Terminally Ill Adults (End of Life) Bill

Debate between Lord Carlile of Berriew and Lord Falconer of Thoroton
Lord Falconer of Thoroton Portrait Lord Falconer of Thoroton (Lab)
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The noble Lord makes a good point: how do you, in dealing with a wide range of cultures, establish that it is the informed wish of the individual that they want an assisted death? You cannot prescribe in a Bill how you would do it in every case, but there is absolutely no doubt, as far as the Bill is concerned, that the establishment of that informed wish is the basic foundation before you get there. Therefore, in each case, if it involves a different culture or a different language, that must be gone through before you can be satisfied.

Lord Carter of Haslemere Portrait Lord Carter of Haslemere (CB)
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I am very grateful to the noble and learned Lord for his explanation of informed consent. There is a little doubt as to whether giving people lots of information, leading to an informed wish, actually encapsulates them fully understanding it. I was wondering: is the answer to this not to put in a definition of informed consent? Would that not be sensible? Then it is there in black and white. I have it here—AI is very helpful sometimes, is it not? “Informed consent is a process where a person voluntarily agrees to medical treatment, research, or a procedure after receiving and understanding all relevant information, including risks, benefits, alternatives and consequences, and they have a capacity to decide and are free from pressure”. There is a beautiful little definition that you could put straight into the definition section, and everyone would be happy.

Lord Falconer of Thoroton Portrait Lord Falconer of Thoroton (Lab)
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I thought carefully about that. The language concerns whether it is the person’s clear, settled and informed wish. Interestingly, the law—the Supreme Court—over a period of years constantly changes what in individual cases informed consent, or informed wish, as it is in the Bill, might be. The essence of the word “informed” is that you have enough material to make the decision. I hear what the noble Lord, Lord Carter, says, and I see what AI says about it, but I think it is better just to say, “informed wish”.

Lord Carlile of Berriew Portrait Lord Carlile of Berriew (CB)
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I apologise to the noble Lord, Lord Carter; I did not see him behind me. The noble and learned Lord, Lord Falconer, has been using the phrase “informed consent”—

Lord Falconer of Thoroton Portrait Lord Falconer of Thoroton (Lab)
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“Informed wish” is in the language of the Bill.

Lord Carlile of Berriew Portrait Lord Carlile of Berriew (CB)
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The noble and learned Lord has been using the phrases “informed consent” and “informed wish” as though they are definitely synonyms. I just wonder why we do not se “consent” with “informed” next to it in the Bill because, as the noble and learned Lord has let slip, informed consent is a well-understood concept. Putting it in the Bill would take away most of the doubts that some of us have expressed. What is the problem?

Lord Falconer of Thoroton Portrait Lord Falconer of Thoroton (Lab)
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The format of the Bill asks: “Is it your wish to receive assistance?” It has to be an informed wish. It seems to me that there is no need to add in another concept—that of informed consent —when we have “informed wish”, which is perfectly adequate.

Terminally Ill Adults (End of Life) Bill

Debate between Lord Carlile of Berriew and Lord Falconer of Thoroton
Lord Carlile of Berriew Portrait Lord Carlile of Berriew (CB)
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I do not want to take up unnecessary time, but the purpose of the judges’ role is to receive the evidence relevant to the issue under consideration. There are many tribunals, such as mental health tribunals, on which doctors serve, but in my view and that of many, where critical issues are being considered, a more satisfactory process, on the whole, is for the judge to hear the evidence and adjudicate on it. To pick up a point made by the noble Lord, Lord Hamilton, as the noble and learned Lord knows, judges are perfectly capable of rejecting medical evidence that is put before them and do so with reasonable frequency.

Lord Falconer of Thoroton Portrait Lord Falconer of Thoroton (Lab)
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I take that to be a yes. The position the noble Lord is proposing is that the judge hears the evidence of the doctors on issues, for example, of coercion, capacity and firm and settled view, and then makes the decision. The comparison we have is between what is in the Bill—two doctors each forming a view on the terminal illness decision and the issues of capacity and whether the person has reached a voluntary decision as to whether to have an assisted death, and the panel either endorsing it by giving the certificate or rejecting it—and, as the noble Lord is suggesting, letting the court in effect decide the whole thing. I reject that view because I am absolutely satisfied, although I accept that this issue requires a lot of work and thinking about, that you are much better off having a multidisciplinary approach to somebody making an assisted death decision. It is much better to let the social worker, the psychiatrist, the doctor and the legally qualified person look at the situation and then decide whether somebody should make that decision on assisted death.

The evidence given in Committee—

--- Later in debate ---
Lord Falconer of Thoroton Portrait Lord Falconer of Thoroton (Lab)
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Can I answer what the noble Lord, Lord Taylor, whom I greatly respect, has said? I have answered in some degree of detail the main substantive points and I believe that I have dealt with them in a way that is appropriate for Committee. One of the things that one has to do in Committee is focus on the things that really matter and avoid the other things—that is what I have done. I am open to anybody coming to see me. I started this process by writing to individual Peers to say, “Come and see me to raise anything you’ve got.” If there is anything that they want to talk about, I am more than willing to talk about it. However, I very much believe that I have answered in detail the substantive application made for an amendment.

Lord Carlile of Berriew Portrait Lord Carlile of Berriew (CB)
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My Lords, I am very grateful to everybody who has taken part in this debate. I hope your Lordships would agree that, although this debate has taken over three hours, it has been conducted in precisely the spirit that was discussed in the short debate yesterday and that it has justified taking that time. I said yesterday that I thought we should move more quickly in this process and I believe we will be able to do so in the future. This has been an example of doing so on a very important subject.

May I express my grateful thanks to both Front Benches for the way in which they summarised their particular interests in this debate? I thought both were extremely helpful. For those who have seen my noble kinswoman, the Minister, during the year she has been here, I think they will be reassured and understand that she is perfectly capable of erecting Chinese walls that put the Great Wall of China to shame.

A point that particularly caught my attention was made by my noble friend Lord Empey. He happens to be a very valued member of a Select Committee of this House that I chair and I can confirm that he is an expert in labyrinths. He is an expert in finding his way out of labyrinths and it is just possible that, from time to time, he is quite good at making labyrinths longer— I hope he takes that in good heart. He raised a question about whether, as he put it, there should be a “special chamber”. It occurs to me that, given that the purpose of my amendments is to ensure that this is a judicial process that falls into our judicial architecture, there may be room for the sort of discussion that we talked about in yesterday’s debate with the noble and learned Lord, Lord Falconer. One might be able to find a hybrid form of what the noble Lord, Lord Empey, and I have proposed that falls within the legal, judicial architecture.