Terminally Ill Adults (End of Life) Bill

Gregory Stafford Excerpts

Friday 16th May 2025 Commons Chamber

[Kim Leadbeater]

The patient could request information, but so could doctors and other healthcare professionals. It would be wrong if people were not allowed to share that information if it was requested, even if their employer did not want them to do it.

I turn now to new clause 11 and consequential amendments 64 and 65, which will ensure that the Bill is workable by making provision about the replacement of the co-ordinating doctor or the independent doctor where they are unable or unwilling to continue to carry out their functions in the Bill. The doctor may be ill or on holiday, retire, or have a change of personal circumstances.

[Gregory Stafford (Farnham and Bordon) (Con)]

What concerns me about new clause 11 is that, essentially, people can shop around if one doctor is unwilling. The hon. Lady has given a list of reasons why a doctor might be unwilling, but surely one of the reasons could be that there is a fundamental change in a person’s circumstances and they do not want to do it. Nothing about that is recorded. Is it not a real weakness of new clause 11 that we do not have the passing on of evidence from one doctor to another?

[Kim Leadbeater]

This is not about eligibility; it is about the doctor’s change of circumstances, rather than the patient’s. If the doctor decides that the person is not eligible, they will reject the application. They would record that in the patient’s records, so it would be transparent.

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[Dr Shastri-Hurst]

I am grateful to the hon. and learned Gentleman for his intervention. These are individuals who are making this ultimate choice for themselves. My fear is that this well-intentioned new clause would make the Bill so unusable as to become ineffective. We are not prosecuting a crime here; we are enabling a choice under tightly prescribed circumstances.

While I accept that each of these new clauses in their own way seeks to improve the Bill, we must be cautious about layering protections to the point of paralysis. The Bill as drafted is not a blank cheque—it contains safeguards, panel oversight and rigorous eligibility criteria. Let us not bury its moral clarity under legal clutter. In defending this legislation, we are not abandoning care; we are affirming dignity. Let us do so with confidence and reject these amendments.

[Gregory Stafford]

On a point of order, Madam Deputy Speaker. I would like your advice. Mr Speaker said that more than 90 people wish to speak in the debate. We have been debating the amendments for an hour and a half and four speeches have been made. If we go to 2 o’clock, that will mean fewer than 20 speakers. I understand that whether a closure motion can be moved is at the discretion of the Chair. If we have not got past, let us say, 20 or 30 Members speaking in the debate, can you give us any indication of whether, if you are still in the Chair, you would accept a closure motion at that point?

[Madam Deputy Speaker (Judith Cummins)]

I thank the hon. Gentleman for his point of order. We will cross that bridge when we come to it. We are currently asking Members to keep their contributions to 15 minutes and that, of course, will be reassessed very shortly—I can give him assurances about that.

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[Daniel Francis]

I rise to speak to amendment 24 in my name, and I will start by thanking my hon. Friend the Member for Spen Valley (Kim Leadbeater) for inviting me to be a member of the Bill Committee.

I accept the principle that somebody given the devastating news that they have six months left to live should be able to choose the moment that they die, with their loved ones around them, but this is not a vote on the principle. We are not being asked to make an arbitrary yes or no choice, for we are legislators, and my experience on the Bill Committee tells me that this Bill, as written, still requires additional safeguards to address the concerns of so many people in this country.

For me, it was death, and my thoughts and concerns about what happens when I die, that drew me to my conclusions on this matter.

[Gregory Stafford]

Will the hon. Gentleman give way?

[Daniel Francis]

I will not, because of time constraints; I am sorry.

Like a small number of other Members in this House, I know the daily concerns of being a parent of a child with complex disabilities, including a learning disability. That concern lives with you every single day of your life: that concern about what will happen to your child when you are gone—about who will assist your child, because of the help they require due to their level of mental capacity and the difficulties they have communicating and interpreting information. The concern that haunts me every single day is, “Who will make, and how will they make, those decisions to support my daughter when my wife and I are gone?”

That concern, shared by thousands of others, led me to the conclusion that the Mental Capacity Act 2005 was not written for this scenario. The parents of someone with a learning disability become accustomed to supporting them in their decision making. We understand their sight and communication difficulties, and the language needed to help them make a decision. The Mental Capacity Act rightly has a low bar to allow individuals to live a fulfilling life, because we would not want individuals to have their capacity assessed to purchase a coffee or withdraw money from the bank.

I raised countless times in Committee—it was never challenged; in fact, it was accepted in some exchanges—that it would absolutely be possible for the following scenario to occur. An adult with a learning disability discovers that they have less than six months to live. They have a level of mental capacity that allows them to make many decisions in life. They have enough capacity to understand that they could be a burden on their elderly parents. Their elderly parents might take the view that their son or daughter requires support to make the most complex decisions, yet because their son or daughter is assumed to have capacity under the first principle of the Mental Capacity Act, they could go through the entirety of this process—and the first time that the parents were aware of it would be when they were informed that their child had been assisted to die.

For the same reason, I support amendment 8, tabled by my hon. Friend the Member for Derby North (Catherine Atkinson), and amendments 10 and 33, tabled by my hon. Friend the Member for Lowestoft (Jess Asato), which relate to family members’ awareness of the process.

The second principle of the Mental Capacity Act is:

“A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success.”

It was accepted in Committee that doctors would have to assist individuals in this scenario to make the decision about an assisted death. From my lived experience, I would query how some aspects of the Mental Capacity Act are being carried out, given that I often have to deal with professionals who deem that my daughter has less or more capacity than she actually does. I have accepted that she would not have enough capacity to go through the process, but the Bill Committee heard from Mencap in oral evidence that the vast majority of people with a learning disability in this country are not in the same position and could apply for an assisted death.

The Bill Committee heard from many people. Dr Rachel Clarke raised her concerns about capacity. Baroness Falkner, giving evidence on behalf of the Equality and Human Rights Commission, said that

“capacity is a very serious consideration in our concern.”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 29 January 2025; c. 178, Q232.]

Dr Jamilla Hussain gave evidence about one palliative care team deeming that someone had capacity, while another palliative care team deemed that they did not. We heard from Professor Gareth Owen, from Dr Annabel Price and from Dan Scorer of Mencap, who all raised concerns.

In the last week, the Law Society has said that Parliament should fully consider how the Mental Capacity Act would operate under the Bill before any legislation is passed. The Royal College of Psychiatrists has said that although it is neutral on the issue, it opposes the Bill as it stands—particularly the mental capacity aspect, because, as it is written, it does not correlate with the Mental Health Act. Over the last few days, the Royal College of Physicians has also come out in support of that position.

Over the last six months, I have heard a lot about choice, compassion and dignity, but what about choice, compassion and dignity for the people I have described? I fundamentally believe that it is my job, and the job of all of us, to protect the most vulnerable—but the Bill, as it stands, fails to do that. I have every sympathy with somebody at the end of their life, as I have said; I believe that they should have the right to go on their own terms, at their own time. But are there sufficient safeguards to ensure—in response to those who have links to the press and Parliament to make their voice heard—that we fully consider every scenario and safeguard those who do not have those links and who do not have a voice?

If that choice comes at the price of one person, in a borderline capacity decision, being presumed to have capacity, that will be one death too many. My view is that it is not a price worth paying to allow others to have that choice. For that reason, I implore colleagues to support my amendment 24.

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[Dr Mullan]

I need to make progress.

I say that not least because I suspect that a very large number of supporters of the Bill might draw on their Christian or other religious compassion to explain why they want to see it pass. There was widespread reporting of how powerful the Second Reading debate was in showcasing the best of Parliament, with thoughtful debate and a consideration of nuanced and varied viewpoints. If Parliament demonstrates itself at its best, that creates a call for the public to do the same.

[Gregory Stafford]

I agree with the shadow Minister that the Second Reading debate was Parliament at its best. Would he say that the length of time that we have had to debate the Bill today, given the number of amendments and the number of people who wanted to speak, showed Parliament at its best?

[Dr Mullan]

I have expressed my views on that matter. I understand why Members are concerned, but it has been in order, and at your discretion, Mr Speaker.

MPs who disagree with campaigners’ views for or against assisted dying are not uncaring or lacking in compassion. They have not failed to understand the arguments; they have just inevitably disagreed with at least some of their constituents. I urge campaigners to use their passion and commitment to the cause to fuel their campaigning, as is their right, but to pause and reach understanding before criticising an MP simply because they have reached a different view on a very challenging matter.

In a democracy, the public are as important as politicians in determining the quality of our discourse. I hope that my remarks remind people of that, and encourage them to aspire to be the best example of the behaviour that they want to see from their elected representatives, just as we have seen again in the Chamber today.

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[Stephen Kinnock]

I thank the right hon. Gentleman for that intervention. As I say, the Government do not take a position on the policy intent that my hon. Friend the Member for Spen Valley has set out. I would simply observe that if somebody has been in a home for a considerable period of time, that home is then considered to be their home. As such, any action to take them out of that home could engage article 8 of the ECHR, on the right to family life.

I now turn to the procedure for receiving assistance under the Bill, including safeguards and protections. First, I will speak to the amendments that have been tabled by my hon. Friend the Member for Spen Valley with technical workability and drafting advice from the Government.

Amendment 58 clarifies the duty on the Secretary of State to make through regulations provisions for training about reasonable adjustments and safeguards for autistic people and those with a learning disability. That remedies previously unclear wording in the Bill. Amendment 60 is required to make provision for circumstances where the independent doctor dies or, through illness, is unable or unwilling to act as the independent doctor. Amendments 67 and 68, tabled by my hon. Friend the Member for Spen Valley, clarify that an approved substance can be self-administered using a device should the individual be unable to self-administer without one. Amendment 91 gives effect to amendment 273, which was accepted in Committee, by ensuring that data will be recorded in the final statement to ensure coherence within the Bill.

I turn now to the amendments tabled by other Members on the subject of procedure, safeguards and protections that the Government have assessed may create workability issues if voted into the Bill. New clause 7 would limit the number of times two doctors can be jointly involved in the assessment of a person seeking assisted dying to three times within a 12-month period. In situations where there is a limited pool of doctors in any geographical location or area of medicine, that could limit access to assisted dying and create inequalities in access. New clause 9 would require the co-ordinating doctor, independent doctor and assisted dying review panels to apply the criminal standard of proof that requires them to be satisfied beyond reasonable doubt. Cases considered by the panel are civil matters, and as such it would not be usual practice for the criminal standard of proof to be applied to their decision making—and it is a very high bar. The provision would also impose additional standards on the assessing doctor that fall outside the usual framework for medical decision making.

[Gregory Stafford]

Is the Minister saying that, in his view, it is better that someone who should not die does die, than that someone who should die does not?

[Stephen Kinnock]

As a Minister at the Dispatch Box, with the Government being neutral, I am not commenting on the policy intent of the Bill. What I am saying is that the new clause could create significant uncertainty. For example, it is not clear how the standard it introduces would interact with the definition of “terminal illness” set out in clause 2, which requires that a person’s death

“can reasonably be expected within six months”,

as it is not clear whether “reasonably be expected” fits within the balance of probabilities threshold or is beyond reasonable doubt.

Amendment 101 would exclude any person with a learning disability, including people with Down syndrome, from a preliminary discussion about assisted dying unless they raise the subject themselves, irrespective of whether they would otherwise be eligible. That may be subject to challenge under various international agreements, including the United Nations convention on the rights of persons with disabilities and article 14 of the European convention on human rights, which prohibits disability discrimination.

Amendment 102 would introduce a requirement that

“the registered medical practitioner must ensure that the person has no remediable suicide risk factors which pose a significant risk to their life”

before holding a preliminary discussion under clause 5. The terms “remediable suicide risk factors” and

“a significant risk to their life”

have not been defined, so the amendment may be difficult to operationalise.