Terminally Ill Adults (End of Life) Bill

Allison Gardner Excerpts

Friday 13th June 2025 Commons Chamber

[John Glen]

I have been very clear that I have tabled my amendments in a constructive way to reflect the will that the hon. Lady has expressed, but to recognise the meaningful dilution in the authority of the process and what can reasonably be amended to invigorate it, based on the principles that I think were intended at the outset.

I will revert to the point I was making about the judiciary. They have a commitment to uphold the law, and that should be the standard we are looking for when it comes to matters of life and death. The Judicial Appointments Commission already conducts appointments for all tribunals, including lay members. The Government’s impact assessment compared the panel to the mental health tribunal. All appointments to the mental health tribunal, including the non-legal members, are made by the Judicial Appointments Commission, so this would not be a novel function for it.

Let me move on to amendment 85, which would ensure that all members of the panel have to take the judicial oath if they have not done so already. If other amendments pass, amendment 85 would be necessary only for the non-legal members, and it is crucial for public confidence that the judicial oath is taken.

Amendments 83 and 84 seek to preserve an important element of the Bill as originally presented to the House. They would ensure that the most senior decision-making figure, the chair of the panel, is a High Court judge with all the experience, responsibility and professionalism that that implies. Under these amendments, all High Court judges would be automatically eligible. They would need to be currently serving or at least be below retirement age, and would have to be a judge of the highest authority and not a deputy judge. Members of this House and the public were originally told that this would be a safe Bill precisely because it would have a High Court judge. That was a persuasive promise, and I think there is a way to honour it, even in the new version of the Bill.

I will briefly mention the retirement age, because it is important. It used to be 70, but judges can now continue until they are 75. However, there is no age limit for members of the panel. If we are saying that an 80-year-old retired judge is still with it and is able to decide on matters of life and death, why are they too old to help clear the backlog of criminal cases? That seems to be a meaningful anomaly.

I have been very clear about the purpose of my amendments. I have tabled them in the spirit of trying to strengthen the Bill and return it to what was intended, so that it can meet the expectations of so many Members who supported it at an earlier point.

[Dr Allison Gardner (Stoke-on-Trent South) (Lab)]

I rise to support a number of new clauses and amendments to the Bill. The common thread running through all of them is a need to address some of the gaps in the safeguards and oversight. Should the Bill pass, I at least want to ensure that we improve its protections and remove some of the risks that it contains.

New clause 4 requires the chief medical officer to monitor the operation of the legislation, rather than depending solely on the assisted dying commissioner. Alongside the requirement for a High Court judge, oversight by the CMO was removed during the Committee stage. This means that, essentially, the assisted dying commissioner would mark their own homework. New clause 4 returns the safeguard of independent oversight, which is sensible given the significant concerns expressed by many experts and organisations, which were often neutral on the principle, but concerned about the Bill. They include the Royal College of Psychiatrists, the Association for Palliative Medicine, the British Geriatrics Society, the Royal College of Physicians and many experts such as Professor James Monckton Smith, a leading criminologist, Baroness Finlay, Parliament’s leading expert on palliative care, Sir David Haslam, former head of the British Medical Association and of the National Institute for Health and Care Excellence—my previous employer—and many more. All have expressed concerns, even when neutral on the principle of the adequacy of the Bill.

Hence new clause 4 requires an annual report to include

“information about the application of the Act in relation to—

persons who have protected characteristics, and

any other description of persons specified in regulations made by the Secretary of State.”

I fervently hope that that includes domestic violence victims.

Amendment 13 very sensibly adds the requirement that the commissioner appointment is not the sole remit of the Prime Minister at the time, by requiring the consent of the Health and Social Care Committee. This provides a safeguard against ideological and politically motivated appointments, and I would be very critical of anyone who would want to prevent that.

Amendment 15 addresses the significant concerns about the involvement of private—for profit—providers of assisted dying. There are concerns that, when there is a commercial relationship between providers, there will be a gaming of the system. That risks compromising the relationship between the co-ordinating doctor and the independent doctor. Likewise, the existence of such providers does not allay concerns about doctor shopping, as was raised in the previous debate. Hence amendment 15 will require private providers to be transparent and provide reports on service members, service numbers, costs and revenue.

In previous debates and in the public discourse I have found it very disconcerting that, in response to legitimate concerns, all that we have been offered—as we have seen today—are some promised, unspecified future regulations that will fix the gap—[Hon. Members: “Hear, hear!”]

[Naz Shah]

My hon. Friend is making a powerful point. Does she share my concern that most of our discussions today were thrashed out in Committee, and now we are being told that we have to leave them to the Lords, because we cannot fix the issues here? That is a really flawed process.

[Dr Gardner]

I entirely agree with my hon. Friend.

To expect MPs to improve the Bill without clarity as to what the regulations are or what they will be, and how the service will be delivered without rigorous regulatory oversight is fundamentally wrong.

Furthermore, the fact that the implementation of the Bill will be automatic in 2029—a general election year, incidentally—is not realistic when reflecting on the many areas that still lack detail. Hence I support amendment 42, proposed by my hon. Friend the Member for Newcastle-under-Lyme (Adam Jogee), which allows the Secretary of State to determine the appropriate date for the Bill to be implemented. This would allow time to make the NHS fit for purpose, to strengthen palliative care, and for Parliament to draft and scrutinise adequate regulations without being rushed.

Similarly, but fundamental to the society in which we live, amendment 12 protects the status of our most dear institution, the NHS. The Bill before us provides Henry VIII powers to amend the National Health Service Act 2006 without limit, which could include a specification of charges. If, as Labour MPs, we are committed to the NHS remaining free at the point of use, then amendment 12 is vital, as it will require any changes to the 2006 Act to be made by an Act of Parliament. The future is uncertain. We must build safeguards in the Bill to protect us from measures that fundamentally alter the fabric of our society.

Briefly, amendment 27 requires the MHRA to license the drugs used for assisted dying. Research has shown that painful and protracted deaths via assisted dying drugs are not uncommon, with deaths ranging from three minutes to 137 hours—nearly a week— with up to eight hours to lose consciousness. Furthermore, serious side effects disproportionately affect younger people. Amendment 27 will help to ensure the safety and efficacy of these substances.

I will close by quoting Sir David Haslam on how we balance some of the individual stories used on both sides of the debate with the good of society. As we know, NICE has to make the difficult decision to approve or not approve medications and treatments based on a cost and clinical effectiveness model. It is experienced in weighing up societal good—[Interruption.] I will be quick, Madam Deputy Speaker—versus the needs and wishes of individuals.