Baroness Lawlor
Main Page: Baroness Lawlor (Conservative - Life peer)(1 day, 8 hours ago)
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Lord Harries of Pentregarth (CB)
My Lords, it has been a privilege to listen and learn and to try to clarify my mind regarding the various amendments. I wish that some of our critics in the press had been here this morning, because the amendments today go to the very heart of the Bill and we have had the opportunity of hearing from people on different sides of real expertise, including the noble Baronesses, Lady Gerada, Lady Hollins, Lady O’Loan and Lady Finlay. It has been a huge privilege for those of us who are not medical experts to be able to clarify our minds on this issue.
I hope the noble and learned Lord will be able to address the points made by the noble Baroness, Lady Cass. She made points I had not heard before, and I do not know whether he had. She claimed that the Bill as drafted is not actually workable, and I very much hope he will be able to address that point.
I shall say three things. First, the noble Baroness, Lady Andrews, suggested that the things we are talking about today should be left to the medical professions to regulate. However, what we have been debating today—whether we should have a public register or whether we should simply have an opt-out clause, which everyone agrees with, of course—is not just simply a detailed regulation, with due respect; it goes to the heart of the Bill and Parliament has to make its mind up about it.
Secondly, towards the end of her speech, the noble Baroness, Lady Gerada, who we listened to with great respect, mentioned the well-known fact that a number of doctors, when patients come to the end of their life, give very large doses of painkiller, which has the effect of shortening the patient’s life. From an ethical point of view, there is a fundamental difference, depending on whether one is a utilitarian or a consequentialist on the one hand, or whether one believes that certain things are fundamentally wrong. This has been mentioned two or three times in the debates over recent years. For the ethical tradition that is this country’s base, particularly for the medical profession, there is a fundamental difference between administering a poison to kill someone and administering a large dose of painkilling drugs that has the foreseen effect of also shortening their lives, which from a moral point of view is entirely legitimate.
Lastly, on the question of language—this has been mentioned before—I say to the noble Baroness, Lady Watkins, that many of us do not like to confuse what we are debating with assisted dying. However, we also respect what the noble Baroness says—that the language of suicide is unpleasant and really not appropriate. Personally, I like to use language that is as neutral as possible and talk about people taking their own life, which seems to me as neutral a language as we can get on this.
Baroness Lawlor (Con)
My Lords, I would like to introduce my Amendment 664. It is designed to ensure not only that no medical professional is obliged to participate in such training but that, in order to do so, the medical professional must give written consent. Professional training aims to show students not only how to apply their academic knowledge in practice but how to approach their role in their chosen profession. The second element has two levels. There is the day-to-day one, as summed up by the Cambridge clinical course under the labels “communication skills” and “patient management”: how, for instance, to deal with a patient who insists, contrary to the evidence, that they have cancer?
However, there is a second, higher level—an induction into the ethos of the profession. This level is of vital importance in training medical professionals, because they are dealing with human beings. Throughout this Committee, one of the most powerful messages has been that each individual is different and that one of the most precious skills of doctors, nurses and other medical professionals is to be sensitive to those differences when applying medical science in a particular case. There is no simple blueprint or checklist to guide them. Rather, they need to be guided by the ethos of the profession into which their training has induced them.
That is a strong reason why this amendment seeks to ensure that the training of health professionals related to assisted suicide needs explicit consent from participants. It implies that training for purposes of the Bill is treated as a separate activity within the course as a whole, requiring consent from the participants, and that there is neither compulsion nor pressure to participate. If assisting suicide or assisting death under this Bill is presented in training as just another element among others of what health professionals do, the ethos will be drastically changed. Instead of one based on supporting the ill, the frail and the elderly, of seeing in every life one worth living and improving health, a new ethos will grow. At first, it will be one of moral equivalence between encouragement and help to live and encouragement and help to die—one in which there is no ethical basis for the profession but everything depends on the apparent preferences of the patient. But soon, I fear, it will develop into something more sinister—an ethos in which medical professionals are servants of the state, deciding for the common good, as they believe, who is to live and who is to die.
A second reason for this amendment is the freedom of conscience of medical and other healthcare professionals.
Baroness Lawlor (Con)
I am just finishing. I will not take interventions.
A second reason for the amendment, which would require written opt-in for training for medical and other health and care professionals, is that to many—not just in this House but in society as a whole—assisting suicide is deeply immoral and it would be obnoxious to have to train in practising it.
Baroness Whitaker (Lab)
May I check that I have understood the noble Baroness correctly? When she said that the patient’s preference should not prevail if they wanted an assisted death but that the doctor should decide, does she mean that the doctor knows best? Is that what she meant?
Baroness Lawlor (Con)
I thank the noble Baroness for this. I am talking about medical professionals, and I am also talking about the moral equivalence. Can she remind me where I exactly said that?
Baroness Smith of Newnham (LD)
My Lords, I will very briefly speak to Amendment 657 in the name of the noble Baroness, Lady Fox, to which I have added my name, to support the amendments in the name of my noble friend Lady Finlay— Amendments 268, 359, 617—and the amendment in the name of the noble Baroness, Lady Cass. In particular, I think that the amendment from the noble Baroness, Lady Cass, in many ways picks up the issue highlighted in Amendment 657 —to make it explicit that an assisted death should not be seen as a form of treatment. I think that was implicit in what the noble and right reverend Lord, Lord Harries, said.
Baroness Cass (CB)
They would; that is the point of it. Your co-ordinating professional, as I described them, would be with you throughout, as would the specialist assisted dying doctor, from the time you started engaging with them. You might want to check in with one or the other, depending on whether you wanted your symptoms addressed or another discussion about what the process of having an assisted death would be like.
Baroness Lawlor (Con)
May I check something regarding my Amendment 664? Given that the noble and learned Lord insists that no person will be under any duty to perform or provide for an act under this measure, will that apply to participation in training, since training is not a duty to do something?
Lord Falconer of Thoroton (Lab)
You have to opt in to training in consequence of my amendment. Therefore, there can be no duty to participate. I do not think it is necessary to say that in the Bill.
The noble Lord, Lord McCrea, who is not in his place, raised the point about care homes, hospices and other institutions. Along with the sponsor of the Bill in the Commons, I have had considerable conversations with Hospice UK. Its anxiety is that if it says “no”, institutionally, to assisted dying, that could affect in various ways its entitlement to funding, particularly from the state. I am alive to that concern, and we should deal with it in the Bill; I have been working on trying to do that. I should make it clear that this is limited to hospices only. We are looking at that area, and once we have done so, it may be limited to private—not NHS—hospices. It requires work, but the point made has validity in relation to hospices but not care homes.
Lord Falconer of Thoroton (Lab)
If the position is that if you are on the roster, there is a risk that you will be in the room and assisting in relation to the provision of assisted dying, of course it would be sensible not to be rostered on that day. That is the sort of solution that I hope that people would be looking for.
Baroness Lawlor (Con)
The noble and learned Lord’s Amendment 669A refers to Sections 8(7), 11(9) and 26(2), but that is only for medical practitioners, it is not for other medical professionals. It is for that reason I tabled my Amendment 664, so that anybody had to opt in to training for this, not just the medical practitioners, which I am very glad to see the noble and learned Lord’s amendment accepts. It is the others.
Lord Falconer of Thoroton (Lab)
The noble Baroness is right that the opt-in provision that I have introduced is in relation only to the doctors. That is because it is the doctors who are given the particular role under the Bill. This says that you need to be trained before you can do particular functions under the Bill. That is why there needs to be an opt-in.
Equally, in relation to others, there is a no-detriment clause if you say you will not participate; and depending on who you are, you can participate if you are any person not in the provision of the assistance. As you go wider, you have wider protections if you are, for example, a doctor or a healthcare professional.
Baroness Lawlor (Con)
Somebody who is employed by an agency, or an agency nurse, may not have the whole provision of the text in front of them, and they may not be encouraged to look into the exemptions for conscientious or other reasons about which we have heard. It is for that reason, if it is on the face of the Bill, that anybody involved in the medical or social care of frail people should know that they are entitled under law to opt out of such training.
Lord Falconer of Thoroton (Lab)
I think we know the differences between us. I have set out what my position is. I am grateful to the noble Baroness for setting out hers again.
Baroness Grey-Thompson (CB)
My Lords, I have 12 amendments in this group, and I am going to speak also to Amendment 241, which is in the next group but which probably fits better in this one, because it is about the time period for recording information.
The words “as soon as possible” appear eight times in this Bill in relation to the recording of information. I believe that that is a little too vague; it feels like a non-binding term without a strict or official definition. It makes me think of the parliamentary term “soon”, often used by Ministers to suggest something may be coming soon—next week, next month or possibly never.
I think about this process in what might be a busy hospital. It is important not only to gather data correctly but to record it accurately and at pace. The lack of a precise timeframe makes it feel as though we are giving busy staff too much flexibility, which might end with it slipping down the list of things that they need to do when there is a lot of call on their time. It is about providing and recording information that can be open to scrutiny, but the phrase could be used to deflect an immediate challenge or an urgent question, and cannot be followed up in an appropriate way.
On my Amendment 214, I expect there to be some pushback and to be told that I am being overly prescriptive. However, it is important to understand why the person wants to enter this process and whether there are other events, family issues or anything else that could possibly impact it, such as a lack of health and social care. I have other amendments on support, which have been discussed in other groups.
Amendment 214A is about having a witness present—someone who can record the conversation. My noble friend Lady Cass in the earlier group talked about the importance of having a person there; someone who can watch facial expressions, take the mood of the room and possibly look out for coercion. That would allow those doing the initial recording to actually listen to what the person is saying, rather than necessarily having to record every part of the conversation. Amendments 217 and 218 are about recording in a timely manner.
Amendments 562, 563 and 564 are about how we record the cancellation of the process. I was interested in the amendment proposed by the noble Lord, Lord Wolfson of Tredegar, which looked at recording the cancellation immediately. That is a better version than the one that I proposed. If someone decides to stop the process, everybody needs to know that straightaway, rather than something getting lost in reporting or a medical practitioner or a doctor assuming that the person still wants assisted dying.
It is also important to record how many times somebody may have entered and dropped out of the process, which is covered in another group. That would check that someone is not being guided by mental health issues, suicide ideation or pressure. These things are important. We need a minimum standard, and doctors and patients need to know what to expect from each other. When the Delegated Powers and Regulatory Reform Committee looked at the Bill, it said that it lacked definition and that there was lots of unknown information being recorded.
We also have to think about non-compliance. I have read the Bill many times, and there is not enough in it about what happens if this information is not reported correctly. In Oregon—which has been mentioned many times—we know that around 70% of information is not recorded in the paperwork, so we do not know if people are having a good death or not. The Delegated Powers and Regulatory Reform Committee recommended that the Bill needed amendment. The timely reporting of information avoids any sanitation of the notes. It is very easy to forget—I do all the time. I scribble notes and come back to them, even just a day later, and cannot necessarily read what I have written. So this is crucial to how the process will work.
Proper recording should also be there to protect the clinician. This is the complication of the Bill. I have 13 amendments that I am talking to. Actually, I am asking for very little change to the Bill, but the Bill has to be amended in so many different ways. This group also fits with the previous group. In another place, the honourable Member for Batley and Spen, Miss Leadbeater, said:
“I agree that, under the provisions of the Bill, the doctor will have a duty to lay out options available to the patient, if they meet the eligibility criteria—absolutely. That is the whole purpose of the Bill”.—[Official Report, Commons, Terminally Ill Adults (End of Life) Bill Committee, 4/3/25; col. 663.]
That is why it is so important that the information is recorded properly.
One of my passholders, Dr David Prosser, is a specialist in forensic psychiatry who works within NHS secure services and His Majesty’s Prison and Probation Service. We have spent a lot of time discussing the Bill: I have been talking to a doctor who could be at the very sharpest end of this. His view is that a doctor has to have very clear criteria against which any assessment is made.
It is also important to achieve operational consistency and quality, because we do not want information being recorded in a different way in different hospitals in different areas. A small business might have to provide more documentation to HMRC than a doctor working in this area. These amendments are not to overcomplicate the process; contemporaneous documentation is really important. This also fits into how the commissioner might oversee compliance with the process if the records are all kept in a different way.
When, in previous groups, we debated face-to-face discussions, the noble and learned Lord, Lord Falconer, said, in that situation:
“It is wrong and dangerous to try to use a phrase such as ‘reasonably practicable’”.—[Official Report, 30/1/26; col. 1214.]
Can the noble and learned Lord therefore explain why it is it okay to use that phrase when we are talking about recording data?
Baroness Lawlor (Con)
My Lords, I will speak to my amendments in this group. They aim to tighten the recording rules in Clause 7 and would make them even tighter than the seven-day limit proposed by the noble Baroness—to whom I am very grateful for her remarks. I propose that, where the discussion is with a practitioner in the patient’s own GP practice, the record of the relevant discussions and assessment is written and saved online on the same day; and that, in other cases, the practitioner must submit the record to the patient’s medical practice, and the commissioner, within a week. My amendments would also require the practice to include this in the patient’s online records. My amendments would impose similarly tight time limits for the submission of the co-ordinating doctor’s assessment.
Speed in recording discussions is of the essence. My experience as a historian, often working with hundreds of documents over a period of a week or even a day in history, suggests speed is important. These are government documents or the private records of officials and politicians. My work suggests that every hour that passes between a conversation and the recording of it brings a loss in accuracy and nuance. In the matter of deciding to take your own life, it is particularly important that the record is as accurate and precise as possible. The same-day requirement should make for greater accuracy, including details that might otherwise be lost if more time elapses. Even insignificant details can turn out to be important.
By contrast, allowing a period of time—the Bill says “as soon as practicable”—will tend to mean that details can be blurred into a general pattern that a doctor may form as a result of having seen a number of patients seeking an assisted death. The individual nature of the case may be lost. A report written up and submitted on the same day is less likely to be affected by hindsight or a desire to tailor the report to ensure that the practitioner will not be held responsible should a breach occur. These amendments in my name leave the medical practitioner the choice of writing a handwritten note at the time or just after the appointment, or keying it later that day into the computer. Although it may be argued that a doctor needs a longer period to see to the paperwork or that the medical practitioner should be allowed more individual choice about how they handle the recording, the obligation for speed and a formal process is imposed by these amendments and is justified, since a person’s life is at stake.
Lord Jackson of Peterborough (Con)
My Lords, I support the amendment in the name of my noble friend Lord Shinkwin and the amendments of my other noble friends, and others. “Verba volant, scripta manent” means “Spoken words fly away, written words remain”. There is a reason that other noble Lords have pressed the issue about the collection of data and how specific it should be. I am going to make a broad reference to the experience in other jurisdictions because, without a record, the preliminary discussion will always be regarded as having been conducted properly, making it impossible to regulate the process.
In Australia, we have already seen VAD documentation failures serious enough to trigger disciplinary action and official findings of non-compliance, including unsigned and backdated declarations in Victoria, witnessing errors, late submission of mandatory forms and hundreds of timeliness-related form issues identified in Western Australia. In Victoria specifically, non-compliant cases included witnessing and late-form problems. In the last annual report, Victoria said one case was non-compliant because of an error in witnessing the contact person appointment form. Six more cases were non-compliant because forms were submitted late, including first assessment, consulting assessment and practitioner administration forms. The board also said a data audit had to identify historic cases where first assessment forms had been started but never submitted specifically to improve data integrity and reporting.
The issues and problems are even more significant and egregious in Canada. There was poor documentation. There are reports of,
“incomplete assessments … recurrent and excessive delays in reporting …frequent errors”
and “missing information”. There has been a lack of evidence on safeguards, Dr Jaro Kotalik, a Canadian academic, noted that, despite federal regulations mandating data collection, there is
“no publicly accessible evidence that the eligibility criteria and safeguards prescribed by law were respected”.
Refusals were also not being tracked. The Canadian system does not require doctors to formally document their refusals, making it difficult to assess patterns of approval bias or doctor shopping.
Back in Australia, former Attorney-General for Victoria Robert Clark described the oversight structure as
“hear no evil, see no evil, speak no evil”.
He testified that the regulator simply checks whether paperwork is signed rather than auditing actual compliance. In one case where a doctor falsely certified a patient’s signature, the regulator merely asked for the missing signature instead of investigating the breach. I am not saying that that is likely to happen, but it is much less likely to happen—even the noble and learned Lord the sponsor will agree—if we have tight wording in the Bill, which is contained in these amendments. For those reasons, I strongly support the amendment of my noble friend Lord Shinkwin and others.