Baroness Fraser of Craigmaddie
Main Page: Baroness Fraser of Craigmaddie (Conservative - Life peer)Terminally Ill Adults (End of Life) Bill
Baroness Fraser of Craigmaddie Excerpts(1 day, 10 hours ago)
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“(6) The Secretary of State must by regulations—(a) establish a register of registered medical professionals who are willing and able to conduct preliminary discussions under subsection (3);(b) make provision for the process by which this register is updated and publicly available.(7) A registered medical practitioner may only conduct the preliminary discussion under subsection (3) if they are entered in the register.(8) Registered medical professionals who are unwilling or unable to conduct preliminary discussion are not required to join the register under subsection (6).(9) A registered medical practitioner who is unwilling or unable to conduct the preliminary discussion mentioned under subsection (3) must refer the person to the register of medical professionals.”
Baroness Fraser of Craigmaddie (Con)
My Lords, this group of amendments seeks to establish an opt-in model for healthcare professionals, as explicitly requested by the various royal colleges, including the Royal College of General Practitioners, the Royal College of Psychiatrists, the Royal Pharmaceutical Society and the Royal College of Nursing. They seek to protect doctors and all other healthcare professionals, not just with a vague formal right to opt out but with a framework in which their rights are clear.
My Amendment 189—supported by the noble Lord, Lord Carlile, and the noble Baroness, Lady O’Loan, to whom I give many thanks—seeks to strengthen transparency in relation to medical practitioners involved in delivering an assisted dying service by setting up a publicly available register of medical professionals who are willing and able to conduct preliminary discussions. While its sponsors have confirmed that the Bill is based on an opt-in system, it is imperative that this opt-in is explicitly referred to in the Bill, to ensure that participation is a positive choice and to avoid it being presumed or open to pressure that all professionals would participate unless they opted out.
Clause 5(6) says that if a doctor is unable or unwilling to participate,
“they must ensure the person is directed to where they can obtain information and have the preliminary discussion”.
But where should that be? Would not a publicly available register be the perfect solution for the patient to seek out a medical professional on the register at their convenience?
The noble and learned Lord’s Amendments 422 and 423 leave it to the Secretary of State to make provisions through regulation at some later date. Amendment 669A covers only co-ordinating and independent doctors and adds an opt-in option only for providing or participating in training. This is not good enough. I am sure the noble and learned Lord will also refer to this matter in his reply to amendments on Clause 31, which I appreciate was expanded in the other place on Report. However, serious gaps remain. Schedule 3 may indeed provide for protection against detriment by incorporating existing employment rights, but this does not resolve the issue because it leaves individuals to resort to the tribunal system, a system that is already crowded and where the remedy is damages, not rehiring, thereby potentially forcing individuals to choose between their conscience and their career.
We know that not all medical practitioners will want to participate in assisted dying. Some 45% of doctors in the BMA’s 2020 study indicated they would not be willing to participate, with a further 19% undecided. It is my belief that a clear and public register of those professionals who wish to participate would enhance transparency and enable everyone to know where they stood. Amendment 189 would require the Secretary of State to set up such a register, ensure there is a process to keep it updated and make it publicly available. A medical practitioner could conduct preliminary discussions only if they were entered in the register.
Concerns have been expressed that assisted dying will for ever change the doctor-patient relationship. Vulnerable patients would not be able to trust that clinicians had their best interests at heart. Such concerns illustrate the importance of ascertaining whether assisted dying is to be considered a treatment, which Amendments 383 and 657, in the names of the noble Baronesses, Lady Cass and Lady Fox, respectively, explore. However, with Amendment 189, patients would know whether their GP was a willing participant, whether or not they wished to avail themselves of assisted dying and, presumably, they could choose or not choose to register with such a practice. Patients would also know if their consultant or other medical professional had opted in, thus providing a context for, say, discussions around future options. The amendment would also protect clinicians, who could point to the register if they wished to have nothing to do with assisted dying.
The BMA has advised that it is against the reintroduction of a requirement on doctors to refer patients, which would undo a change from “refer” to “direct” made in the other place, but I understand that not all royal colleges are at one on this point. I take the point that proposed subsection (9) in my amendment reads that a professional who is
“unwilling or unable to conduct the preliminary discussion … must refer the person to the register of medical professionals”,
and I know that the BMA attached a specific meaning to “refer”. As I am sure the Minister will tell me in her reply, my amendment has not had the advantage of technical support in its drafting. Frankly, if the BMA would prefer “direct”, I would be perfectly happy with that. But even if we removed subsection (9) in my amendment, the point remains, which is to set up a publicly available register for those who want to opt in. Such a register also has the advantage of being able to be tracked. We could review whether certain areas of the country were being better or worse served. We could monitor the practice of doctors on the register to track concerns of doctor shopping. We could analyse which professionals or specialisms are or are not participating in assisted dying. All this would assist with the regulation of assisted dying.
Baroness Fraser of Craigmaddie (Con)
My Lords, I thank all noble Lords for this extremely interesting and long debate. I do not think I can possibly sum up in any better way than the noble and learned Baroness, Lady Scotland, did. I felt that she summed up brilliantly the issues that have been raised over the last three and a half hours.
I will come back to the noble and learned Lord, the sponsor. He posed four responses. First, we all seem to be coalescing around the idea that the Bill should contain an opt-in, and he has given us Amendment 669A as his response. The mood of the Committee, if I may say so, is that that is not sufficient, and the mood of the royal colleges seems to be the same.
The second point was: is it wide enough? The resounding answer seems to be no. I am sorry, I always come back to practicalities in this Bill; although it is fine to refer to the clauses, it is about what is actually going to happen—how are people going to take these words and implement them? How would you say no? I am thinking about a busy ward where an assisted dying request is in process but someone does not want to participate. They might fear that speaking up at that point might be seen as obstructive or harm their chances of promotion. They might not have the confidence to speak up to their superiors, which would not be a healthy work dynamic. There is nothing in the Bill that allows that person to say, “I didn’t opt in to this”. An opt-in system would make it all agreed. Things would be known about before there was a crisis, people would have the right to change their minds and there would be a mechanism to do so. I am afraid that is where Amendment 669A fails, because how can you opt out later? Where is the provision for that?