Lords Chamber
10:08
Lord Falconer of Thoroton (Labour)
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Lord Falconer of Thoroton (Labour)
House House to House to be House to be again House to be again in House to be again in committee House to be again in committee on the terminally ill adults end of life. Bill Lord Falconer of Thoroton Lords. I beg to move that the House do once again resolve itself into a committee on the Bill. The question is that the House do now again resolve itself into a committee upon the Bill, as many of that content, not content. The that content, not content.
The
The
10:09
Lord Kennedy of Southwark (Labour)
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Lord Kennedy of Southwark (Labour)
I don't >> I don't disappoint noble Lords. My Lords, before we begin Committee stage, I would like to make my usual brief remarks. Firstly, I reiterate the thanks on behalf of reiterate the thanks on behalf of the whole House to all staff across the House for facilitating this sitting. I know noble Lords will be aware a huge amount of work that takes place enables us to consider this important business. I will not repeat everything I've said before at length, but I thought it would be helpful to remind the noble Lords a few key points.
I will again look to adjourn proceedings at around 6 p.m. and enable. Lord can seek to bring to an end before that. By moving the motion the house be now resumed. Committee today will begin with the debate on a group of amendments that was adjourned when proceedings concluded on the previous day of committee. Once the deputy on the Woolsack calls the debate on that group amendments, any noble Lord who was here at the start of the proceedings last week, asked to be activated, can participate, but nobody else.
The clerks have helpfully provided a list of all those present, and it was shared with the usual channels last week and again yesterday. I've asked the whips to monitor this and ensure that only those on the list can participate. So please, if you hear at the start of the debate last when we sat, do not attempt to speak and shouting out let them speak is not helpful. My Lords, when the pain is clear, my Lords, can I also say that when we conclude the group today, when we look to finish up at 6:00, it's easy.
We can conclude the group at 6:00 by 6:00 rather than going to a new group. Obviously, if we have to, I will adjourn again in the middle of the group, but it's much cleaner for everybody and we finish with debate and then we can start a new debate the next day. But the class will compile a list of the people speaking in later debates. Ensure we have to. We've got everyone's name, my noble friend Lord Falconer of Thoroton has again set a target for today's Committee stage.
As I've said before, I hope that discipline. The usual courtesies will apply and we can progress towards the target. The whips will facilitate a short 40 minute break for lunch break, and around a point around 1 p.m. for general guidance on how we should proceed conduct ourselves. I highly recommend the companion and particularly paragraphs 4.29 on page six and paragraphs 8.81 and 8.82 on page one for three. Finally, my Lords conversations during the debate are not welcomed. So please, if you can, one other conversation, please leave the chamber and then come back when you finished it with.
I
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think we should move on to the debate. Clause for resume debate on
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Clause for resume debate on
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amendment 142. My Lords, this group, like every
I will again look to adjourn proceedings at around 6 p.m. and enable. Lord can seek to bring to an end before that. By moving the motion the house be now resumed. Committee today will begin with the debate on a group of amendments that was adjourned when proceedings concluded on the previous day of committee. Once the deputy on the Woolsack calls the debate on that group amendments, any noble Lord who was here at the start of the proceedings last week, asked to be activated, can participate, but nobody else.
The clerks have helpfully provided a list of all those present, and it was shared with the usual channels last week and again yesterday. I've asked the whips to monitor this and ensure that only those on the list can participate. So please, if you hear at the start of the debate last when we sat, do not attempt to speak and shouting out let them speak is not helpful. My Lords, when the pain is clear, my Lords, can I also say that when we conclude the group today, when we look to finish up at 6:00, it's easy.
We can conclude the group at 6:00 by 6:00 rather than going to a new group. Obviously, if we have to, I will adjourn again in the middle of the group, but it's much cleaner for everybody and we finish with debate and then we can start a new debate the next day. But the class will compile a list of the people speaking in later debates. Ensure we have to. We've got everyone's name, my noble friend Lord Falconer of Thoroton has again set a target for today's Committee stage.
As I've said before, I hope that discipline. The usual courtesies will apply and we can progress towards the target. The whips will facilitate a short 40 minute break for lunch break, and around a point around 1 p.m. for general guidance on how we should proceed conduct ourselves. I highly recommend the companion and particularly paragraphs 4.29 on page six and paragraphs 8.81 and 8.82 on page one for three. Finally, my Lords conversations during the debate are not welcomed. So please, if you can, one other conversation, please leave the chamber and then come back when you finished it with.
I
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think we should move on to the debate. Clause for resume debate on
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Clause for resume debate on
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amendment 142. My Lords, this group, like every
10:11
The Earl of Effingham (Conservative)
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The Earl of Effingham (Conservative)
>> My Lords, this group, like every group thus far in the Bill, has been both extensive and in depth. been both extensive and in depth. We have heard from around 19 noble Lords on over 70 amendments. His Majesty's loyal opposition does not believe it would be an effective use of your Lordship's time for us to summarise the excellent contributions made across all benches by many noble Lords. The relevant points have been highlighted and we welcome the opportunity to hear from the noble Baroness, the Minister, Lady Levitt and the noble and learned Lord, Lord Faulkner, to understand their position on the proposals we have all listened to with interest the.
10:12
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)
Lords, as I did for the groups on the 27th of February. I've structured this speech by grouping amendments by theme rather than amendments by theme rather than taking them in order. This is in the interests of dealing with them as quickly as possible. But if anything needs a longer explanation, of course I wouldn't prevent. If anybody wished to intervene, I would take it. But it might be a more effective use of time if noble Lords were to write to me, and I will try and give a fuller and more detailed explanation.
My Lords, I begin first with some observations about the legal implications of some of the amendments. Then I'm going to outline what the government sees as operational workability issues presented by some amendments. And finally, briefly, some drafting considerations. My Lords, I'll continue to limit my comments to amendments on which the government has major legal, technical or operational workability concerns. And I remain, of course, happy to write to any of your Lordships who have any further questions relating to the workability of any amendment, and I will place a copy in the House library.
As I said earlier, the government's position remains that it is for Parliament to consider the policy. I will therefore not be providing a government view on the merits of any proposed changes, nor make any observations in a personal capacity. The noble Lady Baroness Fox, on the last occasion that we were here, raised the question about how the government plans to implement this bill. She was not alone in doing so, but she was one who mentioned it specifically. We've not undertaken detailed implementation work because that would precede the parliamentary process.
Should Parliament pass the bill, the government will undertake detailed work to develop a delivery model and on workforce planning, and we will engage with stakeholders and delivery partners, including the judiciary. I turn first to legal considerations and specifically the compatibility of some proposed amendments with the European Convention on Human Rights. The articles in question are article six and article eight. I turn first to article six, the right to a fair trial. There are four amendments in this group which, in the government's opinion, may interfere with a person's right to a fair trial under article six, First amendment 499, in the name of the noble Lady Baroness Finlay of Llandaff, which would introduce a route to annulment of a certificate of eligibility where material circumstances have changed.
But it requires further detail about the process. And so it is difficult for us properly to assess it at the moment. Amendment 498 in the name of the noble Lady Baroness Grey-Thompson, the government has concerns that this would prohibit any further referral to a panel where the commissioner has previously dismissed the individual's application to review a panel decision. This has the potential to breach article six in circumstances where a material change has arisen. Subsequently, amendments 405 and 460. In the name of the noble Lord, Lord Harper.
This. They would require that a person must apply to the Commissioner for referral to a second panel within ten calendar days of the refusal from the first panel, given the short time frame, these amendments may raise article six issues if there is no discretion involved. Turning to article eight, the right to private and family life. There are five amendments in this group which, in the government's view, may interfere with the person's right to private life. The first is amendment 462B in the name of the noble Lord Lord Jackson of Peterborough, which would introduce a blanket requirement for the publication of a person's name following their application to the panel.
The second is amendment 492 in the name of the noble Lord Lord Sandhurst, which would require notification of a panel's decision on this personal matter to any person who has given evidence, but without any discretion to the panel to assess either the necessity or the proportionality of that notification. The third is amendment 933A in the name of the noble Lady Baroness Coffey, which would restrict a panel chair's discretion to grant a person full private hearing. And fourth is amendment 480A also in the name of the noble Lady Baroness Coffey, which would remove the panel's discretion over the technology that can be used to contribute to hearings.
This could mean that the panel are unable to make appropriate adjustments for all circumstances, such as a person living in a rural area with low connectivity. Without such a discretion. There are issues about equality and discrimination which might arise, leading to a risk under article eight when read with article 14 regarding the equality implications of allowing video and audio evidence. As asked by my noble friend Baroness Keeley, I would refer her to the letter put in the house library by my noble friend, the Health Minister, Baroness Merron Baroness Merron, on matters covered by the Equalities Impact Assessment and the government's rationale for doing so, and fifthly, amendment 459.
Again in the name of the noble Lady Baroness Finlay, an individual who does not wish their children to be informed of their decision to request an assisted death, would then be excluded from accessing assisted dying related services once again, in the absence of a discretion, the government has concerns that that might infringe article eight. It also. This amendment also raises operational workability issues in its requirement for bereavement support for some children of people seeking assistance, but not for others. Next, I turn to amendments where the government wishes the House to note operational workability issues.
I start with the group of amendments which deal with the Assisted Dying Review panel recruitment. This is amendments 95, recruitment. This is amendments 95, A 98 921ZB921ZA and 929B amendment 95 A in the name of the noble Lord Lord Elliott Lord Murray of Blidworth is in direct conflict with the established legislative process governing the involvement of the Judicial Appointments Commission, the JSC, in the appointment of non-judicial officeholders, and it would create significant workability issues where the amendment enacted.
The incompatibilities are complex and the analysis is too long fully to explain. I do not think I'd be thanked for many, many pages of going into it now on Friday morning. But let me try and just very briefly outline the problems. It's already possible for the Lord Chancellor to request that the Jac recommend individuals to a role such as this. The process is governed by an established and carefully and clearly defined statutory framework, and it requires specific steps such as statutory consultation, to be undertaken before such a request is made.
Placing a legislative requirement on the Jac to make such a recommendation would be in direct conflict with this established process. But should the noble Lord wish a fuller explanation, I would of course be delighted to write to him. Amendment 98 in the name of the noble Lady, Baroness Hollins would expand the size of the panel to six members and sets out further detail as to the required qualifications and experience of panel members. The House may also wish to note that the Health and Care Professions Council and the General Medical Council would need to create new assisted dying specialist registrars.
The Health and Care Professions Council does not currently offer any form of specialist registration, so this change may give rise to unintended consequences. Without detailed further consideration. It might also limit the pool of healthcare professionals able to provide services should this change be made. Should that be the wish of your Lordships House? Legislative amendments to the Health Professions Order 2001 would also be required. Amendment 921ZB in the name of the noble Lady Baroness Coffey would significantly reduce the pool of eligible legal panel members, which may limit the speed and flexibility of appointments to the panel.
But of course, if it is the will of the House to accept this amendment, the government will work with the judiciary to deliver it. Amendment 921ZA also, in the name of the noble Lady, Baroness Coffey requires that a legal panel member could be a person who holds or has held judicial office in England. But the explanatory statement accompanying the amendment notes the intention is to clarify that the legal panel member could be a person who holds or has held judicial office in both England and Wales.
It is therefore unclear to the government what this amendment is trying to achieve. But if it's trying to restrict legal panel members to current or past judicial office holders in England, that is not possible, given that judges of the senior courts are appointed in the unified
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jurisdiction of England and Wales. Please. The Minister will know that I'm discussing later why I don't think this should apply to Wales or Welsh to make a decision. The reason I'm putting that amendment in is at the moment, the amendment in is at the moment, the judge doesn't have to be basically a judge from this country. It could be a judge from anywhere in the be a judge from anywhere in the world, one that has served under the common law process, as far as I can tell from the bill.
So that's
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can tell from the bill. So that's the intention. Greatly welcome that clarification from the noble Lady. But it may be that there is then a drafting issue because it says England rather than England and Wales, and there's no such creature as a member of the senior judiciary from England. Only. Finally, in this group the government has concerns that amendment 99 B, also in the name of the noble Lady, may have an impact on the ability of an assisted dying service by placing apparently arbitrary limits on the resourcing of the panel, when the demands of that service are as yet unknown.
I turn now to groups of amendments dealing with assisted dying, review panel proceedings and powers. Amendment four, six three in the name of the noble Lord, Lord Murray would require the Commissioner to assess the procedure adopted by every every individual assisted dying review panel. This would remove any flexibility for the panel to deviate from procedure, should it seem appropriate to do so for either inquisitive or compassionate reasons associated with the case, and then at four six, four also in the name of the noble Lord, Lord Murray will give the panel the same powers, privileges and authority as the High Court.
My Lords, the powers of a High Court judge are significant and wide ranging. They are set out across statute, across court rules and the inherent jurisdiction of the court, and some of them, the government thinks, are not the sorts of powers that your Lordships may feel are appropriate for such a panel, such as the power to imprison for contempt. Without more clarity and detail, it is impossible to assess whether this kind of extension would be appropriate, and it would be extremely difficult to apply in practice.
My Lords, in the view of the government, the amendment ought to set out which powers privileges and authorities it's intended to capture regarding amendments 405 B and 4493495B and 941A, both in the name of the noble Lady. Baroness Maclean of Redditch. Your Lordships may wish to note that requiring the panel to identify and provide a report on unmet social or palliative care needs is not within their remit, nor would the panel necessarily have the knowledge of local service provision or the expertise to make personalised recommendations on social and palliative care.
Such a report, therefore, risks containing inaccurate or incomplete advice. I tend to panel referrals and capacity amendment 445 also in the name of the noble Lady Baroness Maclean of Redditch, which seeks to ensure that the panel is independently satisfied that the person seeking assistance has continuously had capacity from the point of their first declaration. Your Lordships may wish to note that this amendment is likely to cause major workability concerns. It would be extremely difficult for the panel to determine whether the person had capacity throughout this period, rather than just at the point at which the capacity assessment is made.
Moreover, it might result in people being excluded because of temporary brief periods of incapacity. So, for example, a person would not have had continuous capacity if they'd had an operation under general anaesthetic. During this period, panel decisions amendments four, nine six and 496A in the name of the noble Lady Baroness Grey-Thompson would mean that a person cannot apply for their case to be reconsidered on the basis that the decision was irrational. And this would be unusual as the elements of the existing test under clause 18 reflect the three primary grounds applicable in judicial review proceedings, and are part of a recognised set of legal principles applicable to the decision making.
So, if a person wished to challenge a first panel's decision for being irrational, which is obviously a term of art in legal proceedings, they would still be able to do so via judicial review, which creates an inconsistency in forum, which would need to be justified. Amendment 496A in the name of the noble Lord Lord Weir would add failure to adequately, adequately to consider evidence relating to disability related vulnerabilities to the grounds under which were a panel declines to grant a certificate of eligibility, the Commissioner could refer a person's case to a second panel.
Your Lordships may wish to note that failure properly to consider relevant information would already be captured by the irrationality ground for reconsideration set down in clause 18 two B. Similarly, a decision that was inconsistent with equality legislation already engages the first round of challenging clause 18 two A because it would contain an error of law. My Lords have taken rather longer over this than I'd intended to. You'll be delighted to know that I'm nearly there. Drafting considerations. Final part amendment 490.
Finally, if your Lordship support any of these amendments, the government may need to revisit the drafting to ensure clarity and coherence with the statute book. To give one example, amendment 490 in the name of the noble Lady Baroness Grey-Thompson contains some ambiguous terms which might need tightening up. As ever, I won't go into more detail in the interest of time, but I'm happy to discuss further with the noble Lady in due course, and taking rather longer than I had hoped. That's it from
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the government on this group. Party from the government response. So in the amendment that response. So in the amendment that I tabled about a King's counsel, His Majesty's counsel, the Minister said due to workability, there may not be enough people in the debate. I mentioned. I'd like to understand I mentioned. I'd like to understand the government proposal suggests that amendment to the promoter of the bill. And has the government the bill. And has the government got any consideration about.
Alternatives? I proposed during the debate where instead of council actually having people like deputy court judges and other sorts of judges, has the government considered that in the two weeks since we last discussed this matter.
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General point, the government merely points out workability concerns and doesn't suggest ways concerns and doesn't suggest ways in which they might be remedied. That would be a matter for the mover of the amendment, and to discuss with the sponsor of the bill. So no, we haven't come up with any proposals because I'm sure the noble Lady sick of me saying the noble Lady sick of me saying this, but we're neutral in relation to this. How it will work. We just point out if we can see
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difficulties with the amendment as drafted. Did the government propose? Did the government propose on workability grounds the suggestion in the schedule two that King's counsel should be there? And it may be that the noble Lord, Lord, Lord, Lord Falconer, can answer that. But what has been a constant theme is trying to understand what the government has suggested in its private workings with the promoter of the Bill, which they won't share with the House. Did they actually suggest this is a way to make it workable? That's what I'm trying to get to the bottom of.
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I think I'm going to have to write to the noble Lady about this, because I don't think that I can answer this. I think the my noble friend, the sponsor, will deal with the question of panels. And if this is a question that is actually is a question that is actually about the assistance given by the government, I refer to my previous answers, but I will write to the
My Lords, I begin first with some observations about the legal implications of some of the amendments. Then I'm going to outline what the government sees as operational workability issues presented by some amendments. And finally, briefly, some drafting considerations. My Lords, I'll continue to limit my comments to amendments on which the government has major legal, technical or operational workability concerns. And I remain, of course, happy to write to any of your Lordships who have any further questions relating to the workability of any amendment, and I will place a copy in the House library.
As I said earlier, the government's position remains that it is for Parliament to consider the policy. I will therefore not be providing a government view on the merits of any proposed changes, nor make any observations in a personal capacity. The noble Lady Baroness Fox, on the last occasion that we were here, raised the question about how the government plans to implement this bill. She was not alone in doing so, but she was one who mentioned it specifically. We've not undertaken detailed implementation work because that would precede the parliamentary process.
Should Parliament pass the bill, the government will undertake detailed work to develop a delivery model and on workforce planning, and we will engage with stakeholders and delivery partners, including the judiciary. I turn first to legal considerations and specifically the compatibility of some proposed amendments with the European Convention on Human Rights. The articles in question are article six and article eight. I turn first to article six, the right to a fair trial. There are four amendments in this group which, in the government's opinion, may interfere with a person's right to a fair trial under article six, First amendment 499, in the name of the noble Lady Baroness Finlay of Llandaff, which would introduce a route to annulment of a certificate of eligibility where material circumstances have changed.
But it requires further detail about the process. And so it is difficult for us properly to assess it at the moment. Amendment 498 in the name of the noble Lady Baroness Grey-Thompson, the government has concerns that this would prohibit any further referral to a panel where the commissioner has previously dismissed the individual's application to review a panel decision. This has the potential to breach article six in circumstances where a material change has arisen. Subsequently, amendments 405 and 460. In the name of the noble Lord, Lord Harper.
This. They would require that a person must apply to the Commissioner for referral to a second panel within ten calendar days of the refusal from the first panel, given the short time frame, these amendments may raise article six issues if there is no discretion involved. Turning to article eight, the right to private and family life. There are five amendments in this group which, in the government's view, may interfere with the person's right to private life. The first is amendment 462B in the name of the noble Lord Lord Jackson of Peterborough, which would introduce a blanket requirement for the publication of a person's name following their application to the panel.
The second is amendment 492 in the name of the noble Lord Lord Sandhurst, which would require notification of a panel's decision on this personal matter to any person who has given evidence, but without any discretion to the panel to assess either the necessity or the proportionality of that notification. The third is amendment 933A in the name of the noble Lady Baroness Coffey, which would restrict a panel chair's discretion to grant a person full private hearing. And fourth is amendment 480A also in the name of the noble Lady Baroness Coffey, which would remove the panel's discretion over the technology that can be used to contribute to hearings.
This could mean that the panel are unable to make appropriate adjustments for all circumstances, such as a person living in a rural area with low connectivity. Without such a discretion. There are issues about equality and discrimination which might arise, leading to a risk under article eight when read with article 14 regarding the equality implications of allowing video and audio evidence. As asked by my noble friend Baroness Keeley, I would refer her to the letter put in the house library by my noble friend, the Health Minister, Baroness Merron Baroness Merron, on matters covered by the Equalities Impact Assessment and the government's rationale for doing so, and fifthly, amendment 459.
Again in the name of the noble Lady Baroness Finlay, an individual who does not wish their children to be informed of their decision to request an assisted death, would then be excluded from accessing assisted dying related services once again, in the absence of a discretion, the government has concerns that that might infringe article eight. It also. This amendment also raises operational workability issues in its requirement for bereavement support for some children of people seeking assistance, but not for others. Next, I turn to amendments where the government wishes the House to note operational workability issues.
I start with the group of amendments which deal with the Assisted Dying Review panel recruitment. This is amendments 95, recruitment. This is amendments 95, A 98 921ZB921ZA and 929B amendment 95 A in the name of the noble Lord Lord Elliott Lord Murray of Blidworth is in direct conflict with the established legislative process governing the involvement of the Judicial Appointments Commission, the JSC, in the appointment of non-judicial officeholders, and it would create significant workability issues where the amendment enacted.
The incompatibilities are complex and the analysis is too long fully to explain. I do not think I'd be thanked for many, many pages of going into it now on Friday morning. But let me try and just very briefly outline the problems. It's already possible for the Lord Chancellor to request that the Jac recommend individuals to a role such as this. The process is governed by an established and carefully and clearly defined statutory framework, and it requires specific steps such as statutory consultation, to be undertaken before such a request is made.
Placing a legislative requirement on the Jac to make such a recommendation would be in direct conflict with this established process. But should the noble Lord wish a fuller explanation, I would of course be delighted to write to him. Amendment 98 in the name of the noble Lady, Baroness Hollins would expand the size of the panel to six members and sets out further detail as to the required qualifications and experience of panel members. The House may also wish to note that the Health and Care Professions Council and the General Medical Council would need to create new assisted dying specialist registrars.
The Health and Care Professions Council does not currently offer any form of specialist registration, so this change may give rise to unintended consequences. Without detailed further consideration. It might also limit the pool of healthcare professionals able to provide services should this change be made. Should that be the wish of your Lordships House? Legislative amendments to the Health Professions Order 2001 would also be required. Amendment 921ZB in the name of the noble Lady Baroness Coffey would significantly reduce the pool of eligible legal panel members, which may limit the speed and flexibility of appointments to the panel.
But of course, if it is the will of the House to accept this amendment, the government will work with the judiciary to deliver it. Amendment 921ZA also, in the name of the noble Lady, Baroness Coffey requires that a legal panel member could be a person who holds or has held judicial office in England. But the explanatory statement accompanying the amendment notes the intention is to clarify that the legal panel member could be a person who holds or has held judicial office in both England and Wales.
It is therefore unclear to the government what this amendment is trying to achieve. But if it's trying to restrict legal panel members to current or past judicial office holders in England, that is not possible, given that judges of the senior courts are appointed in the unified
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jurisdiction of England and Wales. Please. The Minister will know that I'm discussing later why I don't think this should apply to Wales or Welsh to make a decision. The reason I'm putting that amendment in is at the moment, the amendment in is at the moment, the judge doesn't have to be basically a judge from this country. It could be a judge from anywhere in the be a judge from anywhere in the world, one that has served under the common law process, as far as I can tell from the bill.
So that's
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can tell from the bill. So that's the intention. Greatly welcome that clarification from the noble Lady. But it may be that there is then a drafting issue because it says England rather than England and Wales, and there's no such creature as a member of the senior judiciary from England. Only. Finally, in this group the government has concerns that amendment 99 B, also in the name of the noble Lady, may have an impact on the ability of an assisted dying service by placing apparently arbitrary limits on the resourcing of the panel, when the demands of that service are as yet unknown.
I turn now to groups of amendments dealing with assisted dying, review panel proceedings and powers. Amendment four, six three in the name of the noble Lord, Lord Murray would require the Commissioner to assess the procedure adopted by every every individual assisted dying review panel. This would remove any flexibility for the panel to deviate from procedure, should it seem appropriate to do so for either inquisitive or compassionate reasons associated with the case, and then at four six, four also in the name of the noble Lord, Lord Murray will give the panel the same powers, privileges and authority as the High Court.
My Lords, the powers of a High Court judge are significant and wide ranging. They are set out across statute, across court rules and the inherent jurisdiction of the court, and some of them, the government thinks, are not the sorts of powers that your Lordships may feel are appropriate for such a panel, such as the power to imprison for contempt. Without more clarity and detail, it is impossible to assess whether this kind of extension would be appropriate, and it would be extremely difficult to apply in practice.
My Lords, in the view of the government, the amendment ought to set out which powers privileges and authorities it's intended to capture regarding amendments 405 B and 4493495B and 941A, both in the name of the noble Lady. Baroness Maclean of Redditch. Your Lordships may wish to note that requiring the panel to identify and provide a report on unmet social or palliative care needs is not within their remit, nor would the panel necessarily have the knowledge of local service provision or the expertise to make personalised recommendations on social and palliative care.
Such a report, therefore, risks containing inaccurate or incomplete advice. I tend to panel referrals and capacity amendment 445 also in the name of the noble Lady Baroness Maclean of Redditch, which seeks to ensure that the panel is independently satisfied that the person seeking assistance has continuously had capacity from the point of their first declaration. Your Lordships may wish to note that this amendment is likely to cause major workability concerns. It would be extremely difficult for the panel to determine whether the person had capacity throughout this period, rather than just at the point at which the capacity assessment is made.
Moreover, it might result in people being excluded because of temporary brief periods of incapacity. So, for example, a person would not have had continuous capacity if they'd had an operation under general anaesthetic. During this period, panel decisions amendments four, nine six and 496A in the name of the noble Lady Baroness Grey-Thompson would mean that a person cannot apply for their case to be reconsidered on the basis that the decision was irrational. And this would be unusual as the elements of the existing test under clause 18 reflect the three primary grounds applicable in judicial review proceedings, and are part of a recognised set of legal principles applicable to the decision making.
So, if a person wished to challenge a first panel's decision for being irrational, which is obviously a term of art in legal proceedings, they would still be able to do so via judicial review, which creates an inconsistency in forum, which would need to be justified. Amendment 496A in the name of the noble Lord Lord Weir would add failure to adequately, adequately to consider evidence relating to disability related vulnerabilities to the grounds under which were a panel declines to grant a certificate of eligibility, the Commissioner could refer a person's case to a second panel.
Your Lordships may wish to note that failure properly to consider relevant information would already be captured by the irrationality ground for reconsideration set down in clause 18 two B. Similarly, a decision that was inconsistent with equality legislation already engages the first round of challenging clause 18 two A because it would contain an error of law. My Lords have taken rather longer over this than I'd intended to. You'll be delighted to know that I'm nearly there. Drafting considerations. Final part amendment 490.
Finally, if your Lordship support any of these amendments, the government may need to revisit the drafting to ensure clarity and coherence with the statute book. To give one example, amendment 490 in the name of the noble Lady Baroness Grey-Thompson contains some ambiguous terms which might need tightening up. As ever, I won't go into more detail in the interest of time, but I'm happy to discuss further with the noble Lady in due course, and taking rather longer than I had hoped. That's it from
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the government on this group. Party from the government response. So in the amendment that response. So in the amendment that I tabled about a King's counsel, His Majesty's counsel, the Minister said due to workability, there may not be enough people in the debate. I mentioned. I'd like to understand I mentioned. I'd like to understand the government proposal suggests that amendment to the promoter of the bill. And has the government the bill. And has the government got any consideration about.
Alternatives? I proposed during the debate where instead of council actually having people like deputy court judges and other sorts of judges, has the government considered that in the two weeks since we last discussed this matter.
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General point, the government merely points out workability concerns and doesn't suggest ways concerns and doesn't suggest ways in which they might be remedied. That would be a matter for the mover of the amendment, and to discuss with the sponsor of the bill. So no, we haven't come up with any proposals because I'm sure the noble Lady sick of me saying the noble Lady sick of me saying this, but we're neutral in relation to this. How it will work. We just point out if we can see
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difficulties with the amendment as drafted. Did the government propose? Did the government propose on workability grounds the suggestion in the schedule two that King's counsel should be there? And it may be that the noble Lord, Lord, Lord, Lord Falconer, can answer that. But what has been a constant theme is trying to understand what the government has suggested in its private workings with the promoter of the Bill, which they won't share with the House. Did they actually suggest this is a way to make it workable? That's what I'm trying to get to the bottom of.
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I think I'm going to have to write to the noble Lady about this, because I don't think that I can answer this. I think the my noble friend, the sponsor, will deal with the question of panels. And if this is a question that is actually is a question that is actually about the assistance given by the government, I refer to my previous answers, but I will write to the
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Lord Falconer of Thoroton (Labour)
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Lord Falconer of Thoroton (Labour)
answers, but I will write to the noble Lady on this specific point. >> My Lords, in the course of this
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My Lords, in the course of this debate, the noble Baroness Baroness Coffey referred movingly to the death of her parents, and I pay tribute to her courage and the contribution she made in relation to it. Could I deal with the groups of amendments in themes? Could I deal, first of all, with the appointments to the panels? First of all, the noble Lord Lord Murray of Blidworth said in amendment 925A there should be a proper appointments procedure. I agree with him.
There should be a proper appointments procedure. The bill currently places the obligation on the appointment of panel members on the Voluntary Assisted Dying Commissioner, that is clause 44B and in part two of schedule two, I believe that that is adequate, that the the Voluntary Assisted Dying Commissioner has to have a proper process, and I have faith that he will do that, and the law will require him to do that. Secondly, the noble Lord, Lord Murray, also proposes that the Judicial Appointments Commission make the legal appointments.
Remember, one of each of the panels has to be either a judge or a king's counsel. I am not in favour of that. My noble friend Baroness Levitt indicated that there were problems in relation to that, but I have a more principled objection is that we're not dealing here with judges. We're dealing with members of a particular panel. So I don't think it is either appropriate or necessary. The noble Lord Lord Moylan, in his amendment 96 and 99, when talking about renewal, said that the voluntary assisted dying commissioner, when thinking about renewal, should not have regard to the particular views expressed by panel members when they were sitting on panels, I completely get what he is getting at.
Namely, you shouldn't be excluded because you've you've come on a principled basis to a particular view, but I think it would be wrong to put that in to the bill. I think it's for the voluntary assisted dying Commissioner to decide what's appropriate in determining what should happen in relation to renewal in relation. This is still dealing with the membership of panels in amendment number 9 to 8. The Baroness Hollins, who I see in her place in, suggested that we widen the groups and categories of people who could be on the panel.
In fact, it doesn't widen her proposal. It gives subgroups. I think that the best method of dealing with this is that you have a lawyer, a social worker, and a psychiatrist. You should stick to the three big groups. It's for the voluntary assisted dying commissioner to decide when he or she is forming the panels or forming the group from which the panels are drawn, that he's got the right degree of expertise, but it would be wrong and unhelpful to him to have another substantial number of categories that need to be included.
Can I move from the appointments to the panels to panel procedure? The noble Lord, Lord Murray's amendments include the following. First of all, it should be mandatory rather than discretionary for the Voluntary Assisted Dying commissioner to issue guidance. I think it's a matter for the voluntary assisted Dying Commissioner to make a judgement about that. Does the. It is. Is guidance required? If it is, he should issue it, but it's for him to decide. I don't think it is necessary to include in the bill words to the effect.
As one of the noble Lord Lord Liddle amendments. Lord Murray of Blidworth amendments suggest it. He should not propose a procedure that is so irrational that no reasonable decision maker would have adapted adopted such a procedure. I think that's probably unnecessary. I think if he did adopt such a procedure, it would be set aside under judicial review. And remember, the Voluntary Assisted Dying Commissioner has to have been a former member of the Supreme Court or the Court of Appeal. So he probably he or she would probably be aware that that's not the right course.
And the noble Lord Lord Murray of Blidworth also suggested that the panel should be given all the powers of the High Court. No, I do not think that would be appropriate. This is not a court. This is a panel, and it's inappropriate for such powers to be given, nor is it necessary. The noble Lord, Lord Sandhurst, said in his amendment 929A that the Commissioner should have regard to the nature of the expertise required for particular panels. The schedule for one of the bill, as currently drafted, requires the Commissioner to determine the membership of each panel, and he should obviously have regard to which particular panel members would be appropriate for which particular case.
I do not think one particular case. I do not think one needs to go further. Than that. Again, the noble Lord Lord Sandhurst and his amendments 923A922 and 928 suggest that the Secretary of State should be allowed by regulations to expand who may be on a panel. Again, for the reasons I've indicated, I don't think you need extra categories. Psychiatrist, lawyer and social worker is the right broad categories. The noble Lord Lord Sandhurst in 927 A says that one member of each panel should be legal.
I agree with that, but that's already provided by clause 342 of schedule two. In amendments four, six, five and 473, the noble Lord Lord Sandhurst provided that instead of saying that, the panel must hear from the applicant or from the doctor, he wants to put in the words, he must hear evidence from the coordinating doctor or the patient. I am not at all in favour of that. I don't think it would be appropriate to incorporate legal concepts of admissibility, which is what the word evidence connotes.
It is for the panels to talk to the doctor and to the patient, to satisfy themselves that the conditions are satisfied. We are not trying to create some pseudo court in relation to this article. Sorry. Amendment 479 again, in the name of the noble Lord, Lord Sandhurst suggests that the panel be given power to require a local authority or an NHS body to do a report for the panel on issues of relevance. Again, I don't think that's either necessary or appropriate.
If one looks at clause 17 subclause four sub E of the existing draft, it allows the panel to ask for a report from anyone with relevant information, and I don't think one should restrict it to either an NHS body or a local authority. Could I move on to amendment 494 where the noble Lord. In his amendment, Mrs. noble Lord Lord Sandhurst, suggests that the panel should. Where they think the. A contributing cause of the application is public authority failure that they should require the panel to give a.
Reference to that in their reasons. Again, I don't think that is appropriate. I think what the panel's job to do is not to sit and do things like a coroner does, but to see whether the eligibility criteria are satisfied and it's wrong to add further duties to them. Could I move on to a separate category, which is the category of privacy, the the the the a number of noble Lords put down amendments dealing with the extent to which the panels should sit in public or sit in private.
The draft, the bill at the moment says the norm is sit in private unless the patient wants it to sit in private, in which case the panel can require that it sits in private. As I indicated at the end of last week's proceedings in relation to this, if the patient wanted it to be in private, then my view was it should be in private because this is such a personal thing. So in relation, first of all, to the the noble Lord, Lord Jackson of Peterborough's amendment, that 28 days notice be given of every time a panel sits.
Again, I'm not in favour of that. It would cause unnecessary delay, and it would cause, in my view, unnecessary intrusion in relation to amendment 439, it was suggested that the panel should give notice to a range of people, including all of the next of kin, the GP, any specialist doctor involved in the provision of services. Again, no to that. I think it's important that it is possible for the panel to sit in public so that people can see how it's done, but if the patient wants privacy, he should have it.
And this is not this is not like a court. This is a process which the public should understand and should be able to see how it works. But normally, if you want it to be in private, it should be kept fully in private. But I move on to the noble Lord. Lord, where's amendments which is 496A and 496F? These amendments relate to the position where the Voluntary Assisted Dying Commissioner can reopen a refusal of eligibility, and what the noble Lord in his amendments is suggesting that an additional category of opening up a refusal should be included, namely, that the reason why it's been refused is because of vulnerabilities arising out of disability, the grounds on which the Voluntary Assisted Dying Commissioner can reopen it are very restricted.
This is where there's a refusal, and it's only with the voluntary assisted dying. Commissioner thinks there's been some very significant failure of process. So whilst I completely understand the motivation of the noble Lord Lord Weir, I don't think it's appropriate and I the tone of the noble Lord. Lord, where's intervention or moving? The amendment was to ensure that vulnerable people would not be over pressed into an assisted death, and I think including this in relation to one of the categories in relation to when you can reopen, wouldn't necessarily meet that overarching aim.
The noble Baroness Baroness Finlay of Llandaff in Amendment four, five nine sought to make it a compulsory that you have to tell children or make adequate arrangements for telling them if you're going to have an assisted death and provide adequate bereavement support. My Lords, I. I adopt fully the reasoning of the noble Baroness Baroness Hayman in an incredibly impressive speech that she made as to why I think that that is a bad proposal in that that is a bad proposal in relation to amendment 483AA.
And this is Baroness Maclean amendment where she suggests that the panel should be able to refer the patient for a further assessment. Again, I understand the motivation for that. She's not in her place. I understand the motivation for that. But again, clause 17 four E of the bill, as it's currently drafted, allows the panel to get a report from anyone. So I don't think that that is necessary. The noble Baroness Bi Baroness Keeley in amendment 483 says that that face to face rather than remote should be the default setting.
And she proposes very restricted circumstances in which the panel can sit remotely again. We discussed this previously in relation to face to face, and I indicated my acceptance of the proposition that there should be some statutory regulatory process in which guidance is given as to whether or not it should be face to face or not. So I understand what the Baroness Healy is saying. I understand that that face to face is better, but I think the previous indication I gave as to a statutory scheme for that is the right course.
In amendment 462A, the noble Baroness Baroness Berridge should be suggests that the panel before it reaches a conclusion has to be. Has to be satisfied that the patient has been referred to a local authority designated officer, the local authority designated officer is normally somebody dealing with safeguarding in relation to children and again, I just don't think that although I understand the motivation, I don't think that's appropriate. The noble Baroness Baroness Berger in amendments four, six six and 471 seeks to require the panel to both hear.
They must hear from the applicant and from the coordinating doctor, and she wishes to say, and they must question the coordinating doctor and the patient. Currently, the draft says they must hear from them, subject to some exceptions, and may question so they don't have to question the patient or the coordinating doctor if they don't think it's appropriate to do so, for example, because they are completely satisfied with what they are hearing from the doctor about terminal illness, for example, or because having heard from the patient, cross-examining or examining the patient does not seem appropriate.
And I think the right balance has been struck in relation to that. Four, seven, four. The proposal is and again, this is from Baroness Berger, my noble friend Baroness Berger that the panel should consider hearing from a person's family and other treatment or care provider. I think the norm should be they should definitely consider whether or not they need to hear from a person's family and other treatment provider, but I don't think I would very much hope that they would do anyway.
They've got the power to do it in clause 17 for E. I think it's a valid point, but I don't think it's necessary to amend the bill in order to do that. Amendment 932 the noble Baroness Baroness Finlay proposes a regional structure for panels. I understand the merit of that, but again, I think it's appropriate that that should be dealt with, not by us in the bill, but by the voluntary assisted dying commissioner when he comes to make organisational arrangements for Panels.
Amendment nine two for the Baroness Grey-Thompson says that where the patient is over 60, one of the panels must have expertise in elder abuse or safeguarding. Again, I think it's an important thing for the panel to focus on. Again, I don't think it's necessary to put that in the bill because the voluntary assisted dying commissioner has got to have in place arrangements that would make it appropriate for the selection of the panel. My Lord, I have tabled an amendment which is 480, which is a drafting amendment which is tabled by me to section 70, clause 17 for to make clear that that to make clear that the obligation to hear either from the patient or the coordinating doctor is subject to the medical exception in sub five.
And it is a drafting change. It doesn't change the sense at all, my Lord, my Lords, amendment 480 A is the Baroness Coffey amendment to delete reference to being able to. Four five currently allows the panel to hear by way of video or audio and the Baroness Coffey, which is to delete the words or audio. I can completely understand that it may be inappropriate just to rely on audio, but again, I think it should be for the panel to decide whether they want to hear from somebody by audio and not video, because it may well be of assistance to them.
Then four three, eight C I've got another amendment put down by the Baroness Coffey. Where the coordinating doctor is ill and the panel are satisfied with his evidence. They should be they should be able to deal with it without hearing from him. I didn't put that clearly. Currently, the position is that if the coordinating doctor is ill, there is a medical reason why he can't appear. Then it's open to the panel to decide. They don't need to hear from him exceptionally, because they normally must hear from him.
In my view, there should be that exception because there will be occasions where the panel are completely satisfied with, for example, a report from the coordinating doctor. It's corroborated by an independent doctor from whom they have heard should the patient, if the panel are completely satisfied, have to wait until there can be a personal hearing with a coordinating doctor? In my view, not so. I'm not in favour of that amendment. Then could I go to nine? Sorry, can I just finish then ask questions at the end.
Nine. Two. One. Is Baroness Coffey amendment about King's counsel? The choice of the grouping of who should be within the legal grouping is for the sponsors, not for the government. So the Baroness Levitt, my learned friend, my friend Baroness Laing, my friend the Baroness Levitt is right when she says that's a question for me, not a question for the government, because the government are saying, I'm not saying it's unworkable. They're saying it's for the sponsor to decide. And we we.
The choice of King's counsel and specified judges or former judges is to provide a wide enough pool from which to draw for legal advisers. As far as King's counsel are concerned, we think they have. By becoming King's counsel, they've proved that they've got sufficient quality to be the chair of such a panel. It's intended to mean King's counsel from England and Wales. If it. I don't think it allows for people from other jurisdictions, but I will check. And if it does allow for other jurisdictions, then I will restrict it to England and Wales, because that is the intention.
The noble Baroness also says it shouldn't necessarily be the lawyer, which is her amendment 932A it shouldn't necessarily be the lawyer who chairs the panel. The reason why the lawyer is put in the driving seat as a chair is because what the panel's got to do is comply with the duties imposed on it by the statute. And lawyers are certainly not the best chairs necessarily, but by putting him in him or her in the chair, it is making sure that the panel focuses on what its legal requirements are.
Those are my only limited comments on the whole thing. The Baroness
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Coffey had a question for me. It's been answered by the noble and learned Lord Bourne in his and learned Lord Bourne in his comments. I want to just briefly go back to 483C so for the amendment is actually about pre-recorded is actually about pre-recorded audio or video material for the purposes of section subsection four. purposes of section subsection four. Now, the noble Lord has just said that if a coordinating doctor is off ill, there are other provisions through medical exceptions. There's through medical exceptions.
There's also a provision in the bill. The coordinating doctor can delegate any of their functions. But I'm going back to the concept that I completely understand. If someone is near the end of their life that. But we should. Why is it that the. Any other doctor or witness a proxy. Why should they be allowed to have pre-recorded audio video material? So I wanted to get an understanding of that. And then separately, I think there was a slip of the tongue earlier by the noble and learned Lord, which was he said the default was expected to be in public, but then they're allowed Allowability I know he doesn't mean that.
I know he means it. Sorry to sit in private. The default has he later then said was this in public? But I wanted to clarify. On 933A. My amendment was suggesting the bit in private only should be the interaction with the applicant. I wonder if he could explain why if somebody has requested it in private, why all the other evidence or no evidence as he's explained, but all the other interaction should not continue to be in public.
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What clause sub clause five of clause 17 says is where the panel considered appropriate for medical considered appropriate for medical reasons, it may make provision for the use of pre-recorded audio or video material for the purposes of video material for the purposes of subsection four and subsection four is all of the material that the panel is saying. So what sub five panel is saying. So what sub five is saying is you can use pre-recorded audio material if you think it's appropriate, and I think think it's appropriate, and I think they should be given that direction.
I can't see any reason why they should be restricted in relation to that. In relation to the privacy point, it's sub six of schedule two panels are to determine referral's in public so that the default is in public, not private. But this is subject to two which says you can sit in private if that's what the person wants. The noble Baroness Baroness Coffey question was basically, why should everything then be in private? Because everything is about the patient. The whole thing is about the patient.
And if I want the circumstances of my illness, why I want an assisted death to be in private, then I should have that. And it's, it's, it's unrealistic to say you can chop it up into the
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bits that are about the patient and the bits that are not. Yeah. And if the.
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Noble and learned Lord is correct that the the amendment refers to the wrong person at the local authority. However, the substance of what I said two weeks substance of what I said two weeks ago for amendment 462A is that. Does not the panel need a power to Does not the panel need a power to ensure that it can ask a local authority to meet unmet needs of the person in front of them? For instance, the care package has fallen apart or there's a problem with their benefits.
They have no power at the moment to do anything other than approve. If the boxes are ticked and I don't, I just do want to know from the noble and learned Lord. Although I'm not saying poor people should not apply, I'm saying the Pan. Should the panel not have a power to ensure those needs are met when they have
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that evidence in front of them? Panel have the power in sub four. The panel may ask any person appearing to have relevant knowledge or experience to report knowledge or experience to report to it on such matters relating to the person to whom the referral relates, as it considers appropriate, that power would appropriate, that power would include their power to ask the local authority to give any
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information that they want. I would like to thank the noble and learned Lord for a very, very comprehensive and useful set of answers. That's the first thing I had actually asked, and it was a long time ago, but I don't. I had actually asked a rather more banal question, which was about workforce challenges in terms of what if you can't find the social workers or the psychiatrist because they actually already acutely we are short, acutely of psychiatrists and social workers in general.
So that's particularly problematic geographically, in particular areas. Just could the noble and learned Lord comment on what will happen if the legal expertise or the social workers or psychiatrists are not available in one part of the country? Will there be a postcode lottery? And the second thing just very quickly is, has the noble and learned Lord consulted the likes of the Royal College of Psychiatrists, British Association of Social Workers about workforce pressures and what the bill will do, because it does seem to me to affect workability, and I'm just worried about if these panels are so important and there's not enough people to go on them, whether they'll be a watering down of kind of grabbing any old social worker that you want to pass, you know what I mean? So maybe he could just clarify on that.
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If there are not enough people with the requisite expertise to people the panels, then there won't people the panels, then there won't be panels to do the job. It's because of that that the broad because of that that the broad categories have been adopted in the bill, and the Royal College of Psychiatrists have expressed views Psychiatrists have expressed views in relation to this. That's not called the Royal College of, of of Social Workers. It's the British Association of Social Workers have Association of Social Workers have have expressed views in relation to this, but it is necessary for us to find people to do it, because the workability of the scheme depends on it.
But we believe that it is possible to do that. We recognise the concerns that have been expressed, but insofar as the noble Baroness is saying, well, if you don't have people who can people the panels, then you can't do the process. You're right. As far as the broader issue is concerned, what happens if you've got people in one part of the country and not the other? It will be for the Voluntary Assisted Dying Commissioner to ensure that when a
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panel is required, it can be provided. My noble. And learned friend sits down if
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And learned friend sits down if I can kindly ask. I've listened closely to all of his response and remarks to this very sizeable group. remarks to this very sizeable group. It's by my counting, it's 105 amendments, of which a handful are presented by the sponsor, my noble presented by the sponsor, my noble and learned friend. But the overwhelming majority have been put forward by noble Lords on all sides forward by noble Lords on all sides of the House, largely informed by the evidence that we heard at the Select Committee and representations made by professional bodies and medical colleges outside of this place that wish us to improve the bill, which is the job that we were tasked to do by the other place and by colleagues.
I've listened to the response, and I was listening very closely to every single word, and I heard every reason why every single one of these amendments shouldn't be accepted. I didn't hear what could come forward to actually make the changes that people think should be made to this bill, to make it safe, particularly to vulnerable groups, and to ensure that we don't see coercion. And so can I just ask him, reflecting on the response he had, is he intending at a future moment to come forward with anything that would put on the face of the bill, things that would make these material differences that have been the reason and impetus by which noble Lords have put forward these
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amendments. I have thought very carefully about the particular amendments about the particular amendments that we've gone through, and I am that we've gone through, and I am sure that they've all been based upon attempts to try to improve the process in relation to, for example, process in relation to, for example, the appointment of the panels, for example, how the panels operate, example, how the panels operate, for example, the privacy issues, I should say, very considerable thought had gone into those issues before the bill was drafted.
And as it went through the other place, I've given very detailed reasons as to why I think the amendments that we've gone through don't really improve the position. And for that reason, after giving it very considerable thought, I think probably the bill reached better conclusion than, for example, the must and may that the noble Baroness was proposing. There needs to be special extra expertises. So I've given it very careful thought, but I don't think on the basis of the amendments we've gone through,
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that any of them would improve the bill. I learned. Lord sits down, just picking up
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Lord sits down, just picking up the point that the noble Lady Burger made and his response two aspects to what she said there was. Did he think that any of the specific amendments may need specific amendments may need changing or bringing forward in a different form? The second part of what she said was, does the noble what she said was, does the noble and Lady Law think any of the issues are addressed? All the concerns expressed by any of the professional organisations who gave evidence raise any issues at all which he thinks need improving in the Bill, even if he thinks all of the amendments are not acceptable? Or is he? Or does he think that all of those professional bodies and the evidence that they gave about their concerns are misplaced? What is.
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The whole range of concerns that has been that's informed the drafting of the bill, and certain drafting of the bill, and certain changes have been made in the light of a variety of the concerns of the professional bodies. So I certainly am not saying we know better on everything than the. The royal everything than the. The royal colleges and their their their thoughts since the bill has been published have been taken into
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account. By Lord Sewell. Thank you for everyone who's spoken in this adjourn group. I
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My Lords, in the course of this debate, the noble Baroness Baroness Coffey referred movingly to the death of her parents, and I pay tribute to her courage and the contribution she made in relation to it. Could I deal with the groups of amendments in themes? Could I deal, first of all, with the appointments to the panels? First of all, the noble Lord Lord Murray of Blidworth said in amendment 925A there should be a proper appointments procedure. I agree with him.
There should be a proper appointments procedure. The bill currently places the obligation on the appointment of panel members on the Voluntary Assisted Dying Commissioner, that is clause 44B and in part two of schedule two, I believe that that is adequate, that the the Voluntary Assisted Dying Commissioner has to have a proper process, and I have faith that he will do that, and the law will require him to do that. Secondly, the noble Lord, Lord Murray, also proposes that the Judicial Appointments Commission make the legal appointments.
Remember, one of each of the panels has to be either a judge or a king's counsel. I am not in favour of that. My noble friend Baroness Levitt indicated that there were problems in relation to that, but I have a more principled objection is that we're not dealing here with judges. We're dealing with members of a particular panel. So I don't think it is either appropriate or necessary. The noble Lord Lord Moylan, in his amendment 96 and 99, when talking about renewal, said that the voluntary assisted dying commissioner, when thinking about renewal, should not have regard to the particular views expressed by panel members when they were sitting on panels, I completely get what he is getting at.
Namely, you shouldn't be excluded because you've you've come on a principled basis to a particular view, but I think it would be wrong to put that in to the bill. I think it's for the voluntary assisted dying Commissioner to decide what's appropriate in determining what should happen in relation to renewal in relation. This is still dealing with the membership of panels in amendment number 9 to 8. The Baroness Hollins, who I see in her place in, suggested that we widen the groups and categories of people who could be on the panel.
In fact, it doesn't widen her proposal. It gives subgroups. I think that the best method of dealing with this is that you have a lawyer, a social worker, and a psychiatrist. You should stick to the three big groups. It's for the voluntary assisted dying commissioner to decide when he or she is forming the panels or forming the group from which the panels are drawn, that he's got the right degree of expertise, but it would be wrong and unhelpful to him to have another substantial number of categories that need to be included.
Can I move from the appointments to the panels to panel procedure? The noble Lord, Lord Murray's amendments include the following. First of all, it should be mandatory rather than discretionary for the Voluntary Assisted Dying commissioner to issue guidance. I think it's a matter for the voluntary assisted Dying Commissioner to make a judgement about that. Does the. It is. Is guidance required? If it is, he should issue it, but it's for him to decide. I don't think it is necessary to include in the bill words to the effect.
As one of the noble Lord Lord Liddle amendments. Lord Murray of Blidworth amendments suggest it. He should not propose a procedure that is so irrational that no reasonable decision maker would have adapted adopted such a procedure. I think that's probably unnecessary. I think if he did adopt such a procedure, it would be set aside under judicial review. And remember, the Voluntary Assisted Dying Commissioner has to have been a former member of the Supreme Court or the Court of Appeal. So he probably he or she would probably be aware that that's not the right course.
And the noble Lord Lord Murray of Blidworth also suggested that the panel should be given all the powers of the High Court. No, I do not think that would be appropriate. This is not a court. This is a panel, and it's inappropriate for such powers to be given, nor is it necessary. The noble Lord, Lord Sandhurst, said in his amendment 929A that the Commissioner should have regard to the nature of the expertise required for particular panels. The schedule for one of the bill, as currently drafted, requires the Commissioner to determine the membership of each panel, and he should obviously have regard to which particular panel members would be appropriate for which particular case.
I do not think one particular case. I do not think one needs to go further. Than that. Again, the noble Lord Lord Sandhurst and his amendments 923A922 and 928 suggest that the Secretary of State should be allowed by regulations to expand who may be on a panel. Again, for the reasons I've indicated, I don't think you need extra categories. Psychiatrist, lawyer and social worker is the right broad categories. The noble Lord Lord Sandhurst in 927 A says that one member of each panel should be legal.
I agree with that, but that's already provided by clause 342 of schedule two. In amendments four, six, five and 473, the noble Lord Lord Sandhurst provided that instead of saying that, the panel must hear from the applicant or from the doctor, he wants to put in the words, he must hear evidence from the coordinating doctor or the patient. I am not at all in favour of that. I don't think it would be appropriate to incorporate legal concepts of admissibility, which is what the word evidence connotes.
It is for the panels to talk to the doctor and to the patient, to satisfy themselves that the conditions are satisfied. We are not trying to create some pseudo court in relation to this article. Sorry. Amendment 479 again, in the name of the noble Lord, Lord Sandhurst suggests that the panel be given power to require a local authority or an NHS body to do a report for the panel on issues of relevance. Again, I don't think that's either necessary or appropriate.
If one looks at clause 17 subclause four sub E of the existing draft, it allows the panel to ask for a report from anyone with relevant information, and I don't think one should restrict it to either an NHS body or a local authority. Could I move on to amendment 494 where the noble Lord. In his amendment, Mrs. noble Lord Lord Sandhurst, suggests that the panel should. Where they think the. A contributing cause of the application is public authority failure that they should require the panel to give a.
Reference to that in their reasons. Again, I don't think that is appropriate. I think what the panel's job to do is not to sit and do things like a coroner does, but to see whether the eligibility criteria are satisfied and it's wrong to add further duties to them. Could I move on to a separate category, which is the category of privacy, the the the the a number of noble Lords put down amendments dealing with the extent to which the panels should sit in public or sit in private.
The draft, the bill at the moment says the norm is sit in private unless the patient wants it to sit in private, in which case the panel can require that it sits in private. As I indicated at the end of last week's proceedings in relation to this, if the patient wanted it to be in private, then my view was it should be in private because this is such a personal thing. So in relation, first of all, to the the noble Lord, Lord Jackson of Peterborough's amendment, that 28 days notice be given of every time a panel sits.
Again, I'm not in favour of that. It would cause unnecessary delay, and it would cause, in my view, unnecessary intrusion in relation to amendment 439, it was suggested that the panel should give notice to a range of people, including all of the next of kin, the GP, any specialist doctor involved in the provision of services. Again, no to that. I think it's important that it is possible for the panel to sit in public so that people can see how it's done, but if the patient wants privacy, he should have it.
And this is not this is not like a court. This is a process which the public should understand and should be able to see how it works. But normally, if you want it to be in private, it should be kept fully in private. But I move on to the noble Lord. Lord, where's amendments which is 496A and 496F? These amendments relate to the position where the Voluntary Assisted Dying Commissioner can reopen a refusal of eligibility, and what the noble Lord in his amendments is suggesting that an additional category of opening up a refusal should be included, namely, that the reason why it's been refused is because of vulnerabilities arising out of disability, the grounds on which the Voluntary Assisted Dying Commissioner can reopen it are very restricted.
This is where there's a refusal, and it's only with the voluntary assisted dying. Commissioner thinks there's been some very significant failure of process. So whilst I completely understand the motivation of the noble Lord Lord Weir, I don't think it's appropriate and I the tone of the noble Lord. Lord, where's intervention or moving? The amendment was to ensure that vulnerable people would not be over pressed into an assisted death, and I think including this in relation to one of the categories in relation to when you can reopen, wouldn't necessarily meet that overarching aim.
The noble Baroness Baroness Finlay of Llandaff in Amendment four, five nine sought to make it a compulsory that you have to tell children or make adequate arrangements for telling them if you're going to have an assisted death and provide adequate bereavement support. My Lords, I. I adopt fully the reasoning of the noble Baroness Baroness Hayman in an incredibly impressive speech that she made as to why I think that that is a bad proposal in that that is a bad proposal in relation to amendment 483AA.
And this is Baroness Maclean amendment where she suggests that the panel should be able to refer the patient for a further assessment. Again, I understand the motivation for that. She's not in her place. I understand the motivation for that. But again, clause 17 four E of the bill, as it's currently drafted, allows the panel to get a report from anyone. So I don't think that that is necessary. The noble Baroness Bi Baroness Keeley in amendment 483 says that that face to face rather than remote should be the default setting.
And she proposes very restricted circumstances in which the panel can sit remotely again. We discussed this previously in relation to face to face, and I indicated my acceptance of the proposition that there should be some statutory regulatory process in which guidance is given as to whether or not it should be face to face or not. So I understand what the Baroness Healy is saying. I understand that that face to face is better, but I think the previous indication I gave as to a statutory scheme for that is the right course.
In amendment 462A, the noble Baroness Baroness Berridge should be suggests that the panel before it reaches a conclusion has to be. Has to be satisfied that the patient has been referred to a local authority designated officer, the local authority designated officer is normally somebody dealing with safeguarding in relation to children and again, I just don't think that although I understand the motivation, I don't think that's appropriate. The noble Baroness Baroness Berger in amendments four, six six and 471 seeks to require the panel to both hear.
They must hear from the applicant and from the coordinating doctor, and she wishes to say, and they must question the coordinating doctor and the patient. Currently, the draft says they must hear from them, subject to some exceptions, and may question so they don't have to question the patient or the coordinating doctor if they don't think it's appropriate to do so, for example, because they are completely satisfied with what they are hearing from the doctor about terminal illness, for example, or because having heard from the patient, cross-examining or examining the patient does not seem appropriate.
And I think the right balance has been struck in relation to that. Four, seven, four. The proposal is and again, this is from Baroness Berger, my noble friend Baroness Berger that the panel should consider hearing from a person's family and other treatment or care provider. I think the norm should be they should definitely consider whether or not they need to hear from a person's family and other treatment provider, but I don't think I would very much hope that they would do anyway.
They've got the power to do it in clause 17 for E. I think it's a valid point, but I don't think it's necessary to amend the bill in order to do that. Amendment 932 the noble Baroness Baroness Finlay proposes a regional structure for panels. I understand the merit of that, but again, I think it's appropriate that that should be dealt with, not by us in the bill, but by the voluntary assisted dying commissioner when he comes to make organisational arrangements for Panels.
Amendment nine two for the Baroness Grey-Thompson says that where the patient is over 60, one of the panels must have expertise in elder abuse or safeguarding. Again, I think it's an important thing for the panel to focus on. Again, I don't think it's necessary to put that in the bill because the voluntary assisted dying commissioner has got to have in place arrangements that would make it appropriate for the selection of the panel. My Lord, I have tabled an amendment which is 480, which is a drafting amendment which is tabled by me to section 70, clause 17 for to make clear that that to make clear that the obligation to hear either from the patient or the coordinating doctor is subject to the medical exception in sub five.
And it is a drafting change. It doesn't change the sense at all, my Lord, my Lords, amendment 480 A is the Baroness Coffey amendment to delete reference to being able to. Four five currently allows the panel to hear by way of video or audio and the Baroness Coffey, which is to delete the words or audio. I can completely understand that it may be inappropriate just to rely on audio, but again, I think it should be for the panel to decide whether they want to hear from somebody by audio and not video, because it may well be of assistance to them.
Then four three, eight C I've got another amendment put down by the Baroness Coffey. Where the coordinating doctor is ill and the panel are satisfied with his evidence. They should be they should be able to deal with it without hearing from him. I didn't put that clearly. Currently, the position is that if the coordinating doctor is ill, there is a medical reason why he can't appear. Then it's open to the panel to decide. They don't need to hear from him exceptionally, because they normally must hear from him.
In my view, there should be that exception because there will be occasions where the panel are completely satisfied with, for example, a report from the coordinating doctor. It's corroborated by an independent doctor from whom they have heard should the patient, if the panel are completely satisfied, have to wait until there can be a personal hearing with a coordinating doctor? In my view, not so. I'm not in favour of that amendment. Then could I go to nine? Sorry, can I just finish then ask questions at the end.
Nine. Two. One. Is Baroness Coffey amendment about King's counsel? The choice of the grouping of who should be within the legal grouping is for the sponsors, not for the government. So the Baroness Levitt, my learned friend, my friend Baroness Laing, my friend the Baroness Levitt is right when she says that's a question for me, not a question for the government, because the government are saying, I'm not saying it's unworkable. They're saying it's for the sponsor to decide. And we we.
The choice of King's counsel and specified judges or former judges is to provide a wide enough pool from which to draw for legal advisers. As far as King's counsel are concerned, we think they have. By becoming King's counsel, they've proved that they've got sufficient quality to be the chair of such a panel. It's intended to mean King's counsel from England and Wales. If it. I don't think it allows for people from other jurisdictions, but I will check. And if it does allow for other jurisdictions, then I will restrict it to England and Wales, because that is the intention.
The noble Baroness also says it shouldn't necessarily be the lawyer, which is her amendment 932A it shouldn't necessarily be the lawyer who chairs the panel. The reason why the lawyer is put in the driving seat as a chair is because what the panel's got to do is comply with the duties imposed on it by the statute. And lawyers are certainly not the best chairs necessarily, but by putting him in him or her in the chair, it is making sure that the panel focuses on what its legal requirements are.
Those are my only limited comments on the whole thing. The Baroness
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Coffey had a question for me. It's been answered by the noble and learned Lord Bourne in his and learned Lord Bourne in his comments. I want to just briefly go back to 483C so for the amendment is actually about pre-recorded is actually about pre-recorded audio or video material for the purposes of section subsection four. purposes of section subsection four. Now, the noble Lord has just said that if a coordinating doctor is off ill, there are other provisions through medical exceptions. There's through medical exceptions.
There's also a provision in the bill. The coordinating doctor can delegate any of their functions. But I'm going back to the concept that I completely understand. If someone is near the end of their life that. But we should. Why is it that the. Any other doctor or witness a proxy. Why should they be allowed to have pre-recorded audio video material? So I wanted to get an understanding of that. And then separately, I think there was a slip of the tongue earlier by the noble and learned Lord, which was he said the default was expected to be in public, but then they're allowed Allowability I know he doesn't mean that.
I know he means it. Sorry to sit in private. The default has he later then said was this in public? But I wanted to clarify. On 933A. My amendment was suggesting the bit in private only should be the interaction with the applicant. I wonder if he could explain why if somebody has requested it in private, why all the other evidence or no evidence as he's explained, but all the other interaction should not continue to be in public.
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What clause sub clause five of clause 17 says is where the panel considered appropriate for medical considered appropriate for medical reasons, it may make provision for the use of pre-recorded audio or video material for the purposes of video material for the purposes of subsection four and subsection four is all of the material that the panel is saying. So what sub five panel is saying. So what sub five is saying is you can use pre-recorded audio material if you think it's appropriate, and I think think it's appropriate, and I think they should be given that direction.
I can't see any reason why they should be restricted in relation to that. In relation to the privacy point, it's sub six of schedule two panels are to determine referral's in public so that the default is in public, not private. But this is subject to two which says you can sit in private if that's what the person wants. The noble Baroness Baroness Coffey question was basically, why should everything then be in private? Because everything is about the patient. The whole thing is about the patient.
And if I want the circumstances of my illness, why I want an assisted death to be in private, then I should have that. And it's, it's, it's unrealistic to say you can chop it up into the
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bits that are about the patient and the bits that are not. Yeah. And if the.
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Noble and learned Lord is correct that the the amendment refers to the wrong person at the local authority. However, the substance of what I said two weeks substance of what I said two weeks ago for amendment 462A is that. Does not the panel need a power to Does not the panel need a power to ensure that it can ask a local authority to meet unmet needs of the person in front of them? For instance, the care package has fallen apart or there's a problem with their benefits.
They have no power at the moment to do anything other than approve. If the boxes are ticked and I don't, I just do want to know from the noble and learned Lord. Although I'm not saying poor people should not apply, I'm saying the Pan. Should the panel not have a power to ensure those needs are met when they have
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that evidence in front of them? Panel have the power in sub four. The panel may ask any person appearing to have relevant knowledge or experience to report knowledge or experience to report to it on such matters relating to the person to whom the referral relates, as it considers appropriate, that power would appropriate, that power would include their power to ask the local authority to give any
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information that they want. I would like to thank the noble and learned Lord for a very, very comprehensive and useful set of answers. That's the first thing I had actually asked, and it was a long time ago, but I don't. I had actually asked a rather more banal question, which was about workforce challenges in terms of what if you can't find the social workers or the psychiatrist because they actually already acutely we are short, acutely of psychiatrists and social workers in general.
So that's particularly problematic geographically, in particular areas. Just could the noble and learned Lord comment on what will happen if the legal expertise or the social workers or psychiatrists are not available in one part of the country? Will there be a postcode lottery? And the second thing just very quickly is, has the noble and learned Lord consulted the likes of the Royal College of Psychiatrists, British Association of Social Workers about workforce pressures and what the bill will do, because it does seem to me to affect workability, and I'm just worried about if these panels are so important and there's not enough people to go on them, whether they'll be a watering down of kind of grabbing any old social worker that you want to pass, you know what I mean? So maybe he could just clarify on that.
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If there are not enough people with the requisite expertise to people the panels, then there won't people the panels, then there won't be panels to do the job. It's because of that that the broad because of that that the broad categories have been adopted in the bill, and the Royal College of Psychiatrists have expressed views Psychiatrists have expressed views in relation to this. That's not called the Royal College of, of of Social Workers. It's the British Association of Social Workers have Association of Social Workers have have expressed views in relation to this, but it is necessary for us to find people to do it, because the workability of the scheme depends on it.
But we believe that it is possible to do that. We recognise the concerns that have been expressed, but insofar as the noble Baroness is saying, well, if you don't have people who can people the panels, then you can't do the process. You're right. As far as the broader issue is concerned, what happens if you've got people in one part of the country and not the other? It will be for the Voluntary Assisted Dying Commissioner to ensure that when a
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panel is required, it can be provided. My noble. And learned friend sits down if
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And learned friend sits down if I can kindly ask. I've listened closely to all of his response and remarks to this very sizeable group. remarks to this very sizeable group. It's by my counting, it's 105 amendments, of which a handful are presented by the sponsor, my noble presented by the sponsor, my noble and learned friend. But the overwhelming majority have been put forward by noble Lords on all sides forward by noble Lords on all sides of the House, largely informed by the evidence that we heard at the Select Committee and representations made by professional bodies and medical colleges outside of this place that wish us to improve the bill, which is the job that we were tasked to do by the other place and by colleagues.
I've listened to the response, and I was listening very closely to every single word, and I heard every reason why every single one of these amendments shouldn't be accepted. I didn't hear what could come forward to actually make the changes that people think should be made to this bill, to make it safe, particularly to vulnerable groups, and to ensure that we don't see coercion. And so can I just ask him, reflecting on the response he had, is he intending at a future moment to come forward with anything that would put on the face of the bill, things that would make these material differences that have been the reason and impetus by which noble Lords have put forward these
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amendments. I have thought very carefully about the particular amendments about the particular amendments that we've gone through, and I am that we've gone through, and I am sure that they've all been based upon attempts to try to improve the process in relation to, for example, process in relation to, for example, the appointment of the panels, for example, how the panels operate, example, how the panels operate, for example, the privacy issues, I should say, very considerable thought had gone into those issues before the bill was drafted.
And as it went through the other place, I've given very detailed reasons as to why I think the amendments that we've gone through don't really improve the position. And for that reason, after giving it very considerable thought, I think probably the bill reached better conclusion than, for example, the must and may that the noble Baroness was proposing. There needs to be special extra expertises. So I've given it very careful thought, but I don't think on the basis of the amendments we've gone through,
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that any of them would improve the bill. I learned. Lord sits down, just picking up
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Lord sits down, just picking up the point that the noble Lady Burger made and his response two aspects to what she said there was. Did he think that any of the specific amendments may need specific amendments may need changing or bringing forward in a different form? The second part of what she said was, does the noble what she said was, does the noble and Lady Law think any of the issues are addressed? All the concerns expressed by any of the professional organisations who gave evidence raise any issues at all which he thinks need improving in the Bill, even if he thinks all of the amendments are not acceptable? Or is he? Or does he think that all of those professional bodies and the evidence that they gave about their concerns are misplaced? What is.
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The whole range of concerns that has been that's informed the drafting of the bill, and certain drafting of the bill, and certain changes have been made in the light of a variety of the concerns of the professional bodies. So I certainly am not saying we know better on everything than the. The royal everything than the. The royal colleges and their their their thoughts since the bill has been published have been taken into
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account. By Lord Sewell. Thank you for everyone who's spoken in this adjourn group. I
10:59
Lord Murray of Blidworth (Conservative)
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Lord Murray of Blidworth (Conservative)
propose to adopt the style, the enviable style of my noble friend, the Earl of Effingham, and not the Earl of Effingham, and not referred to everybody's speeches, and. I would, however, pick up just and. I would, however, pick up just one point from our discussion on the 27th of February, and that was the 27th of February, and that was in the speech of the noble Lady Baroness Hayter, when she Baroness Hayter, when she criticised my comment in the opening of the group that this was not a life and death decision, that the panel were making.
And I answer that by simply pointing to the contents of clause 17 two of the Bill 17. Two of the bill sets out the checklist of which the panel must be satisfied, and the most pertinent of those are that the person is terminally ill, that the person has a clear, settled and informed wish to end their own life, and that the person made the declaration voluntarily and was not coerced or pressured by any other person into making that declaration.
In my submission, my Lord, it is plainly a decision, the question of life and death that the panel is life and death that the panel is making. I propose to respond to the noble Lord Falconer and the noble Baroness Miller Minister, thematically adopting their own approach. It seems to me there are key three key themes in my amendments. They are the appointment process, whether there should be guidance to the panels and what powers the panels should have.
And I'm very glad that the noble and learned Lord, Lord Falconer, agreed with me that there needed to be an appointment process, but I am afraid I do not share his laissez faire approach, that it all just can be left to the person of the assisted dying Commissioner. It seems to me, my Lords, that it is appropriate for such a significant post to be considered by a formal body, and I do not accept the account given by the government that it's all a bit too administratively difficult for the Jac to consider this.
The Jac is a body set up under the Constitutional Reform Act 2005, and it's governed by Statutory Instrument of 2013. Those are all capable of amendment, and with
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resourcing, it is entirely capable of managing the task that I envisage in my amendments. Here, here, here.
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Here, here, here. Turning then to the question of guidance, there is no provision that there must be guidance to the panels. And it seems to me, unless panels. And it seems to me, unless you have guidance, there is a real risk that panels will be of differing quality and adopt differing quality and adopt different local practices. And this could cause terrible errors, errors with very significant and ultimately irreversible consequences. There must be guidance and there must be guidance made by the commissioner to the panels, and that guidance must be informed by consultation with relevant bodies.
And that is what my amendments achieve. And I'm afraid I don't share the what we might call the good chap theory of assisted death that the noble Lord, Lord Falconer, appears to suggest by having an option to to create guidance to the panels, and then finally, as to powers, criticism was made of me by the noble Baroness, the Minister, and the noble and learned Lord, that I had asked too much in my amendment, asking for the powers of the High Court to be imposed upon the panels, as I made clear in my speech, and as indeed is clear in the member's explanatory statement, my Lords, if you look at the Marshalled List, this was always a probing amendment.
The powers and the noble Lady, the Minister said I hadn't specified which powers. Well, if she'd looked at the member's explanatory statement, she would have seen it's targeted at the powers to require evidence because, as I said in my Second Reading speech, at the moment, these panels have fewer powers than the parking adjudicator of Greater London in in a matter where they're looking at whether or not somebody is being coerced into volunteering to die, the panel can't even ask to see their will.
These powers are an essential addition to the bill if it is to proceed. And with that, I beg to withdraw my amendment.
And I answer that by simply pointing to the contents of clause 17 two of the Bill 17. Two of the bill sets out the checklist of which the panel must be satisfied, and the most pertinent of those are that the person is terminally ill, that the person has a clear, settled and informed wish to end their own life, and that the person made the declaration voluntarily and was not coerced or pressured by any other person into making that declaration.
In my submission, my Lord, it is plainly a decision, the question of life and death that the panel is life and death that the panel is making. I propose to respond to the noble Lord Falconer and the noble Baroness Miller Minister, thematically adopting their own approach. It seems to me there are key three key themes in my amendments. They are the appointment process, whether there should be guidance to the panels and what powers the panels should have.
And I'm very glad that the noble and learned Lord, Lord Falconer, agreed with me that there needed to be an appointment process, but I am afraid I do not share his laissez faire approach, that it all just can be left to the person of the assisted dying Commissioner. It seems to me, my Lords, that it is appropriate for such a significant post to be considered by a formal body, and I do not accept the account given by the government that it's all a bit too administratively difficult for the Jac to consider this.
The Jac is a body set up under the Constitutional Reform Act 2005, and it's governed by Statutory Instrument of 2013. Those are all capable of amendment, and with
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resourcing, it is entirely capable of managing the task that I envisage in my amendments. Here, here, here.
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Here, here, here. Turning then to the question of guidance, there is no provision that there must be guidance to the panels. And it seems to me, unless panels. And it seems to me, unless you have guidance, there is a real risk that panels will be of differing quality and adopt differing quality and adopt different local practices. And this could cause terrible errors, errors with very significant and ultimately irreversible consequences. There must be guidance and there must be guidance made by the commissioner to the panels, and that guidance must be informed by consultation with relevant bodies.
And that is what my amendments achieve. And I'm afraid I don't share the what we might call the good chap theory of assisted death that the noble Lord, Lord Falconer, appears to suggest by having an option to to create guidance to the panels, and then finally, as to powers, criticism was made of me by the noble Baroness, the Minister, and the noble and learned Lord, that I had asked too much in my amendment, asking for the powers of the High Court to be imposed upon the panels, as I made clear in my speech, and as indeed is clear in the member's explanatory statement, my Lords, if you look at the Marshalled List, this was always a probing amendment.
The powers and the noble Lady, the Minister said I hadn't specified which powers. Well, if she'd looked at the member's explanatory statement, she would have seen it's targeted at the powers to require evidence because, as I said in my Second Reading speech, at the moment, these panels have fewer powers than the parking adjudicator of Greater London in in a matter where they're looking at whether or not somebody is being coerced into volunteering to die, the panel can't even ask to see their will.
These powers are an essential addition to the bill if it is to proceed. And with that, I beg to withdraw my amendment.
11:04
Amdt. 143
Baroness Finlay of Llandaff (Crossbench)
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Amdt. 143
Baroness Finlay of Llandaff (Crossbench)
Is it your Lordships pleasure? The amendment be withdrawn? Amendment is by leave withdrawn. Amendment is by leave withdrawn. Amendment 143 Baroness Finlay of Llandaff.
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Llandaff. I now rise to speak to this rather large group of amendments, many of which were simply many of which were simply consequential. So I've withdrawn those to focus the debate. I ask noble Lords who may have questions, to kindly allow me to explain the whole process rather than interrupt the sequence. My Lords, we took extensive evidence in our select committee and had many briefings critical of the panel process. As written in the bill, the Royal College of General Practitioners clearly stated that any legislation must ensure that any assisted dying service should be seen as a standalone service and not be deemed core GP work.
They are clear any assisted dying service needs to be separately and adequately resourced, and not in any way result in a deprioritization of core general practice or palliative care services, and the promoters of the Bill themselves have said that the voluntary assisted dying service must be clearly defined and not complicated. The model proposed here would meet those essential criteria and improve safety, providing legitimacy with an expert multidisciplinary panel. Bureaucracy is simplified, avoids burdening family or treating clinicians, and provides statutory separation between assessment and the process of causing death.
The effect of the scheme is to provide clarity by strengthening the process, so the request goes directly through a genuinely multidisciplinary panel involving rigorous assessment, strong conflict of interest rules, clear statutory guidelines, clear norms for the collection of data and in the event of doubt, there is potential court involvement. This creates a higher level of professionalism and greater legitimacy for the person. There's also a clear framework for the panel procedure. Unlike the proposed ADR panels that we previously debated in the bill, these panels are genuinely multidisciplinary across relevant specialities.
The major effect of this is to remove individual doctors, assessing in isolation and the risk of doctor shopping. There is also a new scheme for licensing and regulating assisted death services, as well as strict regulation of the lethal substances used to bring about an assisted death. This would decrease the risk of dispensing errors as the process of dispensing approved lethal substances is closely monitored. These amendments move the provision of accurate information to the patient and the assessment of eligibility upfront in the bill.
The assessment is all undertaken by a defined group with expertise across different disciplines. Clinicians looking after the patient, irrespective of whether they support or do not support the provision of assisted dying, would continue with their duty of care to the patient and family throughout the process. Thus, the patient would continue to have their usual clinicians look after them as always, whilst in parallel they could be assessed for eligibility against the criteria to be established in a statutory code of practice.
My Lords, let me explain. Amendment 143 requires the Independent Commissioner to support the new multidisciplinary panel workings, retain records for at least ten years, support research and report to Parliament. Amendment 266 ensures the panel members independence amendment 192 signposts the person to the panel. Because an assisted death is not a medical treatment, the person can obtain accurate, up to date information, including in one two, in sorry, in two, three, two. How to initiate the process amendments three, three three and 334 describe the panel makeup and its process.
The panel would have a lawyer, a social worker or psychologist, a specialist in end of life care, all of whom would have at least ten years clinical experience, and an administrator, plus a consultant specialist in the disease of the person and, if required, the option to co-opt up to seven members. Their statutory duties relate to licensing or declining the provision of lethal drugs or poisonous substances. They can refer to the High Court if in doubt. Amendment 233 clarifies that two panel members conducting a documented hearing must go to the patient.
New clause amendment 615 explains how the assisted dying service that comes into operation when a person's assisted death has been approved executes its functions in complying with the person's wishes, including the safe transport of dispensed substances. 551 describes a neutral professional of experience who, once an assisted death is approved, can help the patient by ensuring all correct processes are followed. Deal with complications, collect all data and notify relevant persons of the death. This avoids the difficulty of a doctor being tied up waiting for the person to die after ingesting the lethal drugs.
As the Oregon data shows that sometimes this can be prolonged, five, five two and 702 determine a designated regional pharmacy to link to the assisted dying service to improve safety in dispensing and transport of lethal drugs or other poisons, and disposal of any unused substances. Amendment 552A in the name of my noble friend Baroness Hollins improves my amendment 552 by ensuring compliance with regulatory ensuring compliance with regulatory safeguards. 704, 705 and 706 relate to the limits on regulation making powers, and 707 covers devices.
We don't know what these devices are, but they are referred to in the bill. 698 requires all lethal substances to be compliant with MHRA regulations and the Misuse of Drugs Act five, five, six and 643 require the GP to be notified of the process. 654 ensures completeness. Amendment 667760761 and 767 make it clear that any health or social care professional involvement in the assisted death service is separate from their health or social care employment, and their employer must know of their involvement.
This is a separate service that must not jeopardise the care of other patients. However, amendment 710 in the section on Regulation of Approved Substances gives effect to the recommendation from the Delegated Powers and Regulatory Reform Committee on which I sit. Although I should say I am not speaking on behalf of the Committee to remove the most sweeping of the Henry VII's powers in the bill, and I do not consider the Noble and learned law. The sponsor's amendment of my amendment to be adequate.
Others may wish to comment all my remaining 56 amendments in this group are consequential and have been written to ensure there's clarity throughout the Bill as to the effect of these changes. This is
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not vexatious order. Grateful to the noble Baroness for describing her scheme, could for describing her scheme, could she explain to the House what are the eligibility requirements that the eligibility requirements that need to be satisfied in order to give a certificate where one finds them in her amendments? And secondly, could she explain what the role of the High Court is?
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the role of the High Court is? I asked first of all, ask that you could wait until I had completed. Secondly, I apologise to the house if coughing and my voice give up in the process, but so be it. And thirdly, if these amendments were all rewritten into the bill, which is what I tried to do, the noble and learned Lord would see that the eligibility criteria remain as he had put at the front of the bill.
So, my Lords, let me summarise. A person wants to seek an assisted death. They're signposted to the panel for their area. The panel gives them accurate information and if they wish to apply their help to ask for their clinical record to be available to the panel to assess all information. Normally, two panel members would meet the person without pressures, listen to them, assess capacity and if they agree, advise the panel who decide whether to issue a license to end life. The navigator would then make sure that lethal drugs are available to the person at the time of the person's choosing, collect them from the designated pharmacy, deliver and oversee the whole process, documenting it carefully if the person changed their mind, unused drugs would be removed by the navigator.
If the person dies, the navigator would verify, not certify death and ensure all who need to be informed are duly and sensitively informed of the death. But throughout their initial information seeking being assessed, their period of reflection and the assisted death being arranged, their health and social care continues in parallel, not diverted away from its core role in care. Let me illustrate. My Lords. 36 years ago, a GP referred a distraught young man whose prognosis, as estimated by him, the surgeon and oncologist, was about three months, saying he is the most clear cut case for euthanasia I have ever seen in total pain, desperate for lethal drugs with the youngest child at only six weeks old, his care was challenging, particularly in the first fortnight.
11 years after that visit and after many times of complex care, David phoned me. His beautiful young wife was dying of advanced cancer. By then a wheelchair user, he and his three children were with her in the hospice as she died just two days ago. I visited David, who with his three fine adult children who he has brought up on his own despite his disability, said I could speak of this in tribute to him and all his care has taught me.
And they're watching this debate today. I know that they have tuned in. It's a great privilege to be entrusted with such care. That is why an assisted death service must be separated from health care provision, not integrated. These amendments would create a clear, streamlined service with greater transparency and with clear defined oversight that is more easily monitored. They've been written to respond to the request from the Royal College of GPS, the Royal College of Physicians and the Royal College of Psychiatrists and the Association for Palliative Medicine that an assisted death service must be a separate service.
They respond to the call for a recognition that multidisciplinary input into assessment and good governance is essential, and that an assisted death is not a medical treatment. They're based on over 20 years of work by clinicians and academics who have not been opposed to assisted dying, but recognise the dangers of a system which can easily expand to have all the complications and escalation that we have seen. For example, in Canada. These amendments are designed to provide coherence. I beg to move.
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I requested. I waited until the noble Lady was was able to to to make her point.
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The noble Lady has moved for amendment amendment. Proposed clause four, page two, line 39 at
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clause four, page two, line 39 at end. Insert the words on the Marshalled List. And now. OK, I was trying to respond to
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Llandaff. I now rise to speak to this rather large group of amendments, many of which were simply many of which were simply consequential. So I've withdrawn those to focus the debate. I ask noble Lords who may have questions, to kindly allow me to explain the whole process rather than interrupt the sequence. My Lords, we took extensive evidence in our select committee and had many briefings critical of the panel process. As written in the bill, the Royal College of General Practitioners clearly stated that any legislation must ensure that any assisted dying service should be seen as a standalone service and not be deemed core GP work.
They are clear any assisted dying service needs to be separately and adequately resourced, and not in any way result in a deprioritization of core general practice or palliative care services, and the promoters of the Bill themselves have said that the voluntary assisted dying service must be clearly defined and not complicated. The model proposed here would meet those essential criteria and improve safety, providing legitimacy with an expert multidisciplinary panel. Bureaucracy is simplified, avoids burdening family or treating clinicians, and provides statutory separation between assessment and the process of causing death.
The effect of the scheme is to provide clarity by strengthening the process, so the request goes directly through a genuinely multidisciplinary panel involving rigorous assessment, strong conflict of interest rules, clear statutory guidelines, clear norms for the collection of data and in the event of doubt, there is potential court involvement. This creates a higher level of professionalism and greater legitimacy for the person. There's also a clear framework for the panel procedure. Unlike the proposed ADR panels that we previously debated in the bill, these panels are genuinely multidisciplinary across relevant specialities.
The major effect of this is to remove individual doctors, assessing in isolation and the risk of doctor shopping. There is also a new scheme for licensing and regulating assisted death services, as well as strict regulation of the lethal substances used to bring about an assisted death. This would decrease the risk of dispensing errors as the process of dispensing approved lethal substances is closely monitored. These amendments move the provision of accurate information to the patient and the assessment of eligibility upfront in the bill.
The assessment is all undertaken by a defined group with expertise across different disciplines. Clinicians looking after the patient, irrespective of whether they support or do not support the provision of assisted dying, would continue with their duty of care to the patient and family throughout the process. Thus, the patient would continue to have their usual clinicians look after them as always, whilst in parallel they could be assessed for eligibility against the criteria to be established in a statutory code of practice.
My Lords, let me explain. Amendment 143 requires the Independent Commissioner to support the new multidisciplinary panel workings, retain records for at least ten years, support research and report to Parliament. Amendment 266 ensures the panel members independence amendment 192 signposts the person to the panel. Because an assisted death is not a medical treatment, the person can obtain accurate, up to date information, including in one two, in sorry, in two, three, two. How to initiate the process amendments three, three three and 334 describe the panel makeup and its process.
The panel would have a lawyer, a social worker or psychologist, a specialist in end of life care, all of whom would have at least ten years clinical experience, and an administrator, plus a consultant specialist in the disease of the person and, if required, the option to co-opt up to seven members. Their statutory duties relate to licensing or declining the provision of lethal drugs or poisonous substances. They can refer to the High Court if in doubt. Amendment 233 clarifies that two panel members conducting a documented hearing must go to the patient.
New clause amendment 615 explains how the assisted dying service that comes into operation when a person's assisted death has been approved executes its functions in complying with the person's wishes, including the safe transport of dispensed substances. 551 describes a neutral professional of experience who, once an assisted death is approved, can help the patient by ensuring all correct processes are followed. Deal with complications, collect all data and notify relevant persons of the death. This avoids the difficulty of a doctor being tied up waiting for the person to die after ingesting the lethal drugs.
As the Oregon data shows that sometimes this can be prolonged, five, five two and 702 determine a designated regional pharmacy to link to the assisted dying service to improve safety in dispensing and transport of lethal drugs or other poisons, and disposal of any unused substances. Amendment 552A in the name of my noble friend Baroness Hollins improves my amendment 552 by ensuring compliance with regulatory ensuring compliance with regulatory safeguards. 704, 705 and 706 relate to the limits on regulation making powers, and 707 covers devices.
We don't know what these devices are, but they are referred to in the bill. 698 requires all lethal substances to be compliant with MHRA regulations and the Misuse of Drugs Act five, five, six and 643 require the GP to be notified of the process. 654 ensures completeness. Amendment 667760761 and 767 make it clear that any health or social care professional involvement in the assisted death service is separate from their health or social care employment, and their employer must know of their involvement.
This is a separate service that must not jeopardise the care of other patients. However, amendment 710 in the section on Regulation of Approved Substances gives effect to the recommendation from the Delegated Powers and Regulatory Reform Committee on which I sit. Although I should say I am not speaking on behalf of the Committee to remove the most sweeping of the Henry VII's powers in the bill, and I do not consider the Noble and learned law. The sponsor's amendment of my amendment to be adequate.
Others may wish to comment all my remaining 56 amendments in this group are consequential and have been written to ensure there's clarity throughout the Bill as to the effect of these changes. This is
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not vexatious order. Grateful to the noble Baroness for describing her scheme, could for describing her scheme, could she explain to the House what are the eligibility requirements that the eligibility requirements that need to be satisfied in order to give a certificate where one finds them in her amendments? And secondly, could she explain what the role of the High Court is?
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the role of the High Court is? I asked first of all, ask that you could wait until I had completed. Secondly, I apologise to the house if coughing and my voice give up in the process, but so be it. And thirdly, if these amendments were all rewritten into the bill, which is what I tried to do, the noble and learned Lord would see that the eligibility criteria remain as he had put at the front of the bill.
So, my Lords, let me summarise. A person wants to seek an assisted death. They're signposted to the panel for their area. The panel gives them accurate information and if they wish to apply their help to ask for their clinical record to be available to the panel to assess all information. Normally, two panel members would meet the person without pressures, listen to them, assess capacity and if they agree, advise the panel who decide whether to issue a license to end life. The navigator would then make sure that lethal drugs are available to the person at the time of the person's choosing, collect them from the designated pharmacy, deliver and oversee the whole process, documenting it carefully if the person changed their mind, unused drugs would be removed by the navigator.
If the person dies, the navigator would verify, not certify death and ensure all who need to be informed are duly and sensitively informed of the death. But throughout their initial information seeking being assessed, their period of reflection and the assisted death being arranged, their health and social care continues in parallel, not diverted away from its core role in care. Let me illustrate. My Lords. 36 years ago, a GP referred a distraught young man whose prognosis, as estimated by him, the surgeon and oncologist, was about three months, saying he is the most clear cut case for euthanasia I have ever seen in total pain, desperate for lethal drugs with the youngest child at only six weeks old, his care was challenging, particularly in the first fortnight.
11 years after that visit and after many times of complex care, David phoned me. His beautiful young wife was dying of advanced cancer. By then a wheelchair user, he and his three children were with her in the hospice as she died just two days ago. I visited David, who with his three fine adult children who he has brought up on his own despite his disability, said I could speak of this in tribute to him and all his care has taught me.
And they're watching this debate today. I know that they have tuned in. It's a great privilege to be entrusted with such care. That is why an assisted death service must be separated from health care provision, not integrated. These amendments would create a clear, streamlined service with greater transparency and with clear defined oversight that is more easily monitored. They've been written to respond to the request from the Royal College of GPS, the Royal College of Physicians and the Royal College of Psychiatrists and the Association for Palliative Medicine that an assisted death service must be a separate service.
They respond to the call for a recognition that multidisciplinary input into assessment and good governance is essential, and that an assisted death is not a medical treatment. They're based on over 20 years of work by clinicians and academics who have not been opposed to assisted dying, but recognise the dangers of a system which can easily expand to have all the complications and escalation that we have seen. For example, in Canada. These amendments are designed to provide coherence. I beg to move.
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I requested. I waited until the noble Lady was was able to to to make her point.
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The noble Lady has moved for amendment amendment. Proposed clause four, page two, line 39 at
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clause four, page two, line 39 at end. Insert the words on the Marshalled List. And now. OK, I was trying to respond to
11:17
Lord Markham (Conservative)
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Lord Markham (Conservative)
>> OK, I was trying to respond to the noble Lady's request not to be intervened during during her what intervened during during her what she had to say so that she could at first. But I did have some questions actually specifically on what she was talking about. And as I say, I was trying to follow her wishes on that and say. And so my concern now is that she won't have the opportunity to answer. OK. So, so thank you. So, so, so specifically around the point and, and I totally appreciate the noble Lady intention in all of this is obviously to try and make it as a robust a process as possible and obviously showed a very moving example there of why she believed it.
But, but my specific question is that surely the people best placed to give evidence and understand the situation on the capacity of the the person involved, whether there is any coercion involved, their own circumstances are the very people that she's suggesting shouldn't be part of that panel, namely the health professionals involved in the doctors. So I'm just again, trying to understand why the noble Lady wouldn't want those professionals involved who are closest to the case involved.
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If I may respond. Unfortunately, I'm not sure that
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Unfortunately, I'm not sure that the noble Lord quite heard me right, because the panels that we were because the panels that we were discussing previously didn't have the treating clinicians on that the treating clinicians on that panel. They were looking at evidence brought to them. And indeed, in the proposal of the indeed, in the proposal of the panel structure that I put down, it would be that panel that would have access to all the patient's notes with the patient's permission, all their investigations and the full assessment of capacity and all other aspects that would be happening in routine practice during the patient's care and concerns over their family, over behaviours during the course of their illness would be documented in the clinical record, and that clinical record would be available to the panel, including the criteria on which the diagnosis was made, which is why I have suggested there needs to be an expert with knowledge of the specific disease of the person who is seeking an assisted death, because there are many rare conditions in medicine.
Common things occur commonly, but rare things are not that uncommon, and it is quite common for there to be a misdiagnosis. So the patient may be making a decision based on a fallacy, believing what they had is, or even what they had been treated for. And we had evidence in a previous select committee that at post-mortem, around 5% of people are found to have died of something different to what had been recorded on the death certificate, suggesting that misdiagnosis is sadly not a very rare occurrence.
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So the specific point I was referring to is the person's health or social care professional cannot participate in any part of the assessment for that person's request for an assisted death. request for an assisted death. That's the point I'm trying to understand. Yes, unfortunately, there are cases of misdiagnosis. The 5% the noble Lady mentioned, but actually the 95% of the time, but actually the 95% of the time, vast majority of these people are the best qualified to to make an assessment on it.
So I'm trying to
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understand why we wouldn't want them involved. Because they won't be involved in the.
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in the. Judgement as to whether the person is eligible for lethal drugs person is eligible for lethal drugs or not eligible for lethal drugs. They are providing their clinical They are providing their clinical expertise and knowledge. It is the
But, but my specific question is that surely the people best placed to give evidence and understand the situation on the capacity of the the person involved, whether there is any coercion involved, their own circumstances are the very people that she's suggesting shouldn't be part of that panel, namely the health professionals involved in the doctors. So I'm just again, trying to understand why the noble Lady wouldn't want those professionals involved who are closest to the case involved.
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If I may respond. Unfortunately, I'm not sure that
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Unfortunately, I'm not sure that the noble Lord quite heard me right, because the panels that we were because the panels that we were discussing previously didn't have the treating clinicians on that the treating clinicians on that panel. They were looking at evidence brought to them. And indeed, in the proposal of the indeed, in the proposal of the panel structure that I put down, it would be that panel that would have access to all the patient's notes with the patient's permission, all their investigations and the full assessment of capacity and all other aspects that would be happening in routine practice during the patient's care and concerns over their family, over behaviours during the course of their illness would be documented in the clinical record, and that clinical record would be available to the panel, including the criteria on which the diagnosis was made, which is why I have suggested there needs to be an expert with knowledge of the specific disease of the person who is seeking an assisted death, because there are many rare conditions in medicine.
Common things occur commonly, but rare things are not that uncommon, and it is quite common for there to be a misdiagnosis. So the patient may be making a decision based on a fallacy, believing what they had is, or even what they had been treated for. And we had evidence in a previous select committee that at post-mortem, around 5% of people are found to have died of something different to what had been recorded on the death certificate, suggesting that misdiagnosis is sadly not a very rare occurrence.
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So the specific point I was referring to is the person's health or social care professional cannot participate in any part of the assessment for that person's request for an assisted death. request for an assisted death. That's the point I'm trying to understand. Yes, unfortunately, there are cases of misdiagnosis. The 5% the noble Lady mentioned, but actually the 95% of the time, but actually the 95% of the time, vast majority of these people are the best qualified to to make an assessment on it.
So I'm trying to
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understand why we wouldn't want them involved. Because they won't be involved in the.
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in the. Judgement as to whether the person is eligible for lethal drugs person is eligible for lethal drugs or not eligible for lethal drugs. They are providing their clinical They are providing their clinical expertise and knowledge. It is the
11:21
Baroness Finlay of Llandaff (Crossbench)
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Baroness Finlay of Llandaff (Crossbench)
panel who separately, independently through a process that can be completely scrutinised and documented, who would then make that assessment completely independently. It means that the patient's care cannot be contaminated by pressures of the doctor being burnt out, by financial pressures on the system in which that patient is being treated, or even by administrative pressures, because the patient's discharge is becoming difficult, and because there are beds that are needed and there are patients being treated in corridors, which we know is happening all the time, it provides separation and a degree of clarity over the assessment and judgement.
11:22
Baroness Cass (Crossbench)
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Baroness Cass (Crossbench)
Can I make a point of >> Can I make a point of clarification that even whether we take the system proposed by my take the system proposed by my noble friend or the original system with the series of of doctors, it is very unlikely under any circumstance, that the clinician who is providing primary care for the patient will also be in one of those formal roles specified by the bill. And the reason for that is that, as we've discussed, people will need to opt in to take on that kind of role and have very specific training for it.
And given the numbers that are predicted to require an assisted death, that will be quite a small cadre of clinicians. So in practical terms, although I understand the aspiration from the sponsor in the other place and certain members here, that there is this close integration in between the the team providing normal care and those involved in the dying process in practice. I don't see that that would be feasible in in either system. Thank you.
And given the numbers that are predicted to require an assisted death, that will be quite a small cadre of clinicians. So in practical terms, although I understand the aspiration from the sponsor in the other place and certain members here, that there is this close integration in between the the team providing normal care and those involved in the dying process in practice. I don't see that that would be feasible in in either system. Thank you.
11:23
Baroness Murphy (Crossbench)
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Baroness Murphy (Crossbench)
My Lords. I would like to express the the opposite view to express the the opposite view to the noble Lady Findlay that that we should have a separate service, should have a separate service, completely separate. We're going to completely separate. We're going to target and isolate people who are An that they will, with the illness, that we should not move them to another place, that they should be seen and examined there. Yes. It's going to be a separate people, perhaps, who take on this role, and they should be properly qualified and discuss it with the panel and whatever, but it is utterly crucial that we should not separate these people off when they are in the process of dying and reject them.
They should be part of the palliative care provided to them. It almost certainly in other countries, usually happens as part of a palliative care service. That's how it is in Oregon and Washington, and very successfully. So we should not separate them off. We are there to support them during this process. And these little nit picking bits of change to the bill will just make it worse.
They should be part of the palliative care provided to them. It almost certainly in other countries, usually happens as part of a palliative care service. That's how it is in Oregon and Washington, and very successfully. So we should not separate them off. We are there to support them during this process. And these little nit picking bits of change to the bill will just make it worse.
11:25
Lord Deben (Conservative)
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Lord Deben (Conservative)
Yeah. Thank you, my Lord. I wasn't going to speak on this, but the last speaker has led me to do so, first of all, to talk about the care with which this proposal has been put forward as nit picking is frankly unacceptable. And the noble Lady should not have said that, because the reason this has been brought forward is because many of us feel that we should take seriously the pressures of the people who are going to have to carry out these arrangements, all of whom either in principle or because of the nature of the bill, have objections to the bill.
So one tries to find answers. And one of my sadnesses is that the noble Lord has the sponsor of the bill has so far not. It seemed to me the. The questions which have been put forward by the Royal Colleges, or. Indeed. And I say this to the noble Baroness, or indeed to the committees of this House that have suggested that the fact that this bill is so unclear over so many things is not an acceptable way of legislation that we need to be much more precise and much less vague.
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Now, it may be I will give way to noble Lady. The fact of the matter is that
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The fact of the matter is that many of the things we are discussing in normal medical and social legislation would be social legislation would be contained in codes of practice, and they will certainly need to be they will certainly need to be worked up in great detail in order that some of these issues can be covered, but it is not necessary to covered, but it is not necessary to put them in primary legislation. For example, the carting of medication around between a pharmacy and the doctors, that is in a code of practice, which is quite straightforward and that needs to be done in detail.
I agree, so that practitioners who are actually implementing the legislation can do it with confidence, and so that it can be monitored. There is no good putting it in primary legislation, which will inevitably change when
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processes change, habits change. That may well be the view of the
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That may well be the view of the noble Lady, but it is not the view of the royal, the Royal Colleges, and it is not the view of the and it is not the view of the select committees that have looked at this of this House. So it is perfectly reasonable for me to perfectly reasonable for me to suggest that there is an alternative, and I am suggesting an alternative to the lady, the noble alternative to the lady, the noble Lady, and I am still sorry that she should think that the word nitpicking was a suitable phrase to use to people who have spent their lives working on these issues, and are trying to find answers to meet the problems which have clearly been raised by this bill, and most of us who have views on this subject have been extremely careful in the language that we've used and have respected the views of those with whom we are fundamentally disagreed, but we have done so with great care.
So may I explain why I think we should consider these amendments very carefully? I am not expert enough to say that this bit or that bit is the right answer to this, but what I think we do have to say is that this is precisely the kind of information which ought to be in the bill, and which is not in the bill. This is the sort of answers which most people who are expert in this matter and have given evidence to the various select committees have asked for it, should not have been needed as an amendment.
It should have been presented by the Noble and learned, Lord Moore and those who are putting forward this bill, because we need to know this before we vote for it, not afterwards. And that is the problem which the noble Baroness is avoiding. What we're being asked to do is to pass a bill and then leave so much to things that we have absolutely no knowledge of how that will be done. There is a second reason why it is important to take very seriously these amendments, and it is the relationship between patient and doctor.
Now, my one expertise is, having spent nearly 40 years as a Member of Parliament representing constituency, and it's all very well for those who are perhaps removed from the generality of the population. But one of the things you learn in your weekly surgery and going round your constituency, is the degree of fear that people have about doctors and hospitals. It just when you do this work, and I think anyone who is is concerned from a pastoral point of view, here is a non-religious element for bishops and for Ministers of all sorts know very well that this is a fundamental fact that you find everywhere.
Now, one of the problems, even for those who are in favour of the principle of this bill, is that it does increase the fear among many people, and therefore ensuring that there is a service which is separate, clearly separate, unconnected in any but necessary connection to which the noble Baroness has pointed us with the care that has taken place is hugely important, and I will return now to the reason why I rose, because it wasn't just the phrase nitpicking that the noble Baroness mentioned, but it was her belief that assisted suicide is part of palliative care.
What she said was that that is the fundamental wrongness of this proposal, because if you say that, then you are saying to people, if you put yourself in the hands of doctors, they will be thinking of palliative care, which includes this. That is not palliative care. Of course, nearly 50% of the people who hear about assisted dying think that assisted dying refers to palliative care, but they don't mean by palliative care that you are, in fact, inviting the opportunity to kill yourself.
They see that as a wholly separate thing. And all that I am saying is that if we want to protect people in general, we have to be quite clear that palliative care, looking after people in the very best way that we can in the most difficult time of their life, is utterly separate from the idea that they can instead decide to kill themselves. Now, it is perfectly reasonable for some people to want to have that choice, but it must be a distinct choice.
It must not be mixed up. Now, there is a third reason for that. The thing that I. I don't normally lose my temper, but I did last week when over lunch, I discovered that my local health authority had removed. I think it was £176,000 from Marie Curie, which meant that they were then unable to provide overnight care for people in real difficulty. That reminds me of the fundamental issue that we face, which is where do we put our resources? We must not confuse assisted suicide with palliative care.
We must ask ourselves if we have limited resources, what is the argument for spending about 40% of the cost of hospices and 100% of the cost of assisted dying? How does one put those two things together morally, leave alone practically? But even if you are prepared to say that this is such a priority that you can spend £31 million on it, even if you're prepared to do that, the one thing you have to have is a clear distinction between those choices.
And I must thank the Baroness for what she said, because what she has revealed is what we've always feared, which is that this would become a cheap alternative to looking after people. I will in a moment. I will in a moment, I will in a moment. But I wish to send my sentence order a cheap alternative to being a society that cares for people right to the end of their lives. And I do know what sort of society I want to live in.
I want to live in a society that looks after the most vulnerable, at the most vulnerable time. And if they are to be given that alternative, it clearly is unconnected with the fundamental moral duty of a society,
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which is to look after those who can't look after themselves. Here. The noble Lord, before he sits.
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The noble Lord, before he sits. Down, how are we looking after the most vulnerable, at the most the most vulnerable, at the most vulnerable time of their life? If we isolate them from those who have given them care in the most given them care in the most difficult time of the life, when proposal.
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proposal. Here is not isolating them in all the things that matter. It's doing something quite different. It's saying that those who are looking after them continue to look after them and give the information that is necessary for those who are going to make judgements, to make those judgements. It is making a distinction between care, which it's the people we're talking about and a decision about life and death, which should not be made by the people who are looking after them, but the information that those people are looking after them should be provided for those who
So one tries to find answers. And one of my sadnesses is that the noble Lord has the sponsor of the bill has so far not. It seemed to me the. The questions which have been put forward by the Royal Colleges, or. Indeed. And I say this to the noble Baroness, or indeed to the committees of this House that have suggested that the fact that this bill is so unclear over so many things is not an acceptable way of legislation that we need to be much more precise and much less vague.
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Now, it may be I will give way to noble Lady. The fact of the matter is that
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The fact of the matter is that many of the things we are discussing in normal medical and social legislation would be social legislation would be contained in codes of practice, and they will certainly need to be they will certainly need to be worked up in great detail in order that some of these issues can be covered, but it is not necessary to covered, but it is not necessary to put them in primary legislation. For example, the carting of medication around between a pharmacy and the doctors, that is in a code of practice, which is quite straightforward and that needs to be done in detail.
I agree, so that practitioners who are actually implementing the legislation can do it with confidence, and so that it can be monitored. There is no good putting it in primary legislation, which will inevitably change when
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processes change, habits change. That may well be the view of the
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That may well be the view of the noble Lady, but it is not the view of the royal, the Royal Colleges, and it is not the view of the and it is not the view of the select committees that have looked at this of this House. So it is perfectly reasonable for me to perfectly reasonable for me to suggest that there is an alternative, and I am suggesting an alternative to the lady, the noble alternative to the lady, the noble Lady, and I am still sorry that she should think that the word nitpicking was a suitable phrase to use to people who have spent their lives working on these issues, and are trying to find answers to meet the problems which have clearly been raised by this bill, and most of us who have views on this subject have been extremely careful in the language that we've used and have respected the views of those with whom we are fundamentally disagreed, but we have done so with great care.
So may I explain why I think we should consider these amendments very carefully? I am not expert enough to say that this bit or that bit is the right answer to this, but what I think we do have to say is that this is precisely the kind of information which ought to be in the bill, and which is not in the bill. This is the sort of answers which most people who are expert in this matter and have given evidence to the various select committees have asked for it, should not have been needed as an amendment.
It should have been presented by the Noble and learned, Lord Moore and those who are putting forward this bill, because we need to know this before we vote for it, not afterwards. And that is the problem which the noble Baroness is avoiding. What we're being asked to do is to pass a bill and then leave so much to things that we have absolutely no knowledge of how that will be done. There is a second reason why it is important to take very seriously these amendments, and it is the relationship between patient and doctor.
Now, my one expertise is, having spent nearly 40 years as a Member of Parliament representing constituency, and it's all very well for those who are perhaps removed from the generality of the population. But one of the things you learn in your weekly surgery and going round your constituency, is the degree of fear that people have about doctors and hospitals. It just when you do this work, and I think anyone who is is concerned from a pastoral point of view, here is a non-religious element for bishops and for Ministers of all sorts know very well that this is a fundamental fact that you find everywhere.
Now, one of the problems, even for those who are in favour of the principle of this bill, is that it does increase the fear among many people, and therefore ensuring that there is a service which is separate, clearly separate, unconnected in any but necessary connection to which the noble Baroness has pointed us with the care that has taken place is hugely important, and I will return now to the reason why I rose, because it wasn't just the phrase nitpicking that the noble Baroness mentioned, but it was her belief that assisted suicide is part of palliative care.
What she said was that that is the fundamental wrongness of this proposal, because if you say that, then you are saying to people, if you put yourself in the hands of doctors, they will be thinking of palliative care, which includes this. That is not palliative care. Of course, nearly 50% of the people who hear about assisted dying think that assisted dying refers to palliative care, but they don't mean by palliative care that you are, in fact, inviting the opportunity to kill yourself.
They see that as a wholly separate thing. And all that I am saying is that if we want to protect people in general, we have to be quite clear that palliative care, looking after people in the very best way that we can in the most difficult time of their life, is utterly separate from the idea that they can instead decide to kill themselves. Now, it is perfectly reasonable for some people to want to have that choice, but it must be a distinct choice.
It must not be mixed up. Now, there is a third reason for that. The thing that I. I don't normally lose my temper, but I did last week when over lunch, I discovered that my local health authority had removed. I think it was £176,000 from Marie Curie, which meant that they were then unable to provide overnight care for people in real difficulty. That reminds me of the fundamental issue that we face, which is where do we put our resources? We must not confuse assisted suicide with palliative care.
We must ask ourselves if we have limited resources, what is the argument for spending about 40% of the cost of hospices and 100% of the cost of assisted dying? How does one put those two things together morally, leave alone practically? But even if you are prepared to say that this is such a priority that you can spend £31 million on it, even if you're prepared to do that, the one thing you have to have is a clear distinction between those choices.
And I must thank the Baroness for what she said, because what she has revealed is what we've always feared, which is that this would become a cheap alternative to looking after people. I will in a moment. I will in a moment, I will in a moment. But I wish to send my sentence order a cheap alternative to being a society that cares for people right to the end of their lives. And I do know what sort of society I want to live in.
I want to live in a society that looks after the most vulnerable, at the most vulnerable time. And if they are to be given that alternative, it clearly is unconnected with the fundamental moral duty of a society,
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which is to look after those who can't look after themselves. Here. The noble Lord, before he sits.
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The noble Lord, before he sits. Down, how are we looking after the most vulnerable, at the most the most vulnerable, at the most vulnerable time of their life? If we isolate them from those who have given them care in the most given them care in the most difficult time of the life, when proposal.
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proposal. Here is not isolating them in all the things that matter. It's doing something quite different. It's saying that those who are looking after them continue to look after them and give the information that is necessary for those who are going to make judgements, to make those judgements. It is making a distinction between care, which it's the people we're talking about and a decision about life and death, which should not be made by the people who are looking after them, but the information that those people are looking after them should be provided for those who