to gather and consider all the evidence and reach a conclusion, it would probably take him at least four hours, at least four hours, about 24,000 hours of judicial time required.
My Lords family courts have frequently been described as complex, inefficient and difficult to navigate for families without legal support. The PAC heard concern. The PAC committee heard concerns that court staff, legal advisers and Kafka staff are poorly resourced or trained to support domestic abuse victims and that their needs are not being met by the family justice process. Moreover, my Lords of those courts can't identify and provided for abuse arising in the current context of current cases. How will they identify abuse in cases where a person seeking an assisted death has been subject to coercion or abuse, yet failure to do so may well result in the state dispensing death to someone who is not making an independent, informed decision.
My Lords, there's also a problem about the cost of lawyers. The current fees for the Family Court range from £579 to £200 per solicito per my Lord. You can do the calculations as to what this would cost a family seeking to be represented in the court, and the assumption must be that this is not going to be publicly funded. The PAC recently published a report about access to legal aid. It states that about 24% of the population, often those most in need of legal assistance.
Disabled people or those living in poverty are excluded from the remote access now provided by digital means. My Lords, these matters should have been considered in public consultation. There was none. There should have been an assessment of risk and cost. There was none. If judges make these decisions, we do need more judges. And it is not enough to say that judges will deliver if we tell them to. The reality is, we know from examining and observing the operation of the courts is that cases are delayed.
I believe there are 80,000 cases alone waiting in the criminal justice system for trial rate. Cases are being listed for hearing in 2029. And how do rape victims and other litigants, how are we to care for them when we're also providing this extra urgent need to make determine applications for assisted death? So I think that I would ask the noble Lord, the Minister, how the government proposes to resource. Even the panel's work is the intention to designate other judges who sit loudly in the Crown Court.
A person making an application will have six months to live, so it's going to be urgent in any situation. The noble Lord, Lord Carlile's amendments are necessary and would provide far greater protection. But if the original proposal, which gave very little protection was secret, could not be delivered, it's difficult to envisage how judicial capacity could be found to deliver the service in the timely manner. An impact assessment is urgently needed before your Lordships could rationally make a decision on these cases.
11:25
Lord Markham (Conservative)
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Lord Markham (Conservative)
I mean, if if I may, and I found this debate very helpful because of course we all want the safest processes possible in all of this, and that's clear. What we're all reaching for here is to try and find a way that we think is going to work, and it's boiled down to a certain degree, as is this the best way to do it through a multidisciplinary or through a judge led court process? I think the example that Lord Carlile used in terms of life support actually is quite illustrative here, because when you think about it, life support decisions are made by medical professionals.
And in the vast majority of those cases, they are then going through on the basis of that professional advice. And it's only in, you know, the the really, you know, edge cases or serious cases where there's an appeal process that the family can, can take to the court. And then if you talk about the process that we're having here, we've got a multidisciplinary panel very, very well described by Lord Pannick, which includes a psychiatrist, a social worker and a judge.
So the professionals in this particular manner, who are going to be very well placed to reach a decision in a similar way to life support decisions, which for the most, you know, for for the vast majority of times, I think everyone will be happy is the safest decision and and the right one. But there is then the oversight role of the commissioner, who of course is a judge in this process who, rather like the example of life support case, has got the ability then to oversee and review that case where there may be serious concerns.
So I think the life support example that was given is actually a very, very good one in here, where actually what we're trying to do is adopt a similar process in in the multidisciplinary panel with the oversight of the commissioner. And so it seems to me, in terms of a way forward, it may be for the Lord Faulkner and and Lord Carlile to discuss how those cases can interact. So where, you know, the concern is where the multidisciplinary panel might need the oversight, how that can be triggered and how that can be worked out in terms of the commissioners, because I think we have a framework there which, you know, like life support can get the best of both worlds.
And I think that could prove a constructive way forward.
And in the vast majority of those cases, they are then going through on the basis of that professional advice. And it's only in, you know, the the really, you know, edge cases or serious cases where there's an appeal process that the family can, can take to the court. And then if you talk about the process that we're having here, we've got a multidisciplinary panel very, very well described by Lord Pannick, which includes a psychiatrist, a social worker and a judge.
So the professionals in this particular manner, who are going to be very well placed to reach a decision in a similar way to life support decisions, which for the most, you know, for for the vast majority of times, I think everyone will be happy is the safest decision and and the right one. But there is then the oversight role of the commissioner, who of course is a judge in this process who, rather like the example of life support case, has got the ability then to oversee and review that case where there may be serious concerns.
So I think the life support example that was given is actually a very, very good one in here, where actually what we're trying to do is adopt a similar process in in the multidisciplinary panel with the oversight of the commissioner. And so it seems to me, in terms of a way forward, it may be for the Lord Faulkner and and Lord Carlile to discuss how those cases can interact. So where, you know, the concern is where the multidisciplinary panel might need the oversight, how that can be triggered and how that can be worked out in terms of the commissioners, because I think we have a framework there which, you know, like life support can get the best of both worlds.
And I think that could prove a constructive way forward.
11:27
Baroness Hayter of Kentish Town (Labour)
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Baroness Hayter of Kentish Town (Labour)
If you're. noble Lady Baroness Hodge and I can now get rid of what I was going to say, because Lord Morgan has said most of it. So I've only now, I think three points to add. So thank you. Thank you for that. First of all, I think it's just with the big discussion really, is whether it should be a court or the panel. The reason for the panel, I think, have been put. So I don't need to repeat that. And the only thing I would say is that when this was discussed in the Commons, it was not about the capacity of the courts that made them make the change to a panel, but for the advice they got that this was a much better, holistic and patient focussed way of doing it.
And in fact, it was very much welcomed by the British Association of Social Work and the Association of Palliative Care Social Workers to make sure that bit was added. The only two other points I'd make, therefore, is one is and the mention just now of legal aid really says it all. Surely we do not want this to be an adversarial process. It shouldn't be argued in front of the court that way. And indeed, I want to be very brief, because I'm taking the advice of the noble Lady to be very brief, if I may.
We want this to be a consensus decision and not one that is adversarial, which is why I think the panel is so much better. The other thing is, and my last point is that this is not a life or death issue because these people are dying. We are only discussing when they die, not whether they die. And I do think that that is different from the point of deciding that a baby is going to die who wasn't going to die anyway, or even someone in a permanent vegetative state, I think is the word.
And that is why I really do not agree that the word suicide, rather than assisted dying, is right, because people are dying. And this is the issue of when, not whether they will die.
**** Possible New Speaker ****
But we are actually discussing the possibility of either a panel or a court process, and that the research and reports show that families and individuals have great families and individuals have great difficulty negotiating the family division of the High Court and the family designated judges processes, family designated judges processes, and that legal aid may well be necessary to assist in some of these matters.
**** Possible New Speaker ****
these matters. My my.
And in fact, it was very much welcomed by the British Association of Social Work and the Association of Palliative Care Social Workers to make sure that bit was added. The only two other points I'd make, therefore, is one is and the mention just now of legal aid really says it all. Surely we do not want this to be an adversarial process. It shouldn't be argued in front of the court that way. And indeed, I want to be very brief, because I'm taking the advice of the noble Lady to be very brief, if I may.
We want this to be a consensus decision and not one that is adversarial, which is why I think the panel is so much better. The other thing is, and my last point is that this is not a life or death issue because these people are dying. We are only discussing when they die, not whether they die. And I do think that that is different from the point of deciding that a baby is going to die who wasn't going to die anyway, or even someone in a permanent vegetative state, I think is the word.
And that is why I really do not agree that the word suicide, rather than assisted dying, is right, because people are dying. And this is the issue of when, not whether they will die.
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But we are actually discussing the possibility of either a panel or a court process, and that the research and reports show that families and individuals have great families and individuals have great difficulty negotiating the family division of the High Court and the family designated judges processes, family designated judges processes, and that legal aid may well be necessary to assist in some of these matters.
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these matters. My my.
11:30
Lord Meston (Crossbench)
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Lord Meston (Crossbench)
Lords, as the noble Lord Garnier said, we really have to make a choice between court based decisions and the panel as provided for under the bill in its present form, and there is merit in both. There is a strong case for the use and of the expertise and skills of the family division of the High Court and of designated family judges. And I should officially declare that until quite recently, declare that until quite recently, I was one of them.
The courts are, however, I suggest, with an initial rush of applications, that tends to happen with any significant change in the law, and it is likely to happen in this situation, and it will take some time for the procedures to settle down, whether it is in front of a panel or in front of the court, and what is really required. As the noble Lady Baroness Brady Berridge said, is some realistic assessment of the likely additional workload on the judiciary and on the court system.
The judiciary are, of course, well used to hard work and work under pressure, finding time when it is required, but it should be borne in mind. I suggest that not all these cases will be complex. Not all these cases will be contested, but in fairness to what was said by the noble Lord Lord Shinkwin, I would suggest that there is no question of cases being nodded through or rubber stamped, whether by the court or the panel. Family judges are used to prioritising cases when urgency is required, and they do that underpinned underpinning their decisions by focussed and robust case management.
No Lady Berridge was, of course, white and I would endorse what she said. Judges are real people and I do endorse, therefore, her call for consultation with the current president of the Family Division. I would also suggest that one way through this might be an enhanced role for the independent advocate provided for in clause 22 of the bill, who will assume the role that Guardians have in more conventional family cases, representing the interests of the person, whether it's a child or an adult? At the heart of the litigation? My Lord, I want to briefly.
Draw the implications for Northern Ireland and the conversation around the noble and learned Lord Carlile amendment. Now, clearly, Northern
The courts are, however, I suggest, with an initial rush of applications, that tends to happen with any significant change in the law, and it is likely to happen in this situation, and it will take some time for the procedures to settle down, whether it is in front of a panel or in front of the court, and what is really required. As the noble Lady Baroness Brady Berridge said, is some realistic assessment of the likely additional workload on the judiciary and on the court system.
The judiciary are, of course, well used to hard work and work under pressure, finding time when it is required, but it should be borne in mind. I suggest that not all these cases will be complex. Not all these cases will be contested, but in fairness to what was said by the noble Lord Lord Shinkwin, I would suggest that there is no question of cases being nodded through or rubber stamped, whether by the court or the panel. Family judges are used to prioritising cases when urgency is required, and they do that underpinned underpinning their decisions by focussed and robust case management.
No Lady Berridge was, of course, white and I would endorse what she said. Judges are real people and I do endorse, therefore, her call for consultation with the current president of the Family Division. I would also suggest that one way through this might be an enhanced role for the independent advocate provided for in clause 22 of the bill, who will assume the role that Guardians have in more conventional family cases, representing the interests of the person, whether it's a child or an adult? At the heart of the litigation? My Lord, I want to briefly.
Draw the implications for Northern Ireland and the conversation around the noble and learned Lord Carlile amendment. Now, clearly, Northern
11:33
Lord McCrea of Magherafelt and Cookstown (Democratic Unionist Party)
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Lord McCrea of Magherafelt and Cookstown (Democratic Unionist Party)
Ireland has its own family court system, which, incidentally, has its own issue and backlog. But that its own issue and backlog. But that does not mean that people in Northern Ireland are not entirely unaffected by court decisions. In unaffected by court decisions. In England and Wales each year, the Family Court for England and Wales Family Court for England and Wales hears cases involving parties on both sides of the Irish Sea. Perhaps most notably, applications Perhaps most notably, applications for a child arrangement order where one parent is living in England and the other in Northern Ireland.
In such cases, delays in the English court can result in parents and children in Northern Ireland being left in limbo awaiting decisions with all the anxiety and parental conflict which goes with it. I simply present this as an example of the sort of impacts that ought to have been considered if we want to make any claim to be engaging in serious policy work, no doubt there will even more acute impacts in England and Wales, where the strain on the court will be more direct.
As Catherine Atkinson, MP in the other place, reminded members of the more than and I quote, more than two thirds of care proceedings involving the most vulnerable children in our society cannot be completed within six months. If this is the case at the moment, what can we expect if family court judges are increasingly swamped with suicide assisted suicide cases? Instead? My Lords, the estimates from the former head of the Family Division, Sir James among the, suggested that at least 34 hours of judicial involvement a year will be required for a proposal like this to work, whereas the 20 judges and the family Division of the High Court currently, I believe, only sit for a total of 19,000 hours between them across all cases.
Clearly, this is not something we can ignore, and it is quite apparent that the bulk of the work will fall on circuit judges. Now, in saying this, I want to stress that I am not without sympathy for many of the concerns raised by the noble and learned Lord Lord Carlile, in the words of the Medical Defence Union, the current approach leaves doctors unduly exposed. I quote, making assessments around coercive capacity. And as we have heard a few weeks ago, residents say that they feel unqualified to make as drafted.
In my opinion, the bill is not fit for purpose. But I have to say, I am equally concerned about the prospect of attempting to legislate on the fly, which is what we seem to be doing here. What level of resource would the Family Court proposal require? How many additional circuit judges would be designated family judges? What impact would this have on the principle that ideally, judges should have or should be specialists in the area in which they are engaged? Incidentally, a principle which I believe the noble and learned Lord, Lord Faulkner, has previously supported.
What would be the cost for an already overstretched court system? My Lord, we have been left to. We have been left to do policy in the dark. As a former Lord Chief Justice, Lord Thomas warned in November, no one has grappled with the the the detail of the impact of the legislation on family courts, the legislative hokey cokey on the issue of judicial involvement, which goes back much further than simply this bill, has certainly not helped. It really gives the impression that nobody has worked out how we resolve the dilemma at the heart of this bill, that the necessary level of safeguarding a bill like this would need ultimately renders it unworkable.
I know that, Lord Pannick said today, but this is only in reference to those and applies to those who have six months to live. But no one can categorically state that a person has only six months to live as a Minister for for 50 years in the church, I have known numerous persons that have been told they have only six months to live and they lived years after that. So therefore, to suggest that this is this is only applies to those who have six.
We don't know that they have only six months. We cannot give that assurance. They have only six months to live. Now. In 2012, the Commission on Assisted Dying, chaired by the noble and learned Lord Faulkner, considered several different models for a for approval of assisted assisted suicide. These included a medical decision making model where doctors are solely responsible for decision making, an NGO or volunteer based organisation model as they have in Switzerland or to a certain extent in Oregon.
A tribunal model and a court model with a question posed as to whether the court should be, as in this amendment, a family court or another, like the Court of Protection in 2012 was chair of the commission. The noble and learned Lord firmly backed the medical only model, as his report reads, and I quote, our assessment of the body of evidence overall has convinced us that it is health and social care professionals who have the knowledge, skills and training structures that would be needed to implement a safeguard system to permit assisted dying in the United Kingdom.
Therefore, we do not consider that it would be necessary or desirable to involve a tribunal or other legal body in decision making. But just two years later, during Committee stage of the Assisted Dying Bill, the the noble and learned Lord made an about turn. He said the court model became the silver bullet and he told the House and I quote, I do not think that one can leave it to doctors alone in particular to form two views. First, on whether it is voluntary, clear, settled and informed wish that somebody wishes to end their own life, and secondly, whether they have the capacity.
In fact, he was such a convert that he made clear and not debate that it needed to be the highest. I quote the highest quality judges to decide these issues, and and a role for the family division was added into the bill. Now this position briefly persisted when this bill was introduced with his co-sponsor introduced the bill in the other place, announcing it as the safest in the world due to the High Court element. But then that idea fell apart too, and the tribunal style model combining medical and legal elements was adopted instead on the claim that it would be more robust.
At first I thought that this was the plan all along because dignity in Dying, the real sponsors behind this bill have indicated this as their preferred option to the Commission on Assisted Dying in 2012. But then I read a line in the Commission's report where Dignity in Dying said if there was going to be a tribunal, then you would expect it to be part of the tribunal service. End of, quote, something, of course, the process currently in the bill does not do this.
Flip flopping does not inspire confidence, my Lord, and I certainly think that we should bear this in mind at the noble and learned Lord. Lord Faulkner, indicate shortly that he suddenly once again thinks that the High Court judge is the way to go. My Lord, I think it's incumbent to consider the reason that the High Court judge was scrapped in the Commons. Again, not because I think that that was it was better, but because it raises those questions of workability. When interviewed by the Select Committee, Mr.
Ledbetter. Ledbetter, in the other case, claimed that the removal of the High Court was to ensure a, quote, a more patient centred approach. But I'm not sure this tells the true story, my Lords. In February, The Guardian reported that senior officials in the Ministry of Justice were understood to have significant concerns about the sign off from a High Court judge in the original bill, given lengthy backlogs in the Family Court. Perhaps the Minister would like to confirm these reports as she, as she stands to reply.
To conclude, I think it is important to stress that decisions around amendment 120 is not peripheral, but a central policy consideration that touches the very heart of this bill is this bill about introducing a new so-called treatment option to be principally overseen by the health care professions, like other end of life choices? Or is this bill more about giving the courts extraordinary discretionary power to resolve concerns about the operation of the Suicide Act in extreme cases? It's astonishing that at this late stage in the process, with the bill having passed through the Commons, we have
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still not resolved this important point of principle. I rise.
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I rise. Because I was persuaded by the case made by Lord Carlile. But I case made by Lord Carlile. But I recognise that there are inevitable questions that his case provokes, which have been reflected in the which have been reflected in the debate. And of course, not everyone has been convinced. I am reassured has been convinced. I am reassured in the strength of his case, having spent four and a half years as an education Minister and one and a half years as a justice Minister, with direct responsibility for liaising with the family courts.
And so my respect for those who work in those courts and the judges in those courts is all the greater for it. But as Lord Pannick has pointed out, not everyone believes that judges would be the ideal
In such cases, delays in the English court can result in parents and children in Northern Ireland being left in limbo awaiting decisions with all the anxiety and parental conflict which goes with it. I simply present this as an example of the sort of impacts that ought to have been considered if we want to make any claim to be engaging in serious policy work, no doubt there will even more acute impacts in England and Wales, where the strain on the court will be more direct.
As Catherine Atkinson, MP in the other place, reminded members of the more than and I quote, more than two thirds of care proceedings involving the most vulnerable children in our society cannot be completed within six months. If this is the case at the moment, what can we expect if family court judges are increasingly swamped with suicide assisted suicide cases? Instead? My Lords, the estimates from the former head of the Family Division, Sir James among the, suggested that at least 34 hours of judicial involvement a year will be required for a proposal like this to work, whereas the 20 judges and the family Division of the High Court currently, I believe, only sit for a total of 19,000 hours between them across all cases.
Clearly, this is not something we can ignore, and it is quite apparent that the bulk of the work will fall on circuit judges. Now, in saying this, I want to stress that I am not without sympathy for many of the concerns raised by the noble and learned Lord Lord Carlile, in the words of the Medical Defence Union, the current approach leaves doctors unduly exposed. I quote, making assessments around coercive capacity. And as we have heard a few weeks ago, residents say that they feel unqualified to make as drafted.
In my opinion, the bill is not fit for purpose. But I have to say, I am equally concerned about the prospect of attempting to legislate on the fly, which is what we seem to be doing here. What level of resource would the Family Court proposal require? How many additional circuit judges would be designated family judges? What impact would this have on the principle that ideally, judges should have or should be specialists in the area in which they are engaged? Incidentally, a principle which I believe the noble and learned Lord, Lord Faulkner, has previously supported.
What would be the cost for an already overstretched court system? My Lord, we have been left to. We have been left to do policy in the dark. As a former Lord Chief Justice, Lord Thomas warned in November, no one has grappled with the the the detail of the impact of the legislation on family courts, the legislative hokey cokey on the issue of judicial involvement, which goes back much further than simply this bill, has certainly not helped. It really gives the impression that nobody has worked out how we resolve the dilemma at the heart of this bill, that the necessary level of safeguarding a bill like this would need ultimately renders it unworkable.
I know that, Lord Pannick said today, but this is only in reference to those and applies to those who have six months to live. But no one can categorically state that a person has only six months to live as a Minister for for 50 years in the church, I have known numerous persons that have been told they have only six months to live and they lived years after that. So therefore, to suggest that this is this is only applies to those who have six.
We don't know that they have only six months. We cannot give that assurance. They have only six months to live. Now. In 2012, the Commission on Assisted Dying, chaired by the noble and learned Lord Faulkner, considered several different models for a for approval of assisted assisted suicide. These included a medical decision making model where doctors are solely responsible for decision making, an NGO or volunteer based organisation model as they have in Switzerland or to a certain extent in Oregon.
A tribunal model and a court model with a question posed as to whether the court should be, as in this amendment, a family court or another, like the Court of Protection in 2012 was chair of the commission. The noble and learned Lord firmly backed the medical only model, as his report reads, and I quote, our assessment of the body of evidence overall has convinced us that it is health and social care professionals who have the knowledge, skills and training structures that would be needed to implement a safeguard system to permit assisted dying in the United Kingdom.
Therefore, we do not consider that it would be necessary or desirable to involve a tribunal or other legal body in decision making. But just two years later, during Committee stage of the Assisted Dying Bill, the the noble and learned Lord made an about turn. He said the court model became the silver bullet and he told the House and I quote, I do not think that one can leave it to doctors alone in particular to form two views. First, on whether it is voluntary, clear, settled and informed wish that somebody wishes to end their own life, and secondly, whether they have the capacity.
In fact, he was such a convert that he made clear and not debate that it needed to be the highest. I quote the highest quality judges to decide these issues, and and a role for the family division was added into the bill. Now this position briefly persisted when this bill was introduced with his co-sponsor introduced the bill in the other place, announcing it as the safest in the world due to the High Court element. But then that idea fell apart too, and the tribunal style model combining medical and legal elements was adopted instead on the claim that it would be more robust.
At first I thought that this was the plan all along because dignity in Dying, the real sponsors behind this bill have indicated this as their preferred option to the Commission on Assisted Dying in 2012. But then I read a line in the Commission's report where Dignity in Dying said if there was going to be a tribunal, then you would expect it to be part of the tribunal service. End of, quote, something, of course, the process currently in the bill does not do this.
Flip flopping does not inspire confidence, my Lord, and I certainly think that we should bear this in mind at the noble and learned Lord. Lord Faulkner, indicate shortly that he suddenly once again thinks that the High Court judge is the way to go. My Lord, I think it's incumbent to consider the reason that the High Court judge was scrapped in the Commons. Again, not because I think that that was it was better, but because it raises those questions of workability. When interviewed by the Select Committee, Mr.
Ledbetter. Ledbetter, in the other case, claimed that the removal of the High Court was to ensure a, quote, a more patient centred approach. But I'm not sure this tells the true story, my Lords. In February, The Guardian reported that senior officials in the Ministry of Justice were understood to have significant concerns about the sign off from a High Court judge in the original bill, given lengthy backlogs in the Family Court. Perhaps the Minister would like to confirm these reports as she, as she stands to reply.
To conclude, I think it is important to stress that decisions around amendment 120 is not peripheral, but a central policy consideration that touches the very heart of this bill is this bill about introducing a new so-called treatment option to be principally overseen by the health care professions, like other end of life choices? Or is this bill more about giving the courts extraordinary discretionary power to resolve concerns about the operation of the Suicide Act in extreme cases? It's astonishing that at this late stage in the process, with the bill having passed through the Commons, we have
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still not resolved this important point of principle. I rise.
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I rise. Because I was persuaded by the case made by Lord Carlile. But I case made by Lord Carlile. But I recognise that there are inevitable questions that his case provokes, which have been reflected in the which have been reflected in the debate. And of course, not everyone has been convinced. I am reassured has been convinced. I am reassured in the strength of his case, having spent four and a half years as an education Minister and one and a half years as a justice Minister, with direct responsibility for liaising with the family courts.
And so my respect for those who work in those courts and the judges in those courts is all the greater for it. But as Lord Pannick has pointed out, not everyone believes that judges would be the ideal
11:43
Lord Gove (Conservative)
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Lord Gove (Conservative)
people to make decisions. In this case, I would remind with respect Lord Pannick the case that he made in his wonderful book judges, where he said that so long as men and women continue to wound, cheat and damage each other, there will be a need for judges. Judges do not have need for judges. Judges do not have an easy job, but they repeatedly do what the rest of us don't make decisions. Now, each of us may consider either judges or a panel preferable.
But there is one key question for those who do agree with Lord Pannick in his current incarnation and believe that a panel is preferable, can we know what the promoter of the bill understands by the term legal member? And can we also understand what the government believes the definition of legal member to be?
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What is the threshold, what qualification? There is a detailed. Definition of legal manual and
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Definition of legal manual and para two. Subparagraph two of schedule two. I will look forward to hearing what the government believes the appropriate definition would be and what they understand. That means in terms of the pressure on resources terms of the pressure on resources for the profession. For those of us who are inclined to support Lord who are inclined to support Lord Carlile, which I strongly am, there are other questions that he and his amendments provoke and which have been touched on.
Different points have been made about the strength of the Family Court judiciary. Some have argued that there are 20 other High Court family judges. My understanding is that there are 17. Would the Minister be able to tell us exactly how many High Court judges there are, and the seniority of each? I understand that there are 40 designated family judges outside the High Court. Is that correct? If it is the case that those broad figures are correct, then Lord Carlile amendment would suggest a tripling in the capacity of the judges who are capable of dealing with cases relative to the introduction of the bill before the insertion of a panel.
Is that correct? How many cases do the government anticipate the family courts, if Lord Carlile amendment were passed, would be dealing with Baroness O'Loan suggested 15,000. That is, based on a projection that comes from the promoter of the bill. In the other place, does the government believe that's accurate? If not, why not? The promoter of the bill in the other place suggested that each of those hearings might take about two hours? Is that correct? On what basis was that judgement made by the promoter of the Bill? What is the government's view? If it is the case that family courts take on these new responsibilities, what impact will that have specifically on the progress of special guardianship orders? What progress, what impact will it have on the declining number and the lengthier wait of children for adoption? What impact will it have on children in care and domestic violence cases? The government could assist us all in deciding if Lord Carlile amendment is the right way to go by providing with this information in a timely manner, if not at the despatch box today, certainly before committee concludes, it is, as the Minister will know, a statutory requirement that all public law cases are currently met within 26 weeks.
This is scarcely, if never met, given the ramifications of public law cases, for the effective operation and protection of children in care, can the Minister let us know what the impact will be on that current timeline if Lord Carlile amendment were to go ahead? There are currently 4000 children in public and private law cases, which have been open for longer than 100 weeks. What impact would Lord Carlile's amendment have on that backlog at the moment, as I'm sure noble Lords are aware, there are 1000 new cases every week entering the Family Court, and the length of time to undertake those cases is rising by 36%.
What impact on those numbers would Lord Carlisle's amendment have? Helpfully, the Public Accounts Committee in Another place has issued a recommendation, a recommendation in September of last year that the government, within three months a deadline which has passed, should produce a report on the basis of what the MoJ and the DfE have done in order to improve family justice. Timeliness. Overall, can the Minister tell us or the promoter of the bill tell us what progress has been made? Finally, as the noble Lord Lord McCrea pointed out, there is some debate over the motivation behind the promoter of the bill in another place, choosing to abandon the original approach of asking judges to decide these cases in order to promote a panel.
There are many people, including Lord Pannick, who believe that that is an improvement, but it was reported, as Lord McCrea pointed out, that the promoter of the bill decided to take this step because she had received advice from the government that her initial proposal would place such strain on the court system that the government could not support it. Now, I would ask the Minister at the despatch box either to confirm or deny that report, and if it is the case that the government gave advice to the promoter of the Bill, will that advice be shared with this House so that we can be better informed before we make any decision?
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I thank the noble Lord. Lord Carlile has done us all a great Carlile has done us all a great service. Last night it was clear that there is a view that there must be some really major parts of must be some really major parts of this legislation that need to be addressed and debated. And indeed, addressed and debated. And indeed, this is absolutely one of those major parts. It is about where decision making actually finally sits. He has provided a clarity that could improve the safety in relation to the bill.
I won't say to make it safer, but I think to make it less unsafe and that becomes important. The scheme that he's proposed reinstates a court based model, which had previously been welcomed when the bill was originally introduced and welcomed because of the clarity of decision making that it provided the process of assistance with suicide or having an assisted death. And we're not going to argue about the wording here. Now, that is not appropriate. And the clauses relating to the specifics of the lethal dosage of drugs both make the death part of the process clearer and provide better governance oversight.
The process also seems to provide some protection for NHS services by putting the decision making outside of healthcare with clarity of the roles in between the two. I added my name to the amendment to strengthen the conscience clause 31, so that no registered medical practitioner is under any duty to perform a function in relation to this act, other than those of notification and recording matters. This avoids eroding NHS clinical
But there is one key question for those who do agree with Lord Pannick in his current incarnation and believe that a panel is preferable, can we know what the promoter of the bill understands by the term legal member? And can we also understand what the government believes the definition of legal member to be?
**** Possible New Speaker ****
What is the threshold, what qualification? There is a detailed. Definition of legal manual and
**** Possible New Speaker ****
Definition of legal manual and para two. Subparagraph two of schedule two. I will look forward to hearing what the government believes the appropriate definition would be and what they understand. That means in terms of the pressure on resources terms of the pressure on resources for the profession. For those of us who are inclined to support Lord who are inclined to support Lord Carlile, which I strongly am, there are other questions that he and his amendments provoke and which have been touched on.
Different points have been made about the strength of the Family Court judiciary. Some have argued that there are 20 other High Court family judges. My understanding is that there are 17. Would the Minister be able to tell us exactly how many High Court judges there are, and the seniority of each? I understand that there are 40 designated family judges outside the High Court. Is that correct? If it is the case that those broad figures are correct, then Lord Carlile amendment would suggest a tripling in the capacity of the judges who are capable of dealing with cases relative to the introduction of the bill before the insertion of a panel.
Is that correct? How many cases do the government anticipate the family courts, if Lord Carlile amendment were passed, would be dealing with Baroness O'Loan suggested 15,000. That is, based on a projection that comes from the promoter of the bill. In the other place, does the government believe that's accurate? If not, why not? The promoter of the bill in the other place suggested that each of those hearings might take about two hours? Is that correct? On what basis was that judgement made by the promoter of the Bill? What is the government's view? If it is the case that family courts take on these new responsibilities, what impact will that have specifically on the progress of special guardianship orders? What progress, what impact will it have on the declining number and the lengthier wait of children for adoption? What impact will it have on children in care and domestic violence cases? The government could assist us all in deciding if Lord Carlile amendment is the right way to go by providing with this information in a timely manner, if not at the despatch box today, certainly before committee concludes, it is, as the Minister will know, a statutory requirement that all public law cases are currently met within 26 weeks.
This is scarcely, if never met, given the ramifications of public law cases, for the effective operation and protection of children in care, can the Minister let us know what the impact will be on that current timeline if Lord Carlile amendment were to go ahead? There are currently 4000 children in public and private law cases, which have been open for longer than 100 weeks. What impact would Lord Carlile's amendment have on that backlog at the moment, as I'm sure noble Lords are aware, there are 1000 new cases every week entering the Family Court, and the length of time to undertake those cases is rising by 36%.
What impact on those numbers would Lord Carlisle's amendment have? Helpfully, the Public Accounts Committee in Another place has issued a recommendation, a recommendation in September of last year that the government, within three months a deadline which has passed, should produce a report on the basis of what the MoJ and the DfE have done in order to improve family justice. Timeliness. Overall, can the Minister tell us or the promoter of the bill tell us what progress has been made? Finally, as the noble Lord Lord McCrea pointed out, there is some debate over the motivation behind the promoter of the bill in another place, choosing to abandon the original approach of asking judges to decide these cases in order to promote a panel.
There are many people, including Lord Pannick, who believe that that is an improvement, but it was reported, as Lord McCrea pointed out, that the promoter of the bill decided to take this step because she had received advice from the government that her initial proposal would place such strain on the court system that the government could not support it. Now, I would ask the Minister at the despatch box either to confirm or deny that report, and if it is the case that the government gave advice to the promoter of the Bill, will that advice be shared with this House so that we can be better informed before we make any decision?
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I thank the noble Lord. Lord Carlile has done us all a great Carlile has done us all a great service. Last night it was clear that there is a view that there must be some really major parts of must be some really major parts of this legislation that need to be addressed and debated. And indeed, addressed and debated. And indeed, this is absolutely one of those major parts. It is about where decision making actually finally sits. He has provided a clarity that could improve the safety in relation to the bill.
I won't say to make it safer, but I think to make it less unsafe and that becomes important. The scheme that he's proposed reinstates a court based model, which had previously been welcomed when the bill was originally introduced and welcomed because of the clarity of decision making that it provided the process of assistance with suicide or having an assisted death. And we're not going to argue about the wording here. Now, that is not appropriate. And the clauses relating to the specifics of the lethal dosage of drugs both make the death part of the process clearer and provide better governance oversight.
The process also seems to provide some protection for NHS services by putting the decision making outside of healthcare with clarity of the roles in between the two. I added my name to the amendment to strengthen the conscience clause 31, so that no registered medical practitioner is under any duty to perform a function in relation to this act, other than those of notification and recording matters. This avoids eroding NHS clinical
11:51
Baroness Finlay of Llandaff (Crossbench)
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Baroness Finlay of Llandaff (Crossbench)
services and maintains the core duties and responsibilities of the duties and responsibilities of the NHS. It will be particularly important if legislation is passed in Scotland because we need compatibility about the conscience clause between England and Wales clause between England and Wales and Scotland. The legislation currently going through Scotland will have its draft conscience clause removed at the time that the Scottish Parliament goes to vote on it, because the provision of such a conscience clause is not a devolved matter, and the exercise of conscience not being a devolved matter will require a Statutory Instrument passed when this House, or even possibly primary legislation, in order for it to be then included later in the Scottish legislation.
In amendment 116, part one, the noble Lady Baroness Berridge has raised concerns about the wording, and I wonder if the noble Lord Lord Carlile would consider changing that to incorporate the amendment that I have down over clause three over the assessment of capacity, which was an amendment developed by the Complex Life and Death Decisions group at King's, where the national expert on mental capacity assessments sits as a key member of that group and as a professor at King's College.
I hope the proposals of the Bill will recognise that. Clause 116 two provide very important minimum criteria that must be provided, questions that must be asked when such a decision is to be made, and the court can certainly ask for them to be provided to them. It seems as if a panel would be discretionary over whether or not these criteria were looked at, and it would strengthen confidence in the decision making to know that they were there because it would provide transparency, a consistency and a process of appeal would be available.
And we know no appeal. The system exists. No appeal system exists in the bill as currently written in relation to panels agreeing to an assisted death being provided, and the concern that the real concern that there is that these panels could eventually become somewhat of a tick box exercise under quite a lot of process, because, as has been said before, those with a judicial background are not acting in a judicial capacity on the panels, whereas the proposal by the noble Lord Lord Carlile provides judicial capacity and processes.
The amendment, though which seems to be key, is amendment 120 and in for B, it requires a statement of medical fact, with the decision making being taken by the court again, it will be much easier for people to provide a statement of medical fact than to feel that they are actually taking a decision over the provision or non provision of lethal drugs. In part five a the doctor has to, I hope, has to be on the specialist register and again I'll seek clarification of that for the specific condition of the patient.
All should have been a GP principal for longer than three years, and it's important to be clear that this should not be a doctor who is at a training level, even if they've been a trainee for more than three years, because the ultimate responsibility sits with the consultant or the GP under whom they are training, and there could be confusion over responsibility if this isn't clarified in 126 A, could the noble Lord Lord Carlile confirm that actually it may not be the GP at all that's involved, but it may be a hospital consultant or long term associate specialist who's been providing medical care.
Again, this might seem like minutiae, but we are at Committee stage. We are discussing amendments that can be changed, and I think it will be important to have that clarity. And it seems that amendment 420 65A is providing additional security with a court appointed medical expert. This proposal does seem to protect us against going down the route that Canada seems to have gone down. It does seem to really attempt seriously to detect undue influence, and allowing interveners is very important, which has been all part of the desire for there also to be an appeals process and getting all the information.
I would like for a moment, though, to stress that there is a clarity between decisions about whether somebody is given lethal drugs to significantly shorten their lives. Accepting that a prognosis of six months is actually not much more than a guesstimate. In fact, it is a guesstimate, and the position that's being discussed over life support decisions. When a patient is on life support, the decision to cease that intervention is based on two potential factors the futility of continuing with an intervention which is not achieving a therapeutic goal, or the other one, may be because the patient themselves withdraws their consent in an informed way and has capacity to do that for continuing that intervention.
And that is fundamentally different to somebody providing lethal doses of drugs with a deliberate intention to shorten a person's life, which may be by days, it may be by weeks or months, but it may be by years and has already been said. We all have experience of people given a very short prognosis where that turned out to be completely wrong. So I do have some questions for the noble Lord, Lord Faulkner. I know that he's already been given a large number of questions to answer, but I think it is really important because in 2024, you had stated that family judges are completely unsupported and the family justice system is, I think I can quote correctly, you said was literally crumbling.
And were these the reasons actually behind the removal of the court oversight when the bill was considered in the other place? In discussing these proposals with officials, what assessment has been made of the volume of cases outlined in the impact assessment being handled by the system, and what provision has been made for recognising that the numbers in the impact assessment are almost certainly inappropriately low, because the data from Australia, New Zealand and other places has shown that by year three the uptake will probably be about ten times higher than written in the impact assessment.
Because the impact assessment was based on data, which was actually from quite a long time ago when the Oregon system was instigated. And thirdly, what costing has been undertaken for each of the models the model of the panels has put in with the different numbers that might be involved, and what consideration has been made for a costing over this model. And I ask the noble Lady, the Minister, what budget has been put aside to fund the system? Whichever model is adopted and what option appraisal has been undertaken over the safety of individuals.
The ability to identify coercion with a higher degree of probability than currently exists, and to identify abusive relationships and the financial costs for each model tested against the impact assessment numbers, which, as I've said, appear unrealistically low. I think we all look forward to the questions being answered next.
In amendment 116, part one, the noble Lady Baroness Berridge has raised concerns about the wording, and I wonder if the noble Lord Lord Carlile would consider changing that to incorporate the amendment that I have down over clause three over the assessment of capacity, which was an amendment developed by the Complex Life and Death Decisions group at King's, where the national expert on mental capacity assessments sits as a key member of that group and as a professor at King's College.
I hope the proposals of the Bill will recognise that. Clause 116 two provide very important minimum criteria that must be provided, questions that must be asked when such a decision is to be made, and the court can certainly ask for them to be provided to them. It seems as if a panel would be discretionary over whether or not these criteria were looked at, and it would strengthen confidence in the decision making to know that they were there because it would provide transparency, a consistency and a process of appeal would be available.
And we know no appeal. The system exists. No appeal system exists in the bill as currently written in relation to panels agreeing to an assisted death being provided, and the concern that the real concern that there is that these panels could eventually become somewhat of a tick box exercise under quite a lot of process, because, as has been said before, those with a judicial background are not acting in a judicial capacity on the panels, whereas the proposal by the noble Lord Lord Carlile provides judicial capacity and processes.
The amendment, though which seems to be key, is amendment 120 and in for B, it requires a statement of medical fact, with the decision making being taken by the court again, it will be much easier for people to provide a statement of medical fact than to feel that they are actually taking a decision over the provision or non provision of lethal drugs. In part five a the doctor has to, I hope, has to be on the specialist register and again I'll seek clarification of that for the specific condition of the patient.
All should have been a GP principal for longer than three years, and it's important to be clear that this should not be a doctor who is at a training level, even if they've been a trainee for more than three years, because the ultimate responsibility sits with the consultant or the GP under whom they are training, and there could be confusion over responsibility if this isn't clarified in 126 A, could the noble Lord Lord Carlile confirm that actually it may not be the GP at all that's involved, but it may be a hospital consultant or long term associate specialist who's been providing medical care.
Again, this might seem like minutiae, but we are at Committee stage. We are discussing amendments that can be changed, and I think it will be important to have that clarity. And it seems that amendment 420 65A is providing additional security with a court appointed medical expert. This proposal does seem to protect us against going down the route that Canada seems to have gone down. It does seem to really attempt seriously to detect undue influence, and allowing interveners is very important, which has been all part of the desire for there also to be an appeals process and getting all the information.
I would like for a moment, though, to stress that there is a clarity between decisions about whether somebody is given lethal drugs to significantly shorten their lives. Accepting that a prognosis of six months is actually not much more than a guesstimate. In fact, it is a guesstimate, and the position that's being discussed over life support decisions. When a patient is on life support, the decision to cease that intervention is based on two potential factors the futility of continuing with an intervention which is not achieving a therapeutic goal, or the other one, may be because the patient themselves withdraws their consent in an informed way and has capacity to do that for continuing that intervention.
And that is fundamentally different to somebody providing lethal doses of drugs with a deliberate intention to shorten a person's life, which may be by days, it may be by weeks or months, but it may be by years and has already been said. We all have experience of people given a very short prognosis where that turned out to be completely wrong. So I do have some questions for the noble Lord, Lord Faulkner. I know that he's already been given a large number of questions to answer, but I think it is really important because in 2024, you had stated that family judges are completely unsupported and the family justice system is, I think I can quote correctly, you said was literally crumbling.
And were these the reasons actually behind the removal of the court oversight when the bill was considered in the other place? In discussing these proposals with officials, what assessment has been made of the volume of cases outlined in the impact assessment being handled by the system, and what provision has been made for recognising that the numbers in the impact assessment are almost certainly inappropriately low, because the data from Australia, New Zealand and other places has shown that by year three the uptake will probably be about ten times higher than written in the impact assessment.
Because the impact assessment was based on data, which was actually from quite a long time ago when the Oregon system was instigated. And thirdly, what costing has been undertaken for each of the models the model of the panels has put in with the different numbers that might be involved, and what consideration has been made for a costing over this model. And I ask the noble Lady, the Minister, what budget has been put aside to fund the system? Whichever model is adopted and what option appraisal has been undertaken over the safety of individuals.
The ability to identify coercion with a higher degree of probability than currently exists, and to identify abusive relationships and the financial costs for each model tested against the impact assessment numbers, which, as I've said, appear unrealistically low. I think we all look forward to the questions being answered next.
11:59
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That have been put to the >> That have been put to the Minister. Indeed, my noble friend, and to the mover of this, I wonder if it might be useful if we now do if it might be useful if we now do move for the Minister and the others to answer some of these questions, because there are so many it would be really help the House. I think that we could hear from some of them. Yeah.
11:59
Lord Harper (Conservative)
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Lord Harper (Conservative)
My Lords, the flaw in that argument is that not all the argument is that not all the questions for the noble and learned Lord, Lord Falconer and the Minister have been asked, and if they were to answer some of them they were to answer some of them now and then more were to be asked, we would need to hear from them again. And I don't think that would again. And I don't think that would help the House make progress. So I think it's better if the noble Lord, Lord Falconer and the Minister hear all of the questions that are to be asked and then they can respond to them.
I listen carefully to the procedural debate yesterday, and there was a great deal of concern that one of the reasons for the slow progress of the debate was the fact that many of the questions raised in the debate haven't been answered by the sponsor of the bill, and indeed, the sponsor of the bill himself, recognised that he needed to do better, and that that's welcome, and we look forward to hearing that later. I just want to raise several points that have arisen during the debate, and I'm speaking primarily to the amendment 120 that was so ably explained to the House by the noble and learned Lord Lord Carlile.
Now I was I was very strongly persuaded by what he said for two reasons. One was because he made a very excellent case for what he said. But I'm also very struck that when this bill was first introduced into the House of Commons, it of course had a High Court and judicial process in it in the first place. And the sponsor of the bill in the House of Commons made a great deal of that being a very clear protection for the vulnerable and disabled people, people not being forced into this process against their will.
And indeed, that, of course, was in the bill all the way through the Second Reading of the debate. And many people who spoke in that debate referred to the High Court process as one of the reasons why they were content to support the bill. Now, the problem is that the that that was then changed radically in a very significant rewriting of the bill. And as my noble friend Lord Gove said, it was reported in in the Times and a number of other newspapers that in the end, and I'm quoting here from Oliver Wright from a report on February the 11th last year, in the end, Kim Leadbeater had little choice but to drop her plan for a High Court judge to personally sign off every assisted dying case in the UK.
It was made very clear it doesn't say by whom. To the Labour MP, whose bill to legalise assisted dying is currently being debated in Parliament, her plan had neither the support of the judiciary or the government. She was told in no uncertain terms that it would bring England's already struggling family courts to a standstill. As a result, she backed down and amended her legislation. Now that wasn't, of course, the reason that was given for making the change to the panel. We were told that the change was made to have a more patient centred process, and that indeed we were told that having a panel produced a better, safer and stronger set of safeguards than having the judicial process in the first place.
Now, those two stories can't both be true. So I support what my noble friend said. Can the Minister and the sponsor of the bill tell us, did the government provide all the judiciary, provide an analysis or advice to the sponsors of the Bill that, along the lines of what has been reported that drove that decision? Now they either did or they didn't. It would be very helpful to have that set out. And I agree with the government did provide such advice, then the government should publish it so that your Lordships can see for themselves what advice was provided.
Now, given that there was a court process in the bill in the first place, and it was said that that was the strong safeguard. And I've listened to the argument that was set out by the noble and learned Lord Carlile. I'm therefore persuaded that having a judicial process is much better than the panel process. I was also struck by what my noble friend at Lord Garnier said about the importance of having a proper system of of record and precedent so that decisions can be taken by higher courts and guidance provided to to judges of courts of first instance, and also that, that, that that appeal mechanism and that way of, of making decisions I thought was very helpful.
The final point I wanted to say is, is flows. I think from the excellent contribution from the noble and learned Lady Baroness Butler-sloss, who, as she said, is one of the members of this House with experience of making these very difficult cases. I was struck by one thing, she said that courts are very able to make these prioritisation decisions in these cases, and by necessity, these cases will always be of a certain level of urgency. Given the six month diagnosis.
The problem is that has a very important consequence is that these cases are then prioritised over other cases, and if there's a fixed level of resource in the system, that means other people, other people's interests are downgraded. So the question for the Minister is this. And this isn't about whether the government takes a view on whether this bill should or shouldn't pass. It's this as a matter of principle, whatever is passed by Parliament, does the government undertake to make the resources available to deliver what Parliament passes now? It's no good people just saying the law will have been passed and so the government must do that.
There are lots of areas of policy where the law says certain things must happen, but they don't happen all or at the the right level of priority because resources are inevitably limited. Ministers, quite rightly, have to make trade offs and judgements. That's why we see delays in the court system today, because there aren't an infinite level of resources. So. So this House needs to know before it makes a decision on whether to move to this judicial model or to remain with the panel system, not just what is the right model in principle, but whether if it chooses to move to a judicial model, the level of resources is going to be provided to make it workable.
And that is a decision ultimately for the government. So without the government taking a view on whether it's the right answer, actually just on this issue and on a number of other issues, we need to know if this bill passes, is the government going to make available the resources in an additional way so that it isn't taken away from other very important issues of priority? For example, in the family court system, one of the very stretched areas of decisions about children with special educational needs, that's a very current issue.
Ministers are currently working through significant changes to that system. It would be quite wrong if we were to put a judicial model in place. That was to gobble up enormous numbers of resources, and the people that paid the price were children with special educational needs and families. So I think if
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the Minister can answer that, of course. I don't want to. Interrupt that, the noble Lord,
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Interrupt that, the noble Lord, but I'm sure the Minister will respond on the question of resources when when the time comes.
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resources when when the time comes. So that's that's useful to know. Very good. Well, I'm glad that he's confirmed that she's going to he's confirmed that she's going to respond, and I look forward to her doing so. And it would also be helpful. Of course, the final point helpful. Of course, the final point is to the sponsor of the bill is whether the sponsors of the bill have actually carried out the modelling and the costings that their proposals are going to require, and have they been put forward before the House as well, so that we can make the appropriate
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decisions? Of course. It will all have read the impact assessment. The impact assessment is based upon the current bill, is based upon the current bill, which includes the panel. It contains detailed costings of the panel.
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I'm aware of that. But what I wanted to know was about whether it was going to contain detailed costings of the court process. If, costings of the court process. If, if. Well, I, I obviously don't know what the noble Lord is going to say. One of the things that we discussed One of the things that we discussed that was discussed yesterday was about whether the noble Lord Lord Falconer of Thoroton, was going to accept any of the amendments put forward. The point I'm making is if he were minded to accept the amendments put forward by the noble and learned Lord Carlile that obviously have a cost implication, there's a role for the government in assessing the cost of that.
But also there's a role for the sponsors. And I was simply asking whether if he were to accept it, it may be, of course, that he's not planning to do so, but if he were going to do so, whether he would also provide the costs for the House. And at that point, I will draw my remarks to a conclusion.
I listen carefully to the procedural debate yesterday, and there was a great deal of concern that one of the reasons for the slow progress of the debate was the fact that many of the questions raised in the debate haven't been answered by the sponsor of the bill, and indeed, the sponsor of the bill himself, recognised that he needed to do better, and that that's welcome, and we look forward to hearing that later. I just want to raise several points that have arisen during the debate, and I'm speaking primarily to the amendment 120 that was so ably explained to the House by the noble and learned Lord Lord Carlile.
Now I was I was very strongly persuaded by what he said for two reasons. One was because he made a very excellent case for what he said. But I'm also very struck that when this bill was first introduced into the House of Commons, it of course had a High Court and judicial process in it in the first place. And the sponsor of the bill in the House of Commons made a great deal of that being a very clear protection for the vulnerable and disabled people, people not being forced into this process against their will.
And indeed, that, of course, was in the bill all the way through the Second Reading of the debate. And many people who spoke in that debate referred to the High Court process as one of the reasons why they were content to support the bill. Now, the problem is that the that that was then changed radically in a very significant rewriting of the bill. And as my noble friend Lord Gove said, it was reported in in the Times and a number of other newspapers that in the end, and I'm quoting here from Oliver Wright from a report on February the 11th last year, in the end, Kim Leadbeater had little choice but to drop her plan for a High Court judge to personally sign off every assisted dying case in the UK.
It was made very clear it doesn't say by whom. To the Labour MP, whose bill to legalise assisted dying is currently being debated in Parliament, her plan had neither the support of the judiciary or the government. She was told in no uncertain terms that it would bring England's already struggling family courts to a standstill. As a result, she backed down and amended her legislation. Now that wasn't, of course, the reason that was given for making the change to the panel. We were told that the change was made to have a more patient centred process, and that indeed we were told that having a panel produced a better, safer and stronger set of safeguards than having the judicial process in the first place.
Now, those two stories can't both be true. So I support what my noble friend said. Can the Minister and the sponsor of the bill tell us, did the government provide all the judiciary, provide an analysis or advice to the sponsors of the Bill that, along the lines of what has been reported that drove that decision? Now they either did or they didn't. It would be very helpful to have that set out. And I agree with the government did provide such advice, then the government should publish it so that your Lordships can see for themselves what advice was provided.
Now, given that there was a court process in the bill in the first place, and it was said that that was the strong safeguard. And I've listened to the argument that was set out by the noble and learned Lord Carlile. I'm therefore persuaded that having a judicial process is much better than the panel process. I was also struck by what my noble friend at Lord Garnier said about the importance of having a proper system of of record and precedent so that decisions can be taken by higher courts and guidance provided to to judges of courts of first instance, and also that, that, that that appeal mechanism and that way of, of making decisions I thought was very helpful.
The final point I wanted to say is, is flows. I think from the excellent contribution from the noble and learned Lady Baroness Butler-sloss, who, as she said, is one of the members of this House with experience of making these very difficult cases. I was struck by one thing, she said that courts are very able to make these prioritisation decisions in these cases, and by necessity, these cases will always be of a certain level of urgency. Given the six month diagnosis.
The problem is that has a very important consequence is that these cases are then prioritised over other cases, and if there's a fixed level of resource in the system, that means other people, other people's interests are downgraded. So the question for the Minister is this. And this isn't about whether the government takes a view on whether this bill should or shouldn't pass. It's this as a matter of principle, whatever is passed by Parliament, does the government undertake to make the resources available to deliver what Parliament passes now? It's no good people just saying the law will have been passed and so the government must do that.
There are lots of areas of policy where the law says certain things must happen, but they don't happen all or at the the right level of priority because resources are inevitably limited. Ministers, quite rightly, have to make trade offs and judgements. That's why we see delays in the court system today, because there aren't an infinite level of resources. So. So this House needs to know before it makes a decision on whether to move to this judicial model or to remain with the panel system, not just what is the right model in principle, but whether if it chooses to move to a judicial model, the level of resources is going to be provided to make it workable.
And that is a decision ultimately for the government. So without the government taking a view on whether it's the right answer, actually just on this issue and on a number of other issues, we need to know if this bill passes, is the government going to make available the resources in an additional way so that it isn't taken away from other very important issues of priority? For example, in the family court system, one of the very stretched areas of decisions about children with special educational needs, that's a very current issue.
Ministers are currently working through significant changes to that system. It would be quite wrong if we were to put a judicial model in place. That was to gobble up enormous numbers of resources, and the people that paid the price were children with special educational needs and families. So I think if
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the Minister can answer that, of course. I don't want to. Interrupt that, the noble Lord,
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Interrupt that, the noble Lord, but I'm sure the Minister will respond on the question of resources when when the time comes.
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resources when when the time comes. So that's that's useful to know. Very good. Well, I'm glad that he's confirmed that she's going to he's confirmed that she's going to respond, and I look forward to her doing so. And it would also be helpful. Of course, the final point helpful. Of course, the final point is to the sponsor of the bill is whether the sponsors of the bill have actually carried out the modelling and the costings that their proposals are going to require, and have they been put forward before the House as well, so that we can make the appropriate
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decisions? Of course. It will all have read the impact assessment. The impact assessment is based upon the current bill, is based upon the current bill, which includes the panel. It contains detailed costings of the panel.
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I'm aware of that. But what I wanted to know was about whether it was going to contain detailed costings of the court process. If, costings of the court process. If, if. Well, I, I obviously don't know what the noble Lord is going to say. One of the things that we discussed One of the things that we discussed that was discussed yesterday was about whether the noble Lord Lord Falconer of Thoroton, was going to accept any of the amendments put forward. The point I'm making is if he were minded to accept the amendments put forward by the noble and learned Lord Carlile that obviously have a cost implication, there's a role for the government in assessing the cost of that.
But also there's a role for the sponsors. And I was simply asking whether if he were to accept it, it may be, of course, that he's not planning to do so, but if he were going to do so, whether he would also provide the costs for the House. And at that point, I will draw my remarks to a conclusion.
12:08
Lord Hamilton of Epsom (Conservative)
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Lord Hamilton of Epsom (Conservative)
Lord, I will not delay the house for very long. And noble Lady, Lady Hayter can be reassured I'm not in the business of making a long speech. I've expressed my concerns with the noble Lord Lord Carlile in the past as to whether judges are the best people to make these decisions, and whether they can do so against the advice of the contracting doctor. The problem is that the doctor will be absolutely adamant that he's right in his case, and I don't see whether why a judge should be able to overrule that.
And I'm not at all certain that actually a panel makes it very much better. So I do think that we should be concentrating very much on the question of the contracting doctor and my amendments in the future, which are coming up, will, I hope, address that point. The problem is that doctors sometimes are malevolent. I accept that the doctors in this house are dedicated to looking after their patients and the public good, but that is not always the case, my Lords.
And of course, there are occasions on when doctors get it completely wrong and the Lord McCrea referred to this and the noble Lord Rooker. I'm very pleased that Esther Rantzen was given six months to live, but it is now two and a half years ago, and she did write an article in the paper saying how much she enjoyed the extra time that she been given. Although she is an advocate of this bill. So we must accept that doctors do get these things wrong, and I think we should be concentrating on the contracting doctor rather than on the process of review.
Thank you ma'am.
And I'm not at all certain that actually a panel makes it very much better. So I do think that we should be concentrating very much on the question of the contracting doctor and my amendments in the future, which are coming up, will, I hope, address that point. The problem is that doctors sometimes are malevolent. I accept that the doctors in this house are dedicated to looking after their patients and the public good, but that is not always the case, my Lords.
And of course, there are occasions on when doctors get it completely wrong and the Lord McCrea referred to this and the noble Lord Rooker. I'm very pleased that Esther Rantzen was given six months to live, but it is now two and a half years ago, and she did write an article in the paper saying how much she enjoyed the extra time that she been given. Although she is an advocate of this bill. So we must accept that doctors do get these things wrong, and I think we should be concentrating on the contracting doctor rather than on the process of review.
Thank you ma'am.
12:10
Baroness Coffey (Conservative)
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Baroness Coffey (Conservative)
My. >> Group of 80 amendments and clause parts, some of which I have tabled, I recognise the majority of the amendments are about the amendments are about establishing a judge and court process, to which I have added various amendments, but separately there are important issues. I'm particularly impressed by amendment 116, and that's about deleting the current clause three and not using the 2005 Mental Capacity Act, instead replacing it with the new proposals. My noble friend Baroness Berridge has already asked some questions on that, but the reason I bring it up at this point is that I wanted to speak to particularly amendment 724, and to try and understand, not 74.
I apologise to amendment 426, which is where the court proceedings are introduced. I was particularly struck by 426, subsection six, where it talks about beyond reasonable doubt that the assessment has capacity. It does not directly refer back to the new amendment, but I'm just considering some of the debate that we'd had previously, which I don't want to repeat. But actually the key point that actually the capacity mental act is used every day by health professionals, but really on balance of probabilities, not beyond reasonable doubt.
And this is why I do support the approach of the noble and learned Lord Lord Carlile in bringing forward reintroducing, in effect, the process that not only was at the start of the Bill in the Commons, where more than half of MPs voted for it when the judge role was removed. When it came to Third Reading, fewer than half of MPs voted for it. There's a substantial reduction in the support, although I accept that there was still admittedly a smaller majority, a majority down to 23.
Now, one of the things that I'm conscious about thinking about is that what isn't in the noble Lord Lord Carlile noble and learned Lord Carlile proposals is about whether the court should be heard in public. And the reason I've put in 46 is because it's not the usual practice, as my understanding of the family court, at whatever level, to sit in public. But I think it's an important element that needs to be considered. Indeed, it is what is proposed for the panels that are considered elsewhere.
I've gone further by in 46 B and 46 C, but 46 B in particular. And this is more of a probing amendment. One of the things that the late Sir Sir James Munby said, why he didn't particularly think this should be done by High Court judges, is basically suggesting, is this just rubber stamping, or is actually the quality of a judge being used to make a determination, a decision about some of the things? Now, going back to amendment 120 and all the the structure that the Noble and learned, Lord Low Lord Carlile has put together is about inserting, actually the requirement for reports to be provided that would help the judge to be able to make that decision.
So one of the things that I think is important is that we don't end up, as happens with a lot of tribunals in effect around the country, making decisions on the papers. This is a life or death decision. I appreciate what the noble Baroness Hayter of Kentish Town has talked about, about when it is actually about how somebody dies, about a medical professional providing not just withdrawing treatment as happened, as been mentioned on some other issues, including the bland case and happens regularly now, but it is actually about supplying lethal drugs to help somebody kill take their own life.
So it is different in that regard. And that's why I'm attracted to the proposals that there were originally in the bill and reintroduced in effect by the noble Lord Lord Carlile. Now I'm conscious that not everybody may be in a fit purpose to attend physically present, but I do think that connection between the person who's asked to make the determination about whether somebody has capacity or not, and there hasn't been coercion of whatever kind, that connection there, I think is a really important part.
And that's why I've put these forward as probing amendments for us to consider. We ultimately we're trying to work out how do we make this element safer. Now, what was said at, I think, in Report stage in the Commons or the general approach is this is now safer. It's safer than a judge led process. I'm not convinced by that at all. I don't need to repeat the arguments that others have made, but I do respect the role of judges in making these decisions, and particularly in the family court.
What I think has been a clever introduction is about not just restricting this to the High Court, but to use a more variety of courts right around the country in this consideration, and one of the very few answers that the government has actually given to my questions in trying to research this bill, recognise that something like nearly a quarter of a million cases were actually disposed of. I think the phrases in courts in 2024, when it comes to family cases, admittedly, they were not principally in the High Court.
There were far fewer there. But that's what you would expect. But I would anticipate that this could be a way forward to still have that very independent view. And frankly, having just a case automatically chairing a panel is not good enough. And I think there's discrepancies there. But I think it's important I don't stray into too many of the 16 courses without further speaking to my amendments, but I was interested to hear here why in particular the noble Lords.
I think there are four people have signed the amendment on clause 37 stand part not only the noble and learned Lord Low Lord Carlile, but indeed Lord Goodman and Lord Rooker, and Baroness Noble, Baroness Baroness Hollins all signed that as well, and I'd be interested to understand even the government from the sponsor why they think that's the right way forward. But ideally, perhaps from these people who don't believe that clause should stand part what it is that worries them about that particular clause.
So in terms of the. Oh, sorry, I thought somebody was trying to intervene. It's already been suggested, of course. What is the best way to determine this? And the noble and Right reverend Lord Harries of Pentregarth has already pointed out the noble Lord, Lord Faulkner's own words, in fact, his own bill about introducing assisted dying still live in this place, still awaiting Second Reading, still has the judge led process, so it would be very useful. I appreciate this is may feel like dancing on the head of a pin, but it's actually pivotal to the concerns of many people about what is the safest approach.
And it does feel that the sponsor of this bill in this House, or in fact, the sponsor of the bill in the other place as well, has changed their mind. And the late Sir James really was not going into whether or not it was whether it was worthwhile to use the time of the judge to do this. He actually pointed to the role of the official solicitor could be done to do this with the support of a doctor. And someone referred to the Spanish process.
So it would be useful to understand what's changed now. I was grateful that the the government whip said the Minister would answer some of the questions that have been outlined. I mean, candidly, so far, Ministers have refused to answer any questions, any written questions they've refused to answer through freedom of information requests, exactly where the government has and Ministers and officials have got involved to try and help this bill work. And that has been one of the frustrations, and indeed, one of the reasons why so many amendments have been tabled to try and tease out what is going on.
How is this going to work? Why is it that the government didn't want this to happen? Why did they want to do it a different way? Why is it doing in regulations as better? So I'll come to some further amendments that I have tabled in terms of amendment 120 very I've tabled 120 a I've specifically tabled an element basically, which doesn't allow state funding, taxpayer funding to be used to by the person applying to get this determination by the court. I think there will be plenty of other ways charities, I'm sure will evolve that can provide financial support if needed.
I don't believe this should be done by taxpayers. Of course, the running of the courts themselves has to be done by taxpayers. And there what is there in terms of amendments 37 and 41, which we didn't really get into? I'd be interested to understand from the sponsor of the bill why it is, I think it's lines 14 and 15 and clause one. Why only sections 8 to 30 are deemed to be important? In particular, I'm talking about amendment 41, why it's only those in particular that need to be there.
Why not just the provisions of the act. So I support the amendment from the noble and learned Lord, in terms of 46 going back to 46. Forgive me for jumping around, but the nature of the group means that there is an element of jumping about. One of the things that I wanted to say to the house, it does suggest here, I think it's in 4 to 6. There was something about promptly that was it. Subsection two. The application must be made promptly following the following the submission of an application.
So I think there is here gives a clear prioritisation to the courts on how these issues should be heard. My Lords, I've taken my ten minutes and I haven't even been able to address every single bit of my amendments. That shows trying to tackle a group of 80 amendments and just ten minutes is really challenging. The final thing I will, with the benefit of the grace of the the committee, there's something here about statistics. It's going to be very important to make sure that we do get an
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understanding of. What is happening. In terms of application. Can I ask the noble Lady to draw
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Can I ask the noble Lady to draw her comments to a close? The time is virtually. Yes, I will. I'm just saying
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Yes, I will. I'm just saying it's really important that we get statistics and that this becomes the premise of the Lord Chancellor. the premise of the Lord Chancellor. This is critical to making sure that we have confidence going forward, and I'll have to work out
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a way to reassess these these amendments in future groups. Yeah, yeah.
I apologise to amendment 426, which is where the court proceedings are introduced. I was particularly struck by 426, subsection six, where it talks about beyond reasonable doubt that the assessment has capacity. It does not directly refer back to the new amendment, but I'm just considering some of the debate that we'd had previously, which I don't want to repeat. But actually the key point that actually the capacity mental act is used every day by health professionals, but really on balance of probabilities, not beyond reasonable doubt.
And this is why I do support the approach of the noble and learned Lord Lord Carlile in bringing forward reintroducing, in effect, the process that not only was at the start of the Bill in the Commons, where more than half of MPs voted for it when the judge role was removed. When it came to Third Reading, fewer than half of MPs voted for it. There's a substantial reduction in the support, although I accept that there was still admittedly a smaller majority, a majority down to 23.
Now, one of the things that I'm conscious about thinking about is that what isn't in the noble Lord Lord Carlile noble and learned Lord Carlile proposals is about whether the court should be heard in public. And the reason I've put in 46 is because it's not the usual practice, as my understanding of the family court, at whatever level, to sit in public. But I think it's an important element that needs to be considered. Indeed, it is what is proposed for the panels that are considered elsewhere.
I've gone further by in 46 B and 46 C, but 46 B in particular. And this is more of a probing amendment. One of the things that the late Sir Sir James Munby said, why he didn't particularly think this should be done by High Court judges, is basically suggesting, is this just rubber stamping, or is actually the quality of a judge being used to make a determination, a decision about some of the things? Now, going back to amendment 120 and all the the structure that the Noble and learned, Lord Low Lord Carlile has put together is about inserting, actually the requirement for reports to be provided that would help the judge to be able to make that decision.
So one of the things that I think is important is that we don't end up, as happens with a lot of tribunals in effect around the country, making decisions on the papers. This is a life or death decision. I appreciate what the noble Baroness Hayter of Kentish Town has talked about, about when it is actually about how somebody dies, about a medical professional providing not just withdrawing treatment as happened, as been mentioned on some other issues, including the bland case and happens regularly now, but it is actually about supplying lethal drugs to help somebody kill take their own life.
So it is different in that regard. And that's why I'm attracted to the proposals that there were originally in the bill and reintroduced in effect by the noble Lord Lord Carlile. Now I'm conscious that not everybody may be in a fit purpose to attend physically present, but I do think that connection between the person who's asked to make the determination about whether somebody has capacity or not, and there hasn't been coercion of whatever kind, that connection there, I think is a really important part.
And that's why I've put these forward as probing amendments for us to consider. We ultimately we're trying to work out how do we make this element safer. Now, what was said at, I think, in Report stage in the Commons or the general approach is this is now safer. It's safer than a judge led process. I'm not convinced by that at all. I don't need to repeat the arguments that others have made, but I do respect the role of judges in making these decisions, and particularly in the family court.
What I think has been a clever introduction is about not just restricting this to the High Court, but to use a more variety of courts right around the country in this consideration, and one of the very few answers that the government has actually given to my questions in trying to research this bill, recognise that something like nearly a quarter of a million cases were actually disposed of. I think the phrases in courts in 2024, when it comes to family cases, admittedly, they were not principally in the High Court.
There were far fewer there. But that's what you would expect. But I would anticipate that this could be a way forward to still have that very independent view. And frankly, having just a case automatically chairing a panel is not good enough. And I think there's discrepancies there. But I think it's important I don't stray into too many of the 16 courses without further speaking to my amendments, but I was interested to hear here why in particular the noble Lords.
I think there are four people have signed the amendment on clause 37 stand part not only the noble and learned Lord Low Lord Carlile, but indeed Lord Goodman and Lord Rooker, and Baroness Noble, Baroness Baroness Hollins all signed that as well, and I'd be interested to understand even the government from the sponsor why they think that's the right way forward. But ideally, perhaps from these people who don't believe that clause should stand part what it is that worries them about that particular clause.
So in terms of the. Oh, sorry, I thought somebody was trying to intervene. It's already been suggested, of course. What is the best way to determine this? And the noble and Right reverend Lord Harries of Pentregarth has already pointed out the noble Lord, Lord Faulkner's own words, in fact, his own bill about introducing assisted dying still live in this place, still awaiting Second Reading, still has the judge led process, so it would be very useful. I appreciate this is may feel like dancing on the head of a pin, but it's actually pivotal to the concerns of many people about what is the safest approach.
And it does feel that the sponsor of this bill in this House, or in fact, the sponsor of the bill in the other place as well, has changed their mind. And the late Sir James really was not going into whether or not it was whether it was worthwhile to use the time of the judge to do this. He actually pointed to the role of the official solicitor could be done to do this with the support of a doctor. And someone referred to the Spanish process.
So it would be useful to understand what's changed now. I was grateful that the the government whip said the Minister would answer some of the questions that have been outlined. I mean, candidly, so far, Ministers have refused to answer any questions, any written questions they've refused to answer through freedom of information requests, exactly where the government has and Ministers and officials have got involved to try and help this bill work. And that has been one of the frustrations, and indeed, one of the reasons why so many amendments have been tabled to try and tease out what is going on.
How is this going to work? Why is it that the government didn't want this to happen? Why did they want to do it a different way? Why is it doing in regulations as better? So I'll come to some further amendments that I have tabled in terms of amendment 120 very I've tabled 120 a I've specifically tabled an element basically, which doesn't allow state funding, taxpayer funding to be used to by the person applying to get this determination by the court. I think there will be plenty of other ways charities, I'm sure will evolve that can provide financial support if needed.
I don't believe this should be done by taxpayers. Of course, the running of the courts themselves has to be done by taxpayers. And there what is there in terms of amendments 37 and 41, which we didn't really get into? I'd be interested to understand from the sponsor of the bill why it is, I think it's lines 14 and 15 and clause one. Why only sections 8 to 30 are deemed to be important? In particular, I'm talking about amendment 41, why it's only those in particular that need to be there.
Why not just the provisions of the act. So I support the amendment from the noble and learned Lord, in terms of 46 going back to 46. Forgive me for jumping around, but the nature of the group means that there is an element of jumping about. One of the things that I wanted to say to the house, it does suggest here, I think it's in 4 to 6. There was something about promptly that was it. Subsection two. The application must be made promptly following the following the submission of an application.
So I think there is here gives a clear prioritisation to the courts on how these issues should be heard. My Lords, I've taken my ten minutes and I haven't even been able to address every single bit of my amendments. That shows trying to tackle a group of 80 amendments and just ten minutes is really challenging. The final thing I will, with the benefit of the grace of the the committee, there's something here about statistics. It's going to be very important to make sure that we do get an
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understanding of. What is happening. In terms of application. Can I ask the noble Lady to draw
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Can I ask the noble Lady to draw her comments to a close? The time is virtually. Yes, I will. I'm just saying
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Yes, I will. I'm just saying it's really important that we get statistics and that this becomes the premise of the Lord Chancellor. the premise of the Lord Chancellor. This is critical to making sure that we have confidence going forward, and I'll have to work out
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a way to reassess these these amendments in future groups. Yeah, yeah.
12:21
Lord Empey (Ulster Unionist Party)
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Lord Empey (Ulster Unionist Party)
Indebted, I think, to the noble Lord Lord Carlile, for.
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I think, bringing to a head one of the critical issues in this of the critical issues in this legislation. It's as one of, I think, the diminishing number of think, the diminishing number of people in this House who is not a lawyer. We have to find our way lawyer. We have to find our way through this labyrinthine structure where we have chambers and all where we have chambers and all sorts of things, and it is a bit difficult as a legislator, even without legal experience, to navigate through this.
But I think the point I want to make at the outset is, given the significance of this legislation, the fact that it started off in the other place with the legal process in, in, in, as a fundamental part of the architecture then that was subsequently changed more than halfway through its process in the other place. And now we're trying to re inject it into the system. It just illustrates to me, and I would ask this sponsor and indeed the Minister, to respond to this.
There are so many issues that have been raised already this morning about the consequences of making this change, for which we have absolutely no information whatsoever. And might I remind colleagues that last Friday there were five separate issues, five for which no response or answer has been provided. And I remind the House that that were the issue between England and Wales, the issue between England and Scotland, the issue of pregnant women, the issue of of homeless people and the issue of prisoners.
There's no clarity on any of that. Now, Lord Carlile is attempting in these amendments and is co-signatories to at least make us Baroness Finlay said. The legislation less less on safe. But, my Lords, we're at a stage in this legislation, probably 75 or 80% of the way through the process. And like a meccano set, we're still bolting bits on and taking bits off. Now, all of this could have been avoided if we'd had the proper process of the Royal Commission and a government bill.
So this sort of Heath Robinson type of legislation on such a serious issue, I have to say to the sponsors, I really think instead of having to battle this out for the next few months, there would be far better to go to the government and ask them to appoint a commission and get on with it, instead of having to fight our way through this morass. However, I would say to the noble Lord the is it the case that, given the pressures that we understand are applied to the courts and the family division, is there a case and not being a legal person, I ask that noble Lord Carlile is there a case for the creation of a special chamber for having people who are dedicated to this, with the training that would be required? Or is it possible that under the pressures that Family Court is under, could it be that comparatively junior people end up being designated to hear these cases because, you know, you're talking about a huge gap in knowledge and experience on a life and death issue? Now, maybe these questions can't be answered now.
Maybe we'll get answers when we come to report. But the very fact that we're having to ask these questions, all of these questions, and we have no information, we have no numbers, we have nothing in front of us. And I just don't believe that that is a coherent and sensible way to go forward. The noble Lord Harries of Pentregarth made the point, a very valid point about the general public's confidence in who makes such decisions. And while I can see the merits, as Lord Pannick pointed out, of having a panel with different disciplines there, the fact of the matter is the persons who are on that panel have to be appointed by somebody, and therefore is there confidence in the people who appoint them, whereas the court system has a level of public confidence miles above any alternative.
So all of these things need to be sorted out. They should have been sorted out before we're even having this debate today and they haven't been. And that is where we are. And I think that the noble Lord Carlile is attempting to put a foundation under this legislation, albeit with all the leaving the principle issues out of it for the moment, because we are legislators and sometimes we have to do things that we don't want to do personally, but we're obliged to undertake this process.
So I assume that what he's trying to do is to put a foundation underneath this legislation that would have confidence amongst the general public, or at least a higher level of confidence than I suspect the panel process has. But the fact that we've had this change and this flip flop is, is very concerning. But could I conclude by asking him, and indeed the Minister necessarily, if this change were to these, this these amendments were to be accepted by the sponsor? What is the government's response to that? And it has been Lord Harper raised it or raised it, others have raised, you know, I understand the Ministers are in a difficult position because they're technically dealing with a private member's bill.
Whatever. Some of us think about that. And without having knowledge of what the state is actually going to do when we're legislating for the state to intervene, to allow a person to end their life, which is against the other legislation that we've already passed. So it is important that the government let us know what their response is going to be in these various scenarios. And I do hope that when we come to the wind up of this debate, we will get some clarity.
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I think, bringing to a head one of the critical issues in this of the critical issues in this legislation. It's as one of, I think, the diminishing number of think, the diminishing number of people in this House who is not a lawyer. We have to find our way lawyer. We have to find our way through this labyrinthine structure where we have chambers and all where we have chambers and all sorts of things, and it is a bit difficult as a legislator, even without legal experience, to navigate through this.
But I think the point I want to make at the outset is, given the significance of this legislation, the fact that it started off in the other place with the legal process in, in, in, as a fundamental part of the architecture then that was subsequently changed more than halfway through its process in the other place. And now we're trying to re inject it into the system. It just illustrates to me, and I would ask this sponsor and indeed the Minister, to respond to this.
There are so many issues that have been raised already this morning about the consequences of making this change, for which we have absolutely no information whatsoever. And might I remind colleagues that last Friday there were five separate issues, five for which no response or answer has been provided. And I remind the House that that were the issue between England and Wales, the issue between England and Scotland, the issue of pregnant women, the issue of of homeless people and the issue of prisoners.
There's no clarity on any of that. Now, Lord Carlile is attempting in these amendments and is co-signatories to at least make us Baroness Finlay said. The legislation less less on safe. But, my Lords, we're at a stage in this legislation, probably 75 or 80% of the way through the process. And like a meccano set, we're still bolting bits on and taking bits off. Now, all of this could have been avoided if we'd had the proper process of the Royal Commission and a government bill.
So this sort of Heath Robinson type of legislation on such a serious issue, I have to say to the sponsors, I really think instead of having to battle this out for the next few months, there would be far better to go to the government and ask them to appoint a commission and get on with it, instead of having to fight our way through this morass. However, I would say to the noble Lord the is it the case that, given the pressures that we understand are applied to the courts and the family division, is there a case and not being a legal person, I ask that noble Lord Carlile is there a case for the creation of a special chamber for having people who are dedicated to this, with the training that would be required? Or is it possible that under the pressures that Family Court is under, could it be that comparatively junior people end up being designated to hear these cases because, you know, you're talking about a huge gap in knowledge and experience on a life and death issue? Now, maybe these questions can't be answered now.
Maybe we'll get answers when we come to report. But the very fact that we're having to ask these questions, all of these questions, and we have no information, we have no numbers, we have nothing in front of us. And I just don't believe that that is a coherent and sensible way to go forward. The noble Lord Harries of Pentregarth made the point, a very valid point about the general public's confidence in who makes such decisions. And while I can see the merits, as Lord Pannick pointed out, of having a panel with different disciplines there, the fact of the matter is the persons who are on that panel have to be appointed by somebody, and therefore is there confidence in the people who appoint them, whereas the court system has a level of public confidence miles above any alternative.
So all of these things need to be sorted out. They should have been sorted out before we're even having this debate today and they haven't been. And that is where we are. And I think that the noble Lord Carlile is attempting to put a foundation under this legislation, albeit with all the leaving the principle issues out of it for the moment, because we are legislators and sometimes we have to do things that we don't want to do personally, but we're obliged to undertake this process.
So I assume that what he's trying to do is to put a foundation underneath this legislation that would have confidence amongst the general public, or at least a higher level of confidence than I suspect the panel process has. But the fact that we've had this change and this flip flop is, is very concerning. But could I conclude by asking him, and indeed the Minister necessarily, if this change were to these, this these amendments were to be accepted by the sponsor? What is the government's response to that? And it has been Lord Harper raised it or raised it, others have raised, you know, I understand the Ministers are in a difficult position because they're technically dealing with a private member's bill.
Whatever. Some of us think about that. And without having knowledge of what the state is actually going to do when we're legislating for the state to intervene, to allow a person to end their life, which is against the other legislation that we've already passed. So it is important that the government let us know what their response is going to be in these various scenarios. And I do hope that when we come to the wind up of this debate, we will get some clarity.
12:28
Baroness Grey-Thompson (Crossbench)
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Baroness Grey-Thompson (Crossbench)
I speak to amendment 67, which is in my name, where I sought to bring back the role of the High Court judge. And I think the complexity of this group of amendments is shown here, that I thought it could be done with one amendment, rather than the number of amendments that my noble friend Lord Carlile had to table. And I think this debate shows many different things, not least that during different periods of time we've heard quotes about how the noble and learned Lord, Lord Falconer, has changed his mind over time, and others in the chamber have have done so as well.
Depending on the situation and the specific piece of legislation, I think we need to give much more consideration to how this bill will work in practice, and I think this is one of the fundamental issues. I was really disappointed when the High Court judge was removed from the process, because it did give me a level of reassurance. I felt that it gave authority and integrity to the process. And I think where we are as as other noble colleagues have said, the to ING and fro ING of of this part of the bill is is very difficult, because in another place, two thirds of the debates on the bill took place with the High Court judge as part of the process.
And if the noble and learned Lord was minded to bring it back in, it yet again changes a huge part of the bill. And I'd like to thank the noble and learned Lord for meeting with me before Christmas, where I think we had a very interesting discussion on one of the areas I'm very concerned about, which is coercion and specifically coercion of disabled people. And I'm not minded to think that the panel is strong enough to cope with not just the number of cases that they may have to deal with, but actually being able to spot some of the things that we've talked about.
Now, I've got amendments on coercion. I've also got amendments on the appointment process of those panel members, which I won't debate now. And I know the noble Lord and I disagree on whether this is the safest bill in the world. This is not the time for me to ask for who has provided independent verification of that, apart from bill sponsors. But I think one thing we have to be talking about in this bill is about how we can make it safe.
And my noble friend Baroness Finlay talked about unsafe. This is probably the one area where I think we we have a sort of a slight difference. I don't think it being not unsafe is is enough to convince either anyone in the chamber or the public who are watching our debates outside that we are doing the the job that we should. I was in the debate last night, and a lot of attention was brought to how we are behaving in the chamber and what we're doing, and I'm very privileged to be part of your Lordship chamber.
One of the things I always say when I visit schools, or I'm asked about the chamber, is it is an amazing privilege to work with the brightest people I have ever worked with. But if we're reading the bill and we're reading it in a different way, and at the moment, it puts great powers in the hands of the Secretary of State or push it into secondary legislation, it makes me even more determined. There is not enough on the face of the bill to actually make it work in practice.
And I just have a couple of questions for the noble and learned Lord, based on the debate that I've heard today. So, you know the role of the commissioner, I've read that in a different way to the noble Lord. Lord Markham. So while the Commissioner has to have had a High Court experience, can the noble Lord confirm whether there be acting as a judge in this situation? And I also think there needs to be much greater clarity on what the panel is able to do.
I've read the bill. I don't know how many times, but I'm convinced from listening to the debate today that there is not the clarity. So whether that's either in writing or in his answer that he gives today, I think that clarity is required. And also I'd be very interested in whether he would be interested in tabling further amendments. I'm making an assumption that this group may not be accepted, but whether he be interested in tabling further amendments to provide clarity on what that role of the panel is going to be, because my concern about it is also the moral pressure that any panel member may feel.
And if there's I mean, the number of deaths we don't know, I my personal view is the equality impact assessment is doesn't give us the the detail we need. The sponsor in the other place said that it could be 3% of deaths. That could be 17,000 deaths a year. If if that is the case, I'd be much happier. The pressure being felt through the high court system, where I think there would be much more attempts to solve it and and deal with it than if it's kind of hidden through a panel, which may not feel that they have the ability to to raise issues.
So the I'm not convinced that the panel is the right way to go. And one thing to say, you know, with the removal of the High Court judge. Yeah.
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That's right. With the noble Lady, she mentioned the word there, moral pressure. Now, I mentioned before in my speech that there is now this is actually a very fundamental change, which I've now noticed. Obviously, clause three is noticed. Obviously, clause three is gone, not by way of clause stand part, that actually pressure is now gone from the test here. We now have coercion and undue influence, not dishonesty, coercion and pressure. And does she have any pressure. And does she have any view I mentioned about domestic abuse victims, about whether that makes any change to the safety of the bill for disabled people?
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Oh, absolutely. I mean, I think pressure is an incredibly important pressure is an incredibly important part that we have to success for it, because I think certainly from the huge number of disabled people I've huge number of disabled people I've spoken to, pressure comes in many different ways, and it's very different ways, and it's very difficult to detect pressure. And, you know, if we don't take that seriously, I do think people will seriously, I do think people will be coerced to think, and this is the only option they have, rather than thinking they have a range of options.
And that's picked up in in some of my amendments. But I thank the noble Lady for her intervention. Other questions I've got, you know, we've talked about the equality impact assessment. We need to look at the impact on the Crown Court, on the Health and Education Committee, about the impact on on children with Senedd. And I do think we probably need another version of the equality impact assessment to enable us to make the best decision on the way forward for this bill.
I'm minded to support my noble friend Lord Carlile, because I do think that what he's proposing is much better than the panel that is currently in the bill. Mindful of Time Lords, I leave my last comments to the Medical Defence Union, who are the leading indemnifies of UK doctors, and they give evidence to the Commons Bill Committee. They said the involvement of the judiciary is essential. Its absence leaves doctors unduly exposed. Media reports suggest that an alternative safeguard is being mooted.
Lord Jones, and this was taken in the context of when the evidence was given. No independent panel, however, so constituted, can replace the legal authority of a course of action sealed and ratified by a judge. Doctors deserve that certainty when relying upon this bill to provide the very best for their patients at the most delicate moment of their duty of care. I think this is one group we haven't really heard a lot from, and we should be minded of their role in the system as well.
Depending on the situation and the specific piece of legislation, I think we need to give much more consideration to how this bill will work in practice, and I think this is one of the fundamental issues. I was really disappointed when the High Court judge was removed from the process, because it did give me a level of reassurance. I felt that it gave authority and integrity to the process. And I think where we are as as other noble colleagues have said, the to ING and fro ING of of this part of the bill is is very difficult, because in another place, two thirds of the debates on the bill took place with the High Court judge as part of the process.
And if the noble and learned Lord was minded to bring it back in, it yet again changes a huge part of the bill. And I'd like to thank the noble and learned Lord for meeting with me before Christmas, where I think we had a very interesting discussion on one of the areas I'm very concerned about, which is coercion and specifically coercion of disabled people. And I'm not minded to think that the panel is strong enough to cope with not just the number of cases that they may have to deal with, but actually being able to spot some of the things that we've talked about.
Now, I've got amendments on coercion. I've also got amendments on the appointment process of those panel members, which I won't debate now. And I know the noble Lord and I disagree on whether this is the safest bill in the world. This is not the time for me to ask for who has provided independent verification of that, apart from bill sponsors. But I think one thing we have to be talking about in this bill is about how we can make it safe.
And my noble friend Baroness Finlay talked about unsafe. This is probably the one area where I think we we have a sort of a slight difference. I don't think it being not unsafe is is enough to convince either anyone in the chamber or the public who are watching our debates outside that we are doing the the job that we should. I was in the debate last night, and a lot of attention was brought to how we are behaving in the chamber and what we're doing, and I'm very privileged to be part of your Lordship chamber.
One of the things I always say when I visit schools, or I'm asked about the chamber, is it is an amazing privilege to work with the brightest people I have ever worked with. But if we're reading the bill and we're reading it in a different way, and at the moment, it puts great powers in the hands of the Secretary of State or push it into secondary legislation, it makes me even more determined. There is not enough on the face of the bill to actually make it work in practice.
And I just have a couple of questions for the noble and learned Lord, based on the debate that I've heard today. So, you know the role of the commissioner, I've read that in a different way to the noble Lord. Lord Markham. So while the Commissioner has to have had a High Court experience, can the noble Lord confirm whether there be acting as a judge in this situation? And I also think there needs to be much greater clarity on what the panel is able to do.
I've read the bill. I don't know how many times, but I'm convinced from listening to the debate today that there is not the clarity. So whether that's either in writing or in his answer that he gives today, I think that clarity is required. And also I'd be very interested in whether he would be interested in tabling further amendments. I'm making an assumption that this group may not be accepted, but whether he be interested in tabling further amendments to provide clarity on what that role of the panel is going to be, because my concern about it is also the moral pressure that any panel member may feel.
And if there's I mean, the number of deaths we don't know, I my personal view is the equality impact assessment is doesn't give us the the detail we need. The sponsor in the other place said that it could be 3% of deaths. That could be 17,000 deaths a year. If if that is the case, I'd be much happier. The pressure being felt through the high court system, where I think there would be much more attempts to solve it and and deal with it than if it's kind of hidden through a panel, which may not feel that they have the ability to to raise issues.
So the I'm not convinced that the panel is the right way to go. And one thing to say, you know, with the removal of the High Court judge. Yeah.
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That's right. With the noble Lady, she mentioned the word there, moral pressure. Now, I mentioned before in my speech that there is now this is actually a very fundamental change, which I've now noticed. Obviously, clause three is noticed. Obviously, clause three is gone, not by way of clause stand part, that actually pressure is now gone from the test here. We now have coercion and undue influence, not dishonesty, coercion and pressure. And does she have any pressure. And does she have any view I mentioned about domestic abuse victims, about whether that makes any change to the safety of the bill for disabled people?
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Oh, absolutely. I mean, I think pressure is an incredibly important pressure is an incredibly important part that we have to success for it, because I think certainly from the huge number of disabled people I've huge number of disabled people I've spoken to, pressure comes in many different ways, and it's very different ways, and it's very difficult to detect pressure. And, you know, if we don't take that seriously, I do think people will seriously, I do think people will be coerced to think, and this is the only option they have, rather than thinking they have a range of options.
And that's picked up in in some of my amendments. But I thank the noble Lady for her intervention. Other questions I've got, you know, we've talked about the equality impact assessment. We need to look at the impact on the Crown Court, on the Health and Education Committee, about the impact on on children with Senedd. And I do think we probably need another version of the equality impact assessment to enable us to make the best decision on the way forward for this bill.
I'm minded to support my noble friend Lord Carlile, because I do think that what he's proposing is much better than the panel that is currently in the bill. Mindful of Time Lords, I leave my last comments to the Medical Defence Union, who are the leading indemnifies of UK doctors, and they give evidence to the Commons Bill Committee. They said the involvement of the judiciary is essential. Its absence leaves doctors unduly exposed. Media reports suggest that an alternative safeguard is being mooted.
Lord Jones, and this was taken in the context of when the evidence was given. No independent panel, however, so constituted, can replace the legal authority of a course of action sealed and ratified by a judge. Doctors deserve that certainty when relying upon this bill to provide the very best for their patients at the most delicate moment of their duty of care. I think this is one group we haven't really heard a lot from, and we should be minded of their role in the system as well.
12:36
Earl Howe (Conservative)
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Earl Howe (Conservative)
For this Minister. >> For this Minister. >> My Lords, very sizeable as this group of amendments is the key group of amendments is the key proposals embodied within it can be described relatively in relatively brief terms, and the Committee brief terms, and the Committee therefore owes its gratitude to the noble Lord Lord Carlile for having achieved exactly that kind of helpful summary in his opening speech, which set our debate going on a good track, and in thanking him for that, what has emerged to me most clearly in this debate is the far reaching nature of the change to the architecture of the bill represented by his proposals.
In addition, were the noble Lords proposals to be adopted in their totality? They would, as I read them, have the effect of simplifying very considerably the procedures required to bring about an assisted death. In combination. Those two consequences inevitably open up a range of questions, as we've heard on how these proposals would work, not just in theory, but also most particularly in practice. We have, for example, heard questions about the capacity of the family courts, about its funding and the extent of the opportunity costs which the family courts would need to sustain the noble and learned Baroness Butler-sloss and my noble and learned friend, Lord Garnier, gave us considerable reassurance on some of those issues, as did the noble Lord Lord Carlile himself.
However, the questions that have been asked are of fundamental significance, and I do think the committee should hear from the noble Baroness, the Minister, how the government view the practical effect of the proposals and their workability on the principle of Lord Carlile's proposals. We've heard some powerful points made in their favour. For example, the established powers vested in the court, the analogous decisions which the courts already have to make, the ability of the court to arrive at a reasoned judgement and to be a court of record.
The fact that the court based appeal system is well understood, and indeed the level of public confidence which the court already enjoys. I would venture to add another, which is that the role for the court envisaged by the noble Lord Lord Carlile, would be a substantive judicial role. In contrast to the role originally envisaged in the first iteration of the bill, which came over to me at least, as more largely more a tick box exercise than an exercise of judicial judgement.
However, what I look forward to hearing from the noble and learned Lord, Lord Faulkner, are his views on the strand of this debate, brought out most ably by the noble Lord Lord Pannick, my noble friend Lady Berridge, and my noble and learned friend Lord Garnier, namely, how he has assessed the merits of Lord Carlile's proposals in comparison to the proposals set out in the Bill. He's on record some years ago as having favoured a court based as having favoured a court based approach in this particular area of of the law.
And if his view is on balance, that he now favours the panel process as set out in the bill, what considerations have led him to that conclusion?
In addition, were the noble Lords proposals to be adopted in their totality? They would, as I read them, have the effect of simplifying very considerably the procedures required to bring about an assisted death. In combination. Those two consequences inevitably open up a range of questions, as we've heard on how these proposals would work, not just in theory, but also most particularly in practice. We have, for example, heard questions about the capacity of the family courts, about its funding and the extent of the opportunity costs which the family courts would need to sustain the noble and learned Baroness Butler-sloss and my noble and learned friend, Lord Garnier, gave us considerable reassurance on some of those issues, as did the noble Lord Lord Carlile himself.
However, the questions that have been asked are of fundamental significance, and I do think the committee should hear from the noble Baroness, the Minister, how the government view the practical effect of the proposals and their workability on the principle of Lord Carlile's proposals. We've heard some powerful points made in their favour. For example, the established powers vested in the court, the analogous decisions which the courts already have to make, the ability of the court to arrive at a reasoned judgement and to be a court of record.
The fact that the court based appeal system is well understood, and indeed the level of public confidence which the court already enjoys. I would venture to add another, which is that the role for the court envisaged by the noble Lord Lord Carlile, would be a substantive judicial role. In contrast to the role originally envisaged in the first iteration of the bill, which came over to me at least, as more largely more a tick box exercise than an exercise of judicial judgement.
However, what I look forward to hearing from the noble and learned Lord, Lord Faulkner, are his views on the strand of this debate, brought out most ably by the noble Lord Lord Pannick, my noble friend Lady Berridge, and my noble and learned friend Lord Garnier, namely, how he has assessed the merits of Lord Carlile's proposals in comparison to the proposals set out in the Bill. He's on record some years ago as having favoured a court based as having favoured a court based approach in this particular area of of the law.
And if his view is on balance, that he now favours the panel process as set out in the bill, what considerations have led him to that conclusion?
12:40
Baroness Levitt, The Parliamentary Under-Secretary of State for Justice (Labour)
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Baroness Levitt, The Parliamentary Under-Secretary of State for Justice (Labour)
My Lords, I rise to respond to the amendments in the names of the the amendments in the names of the noble Lord Lord Carlile of Berriew and the noble Ladies Baroness Grey-Thompson and Baroness Coffey. As some of your Lordships may be As some of your Lordships may be aware, I know the noble Lord Lord Carlile very well indeed. The convention of this house, as I refer to him as my noble kinsman, and this has given rise to a number of jokes outside this chamber.
But there is a serious point to be made here. I want to reassure your Lordships that this has had no effect on the government's neutral analysis of the workability of the amendments in question, and although I have had the advantage of having advanced notice of my Noble Kinsmen position, I have engaged with him as to the government's response in no different way from the way I would with any of your Lordships, as this is the first time a Minister from the Ministry of Justice has spoken in this debate, I reiterate what's been said on many, many occasions by my noble friend Baroness Merron.
The government's position is that it is a matter for Parliament to decide the policy which underpins this Bill, and it follows that I will not be providing a government view on the merits of any of the amendments, nor will I make any observations in a personal capacity. But I will deal with the question that has been asked by a number of your Lordships as to whether the government would deliver this. Were the will of Parliament to be that the the general principle contained in the noble Lord Lord Carlile amendments were to be adopted.
The answer is that given our current workload, it would of course be challenging. And I say this because I am in fact the family justice Minister as well as the Lords Minister. But if it is the will of Parliament, then we will work with the judiciary to make sure that we have the resources in place to deliver what Parliament has decided. My Lords, this is a large group of amendments, and it's the government's view that to a great extent.
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The point about resources. Can I just ask her briefly? She's made the point about making available the point about making available the resources to deliver what would be in the bill. The question I asked, which the whip on the bench asked, which the whip on the bench confirmed she would answer is, is would that be at the impact of other users of the court system, or other users of the court system, or would the government make available extra resources to deliver what's in the bill, but without disadvantaging other users of the court system? He did say you'd answer.
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No, he didn't. He didn't intend to say that he would go further than I have just gone. Confirm? Yes, absolutely. I'd be surprised if he had intended that he would go had intended that he would go further than I intended to go. With respect to the noble Lords, we're not here to debate what is going on not here to debate what is going on in family justice system. We are here to debate these amendments and I'm going to stick to this. I also am anxious not to take too many interventions, because this is a large group, and there are things that the government wants to say about workability.
I need to get through them in the time allotted to me. So it is.
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It is of crucial importance for us to know that if we pass this us to know that if we pass this bill in these terms, other people who are in desperate need would who are in desperate need would find that they had to wait longer for that need to be met. It is not for that need to be met. It is not good enough for the government to say, we'll provide resources to meet the bill. It must tell us whether those are additional resources or whether this is going to be something at which very sad and poor people are going to lose out because the government takes the money away.
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I'm sorry to disappoint the noble Lord, but I am not going noble Lord, but I am not going further than I have gone. It is the government's view that, to a great extent, the amendments in the name of the noble Lord Lord Carlile should stand or fall together as we understand matters. The overall intention of the noble Lords intention of the noble Lords amendments is to replace the assisted dying model set out in the bill with a court based system, and bill with a court based system, and that is a policy choice and is a matter for Parliament.
But the government's view is that were Parliament to allow some of the noble Lords amendments, but not others, this might cause problems with the drafting of other provisions both in the bill and elsewhere. One further note of caution if your Lordships support these amendments, the governments may need. Government may need to revisit the drafting in order to ensure coherence with the statute book. And the noble Lord has readily acknowledged as much in his speech, although our view is that the noble Lord Lord Carlile amendment stand or fall together, the government believes that your Lordship should be aware of the observations we have and any concerns we need to raise about the workability of proposed clauses as currently drafted.
But as I have said, this is a large group and for this reason I apologise in advance for the fact it will take me a little bit of time to go through them, and it may limit my taking interventions, but I shall not comment on all of the amendments in this group so your Lordships can take it that if there are some which I do not mention explicitly, this is only because the government has no observations to make, or at least none at the moment, although it's always possible that something may arise at some later stage.
I begin with the proposed new process, dealing first with our observations about amendment 120. Applications to the Family Division of the High Court would need to be accompanied by statements from two medical professionals as drafted. Both medical professionals must have at least three years experience in the diagnosis of, and prognosis for, the terminal illness from which the applicant suffers, and one of them must be the practitioner with whom the applicant has been registered for the provision of medical care for at least six months.
The government is of the view that, in the absence of a discretion, this may have the effect of preventing some people from getting assistance if, for example, they have a very rare illness and the pool of willing specialists is small, or if they have comorbidities and are under the care of multiple specialists, the government wants the House to note that this might be open to challenge by an individual who wishes to be given assistance, but is prevented from doing so when others are able to, solely because they have a more common or more straightforward condition.
Next amendment 128. In the name of the noble Lady Baroness Coffey. I really do need to get through. Could could all interventions be saved till the end? And if I can get through the things that I really need to tell the house about, then I will take interventions.
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Immediately. No, no, I'm.
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Immediately. No, no, I'm. Sorry to the no to the noble Lady. But we really the Minister has made it clear that she won't. She'll try and take any
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She'll try and take any time. Thank you. Order! Order!
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Thank you. Order! Order! No I'm not. I'm so sorry. I'm in no discourtesy to the noble Lady. Who? For whom? I have a great deal Who? For whom? I have a great deal of respect. But I must get through the matters that the government needs to tell the House about, so it can make decisions about this particular group. Amendment 120. In the name of the noble Lady Baroness Coffey. Plainly, this is contingent upon Parliament agreeing to a court based application system.
In that event, the noble Lady's amendment would then exclude those making applications to the court from obtaining legal aid or legal help otherwise sourced from taxes, except indirectly through benefits. My Lords, the framework for legal aid funding is set out in Legal Aid, Sentencing and Punishment of Offenders Act, known colloquially as Laspo. An old friend of mine. The House should note that there are no primary provisions permitting the grant of legal aid outwith Laspo, so the noble Lady's Amendment would present a novel approach to extending those provisions.
The government's view is that if the principle contained within this amendment is the will of Parliament, then the mechanism for achieving this may need to be considered within Laspo in order for there to be legislative coherence. There is a further point your Lordship should note in relation to the noble Ladies Amendment hearings related to assisted dying, as proposed by this bill, are not currently in scope for legal aid funding within Laspo, but Laspo does contain provision for exceptional case funding, and this provides for legal aid in circumstances in which the Echr requires an individual to be able to be legally represented, and the government's view is that excluding assisted dying hearings from legal aid funding, including the exceptional case funding mechanism as a matter of principle and without exception could lead to a breach of convention rights.
Returning to the amendments in the name of the noble Lord Lord Carlile, amendment 46 requires the court to be satisfied beyond reasonable doubt that first the applicant has sufficient capacity, and secondly, to refuse to make the order would amount to a breach of the relevant human rights law. Government has one concern and one observation. First, the concern. It's not clear what the relevant human rights law means in this context, given that there is currently no right to an assisted death under the convention as drafted.
This would mean that the test could never be met, but if the amendment is referring to other rights, then for clarity, the government feels that these should be specified. Secondly, the observation as you Lordships will be aware, the expression beyond reasonable doubt means that it is the criminal standard of proof which applies. Thus, and unsurprisingly, it is in criminal proceedings that the higher standard is generally required. In civil law, the criminal standard is usually reserved for cases where the courts imposing a punitive measure, and the issue to be determined is a question of fact, including findings as to states of mind such as intention and recklessness.
It would be unusual for there to be a requirement that a judge be satisfied to the higher standard as to questions of clinical opinion and breaches of legal rights. But that said, it would be a policy decision for Parliament whether cases of this kind require the application of a higher standard. Amendment 46 be in the name of the noble Lady. Baroness Coffey requires the physical attendance of the applicant in court. It seems that this would exclude any person who is unable to attend the hearing from accessing an assisted death, and for this reason, the government this this amendment would, in the government's view, engage with article eight right to private life and article 14 prohibit prohibit, prohibition of discrimination.
And that restriction would have to be objectively and reasonably justified in order to comply with Echr obligations. I turn now to eligibility and amendment 69 and 95. In the name of the noble Lord Lord Carlile. The government has a concern that amendment 69 and 95 would create uncertainty in relation to eligibility for assistance. It might be difficult to prove that a disease could not be halted for a short time, even in cases in which clinical opinion is that its return and progression is inevitable.
There may be a risk that this could be seen as creating unprincipled distinctions in eligibility, and could therefore give rise to legal challenge, for example, on the basis that excluding certain people is not justified under article 2 or 8 of the European Convention on Human Rights and or amounts to unjustified discrimination under article 14. Court based mental capacity assessments. Amendment 116 removes the use of the Mental Capacity Act and proposes a different and untested approach to capacity. As part of this, the court would be required to play a more direct investigative role than is standard practice in capacity assessments, and the government is concerned that this could create confusion for practitioners who have experience in applying and are trained to apply the test under the Mental Capacity Act.
Switching to this new approach might risk undermining the quality of capacity assessments. There might also be a risk that this creates unprincipled distinctions in capacity. By excluding anyone with any impairment of the brain or mind, even if that would not affect their capacity under the Mental Capacity Act. It would be important to be able to justify the different approach in order to prevent discrimination under the convention. Amendments four two, 7428, 613 and 781 introduced the concept of independent persons who would be required to carry out various functions.
It is not clear from the proposed new clauses how these independent persons would work together to carry out these functions, or resolve any disagreements between them, or how the skills and experience of each profession would align with their duties. For example, under the new clause, as currently drafted, a solicitor might be responsible for the collection and transportation of the approved substance. It seems that the solicitor would then be required to report on medical matters, such as pronouncing the death of the person without any requirement that they complete medical training.
The government also has a concern that, should medical help be needed as an unforeseen consequence of the self-administration procedure, amendment 613 might create a risk if that independent person had no medical qualifications. Amendment 47 requires the lethal dosage of the approved substance to be ingested by the person accessing an assisted death, giving the word its ordinary meaning. Ingested would not include intravenous or injectable administration. Ingestion is generally understood to mean taking a substance into the body via the gastrointestinal tract, that is to say, via oral, nasogastric, or gastronomy routes.
The government believes that this is how most doctors would understand the word ingest. The House may wish to note that this amendment, as drafted, might prevent clinicians from proposing a more clinically appropriate mechanism for a particular person, such as intravenous or injectable self-administration. Or it might have the effect of excluding some patients from having an assisted death, even though they might be capable of self-administration by other means. Additional drafting issues are that at the beginning of my speech, I observed that if Parliament were to allow some of these amendments, they might require some redraughting in order to make them workable.
And I give as an example amendment 626. First, the word form and the expression lethal dosage. Dosage of drugs would, in the government's view, need more clarity in order not to give rise to uncertainty when regulations are drafted. Second, the requirement to specify the exact composition of each dosage might also raise issues of liability, intellectual property, and safety. And thirdly, it should also be noted that what constitutes a lethal dose may be patient specific, depending on factors such as weight tolerance, the patient's health status, and other medication, so the drafting may need to make provision for this.
In his speech, the noble Lord Lord Carlile readily acknowledged that there are likely to be some drafting issues. Government's position is that whilst we are neutral on all the policy choices that are reflected in these amendments, as on the bill as a whole, I can confirm that the government would provide drafting support to ensure any amendments passed by either House are both legally workable and consistent and coherent with the statute book. Turning finally to amendment 67, in the name of the noble Lady Baroness Grey-Thompson, this would require the family division of the High Court to make an order confirming compliance with the act, before a person could be provided with assistance.
This would be in addition to consideration given by an assisted dying review panel. The government has one observation the amendment does not set out how and when a person's case would be referred to the High Court, and the government feels that further detail is needed in the primary legislation in order to ensure that supporting procedural rules and practice directions would be adequate. That brings to an end my observations on behalf of the government in relation to the workability of the bill. I haven't addressed all clauses, but there are.
I have a few moments left, and as I said, I would if the noble Lady Baroness Nicholson wishes to make her intervention, I will of
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course, take it. Mr. My question is to do or my
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Mr. My question is to do or my point. I would appreciate it if you would consider it some moment. Is that two medical professionals that two medical professionals coming on the panel will not have any knowledge of hearing, because any knowledge of hearing, because there's about one week of a medical professional's training which is on hearing. And that, of course, is hearing. And that, of course, is almost nothing. And unfortunately, in the United Kingdom, we have about 20 million people with hearing defects, some large and some less.
And nonetheless, when people are dying or very poorly, they find understanding considerably more difficult. And I would want that point to be brought in, and I will raise it in considerable detail at the right moment. And I merely ask the
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Minister to take account of this at this time. I'm sure that. The Committee is entirely
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The Committee is entirely endorse what the noble Lady says in relation to the importance of those who are hearing impaired. I think that in these circumstances, this that in these circumstances, this is not actually a matter for the government. It's a matter for the proposer of the amendment and for the sponsor of the bill should the sponsor of the bill should should it be passed. But the point is, remains an important one.
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is, remains an important one. The inadvertently omitted to answer the important question that both myself and Lord Gove asked, and this is a resources question. And the whip, of course, confirmed that she would answer it, which was my question about the bill was introduced. Had a court system in it. It was reported that the sponsor of the bill had been advised by the government and the judiciary that it was not possible to deliver that for capacity reasons. Did the government provide that advice, and if it did, will
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the Minister publish it? I'm going to repeat the words that were used by my hon. Friend, the Minister for courts in the other place, which is that the decision as to the introduction of
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the panel was made by the sponsor. In answer to my question. I just outlined it is a matter
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I just outlined it is a matter for the Minister. There is a series of of correspondence between the Minister and the other place and Minister and the other place and Rebecca Paul MP that specifically relates relates to the issue of undue influence, which the noble Lord Lord Carlile has now added for the first time into the bill. I would be really grateful if the noble Lady would go back and look at that correspondence and write and put that letter in the library, because the government did express, if I'm remembering correctly, a view on why undue influence was not
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appropriate to add to the bill. It sounds like an important point, and I'm sure that the noble point, and I'm sure that the noble Lady will understand that I don't have the answer to that at my fingertips right now, but I will
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write to her. My Lords, I have to make a
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My Lords, I have to make a declaration, namely, that my wife is a recently retired designated family judge, one of the people
But there is a serious point to be made here. I want to reassure your Lordships that this has had no effect on the government's neutral analysis of the workability of the amendments in question, and although I have had the advantage of having advanced notice of my Noble Kinsmen position, I have engaged with him as to the government's response in no different way from the way I would with any of your Lordships, as this is the first time a Minister from the Ministry of Justice has spoken in this debate, I reiterate what's been said on many, many occasions by my noble friend Baroness Merron.
The government's position is that it is a matter for Parliament to decide the policy which underpins this Bill, and it follows that I will not be providing a government view on the merits of any of the amendments, nor will I make any observations in a personal capacity. But I will deal with the question that has been asked by a number of your Lordships as to whether the government would deliver this. Were the will of Parliament to be that the the general principle contained in the noble Lord Lord Carlile amendments were to be adopted.
The answer is that given our current workload, it would of course be challenging. And I say this because I am in fact the family justice Minister as well as the Lords Minister. But if it is the will of Parliament, then we will work with the judiciary to make sure that we have the resources in place to deliver what Parliament has decided. My Lords, this is a large group of amendments, and it's the government's view that to a great extent.
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The point about resources. Can I just ask her briefly? She's made the point about making available the point about making available the resources to deliver what would be in the bill. The question I asked, which the whip on the bench asked, which the whip on the bench confirmed she would answer is, is would that be at the impact of other users of the court system, or other users of the court system, or would the government make available extra resources to deliver what's in the bill, but without disadvantaging other users of the court system? He did say you'd answer.
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No, he didn't. He didn't intend to say that he would go further than I have just gone. Confirm? Yes, absolutely. I'd be surprised if he had intended that he would go had intended that he would go further than I intended to go. With respect to the noble Lords, we're not here to debate what is going on not here to debate what is going on in family justice system. We are here to debate these amendments and I'm going to stick to this. I also am anxious not to take too many interventions, because this is a large group, and there are things that the government wants to say about workability.
I need to get through them in the time allotted to me. So it is.
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It is of crucial importance for us to know that if we pass this us to know that if we pass this bill in these terms, other people who are in desperate need would who are in desperate need would find that they had to wait longer for that need to be met. It is not for that need to be met. It is not good enough for the government to say, we'll provide resources to meet the bill. It must tell us whether those are additional resources or whether this is going to be something at which very sad and poor people are going to lose out because the government takes the money away.
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I'm sorry to disappoint the noble Lord, but I am not going noble Lord, but I am not going further than I have gone. It is the government's view that, to a great extent, the amendments in the name of the noble Lord Lord Carlile should stand or fall together as we understand matters. The overall intention of the noble Lords intention of the noble Lords amendments is to replace the assisted dying model set out in the bill with a court based system, and bill with a court based system, and that is a policy choice and is a matter for Parliament.
But the government's view is that were Parliament to allow some of the noble Lords amendments, but not others, this might cause problems with the drafting of other provisions both in the bill and elsewhere. One further note of caution if your Lordships support these amendments, the governments may need. Government may need to revisit the drafting in order to ensure coherence with the statute book. And the noble Lord has readily acknowledged as much in his speech, although our view is that the noble Lord Lord Carlile amendment stand or fall together, the government believes that your Lordship should be aware of the observations we have and any concerns we need to raise about the workability of proposed clauses as currently drafted.
But as I have said, this is a large group and for this reason I apologise in advance for the fact it will take me a little bit of time to go through them, and it may limit my taking interventions, but I shall not comment on all of the amendments in this group so your Lordships can take it that if there are some which I do not mention explicitly, this is only because the government has no observations to make, or at least none at the moment, although it's always possible that something may arise at some later stage.
I begin with the proposed new process, dealing first with our observations about amendment 120. Applications to the Family Division of the High Court would need to be accompanied by statements from two medical professionals as drafted. Both medical professionals must have at least three years experience in the diagnosis of, and prognosis for, the terminal illness from which the applicant suffers, and one of them must be the practitioner with whom the applicant has been registered for the provision of medical care for at least six months.
The government is of the view that, in the absence of a discretion, this may have the effect of preventing some people from getting assistance if, for example, they have a very rare illness and the pool of willing specialists is small, or if they have comorbidities and are under the care of multiple specialists, the government wants the House to note that this might be open to challenge by an individual who wishes to be given assistance, but is prevented from doing so when others are able to, solely because they have a more common or more straightforward condition.
Next amendment 128. In the name of the noble Lady Baroness Coffey. I really do need to get through. Could could all interventions be saved till the end? And if I can get through the things that I really need to tell the house about, then I will take interventions.
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Immediately. No, no, I'm.
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Immediately. No, no, I'm. Sorry to the no to the noble Lady. But we really the Minister has made it clear that she won't. She'll try and take any
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She'll try and take any time. Thank you. Order! Order!
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Thank you. Order! Order! No I'm not. I'm so sorry. I'm in no discourtesy to the noble Lady. Who? For whom? I have a great deal Who? For whom? I have a great deal of respect. But I must get through the matters that the government needs to tell the House about, so it can make decisions about this particular group. Amendment 120. In the name of the noble Lady Baroness Coffey. Plainly, this is contingent upon Parliament agreeing to a court based application system.
In that event, the noble Lady's amendment would then exclude those making applications to the court from obtaining legal aid or legal help otherwise sourced from taxes, except indirectly through benefits. My Lords, the framework for legal aid funding is set out in Legal Aid, Sentencing and Punishment of Offenders Act, known colloquially as Laspo. An old friend of mine. The House should note that there are no primary provisions permitting the grant of legal aid outwith Laspo, so the noble Lady's Amendment would present a novel approach to extending those provisions.
The government's view is that if the principle contained within this amendment is the will of Parliament, then the mechanism for achieving this may need to be considered within Laspo in order for there to be legislative coherence. There is a further point your Lordship should note in relation to the noble Ladies Amendment hearings related to assisted dying, as proposed by this bill, are not currently in scope for legal aid funding within Laspo, but Laspo does contain provision for exceptional case funding, and this provides for legal aid in circumstances in which the Echr requires an individual to be able to be legally represented, and the government's view is that excluding assisted dying hearings from legal aid funding, including the exceptional case funding mechanism as a matter of principle and without exception could lead to a breach of convention rights.
Returning to the amendments in the name of the noble Lord Lord Carlile, amendment 46 requires the court to be satisfied beyond reasonable doubt that first the applicant has sufficient capacity, and secondly, to refuse to make the order would amount to a breach of the relevant human rights law. Government has one concern and one observation. First, the concern. It's not clear what the relevant human rights law means in this context, given that there is currently no right to an assisted death under the convention as drafted.
This would mean that the test could never be met, but if the amendment is referring to other rights, then for clarity, the government feels that these should be specified. Secondly, the observation as you Lordships will be aware, the expression beyond reasonable doubt means that it is the criminal standard of proof which applies. Thus, and unsurprisingly, it is in criminal proceedings that the higher standard is generally required. In civil law, the criminal standard is usually reserved for cases where the courts imposing a punitive measure, and the issue to be determined is a question of fact, including findings as to states of mind such as intention and recklessness.
It would be unusual for there to be a requirement that a judge be satisfied to the higher standard as to questions of clinical opinion and breaches of legal rights. But that said, it would be a policy decision for Parliament whether cases of this kind require the application of a higher standard. Amendment 46 be in the name of the noble Lady. Baroness Coffey requires the physical attendance of the applicant in court. It seems that this would exclude any person who is unable to attend the hearing from accessing an assisted death, and for this reason, the government this this amendment would, in the government's view, engage with article eight right to private life and article 14 prohibit prohibit, prohibition of discrimination.
And that restriction would have to be objectively and reasonably justified in order to comply with Echr obligations. I turn now to eligibility and amendment 69 and 95. In the name of the noble Lord Lord Carlile. The government has a concern that amendment 69 and 95 would create uncertainty in relation to eligibility for assistance. It might be difficult to prove that a disease could not be halted for a short time, even in cases in which clinical opinion is that its return and progression is inevitable.
There may be a risk that this could be seen as creating unprincipled distinctions in eligibility, and could therefore give rise to legal challenge, for example, on the basis that excluding certain people is not justified under article 2 or 8 of the European Convention on Human Rights and or amounts to unjustified discrimination under article 14. Court based mental capacity assessments. Amendment 116 removes the use of the Mental Capacity Act and proposes a different and untested approach to capacity. As part of this, the court would be required to play a more direct investigative role than is standard practice in capacity assessments, and the government is concerned that this could create confusion for practitioners who have experience in applying and are trained to apply the test under the Mental Capacity Act.
Switching to this new approach might risk undermining the quality of capacity assessments. There might also be a risk that this creates unprincipled distinctions in capacity. By excluding anyone with any impairment of the brain or mind, even if that would not affect their capacity under the Mental Capacity Act. It would be important to be able to justify the different approach in order to prevent discrimination under the convention. Amendments four two, 7428, 613 and 781 introduced the concept of independent persons who would be required to carry out various functions.
It is not clear from the proposed new clauses how these independent persons would work together to carry out these functions, or resolve any disagreements between them, or how the skills and experience of each profession would align with their duties. For example, under the new clause, as currently drafted, a solicitor might be responsible for the collection and transportation of the approved substance. It seems that the solicitor would then be required to report on medical matters, such as pronouncing the death of the person without any requirement that they complete medical training.
The government also has a concern that, should medical help be needed as an unforeseen consequence of the self-administration procedure, amendment 613 might create a risk if that independent person had no medical qualifications. Amendment 47 requires the lethal dosage of the approved substance to be ingested by the person accessing an assisted death, giving the word its ordinary meaning. Ingested would not include intravenous or injectable administration. Ingestion is generally understood to mean taking a substance into the body via the gastrointestinal tract, that is to say, via oral, nasogastric, or gastronomy routes.
The government believes that this is how most doctors would understand the word ingest. The House may wish to note that this amendment, as drafted, might prevent clinicians from proposing a more clinically appropriate mechanism for a particular person, such as intravenous or injectable self-administration. Or it might have the effect of excluding some patients from having an assisted death, even though they might be capable of self-administration by other means. Additional drafting issues are that at the beginning of my speech, I observed that if Parliament were to allow some of these amendments, they might require some redraughting in order to make them workable.
And I give as an example amendment 626. First, the word form and the expression lethal dosage. Dosage of drugs would, in the government's view, need more clarity in order not to give rise to uncertainty when regulations are drafted. Second, the requirement to specify the exact composition of each dosage might also raise issues of liability, intellectual property, and safety. And thirdly, it should also be noted that what constitutes a lethal dose may be patient specific, depending on factors such as weight tolerance, the patient's health status, and other medication, so the drafting may need to make provision for this.
In his speech, the noble Lord Lord Carlile readily acknowledged that there are likely to be some drafting issues. Government's position is that whilst we are neutral on all the policy choices that are reflected in these amendments, as on the bill as a whole, I can confirm that the government would provide drafting support to ensure any amendments passed by either House are both legally workable and consistent and coherent with the statute book. Turning finally to amendment 67, in the name of the noble Lady Baroness Grey-Thompson, this would require the family division of the High Court to make an order confirming compliance with the act, before a person could be provided with assistance.
This would be in addition to consideration given by an assisted dying review panel. The government has one observation the amendment does not set out how and when a person's case would be referred to the High Court, and the government feels that further detail is needed in the primary legislation in order to ensure that supporting procedural rules and practice directions would be adequate. That brings to an end my observations on behalf of the government in relation to the workability of the bill. I haven't addressed all clauses, but there are.
I have a few moments left, and as I said, I would if the noble Lady Baroness Nicholson wishes to make her intervention, I will of
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course, take it. Mr. My question is to do or my
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Mr. My question is to do or my point. I would appreciate it if you would consider it some moment. Is that two medical professionals that two medical professionals coming on the panel will not have any knowledge of hearing, because any knowledge of hearing, because there's about one week of a medical professional's training which is on hearing. And that, of course, is hearing. And that, of course, is almost nothing. And unfortunately, in the United Kingdom, we have about 20 million people with hearing defects, some large and some less.
And nonetheless, when people are dying or very poorly, they find understanding considerably more difficult. And I would want that point to be brought in, and I will raise it in considerable detail at the right moment. And I merely ask the
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Minister to take account of this at this time. I'm sure that. The Committee is entirely
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The Committee is entirely endorse what the noble Lady says in relation to the importance of those who are hearing impaired. I think that in these circumstances, this that in these circumstances, this is not actually a matter for the government. It's a matter for the proposer of the amendment and for the sponsor of the bill should the sponsor of the bill should should it be passed. But the point is, remains an important one.
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is, remains an important one. The inadvertently omitted to answer the important question that both myself and Lord Gove asked, and this is a resources question. And the whip, of course, confirmed that she would answer it, which was my question about the bill was introduced. Had a court system in it. It was reported that the sponsor of the bill had been advised by the government and the judiciary that it was not possible to deliver that for capacity reasons. Did the government provide that advice, and if it did, will
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the Minister publish it? I'm going to repeat the words that were used by my hon. Friend, the Minister for courts in the other place, which is that the decision as to the introduction of
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the panel was made by the sponsor. In answer to my question. I just outlined it is a matter
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I just outlined it is a matter for the Minister. There is a series of of correspondence between the Minister and the other place and Minister and the other place and Rebecca Paul MP that specifically relates relates to the issue of undue influence, which the noble Lord Lord Carlile has now added for the first time into the bill. I would be really grateful if the noble Lady would go back and look at that correspondence and write and put that letter in the library, because the government did express, if I'm remembering correctly, a view on why undue influence was not
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appropriate to add to the bill. It sounds like an important point, and I'm sure that the noble point, and I'm sure that the noble Lady will understand that I don't have the answer to that at my fingertips right now, but I will
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write to her. My Lords, I have to make a
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My Lords, I have to make a declaration, namely, that my wife is a recently retired designated family judge, one of the people
12:59
Lord Falconer of Thoroton (Labour)
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Lord Falconer of Thoroton (Labour)
family judge, one of the people that the noble Lord, Lord Carlile, wishes to include in his court based process. I should say that it makes me very warm. In favour of the Or. I admire greatly the family division. I also completely endorse what the noble and learned Baroness May Baroness Butler-Sloss said that if this was put into the bill, I've got absolutely no doubt that the family division would deal with it in accordance with the directions of Parliament, and I believe that they would deal with it well.
But I am not in favour of the change proposed by the noble Lord Lord Carlile. Under amendment 120. And I'll deal with that in detail in a moment. Can I agree with the noble Lord Earl Howe when he says, there's quite a lot in this group, and I will deal with the specific points that have been raised. But the central issue for the for this House in relation to this group is do we think a panel, as in the current bill, is better or worse than the sort of situation that the noble Lord proposes in his amendment 120? I do not intend to pick at the detail of amendment 120, because there's plainly a point of principle there.
I also agree that if the House were to agree to it, then there would no doubt need to be drafting changes. I do think I should say, first of all, what I understand the essence of it to be, and then to describe the panel situation. First of all, the essence that he described, he in effect says the High Court judge should say yes or no, or the expanded number of judges should say yes or no to an assisted death. The material they've got to work on is the evidence they think is appropriate.
He is, I think, though I'm not clear about this saying the High Court judge decides and there doesn't need to be the two doctors dealing with issues such as firm and settled view. The only requirement for the two doctors, as I read his proposal, is that they've got to give evidence or have a view in relation to the terminal illness aspect. That is why he objects and objects is objecting to the various clauses standing part that involve the
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First Doctor and Second Doctor. I'm grateful to the noble Lord Leonard Lord for giving way, and I Leonard Lord for giving way, and I don't want to take up unnecessary time. The purpose of the judge's time. The purpose of the judge's role is to receive the evidence which is relevant to the issue which is relevant to the issue under consideration. There are many tribunals, for example, mental health tribunals, on which doctors serve. But in my view, and in the view of many, I believe a more satisfactory process on the whole where critical issues are being considered is for the judge to hear the evidence and adjudicate upon it.
And just to pick up a point made by the noble Lord, Lord Hamilton, as the noble and learned Lord knows, judges are perfectly capable of rejecting medical evidence that is
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put before them, and do so with reasonable frequency. I take. That to be a yes. So the
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That to be a yes. So the position that the noble Lord is proposing is that the judge hears proposing is that the judge hears the evidence of the doctors on the issues of, for example, coercion, for example, capacity, for example, for example, capacity, for example, firm and settled view. And then the judge makes the decision. So the judge makes the decision. So the comparison that we have is between two doctors, each forming a view in relation to the terminal illness decision.
Also, the issue of capacity and the issue of whether or not the person has reached a voluntary decision as to whether to have an assisted death, and the panel then either endorses that by giving a certificate or rejects it. That's in the bill. What the noble Lord Lord Carlile is suggesting is let the court decide. In effect, the whole thing, the reason I reject that view is that I am absolutely satisfied and I don't. I accept this is an issue that requires a lot of work, and thinking about that, you are much better off having a multidisciplinary approach to the question of whether or not somebody is going to make an assisted death decision, and you are much better in letting the social worker, the psychiatrist, the doctor, and the legally qualified person have a look at the situation and then decide whether or not somebody can I just finish that? Somebody should make the decision about assisted death.
The evidence that was given death. The evidence that was given in the court of. No, no. Sorry, sorry. Can I just continue this? I'll come back to you. I'll come back to your question in a moment. But it's very important because this is the absolutely critical bit of the whole thing. There was a lot of evidence given to the committee in the Commons in which this very, very issue was discussed. And somebody called Sarah Cox gave evidence, who was an expert.
The other thing that concerns me, she said, is that you're putting all these assessments on the shoulders of two doctors individually, followed by a High Court judge. In any other clinical practice, when we are making very serious decisions. We know that shared decisions are much better quality, much more robust and much safer in clinical practice. We make all these decisions in multi-professional terms. I would never make these decisions independently of my team because the perspective they bring can help me to understand the things that I am not seeing.
Judges are upkeep going. Judges are marvellous, but a number of pair of eyes in relation to this is better. Now there is a huge number of questions asked of me as to why did I and the sponsor in the Commons change? No, no, let me finish, let me finish. No, I'm sorry, I'm not going to take the intervention at this stage. I'm not going to. I'm sorry. I will come to you. I will come to you in a moment. But I think I should make the argument in full.
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Yeah. The argument is that we. We made
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The argument is that we. We made the decision to change from a judge, which initially I had favoured which initially I had favoured because of pressure or advice from the Ministry of Justice. That is the Ministry of Justice. That is not right. The reason the decision was made, and it was a change, was was made, and it was a change, was because the evidence was very clear and I accepted that you are better off and it is safer if one does it with a multidisciplinary panel.
So that is the reason that the change was made. Now what are the reasons advanced by the noble Lord, Lord Carlile, for saying that we should have a court based process, not a panel based process. First, he says, the court has experience of making analogous type decisions. The sort of analogous type decision he's referring to is the one that the noble and learned Lord Low, the noble and learned Baroness Baroness Butler-Sloss, referred to the blind people in a permanent vegetative state, should their life support be turned off? Yes, that would be of assistance.
But what we are proposing in the bill is a panel supervised by a commissioner that is devoted completely to the question of whether or not assisted deaths should be permitted. So, yes, you get the benefit at the very outset of the analysis that the court has made. What you've got here is one that is only devoted to that issue, which is bound to become better and more, not better, but more experienced at it than the courts that are rightly dealing with a whole range of things.
Secondly, it is said the courts would give a reasoned judgement. Well, as was pointed out in the course of the debate, there is a requirement in paragraph nine of schedule two of the bill that the panels must give reasons in writing, and that will give rise to a body of decisions being made. Thirdly, it is said that the that the that the that the court is a court of record. Yes, it is a court of record. But the the key thing in relation to this is who is best at making the decision.
Is it better you just have the judge, or is it better that you have both the experienced legal member, but also a psychiatrist and a social worker? And I don't think, in all honesty, that the fact that it is a court of record is will make any difference to that whatsoever. Fifthly, it is said, well, you can appeal to the Court of Appeal. We are talking here about people who want an assisted death. You want a safe process. You do not want an overengineered process.
The idea that you've got to go into a system that carries with it appeals, in my respectful view, is putting too much of a burden on the people. And then finally it is said, and it's a point made by the noble Lord. On the crossbenches to the effect that that the judges, Lord Harris, I apologise the the, the, the, the, the judges have especial respect in our system. The key thing is not do the judges have respect, but will our system of assisted dying carry respect? And this is a better way of making the judgement.
So that is why I support it. One final point that was made, I think, by the noble Lord Lord Pannick, or he raised it and then said, this is the answer, and that is. And this may have to do with the fact that it's a court of record. Well, the court have powers, discovery, powers, etc. Yes, they do, but if the position is that the panel feels that there are areas that they are not getting to the point of that, then of course they will not be satisfied and cannot give the certificate.
So for all of those reasons, a panel is better and than the courts, and that is why the decision was made. Could I go to Baroness O'Loan now and answer a question? I apologise for not answering it before.
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Thank you very much, my Lord. My Lord. The question. The question I wanted to ask the noble and learned Lord was in this connection of he's Lord was in this connection of he's telling us about panel and and and judges. The three members, as I judges. The three members, as I understand it, in the legislation which he has presented to the House or have expertise in their own area or have expertise in their own area of competence, the benefit of the.
Does he accept that the benefit of the system devised by Lord Carlile is to bring many more disciplines, medical disciplines, particularly into the agenda, and in particular, the judge would have the right to sit with the doctor and there would be a psychiatrist, report on the capacity, etc. of the individual, so the psychiatric issues would be taken care of. So it actually what this Lord Carlile amendment proposes is something wider than
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that which the panel could provide. I don't accept that the position is in relation to the panel. If they think that they need they want they think that they need they want a report from a doctor, they can get it. What I understand the noble Lord Lord Carlile is saying is, Lord Lord Carlile is saying is, well, the court can ask for all these things. Of course it can. And if it thinks they're appropriate, if it thinks they're appropriate, then it will do so.
It won't ask them, I assume, when they don't think it's necessary to the resolution of the issues, the panel resolution of the issues, the panel can do the same. And if they don't get them, then just like the court, they will have to say no, no, no.
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Thank you. In relation to the panel. And as a non-medical, I understand from my time on the understand from my time on the select committee, multidisciplinary has a particular meaning within healthcare that the witness to the Commons was relating to. So it's Commons was relating to. So it's not quite the same issue, but it's not the noble and learned Lords not the noble and learned Lords concerned that both the only two of the three representative bodies of the panel could, came and gave evidence to the Select Committee, evidence to the Select Committee, the British Association of Social Workers and the Royal College of Psychiatrists are not supporting the bill, regardless of what they might view on the principle.
So that you have, although the noble Lord is is obviously very well persuaded by the evidence, the professional bodies who would sit
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on this panel are not yet persuaded. Colleges aren't neutral on the principle. The Royal College of Psychiatrists have said they're worried about the burden on worried about the burden on psychiatrists, not by reference specifically to the panel, though it comes into it what they say, but in relation to some of the capacity assessments they've made, I do not think that it will be difficult to think that it will be difficult to find, for the purposes of the panel, people who have the appropriate qualifications in psychiatry to sit on the panel.
It will, for example, be people who have who have had some experience and maybe working part time. They will be able to do it. So I'm not concerned about the it.
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Baroness Nicholson noble Lord, does the noble Lord not accept that his particular panel make up disregards probably the largest disability in the whole of the United Kingdom, which is deafness, United Kingdom, which is deafness, where 19 or 20 million people are deaf in various different degrees. deaf in various different degrees. It is an issue that is very underrepresented in this, in this House. Oddly enough, although a House. Oddly enough, although a large number of members suffer from deafness, and it is also particularly badly treated in the National Health Service, as we've seen from the recent assault report, on 1 in 1000 deaf babies being born and not actually having the issues addressed in the way that they should have.
Why does the noble Lord think his panel will therefore be any better than the noble Lord? Lord Carlisle's proposal, which presumably the judge would look at every aspect of a patient before making any decision. I'm concerned that this panel attitude is quite irrelevant to those of us who are deaf. Nearly 20 million British people are deaf, and there's also the numbers of people who don't speak English, which is a very
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large number indeed. Lord can respond to your to the lady's point.
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I'm not sure, particularly in the way that the noble Baroness Baroness Nicholson addressed the issue at the very end, that this really is a point about panel versus judge. I would expect a versus judge. I would expect a judge to be experienced and able to deal with somebody who is deaf, and if they weren't able to, they if they weren't able to, they should be equally, the panel would be dealing with it in the same way. That is what I would expect.
But it, in all honesty, was not a factor in determining which was better. Panel or judge. Both would have to deal
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with that particular. Oh no, no no. And there is no social work
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relevant to deafness. Your panel is very specific. The noble Lord. I hope, I hope, I hope I've
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I hope, I hope, I hope I've given a satisfactory answer in
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relation to it. Sir. Claire, my interest as a former Deputy High Court judge and recorder. But does the noble and learned Lord not think that one of the ways of curing his concern in relation to the multidisciplinary nature that's needed in the assessment, if that multidisciplinary assessment was made earlier in the process and that evidence was available to the court, the court could then better determine. Thank you.
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Yes, I agree very strongly with that, that the multidisciplinary team, this is a different use of the phrase, the word multidisciplinary team in relation to the the person who is actually to the the person who is actually treating the person. I think the more input they can have, the better. But with respect to the noble and learned Baroness, I'm not sure that that bears on the question of whether panel or tribunal is better, because as far as panel on court is better, because whichever route was reached, you would hope that at the stage where either the panel or the court was having to make a decision, they would have access to what the multidisciplinary team treating the patient thought about the patient.
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consideration. Lord Wood I. Can just assist the noble and learned Lord, the reason I think it learned Lord, the reason I think it is relevant is if that multidisciplinary assessment is available and the court has that evidence available to it, together with any other assessment made by the individual additional clinicians. The court can then make clinicians. The court can then make an informed assessment as to which method or which approach they are minded to deal with, particularly dealing with the issue when the court does not necessarily agree with the evidence of one particular
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clinician who they have had the benefit of hearing from. That is useful. I don't understand that
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I don't understand that proposition because it seems to me the panel is well able to take into account that as well. This is the account that as well. This is the court would be and indeed, I would think they would probably be better able to assess it. So so I'm not
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able to assess it. So so I'm not sure I accept that proposition. No. Sir, I'm not sorry.
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Sir, I'm not sorry. Thank you. When the this was debated in another place, the argument was made around this. The Association of Palliative Medicine wrote formally to correct the record, and the statement said that the APM clarified the current bill doesn't align with the standard multi-professional team decision making process, and the noble and learned Lord mentioned Doctor Cox and the noted Doctor. Cox was arguing that the bill's model of two independent doctors working alone was inadequate, and assessment should be carried out within the Multi-professional team model to strengthen the bill.
So the discrepancy the APM and MPs noted well, the bill introduces the panel psychiatrist and social worker at the end of the process. This does not equate to the multi-professional assessment at the beginning. The assessment stage that Doctor Cox was advocating for, and I think that is really important because the Association of Palliative Medicine wrote formally to correct the record of the debate in the other place. I understand the Noble and learned law doesn't want to respond to that right now.
I'm very happy for him to write to me, but I think it's really important that that is on the record in this chamber as a by-product of what happened in another place.
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You know. The, the, the reason I quoted Doctor Cox of the Association of Doctor Cox of the Association of Palliative Medicine was because she specifically said it is better to specifically said it is better to approach this issue on a multidisciplinary process rather multidisciplinary process rather than placing it on the shoulders of the two doctors and the High Court judge. And the panel approach reflects that approach. So that is why I quoted it. And I'm not I don't think I need to write to say that it was part of the evidence, which was saying, have not two pairs of eyes but three pairs.
So
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not one pair of eyes the judge, but three pairs of eyes in relation to it. Can I.
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Can I. I think I've got 21 minutes. So I think I've got to go on and just deal very quickly if I may. First deal very quickly if I may. First of all the costings, the only costings that have been done have been done by the government. The government's costings have been done in relation to the panel, not in relation to the High Court. I have no desire for a High Court costing to be done. If others want it, they can press for it, but I'm not asking for it, nor would I expect it from the government.
The impact assessment has been done on the basis of the Bill as it is, and I am against the proposition of changing the provision in relation to a panel. So I am not pressing for any such panel. Can I just get on and deal with the other? Smaller the prime points in relation to it? Amendment 116, which I think was is tabled by Baroness Coffey says don't use the Mental Capacity Act. I'm against that for the reasons I've already given, which is you should have one system for all of these situations.
Amendment 46 says, this is the noble Lord. Lord Carlile says use the criminal standard of capacity. I'm against that for the reasons given by the Minister. Baroness Coffey in 4.26 A says sit, don't sit in private. What? This is the panel. Don't sit in private. What the bill says is that panels can sit. Panels are to determine referrals in, in public. But the chair of a panel may, at the request of the person to whom a referral relates, decide that the panel is to sit in private.
If you want this last discussion with the panel, if you are dying to be in private, then you should have that right in my respect for you. So I'm I'm strongly against the proposal that she was making amendment 46 be in this group by Baroness Coffey is a requirement that the person attend in person, which I think is unfair understanding of the fact that obviously for some people, they wouldn't be able to attend in person for obvious reasons.
Amendment one to A, one to a in the name of Baroness Coffey says exclude legal aid for the reasons that the Minister gave. I don't think that is possible, but amendment 37 asks why does clause one only refer to sections 8 to 30 and not to the whole bill? The reason is because in section one two of the bill, section 8 to 30, section one two is setting out what are the steps that have to be taken to satisfy the the, the circumstance of the bill.
And that is only 8 to 30. The other parts of the bill are things like keeping records, etc. Well, I think I have I've dealt with all the substantive points and for the reasons I've given, and without any lack of
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respect for the noble Lord Lord Carlile, who presented it very clearly, I am against the proposal he's making. Yes.
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Lord. One thing for granted that the panel and a court based system have panel and a court based system have a great deal, of course, in common six months to live, mental capacity,
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six months to live, mental capacity, a clear and settled decision. Could I ask for the noble Lord
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Could I ask for the noble Lord to write to you about your things? We've had enough explanation from the noble Lord Falconer. We need to move on to the noble Lord Carlile. Thank you.
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Can I just say, I think part of the difficulty that we're having, we're trying to make a pragmatic method of discussing this complicated bill. There have been complicated bill. There have been what is it, 80 amendments in this what is it, 80 amendments in this particular group and in 20 minutes, impossible for the noble Lord to give justice to all those things. I give justice to all those things. I know he's talked in general principles, but he must be aware that one of the difficulties that and it connects with the debate we had yesterday afternoon, which I wasn't here but I saw on television, was that he was not satisfying the need of explanation for those who are articulating points of view, and to just take a little bit longer than the time he needs may well be a shortcut to getting this bill done.
Part of the difficulty I feel, having listened to a lot of the bill, is that he is desperately keen to keep moving. I understand that, but there are points where he can stop and explain, perhaps with a bit more, bit more sympathy to the points that have been made by
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other members of the House armed. Can I first of all, can I just answer what the noble Lord, Lord answer what the noble Lord, Lord Taylor, who I greatly respect, has said? I have answered in some degree of detail the main substantive points that I have dealt with it. I believe in a way that is appropriate for a Committee stage. One of the things we've got to do at committee is try to focus on the things that really matter on the things that really matter and avoid the other things, and that is what I have done.
I am open to anybody coming to see me, and I started this process by writing to individual peers and say, come and see me to raise anything you've got. If there is anything that they want to talk about, I am more than willing to talk about it. But I very much believe that I've answered in detail the substantive application made for an amendment.
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Lord Carlile. My Lords, I'm very grateful to everybody who has taken part in everybody who has taken part in this debate. I hope your Lordships would agree that although this debate has taken over three hours, it's been conducted in precisely the spirit that was discussed in the spirit that was discussed in the debate yesterday, and that has justified taking that time. I said yesterday that I thought we should
But I am not in favour of the change proposed by the noble Lord Lord Carlile. Under amendment 120. And I'll deal with that in detail in a moment. Can I agree with the noble Lord Earl Howe when he says, there's quite a lot in this group, and I will deal with the specific points that have been raised. But the central issue for the for this House in relation to this group is do we think a panel, as in the current bill, is better or worse than the sort of situation that the noble Lord proposes in his amendment 120? I do not intend to pick at the detail of amendment 120, because there's plainly a point of principle there.
I also agree that if the House were to agree to it, then there would no doubt need to be drafting changes. I do think I should say, first of all, what I understand the essence of it to be, and then to describe the panel situation. First of all, the essence that he described, he in effect says the High Court judge should say yes or no, or the expanded number of judges should say yes or no to an assisted death. The material they've got to work on is the evidence they think is appropriate.
He is, I think, though I'm not clear about this saying the High Court judge decides and there doesn't need to be the two doctors dealing with issues such as firm and settled view. The only requirement for the two doctors, as I read his proposal, is that they've got to give evidence or have a view in relation to the terminal illness aspect. That is why he objects and objects is objecting to the various clauses standing part that involve the
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First Doctor and Second Doctor. I'm grateful to the noble Lord Leonard Lord for giving way, and I Leonard Lord for giving way, and I don't want to take up unnecessary time. The purpose of the judge's time. The purpose of the judge's role is to receive the evidence which is relevant to the issue which is relevant to the issue under consideration. There are many tribunals, for example, mental health tribunals, on which doctors serve. But in my view, and in the view of many, I believe a more satisfactory process on the whole where critical issues are being considered is for the judge to hear the evidence and adjudicate upon it.
And just to pick up a point made by the noble Lord, Lord Hamilton, as the noble and learned Lord knows, judges are perfectly capable of rejecting medical evidence that is
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put before them, and do so with reasonable frequency. I take. That to be a yes. So the
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That to be a yes. So the position that the noble Lord is proposing is that the judge hears proposing is that the judge hears the evidence of the doctors on the issues of, for example, coercion, for example, capacity, for example, for example, capacity, for example, firm and settled view. And then the judge makes the decision. So the judge makes the decision. So the comparison that we have is between two doctors, each forming a view in relation to the terminal illness decision.
Also, the issue of capacity and the issue of whether or not the person has reached a voluntary decision as to whether to have an assisted death, and the panel then either endorses that by giving a certificate or rejects it. That's in the bill. What the noble Lord Lord Carlile is suggesting is let the court decide. In effect, the whole thing, the reason I reject that view is that I am absolutely satisfied and I don't. I accept this is an issue that requires a lot of work, and thinking about that, you are much better off having a multidisciplinary approach to the question of whether or not somebody is going to make an assisted death decision, and you are much better in letting the social worker, the psychiatrist, the doctor, and the legally qualified person have a look at the situation and then decide whether or not somebody can I just finish that? Somebody should make the decision about assisted death.
The evidence that was given death. The evidence that was given in the court of. No, no. Sorry, sorry. Can I just continue this? I'll come back to you. I'll come back to your question in a moment. But it's very important because this is the absolutely critical bit of the whole thing. There was a lot of evidence given to the committee in the Commons in which this very, very issue was discussed. And somebody called Sarah Cox gave evidence, who was an expert.
The other thing that concerns me, she said, is that you're putting all these assessments on the shoulders of two doctors individually, followed by a High Court judge. In any other clinical practice, when we are making very serious decisions. We know that shared decisions are much better quality, much more robust and much safer in clinical practice. We make all these decisions in multi-professional terms. I would never make these decisions independently of my team because the perspective they bring can help me to understand the things that I am not seeing.
Judges are upkeep going. Judges are marvellous, but a number of pair of eyes in relation to this is better. Now there is a huge number of questions asked of me as to why did I and the sponsor in the Commons change? No, no, let me finish, let me finish. No, I'm sorry, I'm not going to take the intervention at this stage. I'm not going to. I'm sorry. I will come to you. I will come to you in a moment. But I think I should make the argument in full.
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Yeah. The argument is that we. We made
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The argument is that we. We made the decision to change from a judge, which initially I had favoured which initially I had favoured because of pressure or advice from the Ministry of Justice. That is the Ministry of Justice. That is not right. The reason the decision was made, and it was a change, was was made, and it was a change, was because the evidence was very clear and I accepted that you are better off and it is safer if one does it with a multidisciplinary panel.
So that is the reason that the change was made. Now what are the reasons advanced by the noble Lord, Lord Carlile, for saying that we should have a court based process, not a panel based process. First, he says, the court has experience of making analogous type decisions. The sort of analogous type decision he's referring to is the one that the noble and learned Lord Low, the noble and learned Baroness Baroness Butler-Sloss, referred to the blind people in a permanent vegetative state, should their life support be turned off? Yes, that would be of assistance.
But what we are proposing in the bill is a panel supervised by a commissioner that is devoted completely to the question of whether or not assisted deaths should be permitted. So, yes, you get the benefit at the very outset of the analysis that the court has made. What you've got here is one that is only devoted to that issue, which is bound to become better and more, not better, but more experienced at it than the courts that are rightly dealing with a whole range of things.
Secondly, it is said the courts would give a reasoned judgement. Well, as was pointed out in the course of the debate, there is a requirement in paragraph nine of schedule two of the bill that the panels must give reasons in writing, and that will give rise to a body of decisions being made. Thirdly, it is said that the that the that the that the court is a court of record. Yes, it is a court of record. But the the key thing in relation to this is who is best at making the decision.
Is it better you just have the judge, or is it better that you have both the experienced legal member, but also a psychiatrist and a social worker? And I don't think, in all honesty, that the fact that it is a court of record is will make any difference to that whatsoever. Fifthly, it is said, well, you can appeal to the Court of Appeal. We are talking here about people who want an assisted death. You want a safe process. You do not want an overengineered process.
The idea that you've got to go into a system that carries with it appeals, in my respectful view, is putting too much of a burden on the people. And then finally it is said, and it's a point made by the noble Lord. On the crossbenches to the effect that that the judges, Lord Harris, I apologise the the, the, the, the, the judges have especial respect in our system. The key thing is not do the judges have respect, but will our system of assisted dying carry respect? And this is a better way of making the judgement.
So that is why I support it. One final point that was made, I think, by the noble Lord Lord Pannick, or he raised it and then said, this is the answer, and that is. And this may have to do with the fact that it's a court of record. Well, the court have powers, discovery, powers, etc. Yes, they do, but if the position is that the panel feels that there are areas that they are not getting to the point of that, then of course they will not be satisfied and cannot give the certificate.
So for all of those reasons, a panel is better and than the courts, and that is why the decision was made. Could I go to Baroness O'Loan now and answer a question? I apologise for not answering it before.
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Thank you very much, my Lord. My Lord. The question. The question I wanted to ask the noble and learned Lord was in this connection of he's Lord was in this connection of he's telling us about panel and and and judges. The three members, as I judges. The three members, as I understand it, in the legislation which he has presented to the House or have expertise in their own area or have expertise in their own area of competence, the benefit of the.
Does he accept that the benefit of the system devised by Lord Carlile is to bring many more disciplines, medical disciplines, particularly into the agenda, and in particular, the judge would have the right to sit with the doctor and there would be a psychiatrist, report on the capacity, etc. of the individual, so the psychiatric issues would be taken care of. So it actually what this Lord Carlile amendment proposes is something wider than
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that which the panel could provide. I don't accept that the position is in relation to the panel. If they think that they need they want they think that they need they want a report from a doctor, they can get it. What I understand the noble Lord Lord Carlile is saying is, Lord Lord Carlile is saying is, well, the court can ask for all these things. Of course it can. And if it thinks they're appropriate, if it thinks they're appropriate, then it will do so.
It won't ask them, I assume, when they don't think it's necessary to the resolution of the issues, the panel resolution of the issues, the panel can do the same. And if they don't get them, then just like the court, they will have to say no, no, no.
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Thank you. In relation to the panel. And as a non-medical, I understand from my time on the understand from my time on the select committee, multidisciplinary has a particular meaning within healthcare that the witness to the Commons was relating to. So it's Commons was relating to. So it's not quite the same issue, but it's not the noble and learned Lords not the noble and learned Lords concerned that both the only two of the three representative bodies of the panel could, came and gave evidence to the Select Committee, evidence to the Select Committee, the British Association of Social Workers and the Royal College of Psychiatrists are not supporting the bill, regardless of what they might view on the principle.
So that you have, although the noble Lord is is obviously very well persuaded by the evidence, the professional bodies who would sit
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on this panel are not yet persuaded. Colleges aren't neutral on the principle. The Royal College of Psychiatrists have said they're worried about the burden on worried about the burden on psychiatrists, not by reference specifically to the panel, though it comes into it what they say, but in relation to some of the capacity assessments they've made, I do not think that it will be difficult to think that it will be difficult to find, for the purposes of the panel, people who have the appropriate qualifications in psychiatry to sit on the panel.
It will, for example, be people who have who have had some experience and maybe working part time. They will be able to do it. So I'm not concerned about the it.
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Baroness Nicholson noble Lord, does the noble Lord not accept that his particular panel make up disregards probably the largest disability in the whole of the United Kingdom, which is deafness, United Kingdom, which is deafness, where 19 or 20 million people are deaf in various different degrees. deaf in various different degrees. It is an issue that is very underrepresented in this, in this House. Oddly enough, although a House. Oddly enough, although a large number of members suffer from deafness, and it is also particularly badly treated in the National Health Service, as we've seen from the recent assault report, on 1 in 1000 deaf babies being born and not actually having the issues addressed in the way that they should have.
Why does the noble Lord think his panel will therefore be any better than the noble Lord? Lord Carlisle's proposal, which presumably the judge would look at every aspect of a patient before making any decision. I'm concerned that this panel attitude is quite irrelevant to those of us who are deaf. Nearly 20 million British people are deaf, and there's also the numbers of people who don't speak English, which is a very
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large number indeed. Lord can respond to your to the lady's point.
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I'm not sure, particularly in the way that the noble Baroness Baroness Nicholson addressed the issue at the very end, that this really is a point about panel versus judge. I would expect a versus judge. I would expect a judge to be experienced and able to deal with somebody who is deaf, and if they weren't able to, they if they weren't able to, they should be equally, the panel would be dealing with it in the same way. That is what I would expect.
But it, in all honesty, was not a factor in determining which was better. Panel or judge. Both would have to deal
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with that particular. Oh no, no no. And there is no social work
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relevant to deafness. Your panel is very specific. The noble Lord. I hope, I hope, I hope I've
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I hope, I hope, I hope I've given a satisfactory answer in
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relation to it. Sir. Claire, my interest as a former Deputy High Court judge and recorder. But does the noble and learned Lord not think that one of the ways of curing his concern in relation to the multidisciplinary nature that's needed in the assessment, if that multidisciplinary assessment was made earlier in the process and that evidence was available to the court, the court could then better determine. Thank you.
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Yes, I agree very strongly with that, that the multidisciplinary team, this is a different use of the phrase, the word multidisciplinary team in relation to the the person who is actually to the the person who is actually treating the person. I think the more input they can have, the better. But with respect to the noble and learned Baroness, I'm not sure that that bears on the question of whether panel or tribunal is better, because as far as panel on court is better, because whichever route was reached, you would hope that at the stage where either the panel or the court was having to make a decision, they would have access to what the multidisciplinary team treating the patient thought about the patient.
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consideration. Lord Wood I. Can just assist the noble and learned Lord, the reason I think it learned Lord, the reason I think it is relevant is if that multidisciplinary assessment is available and the court has that evidence available to it, together with any other assessment made by the individual additional clinicians. The court can then make clinicians. The court can then make an informed assessment as to which method or which approach they are minded to deal with, particularly dealing with the issue when the court does not necessarily agree with the evidence of one particular
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clinician who they have had the benefit of hearing from. That is useful. I don't understand that
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I don't understand that proposition because it seems to me the panel is well able to take into account that as well. This is the account that as well. This is the court would be and indeed, I would think they would probably be better able to assess it. So so I'm not
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able to assess it. So so I'm not sure I accept that proposition. No. Sir, I'm not sorry.
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Sir, I'm not sorry. Thank you. When the this was debated in another place, the argument was made around this. The Association of Palliative Medicine wrote formally to correct the record, and the statement said that the APM clarified the current bill doesn't align with the standard multi-professional team decision making process, and the noble and learned Lord mentioned Doctor Cox and the noted Doctor. Cox was arguing that the bill's model of two independent doctors working alone was inadequate, and assessment should be carried out within the Multi-professional team model to strengthen the bill.
So the discrepancy the APM and MPs noted well, the bill introduces the panel psychiatrist and social worker at the end of the process. This does not equate to the multi-professional assessment at the beginning. The assessment stage that Doctor Cox was advocating for, and I think that is really important because the Association of Palliative Medicine wrote formally to correct the record of the debate in the other place. I understand the Noble and learned law doesn't want to respond to that right now.
I'm very happy for him to write to me, but I think it's really important that that is on the record in this chamber as a by-product of what happened in another place.
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You know. The, the, the reason I quoted Doctor Cox of the Association of Doctor Cox of the Association of Palliative Medicine was because she specifically said it is better to specifically said it is better to approach this issue on a multidisciplinary process rather multidisciplinary process rather than placing it on the shoulders of the two doctors and the High Court judge. And the panel approach reflects that approach. So that is why I quoted it. And I'm not I don't think I need to write to say that it was part of the evidence, which was saying, have not two pairs of eyes but three pairs.
So
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not one pair of eyes the judge, but three pairs of eyes in relation to it. Can I.
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Can I. I think I've got 21 minutes. So I think I've got to go on and just deal very quickly if I may. First deal very quickly if I may. First of all the costings, the only costings that have been done have been done by the government. The government's costings have been done in relation to the panel, not in relation to the High Court. I have no desire for a High Court costing to be done. If others want it, they can press for it, but I'm not asking for it, nor would I expect it from the government.
The impact assessment has been done on the basis of the Bill as it is, and I am against the proposition of changing the provision in relation to a panel. So I am not pressing for any such panel. Can I just get on and deal with the other? Smaller the prime points in relation to it? Amendment 116, which I think was is tabled by Baroness Coffey says don't use the Mental Capacity Act. I'm against that for the reasons I've already given, which is you should have one system for all of these situations.
Amendment 46 says, this is the noble Lord. Lord Carlile says use the criminal standard of capacity. I'm against that for the reasons given by the Minister. Baroness Coffey in 4.26 A says sit, don't sit in private. What? This is the panel. Don't sit in private. What the bill says is that panels can sit. Panels are to determine referrals in, in public. But the chair of a panel may, at the request of the person to whom a referral relates, decide that the panel is to sit in private.
If you want this last discussion with the panel, if you are dying to be in private, then you should have that right in my respect for you. So I'm I'm strongly against the proposal that she was making amendment 46 be in this group by Baroness Coffey is a requirement that the person attend in person, which I think is unfair understanding of the fact that obviously for some people, they wouldn't be able to attend in person for obvious reasons.
Amendment one to A, one to a in the name of Baroness Coffey says exclude legal aid for the reasons that the Minister gave. I don't think that is possible, but amendment 37 asks why does clause one only refer to sections 8 to 30 and not to the whole bill? The reason is because in section one two of the bill, section 8 to 30, section one two is setting out what are the steps that have to be taken to satisfy the the, the circumstance of the bill.
And that is only 8 to 30. The other parts of the bill are things like keeping records, etc. Well, I think I have I've dealt with all the substantive points and for the reasons I've given, and without any lack of
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respect for the noble Lord Lord Carlile, who presented it very clearly, I am against the proposal he's making. Yes.
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Lord. One thing for granted that the panel and a court based system have panel and a court based system have a great deal, of course, in common six months to live, mental capacity,
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six months to live, mental capacity, a clear and settled decision. Could I ask for the noble Lord
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Could I ask for the noble Lord to write to you about your things? We've had enough explanation from the noble Lord Falconer. We need to move on to the noble Lord Carlile. Thank you.
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Can I just say, I think part of the difficulty that we're having, we're trying to make a pragmatic method of discussing this complicated bill. There have been complicated bill. There have been what is it, 80 amendments in this what is it, 80 amendments in this particular group and in 20 minutes, impossible for the noble Lord to give justice to all those things. I give justice to all those things. I know he's talked in general principles, but he must be aware that one of the difficulties that and it connects with the debate we had yesterday afternoon, which I wasn't here but I saw on television, was that he was not satisfying the need of explanation for those who are articulating points of view, and to just take a little bit longer than the time he needs may well be a shortcut to getting this bill done.
Part of the difficulty I feel, having listened to a lot of the bill, is that he is desperately keen to keep moving. I understand that, but there are points where he can stop and explain, perhaps with a bit more, bit more sympathy to the points that have been made by
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other members of the House armed. Can I first of all, can I just answer what the noble Lord, Lord answer what the noble Lord, Lord Taylor, who I greatly respect, has said? I have answered in some degree of detail the main substantive points that I have dealt with it. I believe in a way that is appropriate for a Committee stage. One of the things we've got to do at committee is try to focus on the things that really matter on the things that really matter and avoid the other things, and that is what I have done.
I am open to anybody coming to see me, and I started this process by writing to individual peers and say, come and see me to raise anything you've got. If there is anything that they want to talk about, I am more than willing to talk about it. But I very much believe that I've answered in detail the substantive application made for an amendment.
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Lord Carlile. My Lords, I'm very grateful to everybody who has taken part in everybody who has taken part in this debate. I hope your Lordships would agree that although this debate has taken over three hours, it's been conducted in precisely the spirit that was discussed in the spirit that was discussed in the debate yesterday, and that has justified taking that time. I said yesterday that I thought we should
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Lord Carlile of Berriew (Crossbench)
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Lord Carlile of Berriew (Crossbench)
yesterday that I thought we should move more quickly in this process. I believe we will be able to do so in the future, and this has been an example of doing so on a very important subject. May I express my grateful thanks to both frontbenchers for the way in which they summarised their particular interests in this debate. I thought both were extremely helpful for those who have seen the noble Lady, the Minister, my noble kinswoman in this House in the year she's been here.
I think you will be reassured and will understand that she's perfectly capable of erecting Chinese walls, which put the Great Wall of China to shame. On a point which particularly caught my attention. It was a point made by Lord MP, my noble friend, Lord MP. My noble friend Lord MP happens to be a very valued member of a select committee of this House, which I chair, and I can confirm that he is an expert in labyrinths. He's an expert in finding his way out of labyrinths, and it's just possible that he's quite good at making labyrinths longer, occasionally from time to time.
And I would hope he will take that in good heart. But he raised a question as to whether, as he put it, there should be a special chamber. It occurs to me that given that the purpose of my amendments is to ensure that this is a judicial process which falls into our judicial architecture. There may be room for the sort of discussion which we were talking about in yesterday's debate with the noble and learned Lord, the Lord Falconer, in which one might find a hybrid form of what he has proposed and what I have proposed, which falls within the legal judicial architecture.
And I'll give you a Lordships an example from my own experience, I was a part time judge for 28 years, including in the High Court and in particular the Competition Appeal Tribunal. The Competition Appeal Tribunal is a creature of the High Court. It's extremely effective. The chair of the Competition Appeal Tribunal, which is something I did part time, sits with two relevant experts. They still have to produce the sort of judgement you would expect sometimes in that tribunal, a little long from the High Court.
And I believe that it may be worth taking that discussion further with the noble and learned Lord. I wanted specifically to to refer to a point raised by the Baroness Berridge about pressure, and this is something she and I have discussed out of the chamber. My concern about adding pressure into this bill is that I can imagine cases based on my own legal experience, where pressure may be applied for entirely morally proper purposes. And I do think that we need to examine that proposal in greater detail if it is to be taken further.
Now I turn to the whole question of costs. My Lords, whichever system we have is going to cost a lot of money. The tribunal system will cost. The panel system will cause a lot, a lot cost a lot of money. And if we look at the draft of the bill, it's quite plain that the architecture of the panel system is based upon a financially viable model. It includes appointing the commissioner who is paid. It includes the commissioner appointing the panel members.
But unlike the judicial system, which we have, we have no architecture for the way in which those people are to be selected, appointed or paid, which seems to me to be a considerable deficiency in the panel system. Furthermore, when people are appointed to the judiciary, although of course in the interviewing process, their prejudices and pleasures may be referred to in the interviewing in the in the interviews, they are not applying to do something which is quite specific, and I think that's a virtue of the judicial process they may be applying, applying to be a member of the family division, or they may be applying to be a member of the Queen's Bench Division or to be a district judge.
But I think that the neutrality of that application process means that the whole process has greater authenticity and a higher reputation, and I think that is something that we should cherish. I should point out that clause 18 of the bill and schedule two as the bill stands now, and indeed, clause four set out the requirement that the Commissioner should set up a completely new system, which is unknown. We have a system, and that is the judicial system, which could make its way towards being effective very quickly.
I want to emphasise in answer to the noble Lady, the Minister, that I took every word she said in her speech, and I hadn't heard any of it before, by the way, I took every word she said in her speech to heart, and I would be absolutely ready. As I said right at the beginning for my speech in moving my amendments and as she recognised, to discuss the what what the contents of the bill are having the same opportunity as the noble and learned Lord had when he presented the bill to the House.
My Lords, I could take a long time. I could have up to a whole 15 minutes to deal with points that have been made in this debate, but I don't want to do that. Not because I'm afraid of taking on the points that have been made. I can assure you that I'm ready to do so. But because I think we should focus on the principle behind what I am putting forward, that principle at the risk of repetition, that principle is that we should have a judicial process, not some panel that's been cobbled together to meet some problems that have arisen.
That is what we should be voting upon if we have to at Report stage. For the time being, I beg leave to withdraw my moment.
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this. Amendment be withdrawn? Amendment is by leave withdrawn.
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Amendment is by leave withdrawn. My Lord. That group took more than three hours. As the noble Lord Lord Carlile said, it is a very important group and we knew it would be a long group. And it does deal with one of the issues at the deal with one of the issues at the heart of this bill. And I'm particularly grateful to the speakers who didn't take their allotted time, and I know many of them didn't. We did all agree, my Lords, last night, that this bill would need more time, and the noble and learned Lady Butler-sloss said, then we might make more progress if people could avoid repetition.
I realise I'm at risk of being accused of repetition myself. But could I reinforce the noble and Lord Eames noble and learned Lady's message about avoiding repetition without repeating it? So.
I think you will be reassured and will understand that she's perfectly capable of erecting Chinese walls, which put the Great Wall of China to shame. On a point which particularly caught my attention. It was a point made by Lord MP, my noble friend, Lord MP. My noble friend Lord MP happens to be a very valued member of a select committee of this House, which I chair, and I can confirm that he is an expert in labyrinths. He's an expert in finding his way out of labyrinths, and it's just possible that he's quite good at making labyrinths longer, occasionally from time to time.
And I would hope he will take that in good heart. But he raised a question as to whether, as he put it, there should be a special chamber. It occurs to me that given that the purpose of my amendments is to ensure that this is a judicial process which falls into our judicial architecture. There may be room for the sort of discussion which we were talking about in yesterday's debate with the noble and learned Lord, the Lord Falconer, in which one might find a hybrid form of what he has proposed and what I have proposed, which falls within the legal judicial architecture.
And I'll give you a Lordships an example from my own experience, I was a part time judge for 28 years, including in the High Court and in particular the Competition Appeal Tribunal. The Competition Appeal Tribunal is a creature of the High Court. It's extremely effective. The chair of the Competition Appeal Tribunal, which is something I did part time, sits with two relevant experts. They still have to produce the sort of judgement you would expect sometimes in that tribunal, a little long from the High Court.
And I believe that it may be worth taking that discussion further with the noble and learned Lord. I wanted specifically to to refer to a point raised by the Baroness Berridge about pressure, and this is something she and I have discussed out of the chamber. My concern about adding pressure into this bill is that I can imagine cases based on my own legal experience, where pressure may be applied for entirely morally proper purposes. And I do think that we need to examine that proposal in greater detail if it is to be taken further.
Now I turn to the whole question of costs. My Lords, whichever system we have is going to cost a lot of money. The tribunal system will cost. The panel system will cause a lot, a lot cost a lot of money. And if we look at the draft of the bill, it's quite plain that the architecture of the panel system is based upon a financially viable model. It includes appointing the commissioner who is paid. It includes the commissioner appointing the panel members.
But unlike the judicial system, which we have, we have no architecture for the way in which those people are to be selected, appointed or paid, which seems to me to be a considerable deficiency in the panel system. Furthermore, when people are appointed to the judiciary, although of course in the interviewing process, their prejudices and pleasures may be referred to in the interviewing in the in the interviews, they are not applying to do something which is quite specific, and I think that's a virtue of the judicial process they may be applying, applying to be a member of the family division, or they may be applying to be a member of the Queen's Bench Division or to be a district judge.
But I think that the neutrality of that application process means that the whole process has greater authenticity and a higher reputation, and I think that is something that we should cherish. I should point out that clause 18 of the bill and schedule two as the bill stands now, and indeed, clause four set out the requirement that the Commissioner should set up a completely new system, which is unknown. We have a system, and that is the judicial system, which could make its way towards being effective very quickly.
I want to emphasise in answer to the noble Lady, the Minister, that I took every word she said in her speech, and I hadn't heard any of it before, by the way, I took every word she said in her speech to heart, and I would be absolutely ready. As I said right at the beginning for my speech in moving my amendments and as she recognised, to discuss the what what the contents of the bill are having the same opportunity as the noble and learned Lord had when he presented the bill to the House.
My Lords, I could take a long time. I could have up to a whole 15 minutes to deal with points that have been made in this debate, but I don't want to do that. Not because I'm afraid of taking on the points that have been made. I can assure you that I'm ready to do so. But because I think we should focus on the principle behind what I am putting forward, that principle at the risk of repetition, that principle is that we should have a judicial process, not some panel that's been cobbled together to meet some problems that have arisen.
That is what we should be voting upon if we have to at Report stage. For the time being, I beg leave to withdraw my moment.
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this. Amendment be withdrawn? Amendment is by leave withdrawn.
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Amendment is by leave withdrawn. My Lord. That group took more than three hours. As the noble Lord Lord Carlile said, it is a very important group and we knew it would be a long group. And it does deal with one of the issues at the deal with one of the issues at the heart of this bill. And I'm particularly grateful to the speakers who didn't take their allotted time, and I know many of them didn't. We did all agree, my Lords, last night, that this bill would need more time, and the noble and learned Lady Butler-sloss said, then we might make more progress if people could avoid repetition.
I realise I'm at risk of being accused of repetition myself. But could I reinforce the noble and Lord Eames noble and learned Lady's message about avoiding repetition without repeating it? So.
13:35
Baroness Finlay of Llandaff (Crossbench)
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Baroness Finlay of Llandaff (Crossbench)
My Lords, we now come to Group two in clause one, amendment 26 Baroness Finlay of Llandaff.
**** Possible New Speaker ****
My Lords, we move on to group of amendments that are extremely important and in some ways complementary to the previous complementary to the previous debate. Autonomy is the lodestar of this bill. The amendments in this group are designed to reinforce and respect that patient autonomy. They do not block access to an assisted death. They aim to ensure people have accurate information, to make informed decisions. For a decision taken, people must have three things. Whatever that decision is accurate information, the capacity to make the decision and be making it voluntarily.
Those are the fundamentals of respecting a person's autonomy. These amendments are to ensure the patient has the opportunity to know what is available. They do not force a patient to be looked after by a palliative care team. They do not stop a patient proceeding with an assisted death. There is clear evidence from studies that underserved groups have poor access to palliative care, and there is poor understanding generally of what palliative care is and what it can do. General doctors often don't understand palliative care, so how can an assessing doctor give good, accurate information to a patient if they themselves have deficit in their knowledge? It's worth noting that in a five year medical training course, it has been estimated that the average time spent on learning about 20 about palliative care is only 20 hours, and only recently has palliative care come into the finals.
Question. So we have thousands of doctors out there who've had almost no education in palliative care, and many patients in the public don't understand palliative care either. A significant number think that assisted dying is palliative care or hospice care, while others think that palliative care simply hastens death. Sadly, misunderstandings are widespread when patients access appropriate specialist palliative care, the desire for a hastened death is often alleviated, and they experience an improvement in quality of life they never believed possible.
But that doesn't apply to everybody. The role of this amendment is simply to give everyone the best opportunity to access the care that they need, whether or not they continue to pursue an assisted death, whether or not they decide to take up the opportunities that may be revealed by such an assessment. The process is related to an assisted death can occur in parallel with, but they're not an integral part of palliative care provision. There's been concerned that palliative care teams couldn't cope with a sudden influx of referrals, but currently any palliative care team prioritises a patient who is in such despair that they want to die.
This is basic care, a core part of the job. Palliative care will not turn its back on patients who are in despair. They want to deliver gold. Standard care. In Oregon, 92% of assisted death patients are recorded as being enrolled in hospice services. Palliative care needs assessment gives patients options to make an informed decision. The patient may conclude that there are other options that they haven't been aware of and want to try, or that they simply want to pursue assessments for an assisted death.
Evidence from Canada has shown that some patients seeking referral for medical aid in dying are actually asking for palliative care. They seek assisted dying as a way to get their problems sorted out. Part of care needs assessment must always be non-judgmental. It is not. This is not, and I would stress that this is not a bad faith amendment. This is to ensure that patients know what they could have and are making an informed choice, respecting their autonomy. My Lords, for every decision in life, we want the best information, whether it's knowing that the House we are buying isn't full of dry rot, or that a car and sales loan hasn't been sold to us, the bills processes must ensure applicants are fully informed.
This is not a costly option. There is high quality evidence that specialist palliative care reduces the chance of dying in hospital, and increases the cost effectiveness of home and hospital based care for those with a poor prognosis. So the adequate provision of services to ensure every patient seeking an assisted death can have their needs assessed will decrease, not increase, cost to the NHS. Home specialist palliative care is associated with reduced costs of nearly £8,000 per person, and increased quality of life adjusted years in the hospital sector.
Costs also reduced, but only by about 6500 pounds per patient, again with increased quality of just life and quality adjusted life years. Overall provision of specialist palliative care to ensure whatever the wherever the patient is, that they can have the option of accurate information with which to make their decision, has been estimated to reduce system expenditure by over £800 million per annum. Unfortunately, I fear that the bill's proposals have rather misunderstood multidisciplinary care working that my friend who I and colleague who I respect enormously, Doctor Sara Cox, I'm afraid I think has indeed been slightly misquoted as the noble Lady Baroness Gerada said in our last debate, modern care is delivered by Multi-professional teams, a team that come together around an individual patient comprising doctors, nurses, physio, occupational therapy, social work, etc.
depending on the needs of that individual patient, patients often communicate more readily with the lowest paid in the team, such as the carers to whom they feel they can talk freely, as there's no power differential that exists between patient and doctor. That multidisciplinary team, Multi-professional team reviews things together, monitors things together. That is quite different to bringing a panel of three different disciplines together, specifically to make one decision and then move away from it without that continuity of knowing people.
And I do think it's important that we're clear what we mean in clinical care, in the hospice, I used to always have the care assistants as part of our weekly multidisciplinary review of patients. They had valuable insights and much to contribute. A mandatory assessment would ensure people knew what's available. It's up to the person to decide whether to try one route or another. Why make this mandatory? Well, unfortunately, the amendment to the Health and Care Act in 2022, which I was pushing for very hard and was glad to see come in stating that palliative care is a core service has not resulted in commissioners adequately commissioning services, in part because they themselves are ignorant of what to commission.
If assessment is mandatory, then commissioners must make sure that patients seeking an assisted death have a service there that can provide a proper needs assessment and give them information. The patient can choose whether to try or not try. I know that my noble friend Baroness Hollins has an amendment about this, and there is indeed a definition which has also been tabled in relation to what specialist palliative care is, and to try to summarise that very quickly, it is about having the appropriate specialist skills in every setting, with advice available at all times of the day, every day, equipment and medication available, and a point of contact so that people can go back and explore and discuss things as they think more and more about the complexities of their situation, and they can access the support that they need.
As my colleague Doctor Rachel Clarke said when she had given evidence previously, she pointed out that the moment of people having a diagnosis of severe life limiting illness is their time of peak vulnerability, is the patient's request for an assisted death, a knee jerk reaction of a new diagnosis that terrifies them? Have they been plunged into a suicidal depression that might pass? Might a desire to death to die be replaced by one to live when they receive the care? Patient centred that they need is a malign partner lurking in the background, putting insidious unvoiced pressure on the person to believe that he or she would be better off dead.
In New Zealand, we hear about patients seeking an assisted death when they're clearly caught up in a cycle of despair and hopelessness and actually want and need to know what's available, but often the services aren't there for them. I hope that my noble colleagues who have tabled amendments in this group will speak to their amendments, and I try to lay out a background template for why mandatory ability to have an assessment of need is important. I beg to move.
**** Possible New Speaker ****
My Lords, we move on to group of amendments that are extremely important and in some ways complementary to the previous complementary to the previous debate. Autonomy is the lodestar of this bill. The amendments in this group are designed to reinforce and respect that patient autonomy. They do not block access to an assisted death. They aim to ensure people have accurate information, to make informed decisions. For a decision taken, people must have three things. Whatever that decision is accurate information, the capacity to make the decision and be making it voluntarily.
Those are the fundamentals of respecting a person's autonomy. These amendments are to ensure the patient has the opportunity to know what is available. They do not force a patient to be looked after by a palliative care team. They do not stop a patient proceeding with an assisted death. There is clear evidence from studies that underserved groups have poor access to palliative care, and there is poor understanding generally of what palliative care is and what it can do. General doctors often don't understand palliative care, so how can an assessing doctor give good, accurate information to a patient if they themselves have deficit in their knowledge? It's worth noting that in a five year medical training course, it has been estimated that the average time spent on learning about 20 about palliative care is only 20 hours, and only recently has palliative care come into the finals.
Question. So we have thousands of doctors out there who've had almost no education in palliative care, and many patients in the public don't understand palliative care either. A significant number think that assisted dying is palliative care or hospice care, while others think that palliative care simply hastens death. Sadly, misunderstandings are widespread when patients access appropriate specialist palliative care, the desire for a hastened death is often alleviated, and they experience an improvement in quality of life they never believed possible.
But that doesn't apply to everybody. The role of this amendment is simply to give everyone the best opportunity to access the care that they need, whether or not they continue to pursue an assisted death, whether or not they decide to take up the opportunities that may be revealed by such an assessment. The process is related to an assisted death can occur in parallel with, but they're not an integral part of palliative care provision. There's been concerned that palliative care teams couldn't cope with a sudden influx of referrals, but currently any palliative care team prioritises a patient who is in such despair that they want to die.
This is basic care, a core part of the job. Palliative care will not turn its back on patients who are in despair. They want to deliver gold. Standard care. In Oregon, 92% of assisted death patients are recorded as being enrolled in hospice services. Palliative care needs assessment gives patients options to make an informed decision. The patient may conclude that there are other options that they haven't been aware of and want to try, or that they simply want to pursue assessments for an assisted death.
Evidence from Canada has shown that some patients seeking referral for medical aid in dying are actually asking for palliative care. They seek assisted dying as a way to get their problems sorted out. Part of care needs assessment must always be non-judgmental. It is not. This is not, and I would stress that this is not a bad faith amendment. This is to ensure that patients know what they could have and are making an informed choice, respecting their autonomy. My Lords, for every decision in life, we want the best information, whether it's knowing that the House we are buying isn't full of dry rot, or that a car and sales loan hasn't been sold to us, the bills processes must ensure applicants are fully informed.
This is not a costly option. There is high quality evidence that specialist palliative care reduces the chance of dying in hospital, and increases the cost effectiveness of home and hospital based care for those with a poor prognosis. So the adequate provision of services to ensure every patient seeking an assisted death can have their needs assessed will decrease, not increase, cost to the NHS. Home specialist palliative care is associated with reduced costs of nearly £8,000 per person, and increased quality of life adjusted years in the hospital sector.
Costs also reduced, but only by about 6500 pounds per patient, again with increased quality of just life and quality adjusted life years. Overall provision of specialist palliative care to ensure whatever the wherever the patient is, that they can have the option of accurate information with which to make their decision, has been estimated to reduce system expenditure by over £800 million per annum. Unfortunately, I fear that the bill's proposals have rather misunderstood multidisciplinary care working that my friend who I and colleague who I respect enormously, Doctor Sara Cox, I'm afraid I think has indeed been slightly misquoted as the noble Lady Baroness Gerada said in our last debate, modern care is delivered by Multi-professional teams, a team that come together around an individual patient comprising doctors, nurses, physio, occupational therapy, social work, etc.
depending on the needs of that individual patient, patients often communicate more readily with the lowest paid in the team, such as the carers to whom they feel they can talk freely, as there's no power differential that exists between patient and doctor. That multidisciplinary team, Multi-professional team reviews things together, monitors things together. That is quite different to bringing a panel of three different disciplines together, specifically to make one decision and then move away from it without that continuity of knowing people.
And I do think it's important that we're clear what we mean in clinical care, in the hospice, I used to always have the care assistants as part of our weekly multidisciplinary review of patients. They had valuable insights and much to contribute. A mandatory assessment would ensure people knew what's available. It's up to the person to decide whether to try one route or another. Why make this mandatory? Well, unfortunately, the amendment to the Health and Care Act in 2022, which I was pushing for very hard and was glad to see come in stating that palliative care is a core service has not resulted in commissioners adequately commissioning services, in part because they themselves are ignorant of what to commission.
If assessment is mandatory, then commissioners must make sure that patients seeking an assisted death have a service there that can provide a proper needs assessment and give them information. The patient can choose whether to try or not try. I know that my noble friend Baroness Hollins has an amendment about this, and there is indeed a definition which has also been tabled in relation to what specialist palliative care is, and to try to summarise that very quickly, it is about having the appropriate specialist skills in every setting, with advice available at all times of the day, every day, equipment and medication available, and a point of contact so that people can go back and explore and discuss things as they think more and more about the complexities of their situation, and they can access the support that they need.
As my colleague Doctor Rachel Clarke said when she had given evidence previously, she pointed out that the moment of people having a diagnosis of severe life limiting illness is their time of peak vulnerability, is the patient's request for an assisted death, a knee jerk reaction of a new diagnosis that terrifies them? Have they been plunged into a suicidal depression that might pass? Might a desire to death to die be replaced by one to live when they receive the care? Patient centred that they need is a malign partner lurking in the background, putting insidious unvoiced pressure on the person to believe that he or she would be better off dead.
In New Zealand, we hear about patients seeking an assisted death when they're clearly caught up in a cycle of despair and hopelessness and actually want and need to know what's available, but often the services aren't there for them. I hope that my noble colleagues who have tabled amendments in this group will speak to their amendments, and I try to lay out a background template for why mandatory ability to have an assessment of need is important. I beg to move.
13:45
Lord Carter of Haslemere (Crossbench)
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Lord Carter of Haslemere (Crossbench)
In clause one, page one, line 12. At end, insert the words as printed in the Marshalled List. in the Marshalled List. >> My Lords, my amendments 51.
**** Possible New Speaker ****
Amendments, my. Group and I don't need to explain what my amendments say because they are all amendments say because they are all replicated by other amendments in the group. So I can be very brief. All these amendments are intended to ensure that a person seeking assistance to end their life first be referred to a registered medical practitioner who specialises in palliative, hospice and other care for the purpose of a full assessment, the operative word being assessment, not necessarily treatment.
The bill currently requires merely that a medical practitioner offer that's the word a referral to a specialist palliative care practitioner. I think this is inadequate in relation to such critical decisions as choosing whether to live or seek a state assisted death. It's important to note that all these amendments are based on evidence in countries with assisted dying, such as Oregon, as has been referred to. Experts say that patients who request help to die often change their minds if provided with proper palliative care.
And yet, the government's impact assessment confirms that fewer than half of dying people have input from a specialist palliative care team in their last three months of life. It seems hard to dispute the case. Therefore, for the bill requiring that persons seeking a state assisted death be given a full palliative care assessment with the opportunity to choose to experience modern specialist palliative care at its very best. It's about doing everything humanly possible to keep people alive with as little pain and suffering as possible, and giving priority to life over death wherever possible.
Recording the debate we had yesterday about which amendments the noble Lord, Lord Faulkner, might be prepared to accept, the amendments in this group are, as the previous group, pivotal to the decision a dying person will have to make. If this bill is enacted, it would save much time at report if the noble Lord could indicate now if he can accept one or more of them, the government would then have a responsibility to ensure that adequate palliative care specialists are available.
I recall again, as I did at Second Reading, the wise words of the noble Baroness, the Minister, Lady Merron, who said in answer to an oral question in this House in in on the 4th of September 2024, and I quote, the government's commitment is to ensure that any debate on assisted dying takes place in a broader context of access to high quality, palliative and end of life care. Well, these amendments in this group would help to ensure that a person at least has a real choice whether to access that palliative and end of life care, or whether to seek a state assisted death.
**** Possible New Speaker ****
Amendments, my. Group and I don't need to explain what my amendments say because they are all amendments say because they are all replicated by other amendments in the group. So I can be very brief. All these amendments are intended to ensure that a person seeking assistance to end their life first be referred to a registered medical practitioner who specialises in palliative, hospice and other care for the purpose of a full assessment, the operative word being assessment, not necessarily treatment.
The bill currently requires merely that a medical practitioner offer that's the word a referral to a specialist palliative care practitioner. I think this is inadequate in relation to such critical decisions as choosing whether to live or seek a state assisted death. It's important to note that all these amendments are based on evidence in countries with assisted dying, such as Oregon, as has been referred to. Experts say that patients who request help to die often change their minds if provided with proper palliative care.
And yet, the government's impact assessment confirms that fewer than half of dying people have input from a specialist palliative care team in their last three months of life. It seems hard to dispute the case. Therefore, for the bill requiring that persons seeking a state assisted death be given a full palliative care assessment with the opportunity to choose to experience modern specialist palliative care at its very best. It's about doing everything humanly possible to keep people alive with as little pain and suffering as possible, and giving priority to life over death wherever possible.
Recording the debate we had yesterday about which amendments the noble Lord, Lord Faulkner, might be prepared to accept, the amendments in this group are, as the previous group, pivotal to the decision a dying person will have to make. If this bill is enacted, it would save much time at report if the noble Lord could indicate now if he can accept one or more of them, the government would then have a responsibility to ensure that adequate palliative care specialists are available.
I recall again, as I did at Second Reading, the wise words of the noble Baroness, the Minister, Lady Merron, who said in answer to an oral question in this House in in on the 4th of September 2024, and I quote, the government's commitment is to ensure that any debate on assisted dying takes place in a broader context of access to high quality, palliative and end of life care. Well, these amendments in this group would help to ensure that a person at least has a real choice whether to access that palliative and end of life care, or whether to seek a state assisted death.
13:48
Baroness Brown of Silvertown (Labour)
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Baroness Brown of Silvertown (Labour)
My amendment 51 and others would require the providers of assisted dying services to ensure that all persons seeking such services have discussed the range of end of life options available to them. With a palliative care specialist, the government, as well as proponents of the bill, have promised that end of life care will not suffer in order to accommodate assisted dying. I have significant reservations about whether or not this would be possible, and I fear a pushback to particularly for those who are vulnerable, who are without family, and to be absolutely frank, those who are poor and cannot fund their own care when done right.
As we know, palliative care can provide a dignified end of life and alleviate the desire to hasten one's death. But equitable access to to options for end of life care must be a cornerstone for this bill, which is why I've made these amendments. I want to ensure, as far as it's humanly possible, that all people have and know that they have equal access to palliative care, to treatments that may extend life, and access to specialist teams to manage the symptoms, pain and provide dignity.
My Lord, we must accept in this House that equal access to these services, as for many, many public services, is not guaranteed and is rarely delivered. Let me give just one example. Due to time, a Liverpool resident with the terrible asbestos related mesothelioma cancer. I almost said that right can undergo a specialist injection which has a high chance of abolishing the pain, whereas a resident of the Midlands, who may be unfit to travel to Liverpool, simply cannot because there are just so few specialists trained to take this work on and therefore access is obviously limited.
Currently, clauses five and 12 of the bill require doctors to have discussions about disease, prognosis, treatment and symptomatic alleviation with patients, and clause five includes an offer to refer them to a specialist. And while these are really important discussions that must be had, I believe they have to be done by somebody who properly trained and experienced in such matters. For conditions like specialist care cases such as motor neurone disease, most doctors will have minimal involvement in the management of that condition, and will likely not have the skills and the training to adequately fulfil the duties that this bill places upon them.
A specialist referral would be absolutely necessary to ensure that patients are able to reach an informed decision about their care with somebody who properly understands the disease, who properly understands where that disease is going to progress, and what can be put in place in order to alleviate their distress and their pain. A person who is seeking assisted dying, I fear, may be worried about there, will absolutely be worried about their future, about losing their independence, about dignity, and also about placing a huge burden upon upon their families.
A dedicated palliative care specialist would have the expertise, the skill and the training to provide the highest level of information and support tailored to the individual needs of each patient, and having a specialist knowledge of the condition that the patient is experiencing. Clause one of the Bill already requires that a person has a clear, settled and informed wish to end their life. I believe that you can only ensure a settled and informed wish and reach an informed decision.
After properly exploring all available care and treatment options with dedicated palliative care specialists and have those options available to you. So this amendment creates a duty on all people who are involved in the provision of assisted dying services to ensure that these discussions have occurred. Covering care options including symptom management and home care provisions. I welcome the amendments tabled by other colleagues to ensure that a dedicated palliative care assessment is part of the assisted dying process, and I believe that this amendment can work alongside theirs.
This amendment would also cover consultations with palliative care specialists that occur prior to a person seeking assisted dying, providing they cover the criteria outlined in this amendment. I believe that you can only reach a clear, informed decision to end your own life after having the advice and support to truly be able to weigh your options, and that guarantee should absolutely be on the face of this bill.
As we know, palliative care can provide a dignified end of life and alleviate the desire to hasten one's death. But equitable access to to options for end of life care must be a cornerstone for this bill, which is why I've made these amendments. I want to ensure, as far as it's humanly possible, that all people have and know that they have equal access to palliative care, to treatments that may extend life, and access to specialist teams to manage the symptoms, pain and provide dignity.
My Lord, we must accept in this House that equal access to these services, as for many, many public services, is not guaranteed and is rarely delivered. Let me give just one example. Due to time, a Liverpool resident with the terrible asbestos related mesothelioma cancer. I almost said that right can undergo a specialist injection which has a high chance of abolishing the pain, whereas a resident of the Midlands, who may be unfit to travel to Liverpool, simply cannot because there are just so few specialists trained to take this work on and therefore access is obviously limited.
Currently, clauses five and 12 of the bill require doctors to have discussions about disease, prognosis, treatment and symptomatic alleviation with patients, and clause five includes an offer to refer them to a specialist. And while these are really important discussions that must be had, I believe they have to be done by somebody who properly trained and experienced in such matters. For conditions like specialist care cases such as motor neurone disease, most doctors will have minimal involvement in the management of that condition, and will likely not have the skills and the training to adequately fulfil the duties that this bill places upon them.
A specialist referral would be absolutely necessary to ensure that patients are able to reach an informed decision about their care with somebody who properly understands the disease, who properly understands where that disease is going to progress, and what can be put in place in order to alleviate their distress and their pain. A person who is seeking assisted dying, I fear, may be worried about there, will absolutely be worried about their future, about losing their independence, about dignity, and also about placing a huge burden upon upon their families.
A dedicated palliative care specialist would have the expertise, the skill and the training to provide the highest level of information and support tailored to the individual needs of each patient, and having a specialist knowledge of the condition that the patient is experiencing. Clause one of the Bill already requires that a person has a clear, settled and informed wish to end their life. I believe that you can only ensure a settled and informed wish and reach an informed decision.
After properly exploring all available care and treatment options with dedicated palliative care specialists and have those options available to you. So this amendment creates a duty on all people who are involved in the provision of assisted dying services to ensure that these discussions have occurred. Covering care options including symptom management and home care provisions. I welcome the amendments tabled by other colleagues to ensure that a dedicated palliative care assessment is part of the assisted dying process, and I believe that this amendment can work alongside theirs.
This amendment would also cover consultations with palliative care specialists that occur prior to a person seeking assisted dying, providing they cover the criteria outlined in this amendment. I believe that you can only reach a clear, informed decision to end your own life after having the advice and support to truly be able to weigh your options, and that guarantee should absolutely be on the face of this bill.
13:54
Baroness Hollins (Crossbench)
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Baroness Hollins (Crossbench)
My Lords, when I first read this bill, I realised that there was something very important missing a something very important missing a first stage, if you like. And I think this group of amendments is actually probably one of the most important to to address before the bill can really make progress. It's and it's actually, I think, perhaps in its drafting, failed to recognise the provisions of the Health and Care Act 22, which my noble friend Baroness Finlay referred to with regard to the new obligations on integrated care boards to commission for the needs of their the palliative care needs of their local populations.
There are several amendments in my name in this group, and I've also added to my noble friend Baroness Finlay amendment. But I think the most important amendment is amendment 2 to 1. I'll try to explain some of of the rationale. The amendments are intended to ensure that specialist, multidisciplinary palliative care is a mandatory, properly resourced and integral part of any assisted dying pathway. The central purpose is quite simple. It's that no person should progress towards assisted dying until their palliative, psychological and wider social care needs have been fully assessed and understood and, where appropriate, address and the Medical Royal Colleges endorsed this request.
Not all doctors are trained or equipped to provide comprehensive information about prognosis, symptom control or the full range of palliative care options at the end of life. This is not the remit of general practitioners or general physicians, nor should such complex and sensitive discussions be taking place in routine medical settings. For that reason, I disagree with the preliminary discussion clauses and the clauses about first and second declarations in the bill as currently drafted. Instead, I propose that once a terminally ill person requests an assisted death under this act, they must be referred for a multidisciplinary specialist palliative care assessment alongside a psychological assessment within established palliative care services, and given the urgency that often accompanies such requests, this assessment should be completed within seven days of referral and to ensure that any subsequent decision is genuinely informed, the individual must then be offered access to appropriate palliative care and psychological support, within 48 hours of that assessment being completed.
Now, a person should not be eligible to proceed until their needs have been assessed and the treatment and support options have been made available. And that's why I propose that before an application can proceed, there must be written confirmation from a consultant in palliative care medicine that all relevant specialist palliative and end of life care options have been discussed, offered and, where appropriate, tried medicine routinely works in this careful, stepwise manner. It's entirely consistent with good clinical care that evidence based palliative care should be fully explored before considering the irreversible act of ending a life.
I've heard discussion in the media suggesting that these amendments would mean that people would be forced to have palliative care against their will. No, this is not their intention. The intention is twofold. Firstly, to make sure that patients can make an informed decision, and secondly, to ensure that specialist palliative care services are available for people who want them and that people are not choosing an assisted death because the NHS is not commissioning for palliative care needs of their population. Obviously, specialist palliative care itself needs to be properly defined, funded and universally available and accessible.
It's far more than the prescription of high dose medication at the end of life. It's an active, multidisciplinary approach that supports patients and families at home, in hospital, in care homes and hospices. And that's why defining specialist palliative care, as set out in one of the amendments before us, is so important. At present, access to such care is inconsistent and heavily dependent on charitable funding. Before introducing assisted dying on a national scale, we must ensure equitable access to high quality, specialist palliative care across the country.
As part of the Multidisciplinary palliative care assessment, I propose that every individual applying for assisted dying should be considered for NHS Continuing Healthcare through the fast track funding process. This is an existing, well-established process, although perhaps not well understood within primary care and perhaps even within your Lordships House. Continuing healthcare provides fully funded health and social care support, including assistance with medication mobility activities of daily living. But it can be slow to arrange. However, the fast track pathway exists precisely to ensure that people with rapidly deteriorating or terminal conditions can access this support.
Within 48 hours of this request. My Lords, it works in practice. It's already there. The architecture already exists. This can make an enormous difference, enabling people to choose their place of care, arranging nursing support, securing equipment or home oxygen, relieving families of both emotional and financial burdens at a critical time. Encouraging fast track access to continuing healthcare within the bill would ensure that individuals receive timely, holistic support and are not driven towards assisted dying by unmet care needs.
Furthermore, patients approved for fast tracked continuing healthcare funding are more likely to have an accurate prognosis of six months or less. Taken together, these amendments place specialist palliative care where it belongs at the centre of end of life decision making, ensuring dignity, compassion and genuine informed choice. I'm going to end by just remarking that there's a world of difference between a multidisciplinary panel and a multidisciplinary specialist assessment. The Royal Colleges support the latter. It's part of normal clinical care, but they do not like the multidisciplinary not like the multidisciplinary panel.
Royal College of Psychiatrists, in their briefing, commented on the psychiatrist's expertise and where and when it's appropriate. It says, I'll quote psychiatrists can only work within their professional competencies and expertise, and should not be required to do any aspect of assessment which they are not appropriately trained or skilled. They also comment and I think this is quite important, that in a well safeguarded process, a person should not access assisted dying if if they would have made a different decision had they received effective treatment for a mental disorder affecting their decision making.
To this end, we would expect that psychiatrists would be involved in an assisted dying service in two ways the identification and treatment of unmet psychiatric need, and supporting assessment assessments of capacity to decide to end one's own life. I amendment one.
There are several amendments in my name in this group, and I've also added to my noble friend Baroness Finlay amendment. But I think the most important amendment is amendment 2 to 1. I'll try to explain some of of the rationale. The amendments are intended to ensure that specialist, multidisciplinary palliative care is a mandatory, properly resourced and integral part of any assisted dying pathway. The central purpose is quite simple. It's that no person should progress towards assisted dying until their palliative, psychological and wider social care needs have been fully assessed and understood and, where appropriate, address and the Medical Royal Colleges endorsed this request.
Not all doctors are trained or equipped to provide comprehensive information about prognosis, symptom control or the full range of palliative care options at the end of life. This is not the remit of general practitioners or general physicians, nor should such complex and sensitive discussions be taking place in routine medical settings. For that reason, I disagree with the preliminary discussion clauses and the clauses about first and second declarations in the bill as currently drafted. Instead, I propose that once a terminally ill person requests an assisted death under this act, they must be referred for a multidisciplinary specialist palliative care assessment alongside a psychological assessment within established palliative care services, and given the urgency that often accompanies such requests, this assessment should be completed within seven days of referral and to ensure that any subsequent decision is genuinely informed, the individual must then be offered access to appropriate palliative care and psychological support, within 48 hours of that assessment being completed.
Now, a person should not be eligible to proceed until their needs have been assessed and the treatment and support options have been made available. And that's why I propose that before an application can proceed, there must be written confirmation from a consultant in palliative care medicine that all relevant specialist palliative and end of life care options have been discussed, offered and, where appropriate, tried medicine routinely works in this careful, stepwise manner. It's entirely consistent with good clinical care that evidence based palliative care should be fully explored before considering the irreversible act of ending a life.
I've heard discussion in the media suggesting that these amendments would mean that people would be forced to have palliative care against their will. No, this is not their intention. The intention is twofold. Firstly, to make sure that patients can make an informed decision, and secondly, to ensure that specialist palliative care services are available for people who want them and that people are not choosing an assisted death because the NHS is not commissioning for palliative care needs of their population. Obviously, specialist palliative care itself needs to be properly defined, funded and universally available and accessible.
It's far more than the prescription of high dose medication at the end of life. It's an active, multidisciplinary approach that supports patients and families at home, in hospital, in care homes and hospices. And that's why defining specialist palliative care, as set out in one of the amendments before us, is so important. At present, access to such care is inconsistent and heavily dependent on charitable funding. Before introducing assisted dying on a national scale, we must ensure equitable access to high quality, specialist palliative care across the country.
As part of the Multidisciplinary palliative care assessment, I propose that every individual applying for assisted dying should be considered for NHS Continuing Healthcare through the fast track funding process. This is an existing, well-established process, although perhaps not well understood within primary care and perhaps even within your Lordships House. Continuing healthcare provides fully funded health and social care support, including assistance with medication mobility activities of daily living. But it can be slow to arrange. However, the fast track pathway exists precisely to ensure that people with rapidly deteriorating or terminal conditions can access this support.
Within 48 hours of this request. My Lords, it works in practice. It's already there. The architecture already exists. This can make an enormous difference, enabling people to choose their place of care, arranging nursing support, securing equipment or home oxygen, relieving families of both emotional and financial burdens at a critical time. Encouraging fast track access to continuing healthcare within the bill would ensure that individuals receive timely, holistic support and are not driven towards assisted dying by unmet care needs.
Furthermore, patients approved for fast tracked continuing healthcare funding are more likely to have an accurate prognosis of six months or less. Taken together, these amendments place specialist palliative care where it belongs at the centre of end of life decision making, ensuring dignity, compassion and genuine informed choice. I'm going to end by just remarking that there's a world of difference between a multidisciplinary panel and a multidisciplinary specialist assessment. The Royal Colleges support the latter. It's part of normal clinical care, but they do not like the multidisciplinary not like the multidisciplinary panel.
Royal College of Psychiatrists, in their briefing, commented on the psychiatrist's expertise and where and when it's appropriate. It says, I'll quote psychiatrists can only work within their professional competencies and expertise, and should not be required to do any aspect of assessment which they are not appropriately trained or skilled. They also comment and I think this is quite important, that in a well safeguarded process, a person should not access assisted dying if if they would have made a different decision had they received effective treatment for a mental disorder affecting their decision making.
To this end, we would expect that psychiatrists would be involved in an assisted dying service in two ways the identification and treatment of unmet psychiatric need, and supporting assessment assessments of capacity to decide to end one's own life. I amendment one.
14:02
Baroness Lawlor (Conservative)
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Baroness Lawlor (Conservative)
Seven eight a m I thank you and requires that those who are seeking requires that those who are seeking assisted suicide are referred to a consultant physician in palliative medicine, who will assess them fully and draw up a plan for care. The bill recognises the importance of. Patients knowing about palliative care, and they the importance of their being informed on the choices. But until week a manner that this these group of amendments are coming forward and other noble Lords who've spoken in the group have have very good amendments, which I support, to the effect that a patient is referred to a specialist team in palliative care, or a team which is dedicated to the treatment of this, this problem.
Now, I, I propose that the in the first instance, the patient should see a consultant in palliative medicine who will 1 to 1 discuss with the patient matters and assess them and prepare the care plan, not instead of the other people who are involved in the care team, but as the person who would be responsible for doing that. And the way my experience of medicine in in other areas works is that is always the first call, and care and treatment are taken from there, from the consultant physician who is responsible.
And I say this because other people on a team may lack the detailed knowledge, experience and intellectual rigour of those who have reached the most senior level in their area and who are responsible for training and leading a team of hospital doctors specialising in their subject. And they see a many hundreds of end of life patients each year. And there is also a very good reason to believe that consultants are more likely to be independently minded and beholden to the virtues of their profession, rather than the guidance of officials.
The amendment requires a full assessment, because only after an assessment can a patient know, as other noble Lords have said, the options and be in the best position to decide them. Yes, my amendment would put might put a strain on palliative care consultants, but in that case we need to have more such consultants and we should not put in the bill into effect without consultants. More broadly, my amendment stresses that, as we see in France and as other noble Lords have said, any move to assisted dying needs to be accompanied by more attention and commitment to palliative care.
My Lords, I rise to speak as a member of the Select Committee that your Lordships House decided to convene at the end of Second Reading, partly because I
Now, I, I propose that the in the first instance, the patient should see a consultant in palliative medicine who will 1 to 1 discuss with the patient matters and assess them and prepare the care plan, not instead of the other people who are involved in the care team, but as the person who would be responsible for doing that. And the way my experience of medicine in in other areas works is that is always the first call, and care and treatment are taken from there, from the consultant physician who is responsible.
And I say this because other people on a team may lack the detailed knowledge, experience and intellectual rigour of those who have reached the most senior level in their area and who are responsible for training and leading a team of hospital doctors specialising in their subject. And they see a many hundreds of end of life patients each year. And there is also a very good reason to believe that consultants are more likely to be independently minded and beholden to the virtues of their profession, rather than the guidance of officials.
The amendment requires a full assessment, because only after an assessment can a patient know, as other noble Lords have said, the options and be in the best position to decide them. Yes, my amendment would put might put a strain on palliative care consultants, but in that case we need to have more such consultants and we should not put in the bill into effect without consultants. More broadly, my amendment stresses that, as we see in France and as other noble Lords have said, any move to assisted dying needs to be accompanied by more attention and commitment to palliative care.
My Lords, I rise to speak as a member of the Select Committee that your Lordships House decided to convene at the end of Second Reading, partly because I
14:05
Baroness Smith of Newnham (Liberal Democrat)
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Baroness Smith of Newnham (Liberal Democrat)
feel, although I'm sure, that noble Lords participating in this debate Lords participating in this debate and in the legislation will be fully aware of the evidence we talk. This debate is one that is broadcast and which is followed much more generally, and I think much more generally, and I think it's useful to put on the record some of the evidence we took, because we did take evidence on palliative care from experts, some of whom are opposed to the principle of assisted dying, some of whom were not, but all of whom raised concerns or sorry, almost all of whom raised concerns about the adequacy of palliative care in the United Kingdom, and in particular, one of the points that I would like to raise, and it follows the contribution from the noble Lady Baroness Brown of Silvertown, Doctor Suzanne Kite.
And I apologise for reading, but I am reading from our report, doctor Suzanne Kite, as president of the Association for Palliative Medicine of Great Britain and Ireland, said that throughout this debate there has been a strong consensus that palliative care provision is inadequate, with many services under threat, and that this constrains choice at the end of life. We advocate strongly for the government to commit to a national policy to ensure universal access to palliative care that is protected from negative financial impact of the introduction of a of assisted dying service, better safeguards for patients, co-workers and organisations, and a public awareness campaign about normal dying.
So my first question is one to the Minister and I realise she's representing the Ministry of Justice rather than the Department of Health, but nevertheless, I hope Baroness Levitt may be able to respond, because yesterday in the chamber, when we discussed the business motion, the noble Lord Lord Stevens of Birmingham, said that the Minister in the House of Commons had suggested that the government's next information about palliative care and its provision of palliative care would not come until after the assisted dying legislation will have gone through Parliament.
I think for many people, whether they support the principle of assisted dying or not, whether they support this legislation in principle or not, would feel much relieved if they could believe that palliative care was going to be more equitable across the country, and that those who are in more deprived parts of the country would have the same access to palliative care as those in more affluent parts of the country. Because there is a disparity. And there is, I think, for many a concern that the choice for an assisted death, which is what advocates of the bill say they support, isn't necessarily going to be an unconstrained choice, that if the choice is one to say, I've been offered everything, including state of the art palliative care, and I still want an assisted death.
That's quite different from the current proposals. Clause five of the bill currently says that the medical practitioner would need to make clear to somebody in a preliminary discussion all appropriate palliative care, hospice or other car that is available. But, my Lords, if there isn't adequate palliative care and we already know that, I think it's 100,000 people are already dying without adequate palliative care. If that palliative care is not available, then the choice that is being given by the medical practitioner is not going to be a real choice.
And when I raised concerns with the those experts who were giving us evidence on palliative care and whether this was constrained choice or not, there was very much a sense from Doctor Kite sharing the concerns that I'd raised essentially about the disparities of palliative care and the fact that for some people there wouldn't be real choice. Her response was, I share your concern. Our members share your concern. This is fundamental to our position on the bill. And Professor Katherine Sleeman, who is also a professor of palliative care at King's College London and also a member of the Complex Life and Death Decision Group, who is not opposed to the principle of assisted dying, nonetheless said that my point was exactly why The Clad group has suggested offering a referral to a specialist palliative that offering a referral is not enough.
Everyone who says that they want an assisted death should receive palliative care assessment, and that would go some way, not all the way, but it would go some way to addressing what we know about the inequalities in terms of access, in light of the evidence we received. I would be grateful to hear from the noble and learned Lord, Lord Falconer of Thoroton, how he would respond to the amendments in this group about palliative care, because they seem to be fundamental to the concerns, not just of people who might be opposed in principle to this bill, but of experts who really understand the detail.
And it is surely the duty of this House to ensure that any legislation that is passed really meets appropriate standards, and that we should be very cautious about supporting legislation that doesn't ensure adequate access to palliative care.
And I apologise for reading, but I am reading from our report, doctor Suzanne Kite, as president of the Association for Palliative Medicine of Great Britain and Ireland, said that throughout this debate there has been a strong consensus that palliative care provision is inadequate, with many services under threat, and that this constrains choice at the end of life. We advocate strongly for the government to commit to a national policy to ensure universal access to palliative care that is protected from negative financial impact of the introduction of a of assisted dying service, better safeguards for patients, co-workers and organisations, and a public awareness campaign about normal dying.
So my first question is one to the Minister and I realise she's representing the Ministry of Justice rather than the Department of Health, but nevertheless, I hope Baroness Levitt may be able to respond, because yesterday in the chamber, when we discussed the business motion, the noble Lord Lord Stevens of Birmingham, said that the Minister in the House of Commons had suggested that the government's next information about palliative care and its provision of palliative care would not come until after the assisted dying legislation will have gone through Parliament.
I think for many people, whether they support the principle of assisted dying or not, whether they support this legislation in principle or not, would feel much relieved if they could believe that palliative care was going to be more equitable across the country, and that those who are in more deprived parts of the country would have the same access to palliative care as those in more affluent parts of the country. Because there is a disparity. And there is, I think, for many a concern that the choice for an assisted death, which is what advocates of the bill say they support, isn't necessarily going to be an unconstrained choice, that if the choice is one to say, I've been offered everything, including state of the art palliative care, and I still want an assisted death.
That's quite different from the current proposals. Clause five of the bill currently says that the medical practitioner would need to make clear to somebody in a preliminary discussion all appropriate palliative care, hospice or other car that is available. But, my Lords, if there isn't adequate palliative care and we already know that, I think it's 100,000 people are already dying without adequate palliative care. If that palliative care is not available, then the choice that is being given by the medical practitioner is not going to be a real choice.
And when I raised concerns with the those experts who were giving us evidence on palliative care and whether this was constrained choice or not, there was very much a sense from Doctor Kite sharing the concerns that I'd raised essentially about the disparities of palliative care and the fact that for some people there wouldn't be real choice. Her response was, I share your concern. Our members share your concern. This is fundamental to our position on the bill. And Professor Katherine Sleeman, who is also a professor of palliative care at King's College London and also a member of the Complex Life and Death Decision Group, who is not opposed to the principle of assisted dying, nonetheless said that my point was exactly why The Clad group has suggested offering a referral to a specialist palliative that offering a referral is not enough.
Everyone who says that they want an assisted death should receive palliative care assessment, and that would go some way, not all the way, but it would go some way to addressing what we know about the inequalities in terms of access, in light of the evidence we received. I would be grateful to hear from the noble and learned Lord, Lord Falconer of Thoroton, how he would respond to the amendments in this group about palliative care, because they seem to be fundamental to the concerns, not just of people who might be opposed in principle to this bill, but of experts who really understand the detail.
And it is surely the duty of this House to ensure that any legislation that is passed really meets appropriate standards, and that we should be very cautious about supporting legislation that doesn't ensure adequate access to palliative care.
14:11
14:11
Baroness Cass (Crossbench)
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Baroness Cass (Crossbench)
comments really about what I hesitate to use this term. But levelling up we know that there is levelling up we know that there is a spectrum of provision available, not just in palliative care, but in all the other aspects of care that all the other aspects of care that a dying patient needs and that are referred to in Baroness Hollins referred to in Baroness Hollins amendment one two, one. I would I would love there to be the kind of wraparound care that my noble friend Baroness Gerada described within the community, and for some patients, that is indeed the case, but for others it is not the case.
So specifying those components that should be available and making them available should be the basic right of every dying patient, but particularly one who is carrying as onerous a decision as seeking an assisted death. But I think the second and equally important point about this is front loading. The multidisciplinary assessment and ideally, having it clearly written down and held by the patient empowers the patient to hold that information and take it with them, and therefore it facilitates the coordinating doctor, the independent doctor, and indeed the panel or judiciary process to have available that information from the team who know the patient best so that they are not having to delay the process by going scurrying around in hospital notes or seeking additional information late on in the process, when the patient will inevitably have made a decision, potentially with their family, and a delay late for missing information will be unbearable.
So front loading is absolutely key to streamlining this process. Throughout. My Lords.
So specifying those components that should be available and making them available should be the basic right of every dying patient, but particularly one who is carrying as onerous a decision as seeking an assisted death. But I think the second and equally important point about this is front loading. The multidisciplinary assessment and ideally, having it clearly written down and held by the patient empowers the patient to hold that information and take it with them, and therefore it facilitates the coordinating doctor, the independent doctor, and indeed the panel or judiciary process to have available that information from the team who know the patient best so that they are not having to delay the process by going scurrying around in hospital notes or seeking additional information late on in the process, when the patient will inevitably have made a decision, potentially with their family, and a delay late for missing information will be unbearable.
So front loading is absolutely key to streamlining this process. Throughout. My Lords.
14:13
Baroness O'Loan (Crossbench)
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Baroness O'Loan (Crossbench)
My Lords, I have put my name to nine amendments in this group and I declare my interest as an unpaid trustee of a hospital which has a hospice attached to it. My Lords, I think we're very fortunate in your Lordships House to have among us distinguished doctors who have spoken with great experience and understanding of the need for access to expert palliative care. When a person faces death from terminal illness. My Lords, for many people, particularly those in care homes, such palliative care simply is not available.
I think of my own mother, who died just three years ago, who was in a care home, and for whom such care was available was provided either by the GP or by paramedics who came and administered morphine. That was not expert palliative care. And many, many people, if this bill is passed, will be in exactly the same position as my mother unless there is change to current systems. Expert palliative care, it has been said, is unavailable in many parts of the country.
And so it's not enough to know that palliative care could be available, but that it is available. That's the most significant thing. People, you know, very small matters can tip people into making a decision, a decision for death. Sometimes people just give up living because their circumstances feel so difficult to them, and they may feel in this situation that they have no option but to opt for assisted death when they don't want to, to sort of burden their family and their friends with excessive costs, including the costs of care homes.
This may seem trivial. Some of these costs may seem trivial to those of us who don't have to count our money so carefully. But for those who are very poor, as I once was getting to a hospital or hospice to visit someone who needs to be visited and whom you wish you need to visit can be very difficult. It can cost money that you don't have and it can take time. Where people have young children and those children need to be looked after.
There are all sorts of complications which ensue from the the situation in which terminal illness occurs. People may not have a car, you know. Things like fairs and coffee, buying lunch, buying a gift. All those things cost money. And for poor people. Given the current cost of living, every penny counts. Money spent on hospital visits and other expenses is not available for food and heat. The terminally ill person may know this and may wish to spare their families.
So I think the the bill is predicated upon the existence of an informed, independent decision. And that's already been spoken about at length. So I will cut down my remarks. But people feel very vulnerable. And I think one of the things we learn to do as a as children was to trust the doctors. The doctors would come and help us. But when these conversations are going to be had with people at their weakest and most vulnerable, they may well feel that they should save everyone the cost of letting them die in dignity and peace.
Naturally by opting for assisted death. And many people have said that they feel that they might be unable to trust doctors. And the people who say that particularly include those who have existing disabilities and who have experiences in other A&E departments and things like that, where assumptions have been made as to the value and dignity of the lives which they live. I was going to quote Doctor Rachel Clarke and the these moments of peak vulnerability, but the noble Baroness Baroness Finlay did that very articulately.
I once asked palliative care experts what was the longest time it had taken them to bring what seemed to be untreatable pain under control when a patient was admitted to a hospice. They told me the longest it had taken them was 12 hours. Now, the bill doesn't require that a patient is suffering pain for the system to operate, but those who are scrutinising how it would work in practice have been repeatedly accused of making people suffer unbearable pain. My Lords. Treatment for pain is almost invariable, invariably available from experts, provided those experts are provided by the state, are failing as a country is that we don't provide the expert palliative care to those who needs it.
And my emphasis, my Lords, is on these words expert palliative care. And so I want to ask the noble Lord, Lord Faulkner, does he still accept that all options for end of life care should be fully explored? He wants described this as a prerequisite for assisted dying. And again, can he share any cost assessment of the cost or logistics of making further provision for access to palliative care experts with the House? Will the noble Lord, the Minister, share any information as to the real costs of extending provision for palliative care and the savings and the savings from assisted death, which may inevitably result if this is not done?
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My Lords. I've added my name to two amendments in this.
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First of all, please hear from those noble Lords of Table and signed amendments before the rest of us speak. I apologise if the
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of us speak. I apologise if the noble Lady is a signatory, but I don't think she was. I have my name on a number of
I think of my own mother, who died just three years ago, who was in a care home, and for whom such care was available was provided either by the GP or by paramedics who came and administered morphine. That was not expert palliative care. And many, many people, if this bill is passed, will be in exactly the same position as my mother unless there is change to current systems. Expert palliative care, it has been said, is unavailable in many parts of the country.
And so it's not enough to know that palliative care could be available, but that it is available. That's the most significant thing. People, you know, very small matters can tip people into making a decision, a decision for death. Sometimes people just give up living because their circumstances feel so difficult to them, and they may feel in this situation that they have no option but to opt for assisted death when they don't want to, to sort of burden their family and their friends with excessive costs, including the costs of care homes.
This may seem trivial. Some of these costs may seem trivial to those of us who don't have to count our money so carefully. But for those who are very poor, as I once was getting to a hospital or hospice to visit someone who needs to be visited and whom you wish you need to visit can be very difficult. It can cost money that you don't have and it can take time. Where people have young children and those children need to be looked after.
There are all sorts of complications which ensue from the the situation in which terminal illness occurs. People may not have a car, you know. Things like fairs and coffee, buying lunch, buying a gift. All those things cost money. And for poor people. Given the current cost of living, every penny counts. Money spent on hospital visits and other expenses is not available for food and heat. The terminally ill person may know this and may wish to spare their families.
So I think the the bill is predicated upon the existence of an informed, independent decision. And that's already been spoken about at length. So I will cut down my remarks. But people feel very vulnerable. And I think one of the things we learn to do as a as children was to trust the doctors. The doctors would come and help us. But when these conversations are going to be had with people at their weakest and most vulnerable, they may well feel that they should save everyone the cost of letting them die in dignity and peace.
Naturally by opting for assisted death. And many people have said that they feel that they might be unable to trust doctors. And the people who say that particularly include those who have existing disabilities and who have experiences in other A&E departments and things like that, where assumptions have been made as to the value and dignity of the lives which they live. I was going to quote Doctor Rachel Clarke and the these moments of peak vulnerability, but the noble Baroness Baroness Finlay did that very articulately.
I once asked palliative care experts what was the longest time it had taken them to bring what seemed to be untreatable pain under control when a patient was admitted to a hospice. They told me the longest it had taken them was 12 hours. Now, the bill doesn't require that a patient is suffering pain for the system to operate, but those who are scrutinising how it would work in practice have been repeatedly accused of making people suffer unbearable pain. My Lords. Treatment for pain is almost invariable, invariably available from experts, provided those experts are provided by the state, are failing as a country is that we don't provide the expert palliative care to those who needs it.
And my emphasis, my Lords, is on these words expert palliative care. And so I want to ask the noble Lord, Lord Faulkner, does he still accept that all options for end of life care should be fully explored? He wants described this as a prerequisite for assisted dying. And again, can he share any cost assessment of the cost or logistics of making further provision for access to palliative care experts with the House? Will the noble Lord, the Minister, share any information as to the real costs of extending provision for palliative care and the savings and the savings from assisted death, which may inevitably result if this is not done?
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My Lords. I've added my name to two amendments in this.
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First of all, please hear from those noble Lords of Table and signed amendments before the rest of us speak. I apologise if the
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of us speak. I apologise if the noble Lady is a signatory, but I don't think she was. I have my name on a number of
14:19
Baroness Fox of Buckley (Non-affiliated)
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Baroness Fox of Buckley (Non-affiliated)
>> I have my name on a number of amendments and. Yes. Thank you. I didn't know those rules applied. No, didn't know those rules applied. No, anyway they don't. I have added my name to a number of amendments in this group. In the name of the noble Lord Lord Carter of Haslemere. But in general, I'm glad to support many of the amendments. On palliative care in this group, we are being asked to accept that assisted dying is a medical intervention, something I'm not entirely happy with, albeit a reversible life ending medical intervention.
But we're this is what the bill asks us to do. So it seems obvious to me then that there's a guaranteed input from the best placed medical experts in end of life care, i.e. palliative care care specialists, because that, it seems to me, is essential, therefore, for informed consent for the patients. And I actually imagine and hope that the noble and learned Lord, Lord Faulkner, is very sensitive to the importance of palliative care. I know that he's in that much cited demos commission, which I won't bother quoting again.
He says that I'm hoping that he, the noble and Lord, hasn't changed his mind. But I think the noble Lord Carter made a very important point earlier when he urged the sponsor of the bill and I would continue to do this, that one of the reasons why there's so many amendments and we've all been chastised and finger pointed at and tut tutted at. I kept my patience last night, although my blood pressure did go up, but nonetheless, nonetheless, I, I genuinely think that the number of amendments could be really slimmed down by the sponsor of the bill.
If the sponsor of the bill were to go through, for example, all of the amendments on palliative care and say to or I accept the, the principle of this and I'll come back with my amendment or what have you, because then we wouldn't have this. And we were not an organised political grouping. People put in amendments in good faith, add their name to things, which is what I've done, and then speak in good faith. You're not trying to repeat things for the purposes of delaying the bill, but because we think it matters and it's important, and that's what we're doing here.
So I would therefore urge in relation to this group and the concept of this ten important themes. I think having an assurance that real choices offered to a patient with a terminal illness and that they're given the option of palliative care assessment, and hopefully then possibly palliative care would really reassure or be a safeguard. It's a key theme and so on. Now, one of the reasons I say that is I know that in the bill, GPS can mention palliative care or to a patient.
But and you know, I'm a great fan of GPS as, as kind of fantastic generalists and doing a good job. But very often they don't know all of the and haven't got the expertise that palliative care specialists would have in terms of how precisely medical intervention can improve a patient's condition and indeed improve or change their will to live. And I do think it's important for us to note, as a house, that that research has shown, that those who wish to hasten their own death often change, change their minds when they receive more information.
And palliative care can mean that people who want to die then want to live. And I think that is important if we're going to have choice and talk about choice because it's possible you might want to die, you you're determined. You want to die. In assisted death terms, having had your terminal illness. But but why is it that you want to die? I mean, actually, that's a motivational discussion in a degree. But one of the things that I think happens is, is that many people are frightened, they're fearful, and one of the things they're fearful of are pain and terrible symptoms, often, by the way, graphically described by supporters of this bill.
And I think that they can scare people. And it's this idea that your pain and your symptoms cannot be controlled. And when I talk to supporters of this bill, some of my friends, colleagues and members of the public and so on, they are completely compassionate. By the way, in talking about this bill will help people who are suffering, having intolerable suffering or excruciating pain. And none of us want to wish that on anyone or indeed on ourselves. It's a frightening prospect, but actually, often that is a fear and a dread that the right kind of care can mean will not be realised.
Patients are understandably frightened of being in that kind of pain, and they need to know that. I think this quote from Toby Porter, the CEO of Hospice UK, sums up the way I feel about this. He says, an outcome in which someone chose an assisted death because of a real or imagined fear that they could not get pain relief or other symptom symptom alleviation, or because their family would not get support through their illness, would clearly be a moral and practical disgrace to any country.
And I think that's absolutely right. Now, you know, I've talked. We all know family, you know, friends and so on. People who have died had terminal illnesses or friends or family. And people will say, you know, morphine is simply not enough to control the pain. And that's the kind of thing that I say or that I think, because I know nothing about medicine. So it's a great relief to discover that actually, if you read what the palliative medicine.
Resident doctors say, they say morphine is the tip of the iceberg for pain management. There are countless other options available, but to know this requires training and experience, which I haven't got, and which when you're having a chat in the pub with mates or indeed when I've been in hospital pumping in the morphine, you know, you kind of think it's good to know somebody somewhere has got the experience. And that's the palliative care specialist that every terminally ill patient should at least be offered the option to go to see.
So I really believe this is a modest but meaningful addition to the bill. And I hope the noble and learned Lord Keen the spirit of listening and accommodating and compromise that we heard last night will make changes to the bill accordingly. I do think also, there is a question to the government and the Minister here though, because I do think it was. Baroness Smith of Newnham new explained this very well, but I think it was a shocking revelation in relation to the noble Lord, Lord Stevens point yesterday that the Minister responsible for palliative care said that the government would not publish their modern framework until after the bill had been passed through Parliament and Lord
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Stevenson respect. With respect, you need not say that what Lord Stevens says was it that what Lord Stevens says was it wouldn't be done. In effect, the implication being that the government's. Don't get me wrong, I don't disagree with what you're saying. The implication being the government's given a date, and that date is beyond when this is expected to be law. The Minister expected to be law. The Minister did not say we're waiting till after the bill, because the crucial words in Lord Stevens were were in commerce in effect.
So it's very
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careful what he said. Yes. I had thought I was implying that I wasn't trying to imply some conspiratorial holding back. It's just that the noble Lord, Lord just that the noble Lord, Lord Stevens, this was what I was going to quote said. This is a dangerous reversal of the timetable we require. And that's the point that I was really getting to. And I think that is shocking, not because I think anyone's malignly behaving I think anyone's malignly behaving in this way, but because I think the government therefore needs to commit to bringing forward that report so that it's available before we have Report stage.
And that's the and I and I really would urge the Minister to reassure us that that's the case. I also just wanted to finish off by saying that the noble Lady Baroness Brown of Silverton, who's whose speech I thought was excellent at explaining that for all of the importance of palliative care and hospices and so on, not everyone has has equal access to them. And this is well documented. And so one of the chilling aspects of this is I want to see that framework, because one of the chilling aspects of this bill for me is that for those of us who've campaigned to raise money for hospices who are desperately keen that palliative care is well resourced to hear, as we heard earlier today by the noble and learned Lord Lord Carlile, who stated baldly, perfectly, reasonably, whichever choice you have, whichever choice we had in the previous group is going to cost a lot of money.
I do think, oh, spend the money at somewhere else.
But we're this is what the bill asks us to do. So it seems obvious to me then that there's a guaranteed input from the best placed medical experts in end of life care, i.e. palliative care care specialists, because that, it seems to me, is essential, therefore, for informed consent for the patients. And I actually imagine and hope that the noble and learned Lord, Lord Faulkner, is very sensitive to the importance of palliative care. I know that he's in that much cited demos commission, which I won't bother quoting again.
He says that I'm hoping that he, the noble and Lord, hasn't changed his mind. But I think the noble Lord Carter made a very important point earlier when he urged the sponsor of the bill and I would continue to do this, that one of the reasons why there's so many amendments and we've all been chastised and finger pointed at and tut tutted at. I kept my patience last night, although my blood pressure did go up, but nonetheless, nonetheless, I, I genuinely think that the number of amendments could be really slimmed down by the sponsor of the bill.
If the sponsor of the bill were to go through, for example, all of the amendments on palliative care and say to or I accept the, the principle of this and I'll come back with my amendment or what have you, because then we wouldn't have this. And we were not an organised political grouping. People put in amendments in good faith, add their name to things, which is what I've done, and then speak in good faith. You're not trying to repeat things for the purposes of delaying the bill, but because we think it matters and it's important, and that's what we're doing here.
So I would therefore urge in relation to this group and the concept of this ten important themes. I think having an assurance that real choices offered to a patient with a terminal illness and that they're given the option of palliative care assessment, and hopefully then possibly palliative care would really reassure or be a safeguard. It's a key theme and so on. Now, one of the reasons I say that is I know that in the bill, GPS can mention palliative care or to a patient.
But and you know, I'm a great fan of GPS as, as kind of fantastic generalists and doing a good job. But very often they don't know all of the and haven't got the expertise that palliative care specialists would have in terms of how precisely medical intervention can improve a patient's condition and indeed improve or change their will to live. And I do think it's important for us to note, as a house, that that research has shown, that those who wish to hasten their own death often change, change their minds when they receive more information.
And palliative care can mean that people who want to die then want to live. And I think that is important if we're going to have choice and talk about choice because it's possible you might want to die, you you're determined. You want to die. In assisted death terms, having had your terminal illness. But but why is it that you want to die? I mean, actually, that's a motivational discussion in a degree. But one of the things that I think happens is, is that many people are frightened, they're fearful, and one of the things they're fearful of are pain and terrible symptoms, often, by the way, graphically described by supporters of this bill.
And I think that they can scare people. And it's this idea that your pain and your symptoms cannot be controlled. And when I talk to supporters of this bill, some of my friends, colleagues and members of the public and so on, they are completely compassionate. By the way, in talking about this bill will help people who are suffering, having intolerable suffering or excruciating pain. And none of us want to wish that on anyone or indeed on ourselves. It's a frightening prospect, but actually, often that is a fear and a dread that the right kind of care can mean will not be realised.
Patients are understandably frightened of being in that kind of pain, and they need to know that. I think this quote from Toby Porter, the CEO of Hospice UK, sums up the way I feel about this. He says, an outcome in which someone chose an assisted death because of a real or imagined fear that they could not get pain relief or other symptom symptom alleviation, or because their family would not get support through their illness, would clearly be a moral and practical disgrace to any country.
And I think that's absolutely right. Now, you know, I've talked. We all know family, you know, friends and so on. People who have died had terminal illnesses or friends or family. And people will say, you know, morphine is simply not enough to control the pain. And that's the kind of thing that I say or that I think, because I know nothing about medicine. So it's a great relief to discover that actually, if you read what the palliative medicine.
Resident doctors say, they say morphine is the tip of the iceberg for pain management. There are countless other options available, but to know this requires training and experience, which I haven't got, and which when you're having a chat in the pub with mates or indeed when I've been in hospital pumping in the morphine, you know, you kind of think it's good to know somebody somewhere has got the experience. And that's the palliative care specialist that every terminally ill patient should at least be offered the option to go to see.
So I really believe this is a modest but meaningful addition to the bill. And I hope the noble and learned Lord Keen the spirit of listening and accommodating and compromise that we heard last night will make changes to the bill accordingly. I do think also, there is a question to the government and the Minister here though, because I do think it was. Baroness Smith of Newnham new explained this very well, but I think it was a shocking revelation in relation to the noble Lord, Lord Stevens point yesterday that the Minister responsible for palliative care said that the government would not publish their modern framework until after the bill had been passed through Parliament and Lord
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Stevenson respect. With respect, you need not say that what Lord Stevens says was it that what Lord Stevens says was it wouldn't be done. In effect, the implication being that the government's. Don't get me wrong, I don't disagree with what you're saying. The implication being the government's given a date, and that date is beyond when this is expected to be law. The Minister expected to be law. The Minister did not say we're waiting till after the bill, because the crucial words in Lord Stevens were were in commerce in effect.
So it's very
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careful what he said. Yes. I had thought I was implying that I wasn't trying to imply some conspiratorial holding back. It's just that the noble Lord, Lord just that the noble Lord, Lord Stevens, this was what I was going to quote said. This is a dangerous reversal of the timetable we require. And that's the point that I was really getting to. And I think that is shocking, not because I think anyone's malignly behaving I think anyone's malignly behaving in this way, but because I think the government therefore needs to commit to bringing forward that report so that it's available before we have Report stage.
And that's the and I and I really would urge the Minister to reassure us that that's the case. I also just wanted to finish off by saying that the noble Lady Baroness Brown of Silverton, who's whose speech I thought was excellent at explaining that for all of the importance of palliative care and hospices and so on, not everyone has has equal access to them. And this is well documented. And so one of the chilling aspects of this is I want to see that framework, because one of the chilling aspects of this bill for me is that for those of us who've campaigned to raise money for hospices who are desperately keen that palliative care is well resourced to hear, as we heard earlier today by the noble and learned Lord Lord Carlile, who stated baldly, perfectly, reasonably, whichever choice you have, whichever choice we had in the previous group is going to cost a lot of money.
I do think, oh, spend the money at somewhere else.
14:29
Baroness Watkins of Tavistock (Crossbench)
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Baroness Watkins of Tavistock (Crossbench)
My Lord, my Lord, I have not intended to speak in this group, but as the only nurse I think present today, I want to say that nobody could deny the principles of the amendments that are being discussed today. They are right and proper in terms of good health care for the nation. I have two concerns, however. One is that we have talked considerably about my medical colleagues who are absolutely essential, but the vast majority of palliative care is delivered by specialist nurse practitioners, and I just feel that it's essential I draw the House's attention to that today.
And I just wanted to read from the ICN Code of Ethics in Nursing, which is nurses, and I believe other healthcare professionals have four fundamental responsibilities to promote health, to prevent illness, to restore health and to alleviate suffering. And what we're talking about today is about alleviating suffering. And there is no doubt that suffering and pain are perceived differently by different patients. So what some people can cope with is not the same as others. And I think it's really essential that we recognise that today and in Second Reading.
And I haven't put an amendment down yet, but we'll do it. Report if we haven't got one by then, is that at some point if you do advance directives, you should be able to say that you never want anybody to discuss assisted dying with you, so that you could make that clear from a faith or culture perspective. Perhaps, you know, at the age of 50 if it is appropriate. But my other concern is that there are a lot of people who work in palliative care who have deep religious beliefs, who do not wish to discuss assisted dying with their patients.
And we have to find a way round to ensure that patients are given options, but that we don't lose really important people from our healthcare team because they are then expected to do something that makes them very uncomfortable. And we've dealt with that in terms of abortion. And I just want to raise that. We need to think about that in the longer term. I'm not proposing an amendment now, but really felt I had to speak.
And I just wanted to read from the ICN Code of Ethics in Nursing, which is nurses, and I believe other healthcare professionals have four fundamental responsibilities to promote health, to prevent illness, to restore health and to alleviate suffering. And what we're talking about today is about alleviating suffering. And there is no doubt that suffering and pain are perceived differently by different patients. So what some people can cope with is not the same as others. And I think it's really essential that we recognise that today and in Second Reading.
And I haven't put an amendment down yet, but we'll do it. Report if we haven't got one by then, is that at some point if you do advance directives, you should be able to say that you never want anybody to discuss assisted dying with you, so that you could make that clear from a faith or culture perspective. Perhaps, you know, at the age of 50 if it is appropriate. But my other concern is that there are a lot of people who work in palliative care who have deep religious beliefs, who do not wish to discuss assisted dying with their patients.
And we have to find a way round to ensure that patients are given options, but that we don't lose really important people from our healthcare team because they are then expected to do something that makes them very uncomfortable. And we've dealt with that in terms of abortion. And I just want to raise that. We need to think about that in the longer term. I'm not proposing an amendment now, but really felt I had to speak.
14:32
Lord Carlile of Berriew (Crossbench)
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Lord Carlile of Berriew (Crossbench)
My Lord, my Lord, I rise to >> My Lord, my Lord, I rise to speak very briefly in relation to amendments 186251 and 380, all of amendments 186251 and 380, all of which were tabled by Lord Hunt of Kings Heath, two of them supported by me. He's asked me to give his apologies to the house. His wife has suffered an accident and he's looking after her at home, quite rightly. I know that Lord hunt, as I do, would have agreed with many of the speeches which have been made, that to the effect that palliative care knowledge must be a prerequisite in any person's decision making.
And there have been many excellent speeches, and I would simply refer to two as examples, one by Baroness Brown of Silvertown and the other by the my noble friend Lord Carter. I represented a constituency which in rural Wales consists of 839mi², with no general hospital. Now I absolutely take Baroness Watkins in my noble friend Baroness Watkins point that a great deal of the skill and knowledge in relation to palliative care does not depend on there being a general hospital and can be supplied by nurses, for example, who work in the area concerned.
But what is extremely important is nobody, whether they live somewhere really remote or somewhere really populous and feel remote, should be deprived of a contribution and not from a knowledge of palliative care before
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ever making such a decision. Lord Chancellor order, my Lords.
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Lord Chancellor order, my Lords. Order! Thank you. It's now 233. Can I suggest the House might like to I suggest the House might like to hear from frontbenchers now to ensure we can conclude proceedings in an orderly manner as planned
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in an orderly manner as planned around 3 p.m. I have an amendment. I have not
And there have been many excellent speeches, and I would simply refer to two as examples, one by Baroness Brown of Silvertown and the other by the my noble friend Lord Carter. I represented a constituency which in rural Wales consists of 839mi², with no general hospital. Now I absolutely take Baroness Watkins in my noble friend Baroness Watkins point that a great deal of the skill and knowledge in relation to palliative care does not depend on there being a general hospital and can be supplied by nurses, for example, who work in the area concerned.
But what is extremely important is nobody, whether they live somewhere really remote or somewhere really populous and feel remote, should be deprived of a contribution and not from a knowledge of palliative care before
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ever making such a decision. Lord Chancellor order, my Lords.
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Lord Chancellor order, my Lords. Order! Thank you. It's now 233. Can I suggest the House might like to I suggest the House might like to hear from frontbenchers now to ensure we can conclude proceedings in an orderly manner as planned
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in an orderly manner as planned around 3 p.m. I have an amendment. I have not
14:34
Lord Goodman of Wycombe (Conservative)
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Lord Goodman of Wycombe (Conservative)
yet been able to speak to, and I think it's surely right and proper that those of us who tabled amendments should be able to speak, especially if and this is true in my case, I was a member of the select committee that examined this bill, and I would like very briefly, to quote some of the evidence we heard, if the House will allow me so very briefly on amendment 394.
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Order, my Lords, the House generally. Plan closes at about 3:00. So I think to be 3:00, we would need to leave the need to the
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would need to leave the need to the consent of the House. Thank you. Be extremely brief. But as I said to the government, I did table an amendment and have did table an amendment and have been waiting patiently to speak to it. If I may. My amendment 394 it. If I may. My amendment 394 would require the assessing doctor to arrange and require the person to attend a consultation with a palliative care specialist. Now, like Baroness Finlay, who moved this group of amendments, and like Baroness Smith who spoke earlier, I was on the select Committee.
I will not repeat the evidence that Baroness Miller quoted, but I do very briefly want to quote a little bit more, because the merit of having these select committee reports is that the House hears them. So very briefly, the Royal College of General Practitioners said, and I quote, it is essential to ensure that every patient approaching the end of life has access to high quality care. Second, Professor Mumtaz Patel of the Royal College of Practitioners said what I really fear is that people are making sometimes these choices because of the lack of provision around palliative care.
Third, Hospice UK, in their written evidence to us, said should the bill progress, it is essential that the government does far more to ensure equitable access to and provision of palliative care ahead of the introduction of assisted dying in practice. Now, I could quote more, but because of the time constraint, I will come to a conclusion as requested. And my conclusion is this when Lord Faulkner came and gave evidence to our committee, he stressed at the start that the guiding principle of the bill is autonomy, but autonomy is compromised if there is not real choice.
And to those who say that you can't have real choice between assisted dying and palliative care because the palliative care is not available, my response is that is precisely what should have been considered in a Royal commission rather than brought to this bill, which has been so heavily criticised by two select committees of this House. However, we are where we are. This is the bill as we have it. So I wait to hear from the sponsor of the bill which of these amendments he's prepared to accept and if he isn't, which amendments he himself will bring forward in due course?
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Order, my Lords, the House generally. Plan closes at about 3:00. So I think to be 3:00, we would need to leave the need to the
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would need to leave the need to the consent of the House. Thank you. Be extremely brief. But as I said to the government, I did table an amendment and have did table an amendment and have been waiting patiently to speak to it. If I may. My amendment 394 it. If I may. My amendment 394 would require the assessing doctor to arrange and require the person to attend a consultation with a palliative care specialist. Now, like Baroness Finlay, who moved this group of amendments, and like Baroness Smith who spoke earlier, I was on the select Committee.
I will not repeat the evidence that Baroness Miller quoted, but I do very briefly want to quote a little bit more, because the merit of having these select committee reports is that the House hears them. So very briefly, the Royal College of General Practitioners said, and I quote, it is essential to ensure that every patient approaching the end of life has access to high quality care. Second, Professor Mumtaz Patel of the Royal College of Practitioners said what I really fear is that people are making sometimes these choices because of the lack of provision around palliative care.
Third, Hospice UK, in their written evidence to us, said should the bill progress, it is essential that the government does far more to ensure equitable access to and provision of palliative care ahead of the introduction of assisted dying in practice. Now, I could quote more, but because of the time constraint, I will come to a conclusion as requested. And my conclusion is this when Lord Faulkner came and gave evidence to our committee, he stressed at the start that the guiding principle of the bill is autonomy, but autonomy is compromised if there is not real choice.
And to those who say that you can't have real choice between assisted dying and palliative care because the palliative care is not available, my response is that is precisely what should have been considered in a Royal commission rather than brought to this bill, which has been so heavily criticised by two select committees of this House. However, we are where we are. This is the bill as we have it. So I wait to hear from the sponsor of the bill which of these amendments he's prepared to accept and if he isn't, which amendments he himself will bring forward in due course?
14:36
Lord Curry of Kirkharle (Crossbench)
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Lord Curry of Kirkharle (Crossbench)
I will be very brief. Come on, come on, come on, come on, come on, come on, come on, come on, come on, come on, come on, come on. My Lords, I have tabled two amendments. Amendments 183 and one eight, for which I would just like to comment on very briefly. They are designed to reinforce what is consistent message within this grouping about the concern of availability. Palliative care. I like my Lords to put some data to this which hasn't been mentioned every day.
It's been estimated that between 250 and 300 people die without adequate palliative care every day, and more than a quarter facing the end of their life do not receive the care they require or deserve. This is a serious figure, my Lords, so the service is under immense strain. It is a lottery. It requires significant and very significant, depending where you live, with ethnic minority groups facing even greater difficulty in accessing the service. One of the benefits of debating this bill is has brought renewed focus on the palliative care crisis, which we face.
We cannot introduce an assisted dying option without first having addressed this serious concern and having qualified palliative care advice available to those who want to, may want to choose end of life options. So amendment 103 is a further strengthening of the noble Baroness Grey-Thompson extremely important amendment, which would require quality palliative care being offered to everyone who may be considering an assisted death so that no one dies without having had this option. They would have had they would have to opt out.
This is important. And secondly, the amendment 184 requires a definition of what constitutes quality care professionals. This has been mentioned before, my Lord. I think this is extremely important. As a caring society, I believe we have a responsibility to ensure that patients can spend their final days being supported by quality palliative care service to relieve their suffering as far as possible. In short, no one should feel they have no choice but to end their life due to gaps in the care system that we have failed to provide.
It's been estimated that between 250 and 300 people die without adequate palliative care every day, and more than a quarter facing the end of their life do not receive the care they require or deserve. This is a serious figure, my Lords, so the service is under immense strain. It is a lottery. It requires significant and very significant, depending where you live, with ethnic minority groups facing even greater difficulty in accessing the service. One of the benefits of debating this bill is has brought renewed focus on the palliative care crisis, which we face.
We cannot introduce an assisted dying option without first having addressed this serious concern and having qualified palliative care advice available to those who want to, may want to choose end of life options. So amendment 103 is a further strengthening of the noble Baroness Grey-Thompson extremely important amendment, which would require quality palliative care being offered to everyone who may be considering an assisted death so that no one dies without having had this option. They would have had they would have to opt out.
This is important. And secondly, the amendment 184 requires a definition of what constitutes quality care professionals. This has been mentioned before, my Lord. I think this is extremely important. As a caring society, I believe we have a responsibility to ensure that patients can spend their final days being supported by quality palliative care service to relieve their suffering as far as possible. In short, no one should feel they have no choice but to end their life due to gaps in the care system that we have failed to provide.
14:39
Baroness Grey-Thompson (Crossbench)
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Baroness Grey-Thompson (Crossbench)
My Lords. group and I beg the indulgence. I will get through them as quickly as I possibly can. So I have amendments 179182185 and I've also signatory 2262 and 263. My Lords, this bill we talk a lot about choice and I believe patients should have real choice, not partial choice. So that's why I've tabled amendments that focus on specialist palliative care. Now in another place, the public Bill Committee accepted amendment 18108, in the name of Polly Billington, requiring doctors to offer palliative care support.
But, my Lords, this could be a case of, you know, almost what you could have one without there being a guarantee of that support being made accessible, then it doesn't offer patients the choice that they may be expecting. And we've seen in cases like Canada where they're sort of told, yes, you can have this, but we're not going to fund it. If this bill is going to be the best in the world, then we genuinely have to offer patients every choice that is available.
In the previous group of amendments, we talked about cost. Were not able to to cost this up, but if patients feel that they have no choice but to end their life, we are stripping choice away from them. So the amendments that are solely my name 179182 and 185 about. Because this bill does not require a medical practitioner to ensure that the patient has access to specialist care for their consideration. Now, during the conversations, I do believe it's important that the patient is automatically referred to specialist care, ensuring that they have a real choice about the treatments that they may choose to have.
And I think it's really important that my amendments 179 goes beyond what the bill says, which is just offering to refer to saying that they must be referred because until you're in that situation where you've been given a terminal diagnosis, even if you have a family member that's going through it, it can be slightly different to when it is you. And how does a patient know about all the different treatment options? Unless they're given them, but also given them a way where they have the time to understand them.
So my amendment 182 is about needs being assessed by an appropriate health or social care professional, and that the second part of it, it must be provided with palliative and end of life care in line with their assessed needs. My Lords, we shouldn't be doing this as a case of this is what you could want. Apologies. I can't think of a better way of saying it, but we see in other jurisdictions like Canada where you can have it, but we're not funding it.
That actually, I think, puts patients in a really difficult and impossible situation. So 185 my amendment there also refers to the specialist support, which I think is really important. Very briefly, my amendments I've signed up to 262 and 263 are in the name of Baroness Ritchie. And again this is to add the specialist part of it because I'm struck by the number of people I've spoken to who said they've had access to palliative care. And when you've actually interrogated it, what it turns out is they've had access to some medical support.
It might be a district nurse, but it doesn't necessarily mean somebody who's had specialist training. And I think that is incredibly important. And, you know, my my own personal experience, I've lost both my parents. And I thought my mother had access to good palliative care. And actually, this is a sense of guilt that myself and others would feel. It was only when my father was dying that I realised what that could and should look like. They died eight years apart in the same hospital.
You would have expected there would be a similar level of treatment and support, but it was very far from that. So my father was involved. He had a multi-disciplinary team, you know, there was lots of information we've given time to understand. He was given time to understand what the situation might be. But one of my concerns with this bill, and why it's so important that the specialist element is there, is my father. Apologies. It's slightly father.
Apologies. It's slightly distracting than chamber. When we were having discussions about my father, we were told he was approaching end of life. We were told, you know, this is very serious. We could let him slip away. That was what we should encourage to happen. And that's what he was encouraged to think about. And this is why I've got real concerns with lots of parts of this bill. At that point in my father's life, he'd had his foot amputated. He was told that he wouldn't have a normal life.
He wouldn't be able to live in the same house. His house I grew up in. It was vaguely adapted. He was told it wouldn't be possible to get a wheelchair. My Lords, if there's one thing I can do for my father, it would have been to get him a really good wheelchair. And this comes back to some of the real issues that I have with the substance of this bill is how it could be misused to by families who aren't loving or caring or kind or for, you know, doctors who are under huge pressure to think about encouraging people to approach their life.
So this is why I think it's really important that the full gamut of options are available for individuals, so they're able to genuinely make open choices about how they choose to end their lives. Just very briefly, my Lords, I'm really conscious of time, and I thank the Lordships chamber for indulging me and allowing me to speak in five of my amendments, but very briefly, picking up on the words of Baroness Fox. My Lords, I've been one of the peers who've been heavily criticised for the number of amendments that I have in this bill.
Being a cross-bencher is quite a lonely place, and I would very much welcome the noble and learned Lords answers on many of the questions that we are raising in terms of moving this bill forward. And I think last night there was a commitment to answer questions. So, you know, would the noble and learned Lord agree that there is a great deal of difference between generic palliative care and specialist palliative care? And actually specialist palliative care is what we should be offering people? And would he commit to exploring the best support under this kind of specialist terminology, so that people are able to make a genuine choice on what is available to them? And Alastair Henderson, when he was giving evidence at the select committee, did refer to the lack of services and how that may influence choice.
And I would not in any way, for lack of social support, poor housing, you know, a myriad of different reasons for people to think that this is the only option they have. If we are going to do this bill and we do this bill properly, it must be based on a genuine settled wish and people giving the best possible people giving the best possible choice that is available to them.
But, my Lords, this could be a case of, you know, almost what you could have one without there being a guarantee of that support being made accessible, then it doesn't offer patients the choice that they may be expecting. And we've seen in cases like Canada where they're sort of told, yes, you can have this, but we're not going to fund it. If this bill is going to be the best in the world, then we genuinely have to offer patients every choice that is available.
In the previous group of amendments, we talked about cost. Were not able to to cost this up, but if patients feel that they have no choice but to end their life, we are stripping choice away from them. So the amendments that are solely my name 179182 and 185 about. Because this bill does not require a medical practitioner to ensure that the patient has access to specialist care for their consideration. Now, during the conversations, I do believe it's important that the patient is automatically referred to specialist care, ensuring that they have a real choice about the treatments that they may choose to have.
And I think it's really important that my amendments 179 goes beyond what the bill says, which is just offering to refer to saying that they must be referred because until you're in that situation where you've been given a terminal diagnosis, even if you have a family member that's going through it, it can be slightly different to when it is you. And how does a patient know about all the different treatment options? Unless they're given them, but also given them a way where they have the time to understand them.
So my amendment 182 is about needs being assessed by an appropriate health or social care professional, and that the second part of it, it must be provided with palliative and end of life care in line with their assessed needs. My Lords, we shouldn't be doing this as a case of this is what you could want. Apologies. I can't think of a better way of saying it, but we see in other jurisdictions like Canada where you can have it, but we're not funding it.
That actually, I think, puts patients in a really difficult and impossible situation. So 185 my amendment there also refers to the specialist support, which I think is really important. Very briefly, my amendments I've signed up to 262 and 263 are in the name of Baroness Ritchie. And again this is to add the specialist part of it because I'm struck by the number of people I've spoken to who said they've had access to palliative care. And when you've actually interrogated it, what it turns out is they've had access to some medical support.
It might be a district nurse, but it doesn't necessarily mean somebody who's had specialist training. And I think that is incredibly important. And, you know, my my own personal experience, I've lost both my parents. And I thought my mother had access to good palliative care. And actually, this is a sense of guilt that myself and others would feel. It was only when my father was dying that I realised what that could and should look like. They died eight years apart in the same hospital.
You would have expected there would be a similar level of treatment and support, but it was very far from that. So my father was involved. He had a multi-disciplinary team, you know, there was lots of information we've given time to understand. He was given time to understand what the situation might be. But one of my concerns with this bill, and why it's so important that the specialist element is there, is my father. Apologies. It's slightly father.
Apologies. It's slightly distracting than chamber. When we were having discussions about my father, we were told he was approaching end of life. We were told, you know, this is very serious. We could let him slip away. That was what we should encourage to happen. And that's what he was encouraged to think about. And this is why I've got real concerns with lots of parts of this bill. At that point in my father's life, he'd had his foot amputated. He was told that he wouldn't have a normal life.
He wouldn't be able to live in the same house. His house I grew up in. It was vaguely adapted. He was told it wouldn't be possible to get a wheelchair. My Lords, if there's one thing I can do for my father, it would have been to get him a really good wheelchair. And this comes back to some of the real issues that I have with the substance of this bill is how it could be misused to by families who aren't loving or caring or kind or for, you know, doctors who are under huge pressure to think about encouraging people to approach their life.
So this is why I think it's really important that the full gamut of options are available for individuals, so they're able to genuinely make open choices about how they choose to end their lives. Just very briefly, my Lords, I'm really conscious of time, and I thank the Lordships chamber for indulging me and allowing me to speak in five of my amendments, but very briefly, picking up on the words of Baroness Fox. My Lords, I've been one of the peers who've been heavily criticised for the number of amendments that I have in this bill.
Being a cross-bencher is quite a lonely place, and I would very much welcome the noble and learned Lords answers on many of the questions that we are raising in terms of moving this bill forward. And I think last night there was a commitment to answer questions. So, you know, would the noble and learned Lord agree that there is a great deal of difference between generic palliative care and specialist palliative care? And actually specialist palliative care is what we should be offering people? And would he commit to exploring the best support under this kind of specialist terminology, so that people are able to make a genuine choice on what is available to them? And Alastair Henderson, when he was giving evidence at the select committee, did refer to the lack of services and how that may influence choice.
And I would not in any way, for lack of social support, poor housing, you know, a myriad of different reasons for people to think that this is the only option they have. If we are going to do this bill and we do this bill properly, it must be based on a genuine settled wish and people giving the best possible people giving the best possible choice that is available to them.
14:47
Lord Harper (Conservative)
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Lord Harper (Conservative)
I just want to make one point. >> I just want to make one point. No, no, no, I'm I'm sorry that there's no there's no requirement in the companion that you can only in the companion that you can only speak in a debate if you've tabled an amendment, and there's no need if we want to finish it at 3:00, we can either go slightly past 3:00 or we can stop at 3:00 and resume this group next week. So I want to make one point that hasn't been made yet, which I think is pertinent to the debate.
And I believe I'm perfectly in order doing so. The point is this two two members have raised, I think, the valuable contribution yesterday in yesterday's procedural debate from Lord Stevens of Birmingham, a man who knows what he's talking about in the NHS, and he ran it for a number of years about the timetable for the government to publish its modern framework for palliative medicine. And he said at the moment that is likely to be published after Parliament will have considered this bill and he felt that was the wrong way round.
And the reason why it matters is the government's published a ten year plan for the NHS. And if you look at that ten year plan, there is nothing in it that will significantly change the provision of palliative care in England. And we know that only about half of people that require specialist palliative care are able to get it. We know that the sponsor of the bill, the noble and learned Lord Falconer of Thoroton, believes or believed and still believes that palliative good palliative care is a prerequisite for there to be assisted suicide.
So I think it's very important that the Minister answers the question and confirms that the government will at least think about publishing that modern framework for palliative care. Before we get to Report stage of this bill, so that this House can make a properly informed decision about amendments that are before it, about palliative care.
And I believe I'm perfectly in order doing so. The point is this two two members have raised, I think, the valuable contribution yesterday in yesterday's procedural debate from Lord Stevens of Birmingham, a man who knows what he's talking about in the NHS, and he ran it for a number of years about the timetable for the government to publish its modern framework for palliative medicine. And he said at the moment that is likely to be published after Parliament will have considered this bill and he felt that was the wrong way round.
And the reason why it matters is the government's published a ten year plan for the NHS. And if you look at that ten year plan, there is nothing in it that will significantly change the provision of palliative care in England. And we know that only about half of people that require specialist palliative care are able to get it. We know that the sponsor of the bill, the noble and learned Lord Falconer of Thoroton, believes or believed and still believes that palliative good palliative care is a prerequisite for there to be assisted suicide.
So I think it's very important that the Minister answers the question and confirms that the government will at least think about publishing that modern framework for palliative care. Before we get to Report stage of this bill, so that this House can make a properly informed decision about amendments that are before it, about palliative care.
14:49
Lord Blencathra (Conservative)
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Lord Blencathra (Conservative)
Hello. This is a self-regulating house, and a self-regulating house does not mean that a government can regulate who can speak and who can't. And I share the point made by my noble friend that if the only way one can speak in these debates is to sign amendments, then I know what to do in the future. I spoke for five minutes, and on the Friday before Christmas I said, not a peep in the earlier debate today because it was not my speciality. I've been waiting here for two hours to make a speech on palliative care, and we seem to be refused to do so because the government wants us to not say anything so we can finish at 3:00.
I agree, we can finish at 3:00. It's a simple matter for the House to adjourn, come back to this matter and we polish it off next Friday morning. But it is absolutely outrageous. If noble Lords who have not had a chance to speak at all on palliative care, are refused to do so because the government has imposed an arbitrary timetable.
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My Lords, it's not an arbitrary timetable and many people have been speaking on palliative care, both in Second Reading and in and in today's debate, and I respect that totally. I'm just asking that we totally. I'm just asking that we need to respect the rules of the House in order to be able to adjourn. It's better if we finish this amendment so that we can start this amendment so that we can start the next session on a new debate.
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Thank you. It must be finished this group and start the next session on a new member. We often adjourn the House during during Committee stage, when we're halfway through a large group at 10:00 at night, and we come back and polish it off the next day. There is nothing in the companion which suggests that we're honour bound, or we're duty bound to finish a group of amendments by a certain timescale. There is no problem coming back to do it again and complete it.
Then.
I agree, we can finish at 3:00. It's a simple matter for the House to adjourn, come back to this matter and we polish it off next Friday morning. But it is absolutely outrageous. If noble Lords who have not had a chance to speak at all on palliative care, are refused to do so because the government has imposed an arbitrary timetable.
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My Lords, it's not an arbitrary timetable and many people have been speaking on palliative care, both in Second Reading and in and in today's debate, and I respect that totally. I'm just asking that we totally. I'm just asking that we need to respect the rules of the House in order to be able to adjourn. It's better if we finish this amendment so that we can start this amendment so that we can start the next session on a new debate.
**** Possible New Speaker ****
Thank you. It must be finished this group and start the next session on a new member. We often adjourn the House during during Committee stage, when we're halfway through a large group at 10:00 at night, and we come back and polish it off the next day. There is nothing in the companion which suggests that we're honour bound, or we're duty bound to finish a group of amendments by a certain timescale. There is no problem coming back to do it again and complete it.
Then.
14:50
Baroness Hayman (Crossbench)
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Baroness Hayman (Crossbench)
Of course, completely correct in saying that there's nothing in the saying that there's nothing in the companion. It is, however, difficult for many members of the House when they've spoken in a debate not to be able to hear because they have arrangements for another occasion, not to be able to hear the front benches. And I would say gently to the last two speakers, we're not talking simply about the companion. We are talking about last night and the decision and the mood and the concern of the House that we make progress.
And I think it's very unfair to attack the government whips on this when they're trying to work their way
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through what the input of last night's decision was. Yeah. I respect.
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I respect. The noble Lady who said, but it's also the case. But it is also the case. It's disrespectful to the case. It's disrespectful to members who are prepared speeches and who wish to say something on palliative care, who have deliberately stayed quiet earlier deliberately stayed quiet earlier on in previous debates, so they can make a point on a subject in which they are interested and are now they are interested and are now being deprived of the opportunity to do so.
Yeah, yeah.
And I think it's very unfair to attack the government whips on this when they're trying to work their way
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through what the input of last night's decision was. Yeah. I respect.
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I respect. The noble Lady who said, but it's also the case. But it is also the case. It's disrespectful to the case. It's disrespectful to members who are prepared speeches and who wish to say something on palliative care, who have deliberately stayed quiet earlier deliberately stayed quiet earlier on in previous debates, so they can make a point on a subject in which they are interested and are now they are interested and are now being deprived of the opportunity to do so.
Yeah, yeah.
14:51
Lord Kamall (Conservative)
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Lord Kamall (Conservative)
My Lords, one of the reasons I was reluctant to get up is because I do believe very strongly that all those who want to speak in these those who want to speak in these debates should be allowed to do so. But also, please bear in mind that there are many others who may want there are many others who may want to speak to that same group of amendments, and we should not be making the Second Reading speeches. And I think we should repeat what the noble Lord True Chief Whip has reminded us a number of times.
Please can we speak to the amendments and keep to the point? I will try and do so in my summing up very quickly. It's quite clear what these amendments relate to. They clearly relate to the issue of palliative care, and whether people who seek assisted dying services are offered a meaningful choice, not just a choice in theory, not just a choice in paper, because it says it's somewhere on the current version of the bill. But they are offered a very real choice. Can I really pay tribute to noble Lady Baroness Finlay? When I was the Minister taking a Health and Care Act in number 20, in 2022 through the House, the noble Lady Baroness Finlay, I came to speak to our officials in Department of Health and Social Care who did not know as much as the Baroness Finlay, and she held a teaching.
She didn't have to do that, but it was very and many of the officials in the department said they very much welcomed the opportunity to learn from such expertise. And that's why I think it's important that we learn from all noble Lords, whatever their expertise is. And I think we should also thank everyone who's working in the under pressure palliative care sector at the moment, especially those specialists who are working in it now. I think this refers to a point very early, made on very early in the Second Reading, when both the noble Lord, Lord hunt and the noble Lord Lord Stevens say, we know how government works, we know how money is shifted around government.
And the point they made is that if this bill goes through, and I do not want to argue the merits of this bill, I'm personally I am torn on this bill at the moment, and I'm waiting for the debates to make up my own mind. But what they have said is if this bill goes through, the money has to come from somewhere and they feel having both been in government or have run run NHS one being a health Minister, that that money will come to palliative care from come at the expense of palliative care.
And I think it's that concern that is behind many of these amendments are made in this group, and it seems that the principle is anyone who is making that decision or seeks that help should make a meaningful choice. So I welcome the intent behind the amendments from all those who laid amendments in this group. And I won't waste time by naming all those noble Lords. They know who they are and I just want to thank them. But I should also point out to them, and some noble Lords have said this, that we actually do see palliative care mentioned in the current version of the bill.
We see it in clause five when it comes to preliminary discussions with registered medical practitioners. We see it in clause 12. When it comes to doctors assessment. We see it in clause 39. When it comes to codes of practice. We see in clause 40, when it comes to guidance about operation of the act, we see in clause 47 about reporting on implementation of Act, and we see it in clause 50, review of Act. So surely the crucial questions at this stage to both the sponsor of the bill, the noble and learned Lord Faulkner, but also the noble Lady, the Minister, are these questions? Can I ask both whether they believe these clauses within the current version of the bill as as entered this House actually address the concerns raised by the many proven amendments discussed in this group.
I think that's the crucial question to both the sponsor of the bill and the noble Lady, the Minister, and the further question for the noble Lady Minister. I know it's a little bit unfair, because it's probably more a question for the Department of Health and Social Care and perhaps the Treasury itself. And so if noble Lady Minister does not have the answer to hand, we obviously understand that noble Lady Minister will write to us, but it also plays a copy in the library. But is there no is the government confident that palliative care will be sufficiently funded so that for those seeking assisted dying services, that they are offered a very real choice as opposed to a theoretical choice when it comes to palliative care, and so they can make a more informed decision, understanding what is available to them.
I recognise that may be a difficult question to to put the noble Lady Minister on the spot, but I would hope that noble Lady Minister could go back to government and ask for an answer that could be shared with the Lordship. I look forward to the answers from both the bill's
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sponsor and the noble Lady Minister. Yeah, yeah. My Lords. I'll be as quick as I can in
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I'll be as quick as I can in relation to this. My comments are restricted to those amendments on which the government has major legal, technical or operational legal, technical or operational workability concerns. I want to make one preliminary point very quickly. At the beginning, pursuant quickly. At the beginning, pursuant to section three of the National Health Service Act, 2006, the provision of palliative care is a provision of palliative care is a statutory requirement. Integrated care boards must arrange for palliative care to meet the reasonable needs of their populations, and this can be delivered through universal services such as GPS and community nursing, or through specialist services where appropriate.
Importantly, not all patients will require specialist palliative care. So with that in mind, I turn first to amendments 53, 54, 64 and 21. In the name of the noble Lady Baroness Hollins. While many people at the
Please can we speak to the amendments and keep to the point? I will try and do so in my summing up very quickly. It's quite clear what these amendments relate to. They clearly relate to the issue of palliative care, and whether people who seek assisted dying services are offered a meaningful choice, not just a choice in theory, not just a choice in paper, because it says it's somewhere on the current version of the bill. But they are offered a very real choice. Can I really pay tribute to noble Lady Baroness Finlay? When I was the Minister taking a Health and Care Act in number 20, in 2022 through the House, the noble Lady Baroness Finlay, I came to speak to our officials in Department of Health and Social Care who did not know as much as the Baroness Finlay, and she held a teaching.
She didn't have to do that, but it was very and many of the officials in the department said they very much welcomed the opportunity to learn from such expertise. And that's why I think it's important that we learn from all noble Lords, whatever their expertise is. And I think we should also thank everyone who's working in the under pressure palliative care sector at the moment, especially those specialists who are working in it now. I think this refers to a point very early, made on very early in the Second Reading, when both the noble Lord, Lord hunt and the noble Lord Lord Stevens say, we know how government works, we know how money is shifted around government.
And the point they made is that if this bill goes through, and I do not want to argue the merits of this bill, I'm personally I am torn on this bill at the moment, and I'm waiting for the debates to make up my own mind. But what they have said is if this bill goes through, the money has to come from somewhere and they feel having both been in government or have run run NHS one being a health Minister, that that money will come to palliative care from come at the expense of palliative care.
And I think it's that concern that is behind many of these amendments are made in this group, and it seems that the principle is anyone who is making that decision or seeks that help should make a meaningful choice. So I welcome the intent behind the amendments from all those who laid amendments in this group. And I won't waste time by naming all those noble Lords. They know who they are and I just want to thank them. But I should also point out to them, and some noble Lords have said this, that we actually do see palliative care mentioned in the current version of the bill.
We see it in clause five when it comes to preliminary discussions with registered medical practitioners. We see it in clause 12. When it comes to doctors assessment. We see it in clause 39. When it comes to codes of practice. We see in clause 40, when it comes to guidance about operation of the act, we see in clause 47 about reporting on implementation of Act, and we see it in clause 50, review of Act. So surely the crucial questions at this stage to both the sponsor of the bill, the noble and learned Lord Faulkner, but also the noble Lady, the Minister, are these questions? Can I ask both whether they believe these clauses within the current version of the bill as as entered this House actually address the concerns raised by the many proven amendments discussed in this group.
I think that's the crucial question to both the sponsor of the bill and the noble Lady, the Minister, and the further question for the noble Lady Minister. I know it's a little bit unfair, because it's probably more a question for the Department of Health and Social Care and perhaps the Treasury itself. And so if noble Lady Minister does not have the answer to hand, we obviously understand that noble Lady Minister will write to us, but it also plays a copy in the library. But is there no is the government confident that palliative care will be sufficiently funded so that for those seeking assisted dying services, that they are offered a very real choice as opposed to a theoretical choice when it comes to palliative care, and so they can make a more informed decision, understanding what is available to them.
I recognise that may be a difficult question to to put the noble Lady Minister on the spot, but I would hope that noble Lady Minister could go back to government and ask for an answer that could be shared with the Lordship. I look forward to the answers from both the bill's
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sponsor and the noble Lady Minister. Yeah, yeah. My Lords. I'll be as quick as I can in
**** Possible New Speaker ****
I'll be as quick as I can in relation to this. My comments are restricted to those amendments on which the government has major legal, technical or operational legal, technical or operational workability concerns. I want to make one preliminary point very quickly. At the beginning, pursuant quickly. At the beginning, pursuant to section three of the National Health Service Act, 2006, the provision of palliative care is a provision of palliative care is a statutory requirement. Integrated care boards must arrange for palliative care to meet the reasonable needs of their populations, and this can be delivered through universal services such as GPS and community nursing, or through specialist services where appropriate.
Importantly, not all patients will require specialist palliative care. So with that in mind, I turn first to amendments 53, 54, 64 and 21. In the name of the noble Lady Baroness Hollins. While many people at the
14:57
Baroness Levitt (Labour)
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Baroness Levitt (Labour)
end of life may benefit from specialist input, this would normally be based on clinical normally be based on clinical judgement and patient need rather than being a blanket requirement. So the committee should notice a So the committee should notice a workability concern in relation to these amendments, in that they diverge from this person centred diverge from this person centred and needs based approach. And it should also be noted that these amendments conflict with current amendments conflict with current NHS statutory requirements on the provision of palliative care and whatever the intention, the government's view is that the effect of these amendments, as drafted, is to exclude someone from eligibility for assisted dying if they refuse these additional assessments.
Consenting to or refusing medical treatment engages article eight of the convention, and the committee may wish to note that these amendments could give rise to legal challenge on the basis that excluding that group of people from eligibility might not be justified under article two, or might amount to unjustified discrimination under article 14. Any differential treatment would need to be objectively and reasonably justified. Amendment 178 in the name of the noble Lady Baroness Lawlor as drafted, the amendment would introduce an additional requirement at the preliminary discussion stage.
Including an obligation to refer anyone who has a forgive me in that every person who wants to have a preliminary discussion with their doctor about an assisted death, irrespective of whether they're irrespective of whether they are eligible for an assisted death, would have to be referred to a consultant physician in palliative medicine for a full assessment and care plan. But a preliminary preliminary discussion could take place before a person, all the eligibility criteria and it could happen more than once, therefore including an obligation to refer anyone who has had a who has a preliminary discussion to a consultant physician in palliative care would create a significant resourcing burden.
This appears contrary to usual clinical practice, whereby the involvement of such specialist services depends upon an assessment of need and on the wishes and preferences of the person, rather than via a mandatory requirement that this amendment removes patient choice from this decision. Finally, as far as this amendment is concerned, the phrase for the purpose of a full assessment and care plan is broad and undefined. I turn now to the group of amendments in the name of the noble Lord Lord Carter of Haslemere and my noble friend Lord Hunt of Kings Heath.
That's 178186252316345385 and 5454. The government does have workability concerns in relation to these amendments. First, it is unclear what the full assessment is intended to cover and what is required for it, potentially making it difficult to demonstrate compliance. Second, the amendments would require repeated referrals at different stages in the process. It would be resource intensive to repeat the same full assessment three times, in addition to the existing assessments in the bill, and this might cause delays in the assisted dying process.
The government does not have a detailed delivery model, so we are unable to comment on the point at which the process process cannot be delivered within a reasonable time scale. Finally, I notice that it's unclear what happens if the individual declines any of the referrals, including if the individual has in fact already undergone such assessments. And that might result in ambiguity for those seeking an assisted death, or for the assessing doctor and panels in fulfilling their duties under the bill. Turning next to amendments 182261262263 and 264 in the names of the noble Lady Baroness Grey-Thompson, My Noble Friend's Baroness Ritchie, and Lord hunt.
These amendments would require someone seeking an assisted death to have their palliative and end of life care needs assessed, and care provided by an appropriate health or social care professional if the person requests it, and these amendments would also place a duty on the Secretary of State and Welsh Ministers to make regulations about the provision of palliative and end of life care. There would need to be justification for the different levels of palliative care being offered, on the one hand, to terminally ill patients who are seeking an assisted death, and those in comparable situations who are not seeking an assisted death.
The government has some concerns, as I said earlier, about creating unequal access to palliative care with the potential effect of prioritising resource for those who wish to pursue an assisted death, rather than for those with the greatest clinical need. I'm not going to take any interventions. I'm very sorry. I'm simply giving the government's view. On the amendment. I'm going to. We're very short of time. I apologise to the noble Lady.
**** Possible New Speaker ****
My noble friend is on that, on that specific amendment and the point that you just made.
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I'm not taking any interventions. I'm not taking any interventions. I'm not taking any interventions. These amendments create further, further risk, incentivising the use of palliative care when it is not of palliative care when it is not in line with the wishes of the individual. If a patient has relevant and available palliative care options, as with all treatment options, it remains their decision whether or not to pursue them. Lastly, I turn to amendment 832, also in the name of the noble Lady Baroness Hollins.
The government has workability concerns in relation to this amendment, which states that no person may access and assisted death unless a consultant in palliative medicine has confirmed in writing that all appropriate specialist palliative and end of life care options have been discussed and so far as is reasonably practicable, tried or considered. This appears contrary to usual clinical practice, whereby the involvement of specialist services depends upon an assessment of need and on the wishes and preferences of the patient. As amendment 832 excludes people from eligibility unless they have tried or considered particular options for care.
This could give rise to legal legal challenge on the basis that it is not justified under article two or article eight, or may amount to unjustified discrimination under article 14. I am not, I would invite the noble Lady with great respect to write to me, and we will deal with the matter then. Finally, in answer to the noble Lady Baroness May who raised the issue along with others including the noble Lord, Lord Harper, I can confirm that the Minister for care said this week that we will publish an interim report in the spring to a final two and a final modern service framework by the autumn.
We want to get this right, so we're not going to rush it. And I remind all noble Lords that this is not a government bill. It is a private member's bill for completeness. As the Committee will be aware, none of the amendments in this group have had technical drafting support. And so the way they are currently drafted means they may not be fully workable, effective or enforceable. But the issues raised are a matter for Parliament to consider and decide. And finally, I'd almost forgotten.
How could I forget? The noble Lord will come. I'm going to commit the noble Lady Baroness Mone
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to writing to him. When will. The. Relationship of palliative
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The. Relationship of palliative care to this bill is very. Important, and concerns both everybody in this. House.
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House. But also people generally. So these are this is an important these are this is an important group of amendments, the group of amendments, if I may say so. Approach it in a number of ways. First of all, it approached it on the basis that the noble Baroness Baroness Finlay of Llandaff said in order to make a decision, you've got to be properly informed. So
Consenting to or refusing medical treatment engages article eight of the convention, and the committee may wish to note that these amendments could give rise to legal challenge on the basis that excluding that group of people from eligibility might not be justified under article two, or might amount to unjustified discrimination under article 14. Any differential treatment would need to be objectively and reasonably justified. Amendment 178 in the name of the noble Lady Baroness Lawlor as drafted, the amendment would introduce an additional requirement at the preliminary discussion stage.
Including an obligation to refer anyone who has a forgive me in that every person who wants to have a preliminary discussion with their doctor about an assisted death, irrespective of whether they're irrespective of whether they are eligible for an assisted death, would have to be referred to a consultant physician in palliative medicine for a full assessment and care plan. But a preliminary preliminary discussion could take place before a person, all the eligibility criteria and it could happen more than once, therefore including an obligation to refer anyone who has had a who has a preliminary discussion to a consultant physician in palliative care would create a significant resourcing burden.
This appears contrary to usual clinical practice, whereby the involvement of such specialist services depends upon an assessment of need and on the wishes and preferences of the person, rather than via a mandatory requirement that this amendment removes patient choice from this decision. Finally, as far as this amendment is concerned, the phrase for the purpose of a full assessment and care plan is broad and undefined. I turn now to the group of amendments in the name of the noble Lord Lord Carter of Haslemere and my noble friend Lord Hunt of Kings Heath.
That's 178186252316345385 and 5454. The government does have workability concerns in relation to these amendments. First, it is unclear what the full assessment is intended to cover and what is required for it, potentially making it difficult to demonstrate compliance. Second, the amendments would require repeated referrals at different stages in the process. It would be resource intensive to repeat the same full assessment three times, in addition to the existing assessments in the bill, and this might cause delays in the assisted dying process.
The government does not have a detailed delivery model, so we are unable to comment on the point at which the process process cannot be delivered within a reasonable time scale. Finally, I notice that it's unclear what happens if the individual declines any of the referrals, including if the individual has in fact already undergone such assessments. And that might result in ambiguity for those seeking an assisted death, or for the assessing doctor and panels in fulfilling their duties under the bill. Turning next to amendments 182261262263 and 264 in the names of the noble Lady Baroness Grey-Thompson, My Noble Friend's Baroness Ritchie, and Lord hunt.
These amendments would require someone seeking an assisted death to have their palliative and end of life care needs assessed, and care provided by an appropriate health or social care professional if the person requests it, and these amendments would also place a duty on the Secretary of State and Welsh Ministers to make regulations about the provision of palliative and end of life care. There would need to be justification for the different levels of palliative care being offered, on the one hand, to terminally ill patients who are seeking an assisted death, and those in comparable situations who are not seeking an assisted death.
The government has some concerns, as I said earlier, about creating unequal access to palliative care with the potential effect of prioritising resource for those who wish to pursue an assisted death, rather than for those with the greatest clinical need. I'm not going to take any interventions. I'm very sorry. I'm simply giving the government's view. On the amendment. I'm going to. We're very short of time. I apologise to the noble Lady.
**** Possible New Speaker ****
My noble friend is on that, on that specific amendment and the point that you just made.
**** Possible New Speaker ****
I'm not taking any interventions. I'm not taking any interventions. I'm not taking any interventions. These amendments create further, further risk, incentivising the use of palliative care when it is not of palliative care when it is not in line with the wishes of the individual. If a patient has relevant and available palliative care options, as with all treatment options, it remains their decision whether or not to pursue them. Lastly, I turn to amendment 832, also in the name of the noble Lady Baroness Hollins.
The government has workability concerns in relation to this amendment, which states that no person may access and assisted death unless a consultant in palliative medicine has confirmed in writing that all appropriate specialist palliative and end of life care options have been discussed and so far as is reasonably practicable, tried or considered. This appears contrary to usual clinical practice, whereby the involvement of specialist services depends upon an assessment of need and on the wishes and preferences of the patient. As amendment 832 excludes people from eligibility unless they have tried or considered particular options for care.
This could give rise to legal legal challenge on the basis that it is not justified under article two or article eight, or may amount to unjustified discrimination under article 14. I am not, I would invite the noble Lady with great respect to write to me, and we will deal with the matter then. Finally, in answer to the noble Lady Baroness May who raised the issue along with others including the noble Lord, Lord Harper, I can confirm that the Minister for care said this week that we will publish an interim report in the spring to a final two and a final modern service framework by the autumn.
We want to get this right, so we're not going to rush it. And I remind all noble Lords that this is not a government bill. It is a private member's bill for completeness. As the Committee will be aware, none of the amendments in this group have had technical drafting support. And so the way they are currently drafted means they may not be fully workable, effective or enforceable. But the issues raised are a matter for Parliament to consider and decide. And finally, I'd almost forgotten.
How could I forget? The noble Lord will come. I'm going to commit the noble Lady Baroness Mone
**** Possible New Speaker ****
to writing to him. When will. The. Relationship of palliative
**** Possible New Speaker ****
The. Relationship of palliative care to this bill is very. Important, and concerns both everybody in this. House.
**** Possible New Speaker ****
House. But also people generally. So these are this is an important these are this is an important group of amendments, the group of amendments, if I may say so. Approach it in a number of ways. First of all, it approached it on the basis that the noble Baroness Baroness Finlay of Llandaff said in order to make a decision, you've got to be properly informed. So
15:04
Lord Falconer of Thoroton (Labour)
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Lord Falconer of Thoroton (Labour)
there is an information aspect which I'll address in a moment. Secondly, there is an issue about Secondly, there is an issue about whether or not you, you you have to subject yourself if you want an subject yourself if you want an application, if you want to make an application for assisted death to a compulsory assessment of some sort. compulsory assessment of some sort. And then thirdly, there is the issue. Should you only be entitled issue. Should you only be entitled to an assisted death if you can access better and therefore more appropriate palliative care than might be actually available to you in the place in which you live.
And can I deal with each of those three issues, which are right at the heart of this group of amendments? First of all, should you be properly informed? Yes, you most certainly should be properly informed of what palliative care is available to you. And the bill should make that clear on the face of the bill. I submit that it does make it clear on the face of the bill, and it does it in a reasonable way. Could I draw Your Lordship's attention to clause five, which says this is the preliminary discussion? If a registered medical practitioner conduct such a preliminary discussion with a person, the practitioner must explain to and discuss with that person all appropriate palliative, hospice or other care, including symptom management and psycho psychological report.
And I'm reading through the bill and offer to refer them to a registered medical practitioner who specialises in such care for the purposes of a further discussion. So all of the palliative care options that are available to you have got to be discussed with you by the doctor for the preliminary discussion. And if you want, you can be referred to a specialist in palliative care as well. In addition to that, could I refer to your Lordships to clause 12? And I'm grateful to the noble Lord Lord Sharma who took us through the provisions very helpfully.
12 to see each of the two doctors has got to explain to the patient any available palliative, hospice or other care, including symptom management and psychological support. So there are three occasions at which the detail of palliative care available to you is explained to you. Noble, Baroness Baroness Finlay of Llandaff, says well, maybe they wouldn't know the full detail. I recognise that might be possible, but is it dealt with adequately in the Bill in terms of the information being provided? My own view is that it is.
I don't think you need to make further provision as far as information is concerned. I'm very happy to talk to any noble Lord in relation to that. But I do think this question has been addressed head on and a proportionate and sensible solution has been reached, proportionate, even having regard to the fact this is the most serious decision that somebody could take. The second aspect, the second issue is nevertheless, should you make a referral mandatory? It's got to be done.
You've got to be examined. You've got to have a meeting with a multidisciplinary palliative care team. I say no. I say that's a choice because the obligations of giving information are sufficient in relation to that. And then the third issue raised by this group is that palliative care is is is patchy throughout the country. It's better in some places than others. And I completely accept that. And everything that we do in relation to assisted dying should not lead to any reduction in relation to finance for palliative care.
I'm sure it won't. Those who have read the impact assessment provided by the health Department make it clear that the amounts of money we are talking about to fund assisted dying are tens of millions. They are not going to make a difference to the provision of palliative care in this country. I am not in favour of additional provision being made to provide palliative care for those who want an assisted death, nor am I in favour of saying, unless the standard is the highest or a reasonable standard, you're not entitled to it.
As to the first of those two points, namely, you're entitled to a higher standard. If you apply for assisted death. The noble Baroness, the Minister, said that might well be contrary to the law. But put that to one side. We should do our best for everybody in relation to palliative care, and you should not get a special advantage if you apply for an assisted death. Secondly, and separately, of course, nobody wants the absence of palliative care to be the reason you apply for an assisted death.
But we have to give everybody this choice on the basis of the way the world is for them. It should not only be available, for example, in the areas where the best medical attention is available, as long as you know what you're entitled to, it should be available to everybody, not just those who live in Oxford or Cambridge, or those who live close to Saint Thomas's Hospital and other palliative care places. So. The various amendments are all twists on those themes.
My view is we should make sure that they have the right information. They should have access to a specialist who will tell them if they want it. But I think the bill does that. So although I'm open, open to any discussion people want. I think we've done enough and addressed head on these issues. So I'd invite
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noble Lords to withdraw their amendments. Sir, the time. That's. Left.
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I would have loved to have responded to all the points, but that. But I'm not going to go through in detail. I am deeply through in detail. I am deeply disappointed in the response from the noble Lord, Lord Faulkner, because it seems that he hasn't even taken on board some of the really important points that were made. I do believe that the amendment that was spoken to by the noble Baroness Baroness Brown of Silverton is actually the beginning of a very, very important statement, and I believe that we must and not just will, but must come back to this at Report stage with all those people who have shown an important investment in time to consider the needs of the individual who is in such distress that they want an assisted death, and that we cannot accept that some people are potentially going down that road simply because care is not available.
With that and the commitment to come back later. I beg to withdraw the amendment. beg to withdraw the amendment.
And can I deal with each of those three issues, which are right at the heart of this group of amendments? First of all, should you be properly informed? Yes, you most certainly should be properly informed of what palliative care is available to you. And the bill should make that clear on the face of the bill. I submit that it does make it clear on the face of the bill, and it does it in a reasonable way. Could I draw Your Lordship's attention to clause five, which says this is the preliminary discussion? If a registered medical practitioner conduct such a preliminary discussion with a person, the practitioner must explain to and discuss with that person all appropriate palliative, hospice or other care, including symptom management and psycho psychological report.
And I'm reading through the bill and offer to refer them to a registered medical practitioner who specialises in such care for the purposes of a further discussion. So all of the palliative care options that are available to you have got to be discussed with you by the doctor for the preliminary discussion. And if you want, you can be referred to a specialist in palliative care as well. In addition to that, could I refer to your Lordships to clause 12? And I'm grateful to the noble Lord Lord Sharma who took us through the provisions very helpfully.
12 to see each of the two doctors has got to explain to the patient any available palliative, hospice or other care, including symptom management and psychological support. So there are three occasions at which the detail of palliative care available to you is explained to you. Noble, Baroness Baroness Finlay of Llandaff, says well, maybe they wouldn't know the full detail. I recognise that might be possible, but is it dealt with adequately in the Bill in terms of the information being provided? My own view is that it is.
I don't think you need to make further provision as far as information is concerned. I'm very happy to talk to any noble Lord in relation to that. But I do think this question has been addressed head on and a proportionate and sensible solution has been reached, proportionate, even having regard to the fact this is the most serious decision that somebody could take. The second aspect, the second issue is nevertheless, should you make a referral mandatory? It's got to be done.
You've got to be examined. You've got to have a meeting with a multidisciplinary palliative care team. I say no. I say that's a choice because the obligations of giving information are sufficient in relation to that. And then the third issue raised by this group is that palliative care is is is patchy throughout the country. It's better in some places than others. And I completely accept that. And everything that we do in relation to assisted dying should not lead to any reduction in relation to finance for palliative care.
I'm sure it won't. Those who have read the impact assessment provided by the health Department make it clear that the amounts of money we are talking about to fund assisted dying are tens of millions. They are not going to make a difference to the provision of palliative care in this country. I am not in favour of additional provision being made to provide palliative care for those who want an assisted death, nor am I in favour of saying, unless the standard is the highest or a reasonable standard, you're not entitled to it.
As to the first of those two points, namely, you're entitled to a higher standard. If you apply for assisted death. The noble Baroness, the Minister, said that might well be contrary to the law. But put that to one side. We should do our best for everybody in relation to palliative care, and you should not get a special advantage if you apply for an assisted death. Secondly, and separately, of course, nobody wants the absence of palliative care to be the reason you apply for an assisted death.
But we have to give everybody this choice on the basis of the way the world is for them. It should not only be available, for example, in the areas where the best medical attention is available, as long as you know what you're entitled to, it should be available to everybody, not just those who live in Oxford or Cambridge, or those who live close to Saint Thomas's Hospital and other palliative care places. So. The various amendments are all twists on those themes.
My view is we should make sure that they have the right information. They should have access to a specialist who will tell them if they want it. But I think the bill does that. So although I'm open, open to any discussion people want. I think we've done enough and addressed head on these issues. So I'd invite
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noble Lords to withdraw their amendments. Sir, the time. That's. Left.
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I would have loved to have responded to all the points, but that. But I'm not going to go through in detail. I am deeply through in detail. I am deeply disappointed in the response from the noble Lord, Lord Faulkner, because it seems that he hasn't even taken on board some of the really important points that were made. I do believe that the amendment that was spoken to by the noble Baroness Baroness Brown of Silverton is actually the beginning of a very, very important statement, and I believe that we must and not just will, but must come back to this at Report stage with all those people who have shown an important investment in time to consider the needs of the individual who is in such distress that they want an assisted death, and that we cannot accept that some people are potentially going down that road simply because care is not available.
With that and the commitment to come back later. I beg to withdraw the amendment. beg to withdraw the amendment.
15:12
Baroness Finlay of Llandaff (Crossbench)
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Baroness Finlay of Llandaff (Crossbench)
Is it your Lordship's pleasure that the amendment be withdrawn?
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Amendment is by leave withdrawn. My Lords, I beg to move the House. Do now resume.
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House. Do now resume. The question is that the House do now resume, as many of that opinion will say. Content contrary, opinion will say. Content contrary,
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not content. The contents have it. My Lords, I beg to move that the House do now adjourn.
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Amendment is by leave withdrawn. My Lords, I beg to move the House. Do now resume.
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House. Do now resume. The question is that the House do now resume, as many of that opinion will say. Content contrary, opinion will say. Content contrary,
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not content. The contents have it. My Lords, I beg to move that the House do now adjourn.