Terminally Ill Adults (End of Life) Bill

Jake Richards Excerpts

2nd reading
Friday 29th November 2024 Commons Chamber

[Ms Abbott]

I entirely agree with my hon. Friend.

Robust safeguards for the sick and dying are vital to protect them from predatory relatives, to protect them from the state and, above all, to protect them from themselves. There will be those who say to themselves that they do not want to be a burden; I can imagine myself saying that in particular circumstances. Others will worry about assets they had hoped to leave for their grandchildren being eroded by the cost of care. There will even be a handful who will think they should not be taking up a hospital bed.

[Jake Richards (Rother Valley) (Lab)]

My right hon. Friend makes her case powerfully. Can I ask her to comment on the current situation whereby people ask themselves the question she just asked today? What safeguards are there for those people? What inquiry is made before those people pass away, often having taken the most drastic and horrific action to do so?

[Ms Abbott]

But if the House passes this legislation, the issue that I have raised will become foremost in people’s minds even more so.

We are told that there is no evidence of coercion in jurisdictions where assisted suicide is possible, but people do not generally write letters to sick relatives urging them to consider assisted suicide and then put those letters on file. Coercion in the family context can be about not what you say but what you do not say—the long, meaningful pause.

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[Jake Richards (Rother Valley) (Lab)]

I welcome the contributions to this debate from all sides of the House. This is Parliament at its best. I support the Bill and am proud to co-sponsor it. We have all received emails from constituents with harrowing stories of the agonising final days and weeks suffered by loved ones. I have no doubt that those stories will weigh heavily on each of us, however we vote today.

Fundamentally, I believe that if we are able to safely offer peace and empowerment to those at the end of their life, then we have a moral imperative to do so. We are lawmakers, and I also fundamentally support this change because our current legal framework is simply not fit for purpose. Our criminal law is a mess. Four former Directors of Public Prosecutions have told us that change is needed. It is pretty unprecedented for four former Directors of Public Prosecutions, the sole people who make decisions about prosecutions in such cases, to urge Parliament to take action.

In the 2014 Nicklinson judgment, the Supreme Court urged Parliament to take action because the law was not working in this area. The law is chaotic, particularly in how it relates to the argument around coercion. If we vote against this legislation today and it falls, do not think that vulnerable people at the end of their lives will not be subject to coercion this weekend and over the coming weeks. The police will investigate, a coroner will undertake an inquest into the circumstances of any suicide and a prosecution may begin, but all these processes will occur after the individual has died. This Bill would shift the emphasis of such inquiries to before the event, which is more logical, more rational and more humane.

Let me quickly deal with the procedural argument. As the hon. Member for Rutland and Stamford (Alicia Kearns) mentioned, private Members’ Bills were sufficient to reform our abortion laws, abolish the death penalty and change our divorce regime, and a private Member’s Bill was good enough when the issue was last before the House in 2015. I have read every single word of that debate, and there was not a single word of opposition to a private Member’s Bill being the mechanism for such change. Since 2015, there have been Select Committee reports and more evidence from around the world, as other jurisdictions move in the direction of assisted dying. One begins to wonder whether opponents to change are grasping at procedural straws, rather than taking on the principle, as we should at Second Reading.

I appreciate that the decision is difficult for colleagues and I respect views on all sides of the debate, but these moments do not come around often. I urge colleagues to seize the moment, shape the world around us and provide for compassion.

Terminally Ill Adults (End of Life) Bill (First sitting)

Jake Richards Excerpts

Committee stage
Tuesday 21st January 2025 Public Bill Committees

[Dr Neil Shastri-Hurst (Solihull West and Shirley) (Con)]

I, too, commend the hon. Member for Spen Valley for her efforts in pulling together this list; it is an unenviable task, given the number of contributions that were made.

It is important that we do not let the perfect become the enemy of the good. There is a wide range of individuals and organisations that we would all benefit from hearing from, but given the time available to the Committee—which is much more extensive than most private Members’ Bills have, by some margin—we are not in a position to hear oral evidence from all of them. But there is an open invitation for everyone to contribute written evidence and for us, as my right hon. Friend the Member for North West Hampshire noted, to speak to engaged parties outside the Committee to feed into our thought processes and deliberations.

On the amendments tabled, I understand the reasons for amendment (b) on the Royal College of Psychiatrists, but I have to say that I disagree. The hon. Member for Bradford West said it was about coercion. I could understand if she were making an argument that we need to hear from the Royal College of Surgeons about the issue of capacity, so I do not think that this is universally confined to psychiatrists; it is something, as a surgeon, I dealt with every day when I was getting consent for operations. We have to think about how we get a wide range of opinions on the subject: we have the Chief Medical Officer, who can comment on such issues from a policy perspective; we have the BMA, which I am sure will send representatives who will be most able to deal with the questions that are to be asked; and, of course, we have the General Medical Council, which is the ultimate regulator and arbitrator of this issue.

The Committee is also about ensuring that this legislation is as fit and as robust as possible when it goes back to the House for consideration. That is where I think that having a legislator from a jurisdiction in which this has been implemented is crucial. Not having the member for Sydney in the New South Wales Parliament—where they have implemented this, and have dealt with some of the thorny issues that the Committee and subsequently the House will have to deal with—would be a mistake. Likewise, having more geriatricians and palliative care physicians is a better balance than having those with some other expertise—well-meaning as they may be, they are not necessarily dealing with this at the coalface. I do not support the amendments for those reasons.

[Jake Richards (Rother Valley) (Lab)]

I will not speak for long. I merely echo what my hon. Friend the Member for Sunderland Central said: this is not an arms race. It is not about who can get more experts with different views; it is about trying to get a wide-ranging and broad sense of different aspects of the Bill. The list that my hon. Friend the Member for Spen Valley has produced does that. I made suggestions that are not on it, by the way, but as the hon. Member for Solihull West and Shirley says, we cannot let perfection be the enemy of the good.

I want to push back briefly on some things that have been said about the lawyers and legal experts. I do not accept what the hon. Member for East Wiltshire says about whether they are for or against, and I am not sure that his numbers tally with my reading of their views. That goes to the subjectivity of this issue. It is not black and white; lots of people have complex views on it.

I am not sure whether amendment (g) was moved, but in any event the notion that issues such as ECHR compatibility cannot be handled by Lord Sumption, Lord Neuberger and Baroness Hale—three former Supreme Court judges and potentially the best legal minds of their generation—is frankly absurd. We all have roles and responsibilities, as members of this Committee and as Members of Parliament, to challenge their evidence and to push different cases. I have no doubt that we are all qualified and able enough to do so without hearing from a junior barrister and a junior lecturer. That is not in any way to belittle their expertise, because I have read endless commentary from both the suggested witnesses that is very valuable and could be put to the three former Supreme Court justices, who grappled with such cases time and again.

[Danny Kruger]

I think Baroness Hale has been knocked off the list. Am I right? I do not think we are going to have the huge pleasure of hearing from Baroness Hale.

[Jake Richards]

Well, we have had lots of lists, but Lord Sumption and Lord Neuberger are giving evidence, I believe; Lord Sumption is, anyway. These things can be tested and challenged, so the notion that we need to have others is slightly absurd. We have the law lecturer from Cambridge University as well.

[Liz Saville Roberts (Dwyfor Meirionnydd) (PC)]

Diolch yn fawr iawn. I put it on record that I am very grateful that we will be able to find time for a legal adviser. It will not be a representative of the Senedd, because it has become apparent that the Senedd itself will not provide a Clerk to advise us. That seems to be a weak point in the process of making legislation: I think that as legislators we should be able to receive advice on the issue that is non-political and is perceived as non-political, so we probably need to address that in future. It will not be a representative of the Senedd, but I will seek within the time to get a legal advisor who is recognised as an expert in this field.

Terminally Ill Adults (End of Life) Bill (Second sitting)

Jake Richards Excerpts

Committee stage
Tuesday 28th January 2025 Public Bill Committees

[Sojan Joseph]

Q My next question is for Duncan. Nurses who work in stressful environments, such as people working in mental health wards, are expected to get clinical supervision. Do you think that the nurses who are going to work in these areas—if this Bill passes—would require that specialist clinical supervision? And do you think the NHS will have the capacity to provide clinical supervision for the nurses working in those areas?

Duncan Burton: I think you are absolutely right—anybody working in stressful environments. If the Bill is passed, we will need to make sure that we have sufficient psychological support for nurses and doctors working in these services, as we do now for many of our nurses and other professionals working in these kinds of situations. People working in end of life, or cancer nurses, for example, often have psychological support to help them deal with some very difficult conversations with patients.

We would need to look at that and make sure that sufficient support was in place for anybody working in these situations. We would also need to be mindful about the wider workforce, given the issues from such a debate as this and how the decisions to signpost people on to services might create—for some people—moral injury. We do need to think about the support in place for those people.

[Jake Richards (Rother Valley) (Lab)]

Q You have touched on this, but perhaps we could have some further clarity. Certain amendments have been suggested that are essentially more prescriptive about what factors need to be taken into account and what steps clinicians would have to take when considering capacity in this context, as well as to inform consent and inform about the options available. Of course this is a matter for Parliament, but would you err on the side of trusting clinicians’ professional judgment within the legal framework, as it is—in terms of the Mental Capacity Act and the guidance on informed consent—or would you deem it suitable for further prescriptive steps to be put into primary legislation in this context?

Professor Whitty: It is entirely a matter for Parliament, at one level, but I can give a view. It goes back to the point that Naz Shah and others made earlier: the situations that people find themselves in are extraordinarily different—culturally, where they are in their lives, where their families are and a whole variety of other issues. Only the clinicians dealing with that person will really know all the different factors at play. If there is a good therapeutic relationship, and you would certainly hope there was, they should understand a whole variety of things that are very difficult for people sitting around this table to predict, however wise you are—although I am sure you are extraordinarily wise, to be clear. That was not my point. My point is that this is very difficult and I could not, at this point, write down a law that would be helpful to someone dealing with a whole range of different scenarios in which they are going to have to have an end-of-life discussion.

My own view, for what it is worth, is that I would do fewer things rather than more. That is partly because simplicity is the key to really good safeguards, in my experience. If the safeguards are really clear and simple, everybody understands them—if you ask six people, “What does this mean?”, those six will give you the same answer. The more complicated you make things, the more room there is for ambiguity and uncertainty—because different things are playing in—and the more difficult it is for the patient, their family and the medical and nursing professionals assisting them, to navigate the system.

Without in any sense wishing to curtail what Parliament might wish to do, I would make a plea for simplicity wherever possible and for accepting the extraordinary variety of people’s lives, which may have unpredictable consequences in terms of the way the end of their lives plays out.

[Jake Richards]

Q In terms of setting standards and ensuring universality of understanding those safeguards, is that better done, in your view, by training and guidance rather than primary legislation setting up factors?

Professor Whitty: I would certainly recommend that this is done by guidance or in secondary legislation, which can be adjusted if it turns out that it is not having the desired effect. Two things can change: first, we can spot things we had not thought of in the first place, however far-sighted each of us is. The second is that medicine itself changes, the diseases people suffer from change and so on.

An Act has to be durable and that is why I have my view about secondary legislation and guidance, which have the ability to adapt in a way that primary legislation cannot. The fundamentals obviously need to be in primary legislation, but these kinds of issues are often done better in secondary legislation.

[The Chair]

I am very mindful of the time, as it is now three minutes past 10. This will be the last question of the session.

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[Kim Leadbeater]

Q On the point about reporting, where patients take that right to refuse treatment, capacity must be assessed at that point if a patient has said, “Look, I don’t want any more treatment.” That is quite an important point to assess capacity. Are those cases logged and recorded?

Mark Swindells: Yes. It would be important for the patient’s records to cover the points of consent and that the doctor has recorded that they have interacted with the patient that way. I do not believe it is centrally held or collated in any sense like that, but I may be wrong.

[Jake Richards]

Q Dr Green, on subsections (4) and (5) of clause 4 and the information services, as opposed to the referral to a practitioner, I think your point has some weight. In terms of the rest of clause 4 as drafted, it has an opt-in, it gives wide discretion to practitioners and there is no obligation to raise it, so from my understanding of your written evidence, it ticks all the boxes. Is that fair?

Dr Green: Yes, with the exception of the referral.

[Jake Richards]

Thank you. I just wanted to clarify that.

Dr Green: Of course, we would regard much of clause 4(4) as normal care in any case.

[Jake Richards]

Q There are some amendments being tabled that would offer further clarification and include more things that have to be considered. I have a similar question to the one I asked the previous panel, when I think you were here in the Public Gallery. Would offering further guidance to your members be welcome, or would you again err on the side of trusting their professional discretion?

Dr Green: As Dr Whitty said, I think simplicity is the key here.

[Liz Saville Roberts]

Q Dr Green, you mentioned the different jurisdictions within the United Kingdom and the Crown dependencies. What issues have your members raised in relation to this legislation?

Dr Green: In terms of the cross-border issues?

Terminally Ill Adults (End of Life) Bill (Third sitting)

Jake Richards Excerpts

Committee stage
Tuesday 28th January 2025 Public Bill Committees

[Dr Tidball]

Q You have helpfully acknowledged the link that we need to make on coercion to strengthen this, but on the other two elements—dishonesty and pressure—is there anything else that we need to look to in order to make this more robust?

Sir Max Hill: “Dishonesty” is a term of art in common use, but it is also a term of statute. Anyone investigating or, still more, prosecuting would understand what dishonesty means. I accept that there is a wider point—not so much for interpretation but for understanding—that this Committee may want to consider, of how much of that existing definition needs to be imported into the Bill. As with mental capacity, I would suggest that, beyond perhaps the odd footnote, it is not necessary for you as a Committee to define again what dishonesty means, because we have it elsewhere.

Alex Ruck Keene: On pressure, I think the Committee would be really assisted by having a look at the learning of the High Court judges exercising their jurisdiction under the inherent jurisdiction in relation to people who are said to be vulnerable. They have developed an awful lot of tools, where they are trying to look at people in complicated situations—potentially, but not necessarily, with impairments—who are caught up in what one person brilliantly described as being caught in a spider’s web. Those are the sorts of sets of tools used when judges are trying to work out what is going on, and whether it is the side of the line we consider to be acceptable or the side of the line we consider unacceptable—because “pressure” is doing a lot of work there.

[Jake Richards (Rother Valley) (Lab)]

Q Thank you all for your written evidence. Sir Nicholas, in your helpful written evidence, you adopt Sir James Munby’s criticism of the current proposal for judicial oversight, and you instead recommend what you call a “Spanish-style specialist panel”. Could you set out for the Committee what you see as the benefit of that approach compared to what might be described as the stark judicial oversight of the High Court judge?

Sir Nicholas Mostyn: One per cent would be 6,000 deaths a year. If each took two hours to process in the High Court—you have to read it and hear the evidence; one of them has to be oral and you have to write a judgment—that is 12,000 hours. Each High Court judge does 1,000 hours in court—outside court, they do lots—so you are talking about nearly three quarters of the entire family division doing nothing but this. It is impossible, in my opinion, for this to be done by the High Court. It should be done in the Spanish way by a panel that is set up. In Spain, the chairperson of the regulator sets up a panel for each case—a doctor and a lawyer. They have to agree and they check that everything has been done lawfully. They do not make any value judgment about whether it is in the person’s best interest. They check that it has all been lawfully.

Interestingly, in 2023, 10% extra denials were done by the panel. I do not know whether that was because they were concerned about voluntariness or whether they were concerned about suffering—because the criterion is suffering there—but an extra 10% was done by the panel, so the panel was not just rubber-stamping. They denied an extra 10%. I believe that an ad hoc system like that, with a doctor and a lawyer doing a check, would be the best way of doing it. The High Court—trust me, I’ve just come from there—has not got the capacity to deal with 6,000 cases of this nature.

[Jake Richards]

Q Apart from capacity, which I appreciate, are there any other problems that you see with clause 12 on judicial oversight? Apart from capacity, is there any benefit that you see from the Spanish model? Alex, you similarly criticised the current judicial provision. You say in your very helpful written evidence at paragraph 10 that perhaps we need to consider a multidisciplinary approach.

Sir Nicholas Mostyn: Can I just answer before he does?

[Jake Richards]

Yes—it’s just that otherwise I will be cut off. I was trying to get two questions in.

[The Chair]

Order. I said earlier that this is not a dialogue. Address your comments to the Chair, and I will decide who speaks and when. I do not wish to be rude, but everybody’s got to have their fair share.

Sir Nicholas Mostyn: I do not know if you have seen Sir Stephen Sedley’s memo, which came today. He has suggested that the Official Solicitor should be the checker of these facts, which seems a sensible idea. The Official Solicitor would be able to recruit more staff to do this. It would not be nearly as expensive as High Court judges, and it would be an efficient way of dealing with the problem. The advantage of the Spanish system is that you have a qualified doctor as well as a lawyer doing the checking. Remember—a High Court judge is not going to be a qualified doctor. That is a significant advantage in my opinion.

--- Later in debate ---

[The Chair]

We have some Members who want to ask more questions; we have about six minutes or so. Jake Richards, you did have a possible question earlier on.

[Jake Richards]

Q Some of it has been answered, but on that point, I just wanted to explore the appeals point. If either side could appeal, as Alex suggested, who would be appealing against the decision to allow assisted dying?

Sir Nicholas Mostyn: Relations who say, for example, “My father has been pressured by his new wife to do this”. If a father has given permission and the child has asked to intervene, there would be some process where the child would be allowed to become a party to the proceedings, because that will have to be specified in rules, and that person would then be the appellant.

[Jake Richards]

Q The Bill at the moment—and for good reason, potentially—potentially does not provide for family members receiving notice of this.

Sir Nicholas Mostyn: Well, it does.

[Jake Richards]

It is an autonomous decision, so—

Sir Nicholas Mostyn: No, but it says, procedurally, they can determine their own procedure.

[Jake Richards]

Yes, sorry, I meant that, in terms of—

[The Chair]

Order. I am giving you an opportunity to ask a question, so ask the question, we will get the answer back and then we can move on. I do not want this dialogue, I am afraid.

[Jake Richards]

Forgive me, Mr Dowd. I meant that, in terms of the assisted dying process in the Bill, there is no automated mechanism for family members, or indeed any third parties, apart from the doctors, to have notice of this intention. Is there a concern, regarding this appeal point, that perhaps interested parties would not know?

Sir Max Hill: I would suggest that the key to this is in clause 12(5), and that is why I have recommended just striking out the words “High Court” and putting in the word “panel”, and then reading the whole of clause 12 as amended, with those situations in which there are steps that “must” be taken—and there are many—and those in which there are steps that “may” be taken.

In clause 12(5), following that logic, we would imagine that a panel, just as the High Court,

“may hear from and question, in person, the person who made the application”

but

“must hear from…the coordinating doctor”.

The appellate mechanism, which I agree there needs to be, will be looking sharply at the operation of that subsection. In other words, when the panel made its decision to refuse, on what basis did it make that decision and from whom had it heard? We can well imagine situations in which a co-ordinating doctor, having taken his or her own steps to ascertain the views of the nearest and dearest, would satisfy the panel as to what the views of the family are. The reverse of that is that there is no indication here that, having gone all the way through the panel, the family would have been made aware or considered at all. I think that that will be a rare scenario, but I am not a medical professional. I think you can cover that, perhaps with some changes here or there on what you impose on the panel as a mandatory duty and what you leave by way of discretion, subject to the rules of procedure that the panel would then adopt.

[Dr Tidball]

Q I have a question for Sir Max Hill and Alex Ruck Keene. Your insight on clause 12 has been helpful. What procedures would you recommend be adopted for testing and, if need be, challenging the evidence as part of an evidentiary process linked to the panel that you set out?

Alex Ruck Keene: This is, for the moment, predicated on the fact that we are still in the High Court, as opposed to slightly making up policy on the fly about a panel. Assuming it is the High Court, it seems to me the Court has to be discharging a properly inquisitorial jurisdiction, which means it has to be armed with the tools to do that, which includes arming it with the tools to call for its own evidence. It also seems to me that the High Court would have to be armed with its own ability to not just receive evidence from one side and have someone testing it. That then brings you to the only player in town who could possibly do that, which would be the Official Solicitor as advocate to the Court.

I do not want to emphasise too much the question of resources, because if Parliament thinks this is sufficiently important, the resources will be voted through. But it is vitally important to note that the Official Solicitor is completely overloaded, and we would be asking the Official Solicitor to act as advocate to the Court in every single one of these cases. You could not have it be optional; you cannot say that it is some and not others. If it is going to be inquisitorial, the High Court has to have the ability to say, “This is one-sided; someone needs to tease it out,” so the Official Solicitor would have to be funded to be advocate to the Court and, if necessary, instruct lawyers in every single case.

Sir Max Hill: The model that I was espousing would not necessarily involve the Official Solicitor at all. It would make no draw on the administration of the Court or any officer of the Court, still less full-time judges. It would allow the appointment of recently retired judges, as we have in a number of scenarios—surveillance commissioners, for example—and a fresh administration. With that, as with the High Court model at the moment, there is the primary set of provisions, which Parliament must impose, and it is important that that is sufficient for what Alex called an inquisitorial function. Those are in part mandatory—those things that the panel must be satisfied about, which are set out in clause 12(3). Then there are those that are discretionary, which are set out in clause 12(5).

What sits between the two is very important. That is currently expressed as “Rules of Court”, but it would be the rules of the panel, or the commission that appoints the panels. In a court scenario, we are all familiar with criminal procedure rules and civil procedure rules; that is the secondary stage that is reached once the primary legislation has been fixed. That, too, would apply to the commission or panel process, but I do not necessarily think that it would involve using existing, paid judicial resources at all.

Terminally Ill Adults (End of Life) Bill (Fifth sitting)

Jake Richards Excerpts

Committee stage
Wednesday 29th January 2025 Public Bill Committees

[Kim Leadbeater]

That is really helpful. Dr Mullock, do you want to add anything?

Dr Mullock: I agree with most of the things that I am aware of that Professor Esmail just talked about. I would add that at the moment, people go sooner than they would wish to die because they have to go to Switzerland while they are still well enough to travel. They also have this terrible fear that their loved ones will be prosecuted by the police, which creates huge amounts of stress and is really unpleasant. I agree that having a system of prospective assessment of the person, rather than retrospective—when it is too late after they have died—will absolutely be a better and more compassionate approach, and provide better safeguards than we have at the moment.

[Jake Richards (Rother Valley) (Lab)]

Q If I may, I will push Professor House on the evidence he was giving to Mr Atkinson’s questions, so that I understand the necessity for psychiatric assessment under the current legal framework. Clearly there are degrees here. If a patient who has diabetes refuses to take insulin but would otherwise be able to manage their disease, then they would be referred to you, but is it your experience that if a patient rejected a round of chemotherapy, they would usually be subject to a psychiatric assessment?

Professor House: No, these things depend on the circumstances. If somebody says, “I’ve had enough of this. I’ve had chemotherapy and I don’t want any more,” they would not be subject to that, unless it was such a sudden change in the context of other changes in the person that the oncologist treating them thought something needed further explanation; it would not be terribly common, no.

[Jake Richards]

Q Would the decision about the need for a psychiatric assessment be undertaken by a medical clinician?

Professor House: In the circumstances you are talking about—generally, yes.

[Sean Woodcock (Banbury) (Lab)]

Q Dr Mullock, during your oral evidence to the Health and Social Care Committee you recommended focusing on Oregon’s approach in particular. Do you have any concerns about the number of people in Oregon who cite being a burden as their reason for choosing assisted dying?

Dr Mullock: I think this is incredibly complicated, because people will have multiple reasons for choosing to seek an assisted death, and that might be one of them. For some people, there is an argument that their experience of feeling like a burden is really overwhelming. If you have been a very independent and active person, the impact of being and feeling like a burden will be so devastating, so in addition to having a terminal condition that is going to end your life soon anyway—and all the pain and fear that that might bring—there is that additional reason.

I do not think we should necessarily say, “Oh, well, that is really problematic there—we can’t engage with the reasons people feel like a burden.” Obviously, feeling like a burden does not mean that people are finding you to be a burden. The questions about whether those caring for you are caring for you well, or whether you are a victim of abuse, are all tangled into the very difficult experiences that terminally ill people have.

--- Later in debate ---

[Kim Leadbeater]

Thank you.

[Jake Richards]

Q Dr Graham, in paragraph 21 of your very helpful written evidence, you say that the judicial involvement in the process strengthens the Bill, in terms of convention compatibility. Do you agree with Lord Sumption about the effect on convention compatibility if that stage were not present, and do you have any comments on the suitability of a judicial function, and whether there is any alternative?

Dr Graham: I am afraid my answer will be quite short.

[Jake Richards]

That is welcome.

Dr Graham: I think the judicial safeguard strengthens the convention compatibility because of the argument relating to Mortier that was set out earlier, but I do not think it is essential for convention combability because of the case law I mentioned earlier.

[Sean Woodcock]

Q Ms Hadi, at the start you said, “Nothing about us without us.” With regard to your previous testimony, I am interested to know how you feel that disabled voices have been heard, if they have been heard, in this process. What gaps have there been, if any? What can the Committee and the Bill do to fill those gaps?

Fazilet Hadi: To build on what Baroness Falkner said earlier, if this had been a Government Bill, we would obviously have had some pre consultation: we would have had a Green Paper and a 12-week consultation period, and we might have had engagement sessions with disabled people. The responses would then have been fed back, and we would then have heard about what the Government were going to do next. Obviously, because it is a private Member’s Bill, none of that has happened. I think there was a call for evidence at the beginning of January, but there was no time period, no framework and no accessible information.

Given that this Bill affects disabled people really, really profoundly—as I said earlier, disabled people often live with conditions that will become terminal illnesses—I feel that it has not been sufficient, and I would like to see much more discussion with disabled people and disabled people’s organisations. Ideally, I want to see the process that Baroness Falkner talked about happen, ideally with a commission and a Government Bill. If the Government are committed to this private Member’s Bill and want it to happen, they should take over and make it a proper part of their legislative agenda.

No, I do not think there has been sufficient dialogue and input from disabled people to this day. Having said that, the first we knew of this Bill was in October, it had its Second Reading on 29 November, and now we are here, so it has been so quick. A lot of disabled people—because we have sensory disabilities, learning disabilities and so on—need a bit more time to input. Thank you for the question.

Terminally Ill Adults (End of Life) Bill (Fourth sitting)

Jake Richards Excerpts

Committee stage
Wednesday 29th January 2025 Public Bill Committees

[The Chair]

Jake Richards was not called for the last panel, so we will start with him.

[Jake Richards (Rother Valley) (Lab)]

Q Thank you for those introductory statements. I have a question for Mr Amin regarding the current operation of the Mental Capacity Act 2005, and how the Court of Protection approaches that issue. The Bill as currently drafted essentially defers to the Act, and I wondered if you have any reservations about that, or any thoughts that you could offer the Committee?

Yogi Amin: Reservations—no. In fact, I wholly recommend and support the idea as drafted to defer to the Mental Capacity Act for capacity assessments. I have been working in this area for over 20 years, before and after the Mental Capacity Act came in, and I have done cases all the way up to the Supreme Court, as well as day-to-day different cases around the country. It is well understood how capacity assessments are done, and it is ingrained into the practice of practitioners generally and of legal practitioners in the courts. Certainly when I give training to advocates, doctors and so on, it is well understood how to apply the test. That could be adapted for this particular decision, which is done here. In the past couple of years, we had a decision in the Supreme Court which settled how to approach the question of capacity, and to disturb that would concern me.

[Jake Richards]

Q To be clear, would it concern you because it would cause confusion?

Yogi Amin: It is a well settled and understood approach to the law, and producing a new one would throw up a whole new conundrum, where people would be questioning how to approach it, etc. It is not broken—it works well.

[The Chair]

That was a specific question to Mr Amin, but it is an important issue. Does anyone else wish to come in, briefly please?

Chelsea Roff: One thing I would like to highlight in our study is that all 60 people who died—young women, mostly—were found to have mental capacity to make the decision to end their life, so I worry that mental capacity will not be an effective safeguard to prevent people with eating disorders from qualifying under the Bill.

I also note that Oregon and California, where I am from and where we have found cases, have an additional safeguard to mental capacity. That is, if there are any indications that the person might have a mental disorder, that person must be referred for a mental health assessment. It is important not to make a false equivalence between mental capacity and mental health.

We could, for instance, have a person who has a prognosis of six months or less, but their wish to die is emerging from severe depression, from suicidality. We saw very high rates of suicidality and depression: 89% were depressed and nearly half chronically suicidal when they died. Physicians emphasised, still, that the wish to die was not emerging from a mental illness, despite them having diagnosed mental illness.

Terminally Ill Adults (End of Life) Bill (Sixth sitting)

Jake Richards Excerpts

Committee stage
Thursday 30th January 2025 Public Bill Committees

[Lewis Atkinson (Sunderland Central) (Lab)]

Q Mr Greenwich, we are minded that as well as passing really good legislation we want to get public confidence behind this. We have heard a level of concern from disabled people’s representative bodies about the inadvertent implications of this law for disabled people. Were those concerns shared when you took your legislation through, and how it has gone since the implementation of the legislation?

Alex Greenwich: In New South Wales, and across Australia, having a disability or complex mental health issue like anorexia does not make you eligible at all for voluntary assisted dying. The legislation we are dealing with and you are dealing with is not for people with a disability or anorexia nervosa, and not for people who feel they are a burden. It is for people with a terminal illness who may want the choice of a death that is better than what the illness would otherwise provide.

We worked closely with disability groups in New South Wales. Their main concern was that they would be treated equally in terms of access to the law if a person with a disability had a terminal illness. The key point is that this legislation is a safeguard to those concerns. To the point about people who are starving themselves, that is happening today in the UK because people do not have access to voluntary assisted dying. They are starving themselves to death rather than accessing a regulated scheme where they can discuss all their options and choices.

[Jake Richards (Rother Valley) (Lab)]

Q This question is probably best for Alex. Yesterday we heard evidence about the health inequalities in our society and fears that they would be exacerbated by the introduction of assisted dying. What was the experience in Australia?

Alex Greenwich: If I think of our health system and how we adopted voluntary assisted dying, like all health systems we were under pressure following the covid pandemic. By legislating in this space you give your health system the priority of dealing with this, making sure doctors are trained to be able to address it and that there is a good implementation period. I believe the Bill has two years, and I think that is completely appropriate to make sure your health system gets up to speed. When it comes to end-of-life choices and healthcare, voluntary assisted dying provides a great deal of honesty and safeguards.

[The Chair]

I think this will probably be the last question.

Terminally Ill Adults (End of Life) Bill (Eighth sitting)

Jake Richards Excerpts

Committee stage
Tuesday 11th February 2025 Public Bill Committees

[Sarah Olney]

I look forward to the hon. Lady’s further comments, but as I said, the psychiatrists were very clear that they did not believe that this was a sufficient safeguard, and we should acknowledge that.

I was unable to put my question to Alex Ruck Keene KC during the oral evidence session, but he kindly agreed to give further evidence in writing in response to a letter I sent to him later that day. That exchange of letters has been published as written evidence. It was his position that, in actual fact, Professor Sir Chris Whitty misinterpreted the Mental Capacity Act when he gave evidence. There is no such requirement in the Mental Capacity Act that states that the more serious the decision, the greater the level of capacity that someone needs to have. Mr Ruck Keene’s view is that that was the common law prior to the Mental Capacity Act coming into force, whereas in actual fact the Mental Capacity Act does not require that the more serious the decision, the more capacity someone needs to be judged to have.

[Jake Richards (Rother Valley) (Lab)]

I am sympathetic to the problem the hon. Lady has identified of people who have a terminal illness as well as other mental health conditions. Instead of rewriting the Mental Capacity Act for this new context, would it not be better to secure safeguards through clause 9, through which further assessments are potentially going to be mandated, if the amendment from the hon. Member for St Albans (Daisy Cooper) is agreed to, for those cases where there is doubt as to capacity? That would add a further safeguard rather than rewriting the established Mental Capacity Act and case law.

[Sarah Olney]

I have no intention of rewriting the Mental Capacity Act. It should stand exactly as it is and be used for the purpose for which it is intended. That is not the intention behind my amendment, which merely proposes that we should assess people’s ability to make the decision and not just their capacity. Many of those who provided evidence demonstrated that merely testing somebody’s capacity to make a decision is insufficient in this case.

--- Later in debate ---

[Sarah Olney]

The hon. Member is absolutely right. That would be another weakness of the Mental Capacity Act being used in this context: if someone is judged to have capacity, they are free to make an unwise decision, yet there is nothing in the Bill to provide a safeguard against people who might have capacity and make an unwise decision because their thinking has been obscured by mental illness, depression or something else.

[Jake Richards]

I have a few questions for the hon. Member. Who does she propose will decide whether a decision by someone who has capacity is wise or unwise? Does she also propose changing the law around patients’ refusing life-saving treatment? Should that be handled under the Mental Capacity Act, as it is at the moment?

[Sarah Olney]

I am grateful to the hon. Member for his intervention, but I am not proposing to change any legislation other than the Bill before us. All the other legislation to which he refers should remain precisely as it is, and for the purpose for which it was intended. He asks who is to say whether someone is making a wise or unwise decision; that is the job of the people who are instructed to provide assessments under the Mental Capacity Act. As was clear from my response to the hon. Member for Reigate, if someone has been assessed as having capacity, there must not be any further interference in their decision-making process, even if there are distinct concerns that that person may be deciding to end their life not purely because of their terminal illness but because they are suffering from depression. There is no other mechanism in the Bill to enable that further safeguard.

--- Later in debate ---

[Dr Shastri-Hurst]

My hon. Friend puts it with his usual candour. He asked a straight question, so I will give him a straight answer: I think there is a difference between somebody who is depressed and somebody who is depressed and suicidal. I have no personal moral objections if someone who has a terminal illness, who suffers from depression and who has capacity as set out through the two-stage test in the Mental Capacity Act, ultimately wishes to end their life because of their terminal diagnosis. If they are doing it because they are suicidal as a consequence of their depression, that is a different and distinct issue. We are talking about individuals who want to end their life because of their terminal diagnosis, not because of their mental disorder.

[Jake Richards]

I keep making the point that clause 9 adds a different element to this process. It says that, when undertaking the assessment, one of the two doctors

“may, if they have doubt as to…capacity…refer the person for assessment”

of their capacity by a psychiatrist. Does that reassure the hon. Member that there is a further layer of safeguards in this area?

[Dr Shastri-Hurst]

That is one of the additional safeguards in the Bill. This Bill has more in-built safeguards than any similar piece of legislation across the world. I think the hon. Gentleman makes a valid point: when a doctor has concerns about somebody’s mental state, they can escalate the case and seek further, specialist opinion.

Terminally Ill Adults (End of Life) Bill (Ninth sitting)

Jake Richards Excerpts

Committee stage
Tuesday 11th February 2025 Public Bill Committees

[Jake Richards (Rother Valley) (Lab)]

I am trying to understand my hon. Friend’s argument. In terms of a person choosing to ask their doctor to turn off their life support machine, as opposed to someone offering a person drugs to self-administer, I understand that there are differences in terms of public policy and that, for some, there are differences morally. However, in terms of capacity—the decision as to whether that person can make that choice themselves—why is it different?

[Naz Shah]

The hon. Member for East Wiltshire answered that question eloquently earlier. Although the outcome is the same, we are asking two different questions. The question is not about turning off and unplugging a machine; it is about whether someone will take drugs to end their life.

Terminally Ill Adults (End of Life) Bill (Tenth sitting)

Jake Richards Excerpts

Committee stage
Wednesday 12th February 2025 Public Bill Committees

[Naz Shah]

I share my hon. Friend’s concerns about the Bill not being tightened and fit for purpose. We cannot afford for those people to slip through the net. One woman’s death is one too many. One older person’s death is one too many. That is the bar we have to set.

I come back to the words of Dr Jamilla: she said, “Yes, absolutely.” Every single Committee member, and anyone familiar with this debate, found it heartbreaking to listen to those who came in to give testimony about how members of their families died. Those stories will stay with us forever, and rightly so. That is why, in principle, I am supportive of where we need to get to with the Bill. However, as Dr Jamilla said, we cannot get there by ignoring this big lot of people with vulnerabilities and inequalities, who would absolutely need this legislation. We need to fix the inequalities first.

Let us be honest: as legislators, we know that we will not fix every ill in society, otherwise we would not need a police force. We would not need laws if everybody behaved as they should and supported each other. However, it is incumbent upon us, as legislators in this place, to try our best.

Nobody came to this Bill Committee thinking it was going to be a walk in the park. We certainly did not know that we were going to get evidence throughout it, and plenty of challenges are popping up. We came to this Committee—I came new to the subject—because it is of such importance. I sat in the Chamber for five hours on Second Reading, bobbing, but I did not get the chance to speak—and that happened to another 100 colleagues, who also did not get to speak. However, those who made contributions—whether they were for the Bill, concerned about the Bill or were clearly not going to support the Bill—did so because they feel very strongly about it. That is our responsibility.

I come back to amendment 23, which was tabled by the hon. Member for Reigate: we should really consider adding it to the Bill, because that would strengthen it. The amendment does not dilute the Bill, and it does not add another hurdle given that the Court of Appeal has already said that there is a responsibility to look for undue influence. I do not understand the resistance to the amendment, which I will support.

[Jake Richards (Rother Valley) (Lab)]

This debate has been very interesting and has reminded me of my life before being elected. When I was a barrister in court, I was often junior counsel and, by the time I stood up, all the best points had been taken. I feel a bit like that this morning.

I have some observations, the first of which is on what is in the Bill currently. My central submission is that the Bill does more than enough in this area, and that simplicity is what is required, especially when dealing with very complex and difficult subjects, which coercion is. There are two sides to the coin of coercion: one is about acts by third parties, such as family members or society at large, and the other is the individual making the decision.

Clause 1 is clear that, as part of the assessment made by the doctor, judge or panel, the person must have

“a clear, settled and informed wish to end their own life”

voluntarily. That precisely echoes words from the Crown Prosecution Service guidance on whether to prosecute that is currently in operation. That guidance has been in use for some time, and it seems perfectly rational and logical to continue that.

The focus of the assessment should be on the individual and whether they make the choice freely. Clause 1 makes that clear, and I presume purposefully echoes the language from the CPS guidance. It then says it must be established that the person has

“made the decision that they wish to end their own life voluntarily and has not been coerced or pressured by any other person into making it.”

That must of course be read with clause 26, which introduces a new offence:

“A person who, by dishonesty, coercion or pressure, induces another person to make a first or second declaration, or not to cancel such a declaration, commits an offence.”

That carries a sentence of up to 14 years in prison.

[Naz Shah]

I am trying to understand the expertise my hon. Friend is speaking from. Was he a criminal barrister?

[Jake Richards]

I am very happy to share my CV afterwards. I practised as a barrister mainly in family law and Court of Protection law, but back in the day I also practised criminal law as a very junior barrister in the magistrates courts up and down the land.

I do not want to delve into the criminal element too much, because we are on clause 1, but it appears to me that the criminal offence set out in clause 26 is far stronger than the Suicide Act 1961, which talks of an act of encouragement. That is not included in clause 26, which talks about inducement—a much more holistic and wider concept than that of an Act probably drafted back in the late 1950s. In my submission, that brings the law far more up to date with modern concepts of coercion and pressure.

[Rebecca Paul]

The hon. Gentleman is making interesting points. This is probably more a question for the Minister. I have been focused on clause 24, in terms of encouragement, but clause 26 obviously makes coercion and pressure a criminal offence. The hon. Gentleman says he thinks coercion includes undue influence; does it include encouragement?

I seek clarification of whether undue influence and encouragement are captured in clause 26. When I tabled the amendments, I assumed not. If it is the case, how does that interact with the Suicide Act, which already makes the encouragement of suicide a criminal offence, and is probably not—I have not checked, so I would have to look—consistent with this? That needs to be looked at. It is easy to say that undue influence is included in coercion, but it has a knock-on impact on a lot of other things. We need to be really clear on that point.

[Jake Richards]

My answer to the hon. Lady’s first question is yes. In my view, clause 26 covers undue influence and encouragement—I could go on to state why.

My reading of the Bill is that clause 24(3) essentially removes from the Suicide Act persons who are by all the other criteria eligible for assistance in death under the Bill. The Act that will be created is, in my view, stronger in any event. That is why—I genuinely mean this respectfully, because the hon. Lady made good points in an impassioned speech—this argument about encouragement in the Suicide Act does not follow through. What we have here is a much safer and more modern piece of legislation, which is reflective of what we all think of when we think of coercion and pressure.

[Rebecca Paul]

Forgive me—I hope the hon. Gentleman will bear with me as I seek to understand this; he is obviously very learned in these matters. My understanding is that clause 24 takes out only the assistance piece, not the encouragement piece. I think the hon. Gentleman just said, if I am right, that encouragement now falls under clause 26, but encouragement is also captured in the Suicide Act 1961. That is my non-lawyer interpretation of reading the Bill. I am not saying that is absolutely right, but I would appreciate it if he could clarify that.

[Jake Richards]

My reading of the Bill—we are dealing with clause 1, but we will get to clause 24—is that clause 24(3) says:

“In the Suicide Act 1961, after section 2A (acts capable of encouraging or assisting suicide) insert”,

followed by the provisions in new section 2AA.

[Juliet Campbell (Broxtowe) (Lab)]

I have a question for the promoter of the Bill, my hon. Friend the Member for Spen Valley. We are having a lengthy conversation about coercion and pressure, and whether those two words are a catch-all for things that can be much more subtle and nuanced. That is the point of the amendment, and it is the point that I will make when I speak to the amendment I have tabled. Clause 26 suddenly introduces new language, with the word “dishonesty”, which brings in another type of coercion and pressure. Could we rethink the wording of clause 1(2)(b), which refers to a person who

“has made the decision that they wish to end their own life voluntarily and has not been coerced or pressured”?

The words “coerced” and “pressured” are insufficient to cover the safeguards that we are asking for. They are not a catch-all. We are asking for something much more nuanced, and for other words to be added, just as the word “dishonesty” appears in clause 26.

[Jake Richards]

I did not draft the legislation, but my understanding is that the reason why the word “dishonesty” appears in clause 26—I do not know whether the Minister wants to comment on this—is that when there is a criminal offence, there needs to be a mens rea. The person who has committed the offence needs to have been intentional or reckless in doing so. As I say, I was a criminal barrister only very briefly; I am sure my law tutors are shaking their heads.

[Naz Shah]

The principle of statutory interpretation means that by mentioning one thing, we exclude others, so it is my understanding that having the terms coercion and pressure in the Bill excludes undue influence. Will my hon. Friend, who has clearly gone through this in detail, also comment on the fact that section 2A of the Suicide Act says that encouragement includes pressure?

[Jake Richards]

With respect, I think my hon. Friend is wrong: it is certainly not an exhaustive list of factors to be taken into account. The courts—this is why we have a common law system—interpret the language used in legislation.

[Naz Shah]

To build on that, I referred to the Court of the Appeal earlier, but when it comes to someone giving their organs, I think from the age of 12 or 13—I will try to find the reference—the words “undue influence” are used in the legislation. It comes back to the crux of my argument; I would like to understand why my hon. Friend is so concerned, from a legal perspective, about putting in the words “undue influence”, when they already appear in legislation.

[Jake Richards]

The issue I have is that if we open the door to all different types of terminology, it will never end. The law is best served when it is clear, simple and straightforward.

[Danny Kruger]

Will the hon. Gentleman give way?

[Jake Richards]

Let me just make this key point. Members have raised the case of Re T. I must admit that I do not know that case, but I believe it is a 1992 Court of Appeal case about a refusal of treatment, so it is 33 years old. The law has moved on. As the Minister said earlier, the terminology of coercion and pressure is much more modern, and is used in legislation that has been drafted in the last decade, rather than the Suicide Act drafted in the 1950s and that Court of Appeal case from the early 1990s.

Last night, I briefly went back to my law books—I sound like I am really missing my old job—and looked into where the concept of coercion is used across different jurisdictions and areas. This is what I read: “Coercion is a phenomenon the courts have experience of handling. Generally, coercion as a concept in our law involves applying pressure, whether physical, psychological or moral, to force someone to act against their free will or better judgment. This pressure can manifest in various forms, such as threats of intimidation and undue influence, and is recognised across criminal, family, consumer and contract law.” It is used in forced marriage legislation. It is used in criminal legislation. Case law has made it very clear that coercion is used interchangeably with duress, defined as a constraint on a person’s choice.

I feel that we are dancing on the head of a pin. The law has been drafted by one of the most senior parliamentary draftspeople. The Government Minister has confirmed that the Ministry of Justice deems this to be a sensible course of action if this legislation is to proceed.

[Dr Tidball]

Does my hon. Friend agree, as Max Hill did in oral evidence, that it would be helpful to have definitions of the three concepts in clause 26? Although we are discussing an earlier clause, it is important to thread the needle with this statute and ensure that we are looking ahead, as the hon. Gentleman has rightly pointed out.

[Jake Richards]

That sounds very sensible—I think my hon. Friend is talking about her amendment.

[Rebecca Paul]

I am so glad that the hon. Member has spoken, because this is a really important conversation. I appreciate that we are getting a little ahead of ourselves, so I will be quick before the Chair tells me off. Section 2A of the Suicide Act includes pressure when it talks about encouragement. That is why it is so useful to have this conversation—because that could mean that encouragement is captured by clause 26. There is some work to be done. I stand by the amendments—it is really important that we have them on the face of the Bill—but, when we get to the relevant point in Committee, we need to think about the interactions of clauses 24 and 26 with the Suicide Act. I am sure that the Ministers will want to look at that, but we may need to be very clear what is included in what, which may require some things in the Bill so that there is no ambiguity. Does the hon. Gentleman agree?

[Jake Richards]

Yes. As I say, the amendments are perfectly reasonable; it is sensible to raise them and it is good that we are having this conversation. I have looked into this carefully and I take it seriously. I feel that the square is squared—or the circle goes all the way round, to mix my metaphors—but that does not mean that we should not look into this further when we get to the relevant clauses.

[Danny Kruger]

I am worried about the constant suggestion that we look at these issues later. The fact is that we do not know what the Bill will look like later. We do not know what amendments will be tabled or what will be agreed. It is always possible to revisit amendments that have been passed in the earlier stages if subsequent amendments make them otiose. The point is that we should not pass this opportunity to strengthen the Bill if we can.

On the point that the hon. Member for Rother Valley was discussing with my hon. Friend the Member for Reigate about the Suicide Act explicitly referring to pressure as a subset, as it were, of encouragement, that Act specifies that encouragement is the general, catch-all term and includes pressure. I think the hon. Gentleman is suggesting, and other hon. Members have suggested, that it is the other way round: that coercion or pressure somehow include encouragement. Surely encouragement is the broader term—it exists in the current law on suicide. What is the problem with using that term in addition to coercion and pressure, consistent with existing law? It is a broader and more sufficient term.

[Jake Richards]

On the first point, in fairness, the hon. Member for Reigate was talking about a clause that we are going to consider and the link between two different criminal offences in the 1961 Act and clause 26 of the Bill.

On the second point, the Bill—to coin a political phrase—needs to be fit for the future. The language used in legislation over the last decade when we are considering coercion—I use that word automatically because that is the language we use now—is much more appropriate than “encouragement”, which is slightly archaic, to be honest. Perhaps we need to look at the Suicide Act as well—although not in this parliamentary term; that is for the second term. [Laughter.] I have nothing further to add.

[Juliet Campbell]

I rise to speak to amendments 113 to 115 and 118 to 121, which would require steps to be taken to establish that a person seeking assistance has not been manipulated by another person.

The amendments would require the co-ordinating doctor to ascertain whether, in their opinion, the person has been manipulated, and would account for additional ways that a person can be influenced by another person into choosing an assisted death. Pressure and coercion may leave an individual feeling that they have no choice but to take that path; however, manipulation can make the person think that they made the choice themselves. Coercion is an overt and clear means of controlling someone, whereas manipulation is a hidden, psychological and deceptive means of control.

Terminally Ill Adults (End of Life) Bill (Eleventh sitting)

Jake Richards Excerpts

Committee stage
Wednesday 12th February 2025 Public Bill Committees

[Rebecca Paul (Reigate) (Con)]

rose—

[Jake Richards (Rother Valley) (Lab)]

rose—

[Danny Kruger]

I will give way first to my hon. Friend and then to the hon. Gentleman.

[Danny Kruger]

I am very grateful to my hon. Friend.

[Jake Richards]

The issue in this interesting debate between the hon. Member and the right hon. Member for North West Hampshire is whether the assessment is of the person making that decision—have they been coerced?—or of actions of a third party. Someone cannot themselves be encouraged; someone else encourages them. It may very well be the case that an individual making a decision has been encouraged to do so, but the issue for an assessing doctor, panel or judge is surely whether that person’s ability to make the decision has been affected. That is not about their being encouraged; it is about whether they have been coerced. That is the differentiation between the two concepts. The concept of coercion is a much better way of ensuring the assessment is about the person’s ability to make the decision, not about third-party factors.

[Danny Kruger]

The hon. Gentleman makes an important point. However, as we discussed earlier, the terms of the Suicide Act 1961—which explicitly include the term “encouragement”—include pressure. The understanding and interpretation of “encouragement” include the effect of the encouragement, which is that someone has been persuaded by a third party to take this step, whereas the principle of the Bill is that people are acting entirely autonomously.

--- Later in debate ---

[Rebecca Paul]

I agree that that would have been helpful. We have spent many, many hours today debating these amendments, and having had advance notice would have allowed some reflection and appropriate advice to be taken. If, indeed, the Minister’s position is right, I could have looked at withdrawing the amendment or tabling a new one. However, I have not had time to do that, so I am in a situation where I have to follow the advice that I have had. I think, if the Minister is right, having this on the face of the Bill is potentially a little messy because we would be duplicating, but that is not a massive downside from my perspective, whereas the upside is that, if she is wrong and I and the advice that I have had are right, we would be ensuring a higher level of safeguarding in this Bill.

[Jake Richards]

The hon. Member said that my hon. Friend the Member for Penistone and Stocksbridge and I contradicted each other. I did not quite understand the logic of her argument; I do not deem that we contradicted ourselves one bit. I also want to push back on the point about process. Let us just step back: we have been debating for a number of hours some very sensible amendments, and that is exactly what this Committee is meant to do. I am new here, the hon. Member is new here, but it seems to me that it is exactly right. She has tabled an amendment, we have had good debates on all sides, and the Government Minister stood up and gave the Government’s view of the workability of the Bill and whether the amendment is necessary. Is that not what this process is meant to be doing?

--- Later in debate ---

[Naz Shah]

I thank my hon. Friend for his valuable intervention. He speaks from his personal experience, and this place and this debate are richer for having those experiences shared. It comes back to the comment made by the hon. Member for Solihull West and Shirley; this is about where there is autonomy. This is about people who make that informed choice without coercion, loss of autonomy, undue influence or encouragement. We are talking about those people; we are not talking about those who do not fall into that category.

Those of us in this House know of inequalities that exist in our communities for disabled people, women, or people with mental health illnesses. We already know that; this is about safeguarding and making sure that we are exploring the reasons why, to safeguard those who do arrive at those conclusions—at that decision of autonomy—so that, should this Bill be passed and become law in two years, we as a Committee will know that we have tried our hardest and our best to support my hon. Friend the Member for Spen Valley to make it the safest Bill in the world.

[Jake Richards]

I am very sympathetic to the amendment, which aims to tackle a mischief that we are all worried about, but there are two fundamental problems. The first, which builds on the intervention from the hon. Member for Solihull West and Shirley, is this issue of deciphering if an action is for your own sake or the sake of others. It is a philosophical question: is there ever really a selfless act? Even if we take an act that may be deemed to be for someone else, it may be because we want that person to receive some pleasure, joy or relief, so in my mind there is a danger that this could become a tautology.

Secondly—I hope that you might be able to comment on this—is there not a danger that we are then putting it on doctors and others in this process to undertake an assessment of welfare? When you are deciding whether something is for an individual’s sake, you are making some determination, are you not, as to what is in their best interests? That directly conflicts with the principles of the Bill, which is all about autonomy and an individual’s choice, rather than others saying what you should and should not do.

[The Chair]

Order. I have no comment to make—“you” again.

[Jake Richards]

Forgive me, Mrs Harris. I apologise profusely.

[Naz Shah]

If we are talking about welfare, I would have thought that this Bill would have included welfare checks, which are absolutely crucial. My definition of welfare encompasses the whole being, with the person at the centre. In this case, welfare would mean putting somebody with a terminal diagnosis at the centre of what service provision looks like, be it for assisted dying or a care pathway through palliative care.

[Jake Richards]

rose—

[Naz Shah]

I am happy to give way if my hon. Friend wants to elaborate.

[The Chair]

Order. Before the hon. Gentleman starts, can I ask for short interventions, please, not speeches?

[Jake Richards]

What I meant by a welfare decision is a paternalistic view, whereby medical practitioners and others say what is in the best interests of an individual, rather than the individual themselves.

[Naz Shah]

I appreciate the clarification and the explanation. I do not feel that having doctors doing this is a contradiction of this Bill at all, because if we go by the letter of the Bill and how it is set out, when a doctor offers those choices, whether it is assisted dying or palliative care, they are giving a choice of welfare options to their patients. That is my understanding, and I am not sure that this is contradicts with the Bill in any way, shape or form.

I have answered my hon. Friend’s first question; can he remind me of his second?

[Jake Richards]

My question was building on the intervention made by the hon. Member for Solihull West and Shirley. It was about whether there can ever be a selfless act.

[Naz Shah]

If we make philosophical and idealistic arguments, we will not be able to legislate on anything. Philosophically, there are people in this House who wear red, blue, green or the colours of smaller parties. We are all different in our positions philosophically. For me, this process is about legislating as well as we can to put safeguards in place that are as strong as possible. I cannot get into that debate because it would not apply to the legal aspect.

--- Later in debate ---

[Danny Kruger]

That is fair enough. The amendment seeks to insist that people will have an assisted death for their own sake. What we are trying to exclude is the opposite of that—that they are doing it for others. The principal reason why people want an assisted death, if they are not being coerced—which we have already sought to exclude—is that their own internalised view that it would be better for other people for them to do so.

[Jake Richards]

Will the hon. Gentleman give way?

[Danny Kruger]

We want to ensure that people decide for their own sake—I will give way in a moment; this is a good opportunity to make this point. The hon. Member for Ashford referred to the Mental Capacity Act, which we have retained as the basis of the capacity test. The Bill would introduce a version of the best interests consideration, which, as we discussed yesterday, will not be triggered in the Bill because that consideration is not triggered if there is capacity—and if there is not capacity, things do not proceed.

I think it is appropriate that the people making the decision have some consideration of their best interests. I understand that we want to make this all about autonomy, so perhaps a better description is a self-interest consideration. That is what the amendment requires doctors and, later, the judges to conclude: is the person making the decision in their own interests, for their own sake? Are they doing it for themselves? If they are doing it for other people, that is problematic.

--- Later in debate ---

[Jake Richards]

The hon. Member is making a powerful argument, but there is a difference between trying to control external factors that may affect an individual making a decision and primary legislation that tries to regulate a person with capacity making an assessment of what is in their best interest. Can he think of any other circumstances in our society or our law where someone with capacity is restrained from making a best-interest decision in primary legislation?

[Danny Kruger]

I am grateful to the hon. Gentleman because he highlights the absolute novelty of this law. We are proposing to do something completely unprecedented. As hon. Members have tried to argue over the last two days, it takes us into extremely dangerous waters with respect to the most vulnerable, so what we are trying to do, through what I concede are some fairly blunt instruments, is to write into the Bill some very strong and clear protections for the most vulnerable people. We have tried to do that in various different ways.

This would be novel. Of course, it is true that the criminal law currently recognises motivation—there are all sorts of aggravating factors that look into the motivation of an individual, so the law is not incapable of making that sort of judgment—but the hon. Gentleman is right to say that this would be a novelty. I am afraid the whole Bill is a novelty.

Terminally Ill Adults (End of Life) Bill (Thirteenth sitting)

Jake Richards Excerpts

Committee stage
Tuesday 25th February 2025 Public Bill Committees

[Naz Shah]

If we take that number, then that 30% or 40% who do not take that decision is maybe a few hundred people. However, the truth from Professor Sleeman’s evidence is that we are talking about thousands of people who are misdiagnosed every single year. She was talking about 3,516 who lived longer than expected. Yes, I recognise and value my hon. Friend’s comment that 30% or 40% of people do not take up assisted dying, but—perhaps I will talk about this when I move on to the next amendment—there is also a risk. If we go back to the Bill promoter’s intention to make the wording tighter, then surely this is a safeguard that she would support, just to ensure that we are making it as tight as we possibly can.

[Jake Richards (Rother Valley) (Lab)]

Can my hon. Friend clarify for me what she means by “reasonable certainty”, and how that differs from the clause as drafted? Can she also explain why, in her amendments, normal language around the burden of proof, such as “on the balance of probabilities” or “beyond reasonable doubt” is not used?

[Naz Shah]

First, this is not an issue for a tribunal, where it would be on the balance of probabilities; it is not an issue for a court of law or a criminal court, where we would be using proof beyond reasonable doubt. What I am trying to demonstrate is that doctors, in those diagnoses where they do get it right, have much more certainty. It might be that people have six months to live because they have different types of cancer. I am certainly not a clinician or an oncologist, but I know from the evidence we have had and from speaking to people that some people’s diseases—the specialists know better—have a trajectory of plateauing out and then dropping right at the end and some have a jagged kind of decline. Some of those diseases can be predicted with much more clarity than others. On the surface of it, in September, it might be the case for somebody that that is within the time—as for one lady who was told that she would not have more than six months to live. She is the founder of the Music of Black Origin awards and I was with her last week. She was absolutely fighting; she was not supposed to make it to that day. It is for the medics to decide—it is not for me to decide—but I would like medics to have much more certainty than they currently do, so that we would not have 47% of cases being misdiagnosed. That is what I am trying to get to, but I thank my hon. Friend for his intervention.

I argue that there is still a danger of using the standard prognosis that is currently in the Bill. The current research into doctors’ prognoses indicates that about half of their estimates are incorrect. My amendment would hold doctors to a higher standard of certainty. Under the measure, they would be explicitly held to a prognosis that death would occur with reasonable certainty within six months, and that that would have to be true even if the patient underwent all recommended treatment.

To go back to my hon. Friend’s intervention, this amendment is about raising the bar for how our medics make decisions. I submit that it would be a stronger test than the one currently included in the Bill. My hon. Friend the Member for Spen Valley has frequently stated that she wishes to create a Bill with the toughest safeguards in the world. I keep coming back to that, because the whole purpose of speaking to all these amendments is to put in opportunities to try to strengthen the Bill. By their nature, all these amendments reflect hon. Members’ concerns. This amendment would tighten the prognostic standard required of doctors and would therefore contribute towards tightening the Bill’s safeguards. I hope that hon. Members support it.

Finally, I turn to amendment 402. I will repeat a lot about anorexia, but it is an important amendment. I have tabled it for a simple but extremely important purpose: to prevent people from qualifying for assisted dying by stopping eating and drinking to the degree that they develop severe malnutrition, such that a doctor would give them a prognosis of six months to live. It specifically aims to protect people with severe eating disorders, including anorexia nervosa, and would also protect people with a severe wish, as one of the psychiatrists who testified before the Committee put it, to “hasten death”. I hope that my hon. Friend the Member for Spen Valley, and all other Committee members, will support this amendment.

Let us make no mistake: the Bill, as currently drafted, has a horrible loophole that all of us should seek to close. We know that anorexia sufferers and other people with eating disorders can and do stop eating to the point where they are dying of malnutrition. We should not allow such people to qualify for assisted death. Unfortunately, that is not a hypothetical danger; it is happening.

We know from the evidence that the Committee has received that that has happened in other countries. A group of eight experts on eating disorders submitted written evidence TIAB54 to the Committee some weeks ago. The experts included Chelsea Roff, who has been referred to many times in this Committee, and who gave clear testimony before the Committee, as well as seven medical doctors from hospitals in the UK, the US and Canada.

I hope that all Committee members have read the evidence, but I would understand if they had not, because we have had nearly 400 pieces of evidence to go through and very little time to read it. It seems to me, however, that if we are trying to write the best possible Bill, with the strongest possible safeguards, we have to pay the written evidence of experts the attention that it deserves. In their written evidence, that group of experts said:

“Patients with severe eating disorders frequently experience profound psychological distress and may express a desire to die. While this may appear to reflect a clear and informed wish, it is often a symptom of their psychiatric condition, which is remediable with appropriate treatment.”

The experts found that at least 60 patients with eating disorders received assisted death in several jurisdictions worldwide, including the US, Canada, the Netherlands and Belgium. I stress the phrase “at least 60” because we cannot be entirely sure that that is the full total. It is sadly the case that some jurisdictions are much more painstaking and transparent in the data they publish on assisted death than others.

In itself, it is tragic that people died in that way, but two things surely make the fact even worse. There are certainly men with eating disorders, but this is a problem that disproportionately affects women and girls. We know that the incidence of anorexia nervosa is much higher among women than among men in every age group. That is tragic. In every case we know of where a person with an eating disorder received an assisted death, that person has been a woman. I say it again: we cannot allow the Bill, as currently written, to stand. The Labour Government was elected with a mandate to reduce violence against women and girls. We surely cannot pursue that goal while at the same time increasing the vulnerability of women and girls who have eating disorders. There is nothing in the Bill as it currently stands that would stop doctors signing off on assisted death for someone who had starved themselves into malnutrition.

The courts in England and Wales have already begun accepting that some people with anorexia have reached a terminal stage. In the Court of Protection case, The NHS Trust v. L & Others, which took place in 2012, a 29-year-old with severe anorexia was described in the ruling as follows:

“The prospects of her recovery overall approach zero…given that it is extremely unlikely that Ms L will recover from her anorexia…in best interests to move to palliative care if L…in terminal stage of her illness.”

The right hon. Member for North West Hampshire raised the Court of Protection. There are 10 cases where the Court of Protection has made rulings. Of them, only one case, in 2012, ruled that the young lady could be force-fed.

Terminally Ill Adults (End of Life) Bill (Fourteenth sitting)

Jake Richards Excerpts

Committee stage
Wednesday 26th February 2025 Public Bill Committees

[Danny Kruger]

Exactly. A few more words of clarification should not be regarded as burdening the Bill or creating bureaucratic obstacles for doctors and patients; the amendment actually specifies more explicitly what is going on. It is almost akin to the debate we had on amendment 181 and those dangerous words “for the avoidance of doubt”; that is essentially what this amendment does, but it goes further, because it imposes clearer obligations on doctors to do their job properly.

[Jake Richards (Rother Valley) (Lab)]

Much has been covered today, and the issue of capacity was debated at length when the Committee considered clause 1, but I do have some observations.

I am sympathetic to the assertion that there should be changes to presumption and burden. Those are things that I have considered and spoken about with the promoter of the Bill and, outside the Committee, with experts who gave evidence to the Committee. I have spoken about them publicly as well; I am very sympathetic.

At the heart of this, we have two options. We could change the burden and presumption in the Mental Capacity Act 2005 for the purposes of assisted dying, rewriting 20 years of case law and medical practice. There is certainly some value to that, but that would be a radical departure from current medical practice, and there are other concerns. The alternative is to put in place rigorous processes and training around the Mental Capacity Act to ensure that it is implemented properly. After some reflection, I err on the side of the latter option, for a number of reasons.

First, I accept that there is debate among psychiatrists about this issue. We heard evidence from some who deem the Act not to be suitable for this new realm—I accept that we are entering new grounds, and I will come back to that point—but many psychiatrists and lawyers working in this area would deem it uncomfortable and unnecessary to depart from the Act.

Secondly, there is an oddity in changing presumption. There is an oddity in someone having to prove that they have capacity to fulfil their own desire. That oddity is one of the reasons that the Act is drafted as it is. It is partly—there are two sides to this coin—to ensure that there is no discrimination, partly to comply with the Human Rights Act 1998 and human rights more generally, and partly to ensure that we do not end up in a medical situation that is patrician, whereby medical doctors take an intrusive view of capacity rather than meeting the individual as they are.

Thirdly, the Bill, when amended—I will come on to the amendments that give me some comfort—will offer more safeguards than the Mental Capacity Act. Amendment 5 to clause 9(3) would ensure a further level of assessment. My hon. Friend the Member for Spen Valley has indicated that she will support that important amendment, as have all members of the Committee. If there is any doubt, there will be a further assessment by a psychiatrist. That goes some way to reassuring me that it is not necessary to rip up the burden or change the presumption in this area.

I want to make an observation about burden of proof, presumption and the nature of the assessment. Professor Whitty clarified his evidence. It is right that the burden and the presumption do not change, but of course the nature of the assessment rightly changes according to the circumstances. Every assessment of capacity is somewhat different, which is why amendment 50 is too prescriptive, in my view.

Of course, we can consider incredibly serious cases involving deprivation of liberty or the ability to conduct litigation. I have worked with parents whose children are being removed and looked at whether they have the capacity to make decisions about how they present their case. It is very dangerous to compare the severity and the profound nature of different circumstances, but let us not pretend that the Mental Capacity Act is not used to assess the most complex issues of capacity every day.

I am very sympathetic to amendment 50. I have met the hon. Member for Runnymede and Weybridge, who tabled it, and the hon. Member for Solihull West and Shirley to discuss it, but I stress that such a prescriptive provision is not appropriate for primary legislation when we are entering new ground. I accept, as hon. Members with different views have said, that we are entering new territory and that this is difficult. I accept that psychiatrists and medical practitioners will have to think long and hard about the nature of the capacity assessments, especially under clause 9(3), when that is activated. That work will have to be done. It has been set out in primary legislation through some of the training clauses, which have already been referred to.

There is no doubt that there will be a lot of work and consideration, but I do not deem it appropriate to have a clause drafted by one psychiatrist, albeit an undoubtedly esteemed and experienced one: the hon. Member for Runnymede and Weybridge, who tabled the amendment. Rather, the work needs to be done as the Bill is implemented over a two-year period. It needs to be done as part of a full consultation with psychiatrists, once the Bill has been passed, and that should be set out in guidance. That is what would usually happen with deprivation of liberty. I do not think it appropriate for primary legislation to set out the factors for a capacity assessment.

[Naz Shah]

My hon. Friend is saying that that will take two years. The MCA, which has been implemented over 20 years, is misunderstood. Does he not see the risk of two years? This is new territory, without change—

[Jake Richards]

We need to be careful when we say that the Mental Capacity Act is misunderstood, full stop. Let us be clear—

[Naz Shah]

Not full stop.

[Jake Richards]

Well, that was the sense—

[The Chair]

Order. Let the Member respond to the point made in the intervention.

[Jake Richards]

I am grateful, Mr Dowd.

The evidence that we have received is that this is a test. These are assessments that happen every day across the country. Now, there are more complex assessments, and there will without doubt be areas in which the assessment is not done as rigorously as it should be done, but that is why I am assured by the safeguards in the Bill that if there is any doubt—any doubt—as to capacity at first instance, there will be a full and thorough assessment by a psychiatrist.

Let us think that through for a minute. Any competent psychiatrist trained in this area will no doubt have a sense of what the Mental Capacity Act says and of the normal test for capacity. Someone who is seeking assistance to die from a doctor who has doubts as to their capacity will have been referred. To my mind, it is unfathomable that that assessment, at that stage, would not be rigorous and would not satisfy every Member that it had been done to the correct extent practicable.

[Naz Shah]

I absolutely agree with my hon. Friend about that in most cases, but in nine of the 10 cases that went to court, young girls were found to have capacity, but their treatment was stopped, leading to their inevitable death. That is not excluded here.

[Jake Richards]

We are debating lots of different things now, rather than just clause 3. There is an issue as to whether in those cases the individuals were found to have capacity, but we are talking about the process by which someone is found to have capacity, rather than what happens thereafter. We have had that debate, and I am happy to have it, but we are talking now about the process by which people are found to have capacity.

This is the problem with interventions: I have lost my train of thought. This is why people do not take them.

[Danny Kruger]

rose—

[Jake Richards]

But I am happy to take another, although I may come to regret it.

[Danny Kruger]

I have a simple point to make; the hon. Gentleman can work out what he is going to say next while I make my brief intervention.

The point is that the referral to a psychiatrist will happen if the doctor has doubts in their mind. There is not an obligation on the doctor to refer; there is only an opportunity for them to do so, if they conclude that there is a reason. May I put a scenario to the hon. Gentleman? It is not clear whether this could happen under the Bill; well, it could happen, because it is not prohibited. A private practice might establish itself to provide assisted death, with the medical assessments and the support right through to the end—to the final act.

In those circumstances, if a patient goes to one of those clinics, does the hon. Gentleman not see that there might be a risk that the whole incentive of the business, even if it is a charity, will be to expedite the process, tick the boxes and pass people through? Does he not consider it dangerous that there is not an absolute obligation to refer to a psychiatrist and in fact, an obligation to pass a higher capacity test than the one that is currently in the MCA?

--- Later in debate ---

[Jake Richards]

That was an intervention that I was grateful to take. I accept the point that there are dangers of a system that somehow incentivises this. That is why the Bill has to have such strict safeguards and such strict regulation of medical practitioners to comply with the law. The point about mandatory referral is key; I would have real concerns about this area of the Bill without that amendment, and unless the sponsor of the Bill had not made it very clear that she would be supporting it. But I take the point.

[Lewis Atkinson]

Does my hon. Friend agree that clause 8(6), which requires the second doctor to be independent of the first—they must not be

“a partner or colleague in the same practice or clinical team”—

would protect against the situation on which the hon. Member for East Wiltshire speculates?

[Jake Richards]

Yes, there are safeguards and mechanisms in the Bill to ensure that and to protect from a culture that would incentivise this practice.

[Naz Shah]

Will my hon. Friend give way?

[Jake Richards]

No, I am not going to, actually. I am taking my rights.

My final point concerns section 1(4) of the Mental Capacity Act and the discarding of the principle about whether a decision is deemed to be unwise. This is an issue we have already debated, but it is really important. Introducing a best interests test is, to my mind, impossible without ending up with a law that discriminates against certain groups. Essentially, it is impossible to do fairly.

I remain to be convinced. If there were an amendment that could do what I think the hon. Member for East Wiltshire wants, I would support it. If there were an amendment that could look into someone’s mind and make sure that they are doing this for reasons that society would deem fit, I would support it, but I think that that is impossible. What the Bill aims to do is assess a person’s capacity and ensure that they are making this decision voluntarily. It also aims to protect them from the influence of third parties and outside sources. That is the only way, if this principle is to be adhered to.

Finally, I will be voting against the amendments, but I will finish where I started. I have genuinely thought long and hard, in particular about the presumption. I have spoken to experts who disagree with me, but in my mind it comes down to whether we rip things up and start again or whether we add rigorous safeguards, practices and processes, which may be a bit more boring but will actually be more effective at protecting any patients who go down this road.

[Sojan Joseph (Ashford) (Lab)]

I rise to speak in support of the amendments. Having worked as a mental health nurse for 22 years, I completed mental capacity training many times in my career, and I carried out capacity assessments as part of my day-to-day job. I think that the capacity assessment proposed in the Bill is not safe enough. That was one of the main reasons I voted against the Bill on Second Reading. I have spoken to many people who oppose the Bill, and one of their concerns is about the capacity assessment.

We have talked about capacity assessments every day in this Committee. It is one of the key issues that we will need to resolve to strengthen the Bill if it goes through. One of the Royal College of Psychiatrists’ concerns is that capacity decisions are

“opinions with a margin of error and are time specific. A person’s capacity can change”.

I will talk about my experience with those margins of error.

A person’s capacity can be influenced by various factors, including their life circumstances, the medication they are taking or severe pain. Suicidal thoughts due to their mental state or depression can also influence their capacity. I have worked in acute mental health units. Every day, we carried out capacity assessments, including before we let someone out of the ward, whether they were admitted under the Mental Health Act or were receiving treatment as a voluntary patient. If somebody wanted to leave the ward, before the member of staff opened the door, they had to assess that person’s capacity. Sometimes a person might have said, “I am going to kill myself,” and the nurse would have had to decide whether or not they had capacity before opening the door.

My hon. Friend the Member for Bradford West has talked about unconscious bias. The initial capacity assessment when a person comes to a hospital is very important. If a doctor has assessed at the beginning that the person has capacity, the following assessment can be influenced by that initial assessment. I totally agree with my hon. Friend’s argument about unconscious bias in capacity assessments. As Members have mentioned, the Bill proposes many occasions in the process when capacity will be assessed, but I am still not confident that each capacity assessment will not be influenced by the initial assessment. The amendments would strengthen that area of concern.

Terminally Ill Adults (End of Life) Bill (Fifteenth sitting)

Jake Richards Excerpts

Committee stage
Wednesday 26th February 2025 Public Bill Committees

[Jake Richards (Rother Valley) (Lab)]

I have been listening to the argument in some detail. Is there not a danger here of trying to translate the dry words of clause 4 to the conversations that naturally happen between clinicians and patients? Subsection (3) attempts to give some discretion as to when, how and whether to raise this prospect, instead of making it mandatory on any prognosis of terminality.

[Danny Kruger]

I recognise that it is an attempt to give maximum leeway to doctors. I think that is dangerous and puts doctors in a very difficult position. The BMA made the point that it is appropriate to enable doctors to raise this option as if it were just another treatment, even though it has also said it is not just another treatment.

I would challenge the BMA with the Medical Defence Union, which is the union that supports doctors in litigation. It points out, more correctly, that this is the worst of all worlds for doctors because they would be liable to complaints in either situation: if they do not raise it, a complaint can be made against them for not having done so; and if they do raise it, a complaint can be made against them on those grounds. We are being extremely unclear by leaving it entirely up to doctors. As I have said, it is not clear to me the circumstances in which it would be appropriate for a doctor to suggest an assisted death to somebody who has not raised it themselves. I would very much like to hear somebody tell me what those circumstances might be and to paint a scenario for us in which it is appropriate.

--- Later in debate ---

[Naz Shah]

I agree that that is what the evidence shows us, and there are many concerns in other jurisdictions as well. I will come back to that distinction.

[Jake Richards]

The evidence that I have heard, both in Committee and from other sources, shows that the gagging clause leads to complete absurdities. Doctors feel completely unable to look after their patients and inform them of their options, and this leads to conversations that involve winks and nods. That is exactly what the Bill is trying to stop. Does my hon. Friend agree? I sense not.

[Naz Shah]

Unfortunately, I do not agree. I do not even agree with the term “gag clause”, which has been used a few times now. From where I stand, this is not a gag clause; it is an amendment that protects those who are most vulnerable. In Committee I have referred continuously to the most vulnerable, as have other hon. Members, and I will return to the evidence from Dr Jamilla Hussain. I do not agree with my hon. Friend’s position.

We need to listen to what doctors who are treating vulnerable patients say about the risks to those people, and then we need to amend the Bill to reduce those risks. Bluntly, there is a choice here. The British Medical Association says that if the Bill becomes law, doctors should be able to raise the subject of assisted dying with patients. Palliative medicine doctors such as Rachel Clarke and Jamilla Hussain, who deal with this every day, are deeply concerned by that prospect, and they want us to avoid it. There is no papering over this: the doctors disagree and it is up to us—the Committee— as lawmakers, and this House, to decide which of them makes the stronger case.

I genuinely think that the BMA makes a strong case. There is no doubt in my mind that it is motivated by empowering doctors to give the best possible care to their patients. It is natural that the BMA looks at existing practice among doctors. Currently, doctors can discuss all possible treatments and pathways with patients—the key words being “possible treatments and pathways”—so the BMA makes the case that that should also be true for assisted death.

In the end, however, I cannot agree with the BMA for one reason: assisted dying will be qualitatively different from every previous kind of medical intervention that has been legally permitted in this country. We have never permitted doctors to legally assist patients to take lethal drug combinations with the sole purpose of ending their lives. Some things really are different from what has come before; if the Bill becomes law, assisted dying will be one of those things.

Terminally Ill Adults (End of Life) Bill (Sixteenth sitting)

Jake Richards Excerpts

Committee stage
Tuesday 4th March 2025 Public Bill Committees

[Dr Opher]

I absolutely agree. We are imagining that the doctors will all be independent and will not know anything about what other doctors have said, but there will be communication and access to medical records, and they will also tell the original doctor what their opinion is, and so on.

If we accept these amendments, we risk over-embroidering the Bill, which will make it almost impossible for doctors to say anything in a consultation. We must leave that free, because that is a central tenet of medical care, and if we put laws around it, there will be legal process over the medical consultation, and doctors will be frozen with fear about breaking the law. They are regulated by the GMC, and we are all terrified of referrals to the General Medical Council for that very reason: because we are trying to operate at the best standard that we can. I truly understand the amendments, but I do not think they will make the Bill any safer, and that is what we are all here for.

[Jake Richards (Rother Valley) (Lab)]

I am very sympathetic to the amendment and have thought long and hard about it. Can my hon. Friend explain to me, from his experience, but also from looking at the Bill and speaking to others, the effect of clause 4(4)(b)? As a non-clinician layperson, it appears to me that if a medical practitioner is discussing the likely effect of any treatment, then by its very nature that would lead to a discussion about prognosis, and the uncertainty and certainty around that.

[Dr Opher]

What my hon. Friend points out is absolutely true. The Bill’s drafting is simple but very effective. For prognosis, for example, it says that it is

“reasonably…expected within 6 months.”

As we have discussed many times in this Committee, prognosis is not exact; it is an estimate. It suggests that the patient has a terminal illness—that is to say, the illness will lead to their death. All we are arguing about is exactly when that will happen. It is reasonable to say, as doctors already do, “It is likely that you have six months to live.” That is not exact—as doctors, we cannot predict the future, even if people think we can. I totally accept that. However, we can make estimates as to what is likely to happen.

As my hon. Friend just mentioned, there are lots of really good news stories of people living longer than their prognosis. However, for the Bill to be effective, and to give relief to people who genuinely need it, we have to have a prognosis, based on medical evidence, of six months.

Terminally Ill Adults (End of Life) Bill (Nineteeth sitting)

Jake Richards Excerpts

Committee stage
Wednesday 5th March 2025 Public Bill Committees

[Jake Richards (Rother Valley) (Lab)]

I was expecting someone else to have spoken in support of amendment 296, but I will be very brief. The tone of the debate so far has been respectful, and it should continue to be so. I hope that this will not be characterised as a personal attack on my hon. Friend the Member for York Central, who tabled the amendment, or anyone else who supports it, but this is a shocking amendment. It is shocking because I doubt that the motives behind it are to improve the Bill or make it safer. In fact, I fear that the motives are to build a political attack to support opposition to the Bill, rather than to be constructive in improving it.

I have come to that conclusion because there is no concept in any other piece of legislation, or in any healthcare guidance in operation, that would ever presuppose that a clinician would undertake a consultation, assessment or meeting that would ever put other patients in danger. I fear that this amendment has been tabled because some people are attempting to assert, perhaps not purposefully or wilfully, that the introduction of an assisted dying system would somehow force clinicians to put other patients at risk. If that is the assertion, that is wrong and—in my view—shocking. It is a shocking indictment on their view of our medical practitioners in the NHS.

[Danny Kruger]

The hon. Gentleman is impugning the motivation of his colleague, the hon. Member for York Central, who is herself an experienced practitioner in the NHS. To suggest that she has tabled this amendment improperly is a serious accusation, which I cannot believe that he really wants to make against his colleague. He said that the amendment’s intention is to suggest that assisted dying would cause problems in the NHS, but the explicit terms of the amendment are to ensure that that does not happen. Of course, no practitioner would want to take choices that would prejudice other patients’ care.

[The Chair]

Order. Mr Kruger, you are down to speak and you can make your point then. I want interventions to be short.

[Jake Richards]

I am grateful, Chair, and I can take further interventions on any further points from the hon. Gentleman, but I will deal with that one. This is not a personal criticism of my hon. Friend the Member for York Central. I do not doubt that she has good intentions. What I stated was that her opposition to the principle of the Bill is guiding some of the amendments that she has tabled, and this is one of them.

[The Chair]

Order. That is not a topic for this debate. Stick to the amendment.

[Jake Richards]

Not only do I question the motives behind amendment 296 but its necessity is—to put it politely—mind-boggling. We have attempted to navigate a balance between ensuring that, when clinicians are dealing with this process, they do so safely, and not mandating them to undertake such conversations, assessments and procedures in a straitjacket. Put simply, this amendment attempts to manage diaries. Primary legislation should not do that. We cannot use primary legislation to manage clinicians’ busy diaries, as this amendment attempts to do. It is not only unnecessary but challenges the integrity of our clinicians and what they do every day. Therefore, I will be voting against it, if it is pressed to a vote.

[The Chair]

I call Danny Kruger.

[Danny Kruger]

I was not intending to speak on this amendment, but since you have called me, Mrs Harris, I will quickly respond to the comments of the hon. Member for Rother Valley. I sincerely think that he should withdraw the suggestion that the amendment was made in bad faith and his remarks about the motivation of the hon. Member for York Central. She clearly tabled it only to make the Bill safer, which is the purpose of all the amendments, even if there might be very good reasons to disagree with them, so I regret that attack on her integrity.

On the point that we should simply rely on the integrity of clinicians—although the hon. Member for Rother Valley has not done so in respect of the hon. Member for York Central, who is herself a clinician—of course we do that. Nevertheless, the laws we make and the guidance we introduce send strong signals about priorities. The purpose of the amendment is to ensure that doctors do not feel that the obligations created by the Bill impose a duty on them to prioritise the assisted death procedure over other priorities. In fact, it would give clinicians genuine autonomy and freedom to make their own decisions—obviously, in consultation with colleagues and patients—about the appropriate prioritisation of the treatments and services they are offering.

The hon. Member for Rother Valley made the point that there is, in a sense, an attempt to suggest that the Bill should not become law because of the pressures it could impose on the NHS. I think that such pressures are a valid concern. When we create new laws, we should consider what new burdens they will place on existing services. We should consider whether the new service will be introduced and implemented safely, and its knock-on implications for the wider system.

[Jake Richards]

The point is that the amendment is not about the wider system; it is about a clinician’s individual decision making. Does the hon. Gentleman agree that that is a very different prospect?

[Danny Kruger]

Well, that concern for the individual clinician is in the context of their wider obligation to treat their patients well and to manage a resource—their own time—in a way that is equitable to all the patients they have to see. As often in these debates, we are really considering the extent to which we should be putting into the Bill an obligation on doctors to do the job that we hope that they are doing anyway. We do have such rules in the system to clarify what we expect of clinicians, however, and I think they would be appropriate in this case, given the resource requirements—which are unknowable, but with common sense one can see that they will be quite significant—that this new service would entail for many clinicians in the NHS.

[Jake Richards]

If the Government were to introduce legislation to expand the NHS’s role in how it undertakes operations in a certain area, would the hon. Member suggest that similar amendments should be added to that legislation, or it is just about this issue?

[Danny Kruger]

There is no rule that can be applied universally in the abstract. All rules take their value from how they are introduced. On the hon. Gentleman’s hypothesis, I do not in principle suggest that every new treatment and every new obligation that is created in the NHS should require laws determining how clinicians prioritise them. In the case of a new service—I am trying not to use the word “treatment”, because I do not accept it as such, but it sounds like it will be treated as an NHS treatment—that is very significant and whose resource implications are unknown, it strikes me as appropriate that, as far as possible, we should be clear that doctors should manage the resource demands placed on them by the Bill in the context of their other obligations to patients.

--- Later in debate ---

[Daniel Francis]

As my hon. Friend will know, my name is down as a supporter of amendment 6. I will get to that in due course. At the moment, I am speaking to amendment 284. I hear what my hon. Friend says—I am talking about the merits of amendment 284, but will get to amendment 6 in my closing comments.

On amendment 284, if a doctor has doubts about the capacity of an applicant, it is good practice to refer that person to a doctor with specialist expertise in that field. That would be true if the doctor was assessing the capacity of a patient to take any important decision, and is surely especially true when we are talking about a decision of this importance. I accept that people will have different views on amendment 6, when we get to it, from those they hold on amendment 284. Amendment 284 would put a duty on doctors to do something that is good practice. Most doctors in most circumstances would do it anyway, but in some cases, some may not. My hon. Friend the Member for York Central, who tabled this amendment, believes that we should write this law as tightly as possible so that doctors have that duty.

Amendment 294, which was tabled by my hon. Friend the Member for York Central, would require the doctor to base their assessment on provided evidence. Again, that is something that most doctors would do anyway in the extremely serious circumstances of a person’s applying for assisted death.

Many laws that we consider in this House relate to things that we are familiar with and understand well; but as my hon. Friend the Member for Bradford West said last week, some laws, such as this one, concern new matters. They are about things to which we need to give due consideration, as we are doing in scrutinising the Bill, because we need to understand the issues that arise. Those laws can introduce powers that could be dangerous if not properly safeguarded. This Bill, as has been accepted, needs strong safeguards. The aim of my hon. Friend the Member for York Central in tabling this amendment was to spell out that a doctor’s assessment of someone seeking assisted dying should be based on evidence. That would make it much less likely that any doctor would not pay sufficient attention to evidence they were presented with.

Lastly, as my hon. Friend the Member for Spen Valley knows, I am a long-standing of supporter amendment 6—I was in that base going into Second Reading. Alongside my concerns about clause 3, which she has heard at length, this matter was a key concern of mine going into Second Reading. I was therefore an early supporter of this amendment to change the wording around the referral from “may” to “must”. That was discussed on Second Reading. I do not want to speak for my hon. Friend, but I think she shares similar views to mine on the matter and suspect that the matter may be supported when we get to that debate.

[Jake Richards]

I will be brief. I will talk about my amendment 280, which I will not press to a vote. There remains an area that needs more exploring in this legislation—it has come up in debates already, but needs to be looked at further—namely, that a person may have capacity but have other mental health conditions that may impair their judgment. In those circumstances, a more thorough assessment than the two-doctor stage there is at the moment would be right. In reality, that is very likely to happen under the current structure of the Bill. My amendment simply attempts to make sure that it is mandatory. Having had discussions with my hon. Friend the Member for Spen Valley, I know that she is sympathetic to that.

There are amendments in the next group that aim to do the same thing. They, along with my amendment, may not be quite right. I urge the Government to look at this issue and see how we can work together to come to a conclusion, because I think that all members of the Committee would want that. I also support amendment 6, as I think everyone does.

[Dr Opher]

I apologise, Mrs Harris—I have got slightly confused with all the amendments. I do not have a speech that has been prepared for me, or anything like that, but I would like to make some comments. I think this is about the role of psychiatry and capacity, and how we deal that in the Bill. All these amendments reflect that. I would like to concentrate on whether we should actually mandate referral for all patients to a consultant psychiatrist, or adopt amendment 6, which suggests that if one of the two assessing doctors has concerns about either capacity or mental health, they should refer the patient to a psychiatrist. Those are the two choices I think we have here.

--- Later in debate ---

[Jake Richards]

The hon. Lady has set out the process, but I believe she may have missed an important juncture in the Bill. If there are any doubts as to capacity, then the person would be referred to a psychiatrist for a full assessment.

[Rebecca Paul]

That is a “may” rather than a “must”. I hope that we would move to “must” in that event.

--- Later in debate ---

[Sean Woodcock]

I will speak briefly on amendment 21, although I will commend my hon. Friend the Member for Ashford for his contribution to the debate. He speaks with clear expertise and experience, and a real love for his profession, and we all benefit greatly from his insights.

Over the last few weeks, I have found myself voting the opposite way from the promoter of the Bill on a number of occasions, but I am not opposed to assisted dying in principle. My issue is more about whether we can ever make it safe enough; the difference between us is marginal. One thing that has been apparent throughout these debates is her passion for improving the training for those involved in palliative care, and in the wider NHS and social care generally.

That is why I want to speak to amendment 21. In the witness testimony, particularly from Rachel Clarke, there was a lot of concern about whether coercion and people being put under pressure to go for assisted dying would be picked up, and whether the NHS was geared up for that. I think that this amendment, tabled by my hon. Friend the Member for Lowestoft, goes some way to addressing that.

I do not think training is a silver bullet, hence my votes over previous weeks, but it would make a massive difference. That is true not only for the implementation of the Bill; it would have wider benefits for the NHS, social care and palliative care more generally. Even though those are not necessarily in scope of the Bill, I suggest that they are good things, which is why Committee members should get behind amendment 21.

[Jake Richards]

I want to speak to amendment 57. I do not intend to press it to a vote, but I will explore whether and how the Bill could be improved in terms of the relationship between the two doctors. There is a tension here. On one hand, we want to keep the two doctors separate, because the second one can then assess the person with a fresh perspective. We have had a debate about where there is a relationship between the doctors, which could cause problems as well. On the other hand, the evidence that we heard from some witnesses who gave evidence to the Committee was that decisions or assessments taken together can be more efficient and safer.

We may come back to this issue when we consider clause 9—next week, I presume, looking at the clock—but I wanted to raise it now. I have had conversations with the promoter of the Bill about it, but we also need to have conversations with Ministers about the best way to regulate the relationship between the two doctors to ensure that it is safe in the way that it keeps them separate but allows them to confer.

[Naz Shah]

I rise to speak to amendment 21, tabled by my hon. Friend the Member for Lowestoft, which is about the second, independent doctor. We debated amendment 20 earlier, and I am genuinely very pleased that the promoter of the Bill accepted that amendment. Some of what I would like to say now will be repetition, because it is a similar amendment, but I will try to keep my remarks contained and shorter.

I am not sure whether the promoter of the Bill is planning to accept amendment 21 as well as amendment 20 —for both doctors. I will be happy to give way if she wants to clarify that now.

Terminally Ill Adults (End of Life) Bill (Twentieth sitting)

Jake Richards Excerpts

Committee stage
Tuesday 11th March 2025 Public Bill Committees

[Lewis Atkinson (Sunderland Central) (Lab)]

It is a pleasure to serve under your chairship, Sir Roger.

I rise to speak to a couple of the amendments. Amendment 348 is likely unnecessary. I would have been minded to support it had it referred to a registered GP, but the language of “usual or treating doctor” is unconvincing. I am not sure what those terms refer to. The registered GP absolutely should be informed, and both normal practice and the provisions in the Bill about entering information into medical records would mean that that is the case. For me, “usual doctor” is not the right terminology; it does not achieve what I think some of its proponents want. With reluctance, I will vote against that amendment because it does not refer to a registered general practitioner.

On amendments 303 and 458, I believe there must be provision for a second opinion. However, I am persuaded by the points made by the hon. Member for Richmond Park about amendment 459. I slightly disagree with my hon. Friend the Member for Stroud: although the independence of the second opinion is important on matters such as the terminal prognosis, when it comes to the detection of coercion, the more information, the better. It is one thing to be independent in a medical assessment, but the amendment speaks to a psychosocial assessment. We are trying to detect coercion, so it is important that every decision maker gets further information as the process progresses.

The provision for five different touchpoints of assessment is one of the strengths of the Bill. Each assessment should be done in a way that can be progressed with more information. It is not just five different independent points of information; because of the Bill’s record-keeping provisions, the assessment should become increasingly informed throughout the process. I certainly think that the panel, or whatever we get to, should have sight of any negative assessment from an independent doctor, as well as any positive one. The panel will then be able to do its job of scrutinising the two decisions, potentially weighing them up, and calling the different doctors who have given different decisions. I am, then, persuaded by amendment 459.

[Jake Richards (Rother Valley) (Lab)]

It came up in the debates last week that we heard some evidence from medical practitioners on how decisions and assessments were better made when done collaboratively. That means that we need to keep them independent but that, where possible, doctors should be working together in this process. Does my hon. Friend agree that amendment 459, tabled by the hon. Member for Richmond Park, may assist in that?

[Lewis Atkinson]

Yes, I do. I recognise the importance of independent assessment for prognosis and capacity. However, particularly with the issue of coercion, healthcare is a team sport, as anyone who has worked in healthcare knows. The more information and the more viewpoints we can get in those instances, the better. One of the strengths of the Bill is the team sense around it, which we will further in the amendments to clause 12 that we will come on to in due course.

I will finish briefly on amendment 460. I do not see the loophole that has been described. I think we would all want someone to be able to cancel their first declaration, and they are more likely to do so if they feel they have the option of going back and making a future first declaration. My worry with amendment 460 is that, by removing the word “particular”, it suggests that people are only able to make one first declaration in the course of their life. With the periods of reflection built into the Bill, which Members spoke about earlier, if someone changes their mind, they should cancel their first declaration. They are absolutely free to do so and the Bill, as currently drafted, makes good provision for that. To me, amendment 460 would remove the ability for that person to come back to that decision at a later point and go through the assessment process again. While I understand the motivations behind amendment 460, I am cautious about it for those reasons.

--- Later in debate ---

[Naz Shah]

Sorry, I will just finish my point.

From a common sense perspective—I am not medically qualified—that situation should make me, as a human being, want to understand more. As a human being, I would like to understand whether something else was going on, such as anger towards—

[Jake Richards]

Will my hon. Friend give way?

[Naz Shah]

Sorry, I will not give way until I have finished my point.

I would like those conversations to be at least explored, which is why I support the amendment.

--- Later in debate ---

[Jake Richards]

Does my hon. Friend agree that she is making a powerful case against amendment 468? A multitude of conversations and different circumstances will need to be taken into account; it is wholly inappropriate to have a mandated question in primary legislation. We should go back to clause 1, which I think the Bill is actually about. It states that the person must have

“a clear, settled and informed wish to end their own life”.

Does my hon. Friend agree that that is what is at the heart of the Bill, rather than decisions about what is in the person’s best interests?

[Naz Shah]

I respectfully disagree. I am making the case that there is a conversation to be had. Yes, there is informed choice but is my hon. Friend suggesting that the question should not be asked at all? I take the point that with an informed choice there would have been an exploratory conversation, but sometimes just calling something out, or stating the obvious, makes a huge difference.

Terminally Ill Adults (End of Life) Bill (Twenty First sitting)

Jake Richards Excerpts

Committee stage
Tuesday 11th March 2025 Public Bill Committees

Requiring the doctor, when considering a patient’s request for assistance to end their life, to decide whether it is appropriate to advise them to discuss it with their next of kin introduces several problems. It places a subjective burden on the doctor. The term “appropriate” is very vague. Does it hinge on the patient’s family dynamics, their emotional state or indeed the doctor’s own biases?

[Jake Richards (Rother Valley) (Lab)]

The amendment that the hon. Member is supporting speaks of a doctor having to consider what is

“in the person’s best interests”,

which is wholly subjective. Does he not agree that the same difficulties he identifies with the current drafting are extrapolated greatly by the amendment?

[Danny Kruger]

I am afraid there is a huge degree of subjectivity throughout the Bill, and we are putting an enormous obligation on doctors to use their best judgment. However, I think it is right to stipulate more clearly that it is appropriate, in general, to inform patients’ families. Leaving the vague term “appropriate” essentially implies that it is either/or—that it is a 50:50 choice whether they do so. So it is important to specify that the expectation is that they should do so. Of course, there will be circumstances in which that would not be the right thing to do, but as the amendments make clear, they should explain that clearly if they are not going to do so.

A doctor might hesitate to suggest a discussion with family if they suspect that there are strained relationships within it. My concern is that, without clear guidance, that judgment could be inconsistent or legally challenged. The doctor might know the next of kin and believe that they would try to stop the patient from ending their life. We have heard quite often the concern about the family being some sort of coercive force, trying to prevent people from fulfilling their autonomous choice to end their life, and that we should put in place barriers to stop families trying to dissuade their loved one from assisted suicide. We heard that repeatedly, particularly from the Australian witnesses.

My concern—this goes specifically to certain communities within our country—is that doctors from individualistic cultures, which we have in western Europe and North America, would prioritise personal autonomy. They would deem it inappropriate to suggest family involvement, viewing that as an intrusion on the patient’s rights. We need to state clearly that that is not the expectation and that the expectation is that they should consider involving the family in the discussion.

My concern is also about an exaggerated respect for medical confidentiality. As the Committee knows, my belief is that this is not a healthcare treatment at all, but if it is to be regarded as such, we should not assume that medical confidentiality applies in an absolute sense. There are specific differences between this so-called medical treatment and others, which do justify an override of the assumption of total medical confidentiality. It is therefore appropriate, as in certain other medical procedures, that family members should be involved.

I want to cite the written evidence from Dr Rosemarie Anthony-Pillai, who pointed out that clause 9

“lays bare the reality that in trying to, rightly, diminish any accusation of coercion or family disagreement, this Bill will lead many to a lonely death.”

She also said:

“Families/loved ones finding out only after the event how the person died will have its own bereavement issues that this Bill in no way seeks to consider.”

I also cite the written evidence we had from AtaLoss, which is a UK charity dedicated to ensuring that bereaved people can access support. It said that discovering the decision that somebody has had help to take their own life without prior warning

“can replicate the distress often associated with sudden or suicide-related deaths, thereby intensifying bereavement trauma and potential suicide contagion.”

That is a very significant threat. We will not rehash the argument about whether suicide increases in countries with assisted suicide, but my strong view, from the evidence, is that it does.

In terms of the patient’s safety, if the process is kept secret even from those who know the patient well, the assessing doctors and the panel will be asking very difficult questions about the patient’s feelings and circumstances partly blindfolded. If a patient is in a controlling relationship, they and the person abusing them are not going to volunteer to the doctor or the panel that there is any pressure going on—indeed, the patient may not even understand it to be pressure. It is very common for an abusive partner to try to isolate the victim from their close friends and family. The hon. Member for Ealing Central and Acton (Dr Huq) wrote recently about how this has come up in her constituency. The ex-husband of her constituent’s sister reappeared on the scene, charmed and isolated this woman, and got her to change her will in his favour. That is a technique of coercive control. Some level of required notification to the wider family would make it much harder for a controlling partner to push someone through this process without it being exposed.

It was made clear earlier today that the Bill’s supporters do not want any hard-edged reasons that count as bad reasons to die to be stated in the Bill—they do not want it asked at all why someone wants to have an assisted death. As it stands, the doctors and the panel would have to approve the death as long as it was the patient’s clear, settled and informed wish, but involvement of those who know the patient well might demonstrate that it was not clear, settled or informed. They may have regularly gone through patches of feeling unloved and unsupported all their life, and that could change. That is information that only the wider family would know.

To conclude, there is real suffering hereto—as I have said, nobody exists in a vacuum. I want to reference the opinion of Judge Elósegui in the European Court of Human Rights. Her opinion was a partial dissent in the Mortier case, which has been discussed before. She said:

“it should be underlined that it cannot be said in an exhaustive way that the principle of autonomy always and at all costs has primacy over the other three principles of bioethics. In particular, we must take into account the consequences of our actions on the rest of the family unit and on our circle of friends.”

That is highly relevant. If we see cases where somebody dies by assisted suicide, and the first thing their child or parent knows about it is they are told to come and collect the body, that will be a scandal. That has happened in other countries, and the Mortier case is a case in point.

I mentioned other cases in which it is obligatory to consult and inform family members. At the moment, that is what happens at the Court of Protection with much less serious applications. Practice directive 9B requires doctors to notify

“at least three persons who are likely to have an interest in being notified”.

That is in the case of organ donation and other procedures. Families are required to be notified, and an indicative list is given, which is supposed to be worked through in order—spouses, people who live with as a spouse, parents, children and so on. The authorities are to jump along through that list, again with some discretion given to them.

To end, on the standard guidance referred to in judgments on that procedure, the judgement of Senior Judge Lush in the Court of Human Rights included the observation that the decision not to notify someone who would otherwise be entitled to be notified is not something that just affects the applicant. It is not just about their interests; there is a wider concern for the whole of society and indeed the family. That is why I support the amendment.

--- Later in debate ---

[Lewis Atkinson (Sunderland Central) (Lab)]

It is a pleasure to serve under your chairship this afternoon, Ms McVey.

I feel that we are dancing on the head of a pin, but I oppose the amendment. Members across the debate have recognised that, as Dr Sarah Cox from the Association for Palliative Medicine said, it is always for the patient to decide. As my hon. Friend the Member for Rother Valley pointed out, both the original clause and the amendment rightly retain that decision with the patient. They also retain the discretion of the doctor, whether that is on an appropriate test or a best interests test.

I note that in its submission the Royal College of Physicians advocated the removal of the clause, saying that it goes beyond current practice. I support the clause on balance, because of the importance of these conversations and so on, but the physicians who are likely to carry out the conversations think that it is inappropriate to specify these conversations in primary legislation.

There are two phrases in the amendment that I think are entirely inappropriate. First, there is “concluded in good faith”. I am sure it is not the intent of the author and mover of the amendment, but it suggests that in other instances people might be acting other than in good faith. I commend the words from my hon. Friend the Member for Ipswich. We have to start from the point that doctors are operating in good faith. It is dangerous to set up a good faith test, as opposed to an “other faith” test, in primary legislation.

Secondly, I am certainly not trying to reopen the long debates we had about the Mental Capacity Act, but Members will recall that in those debates we were very clear that the “best interests” test should not and does not apply. Introducing language about best interests the first time in the Bill is very dangerous, and totally against the spirit and principle of what we have debated so far. For those reasons, I am against both amendments.

[Jake Richards]

My hon. Friend the Member for Sunderland Central has made many of the points that I planned to, so I will be brief. The primacy of patient autonomy when it comes to familial relationships is a principle that should not be interfered with in the medical sphere, which this is—we can call it treatment or something else, but it is undoubtedly a relationship between a doctor and a person.

I agree with my hon. Friend on the term “good faith”. I do not doubt the motives, but it put forwards the proposition that a doctor would act in bad faith and not tell a family member. It is a rather bizarre drafting, and wholly unhelpful for the intent for which it was put forward.

The most alarming is the second part and the issue of “best interests”. I will not labour the point that my hon. Friend has made, but what is a doctor to do? A doctor is not a social worker. A doctor is not a family support worker. What questions are they to ask? If someone says, “Oh, I don’t really want to tell my next of kin, who is my sister. We fell out last year because of tit for tat,” is the doctor going to make a value judgment as to whether that argument is profound enough to stop the notification?

[Tom Gordon (Harrogate and Knaresborough) (LD)]

The point that the hon. Member makes is, I think, exactly the case—raising this conversation and talking about it is probably not in anyone’s best interests in the first instance. I think about my own situation. If I were to find myself terminally ill and falling within the scope of this law, and my mum had passed away, then my dad, who I have not spoken to in over a decade, with whom I have a very difficult and estranged relationship, would have to be notified and we would have to have a conversation about it. On my deathbed, the last thing I want to be thinking about is some childhood trauma being brought back before me in the confines of that terminal illness. Does the hon. Member agree that, while the intention might be good, the consequences could be damaging to the patient and their best interests?

[Jake Richards]

I agree. I think in some of these debates—I am probably guilty of this as well—we forget the context in which we are operating: someone is dying, imminently. Therefore, how we approach these conversations, these assessments and this process must take that into account.

[Danny Kruger]

The hon. Gentleman accurately points out that doctors are not social workers or psychiatrists, and we are asking them to make a difficult judgment, in consultation with the patient, about whether they should engage wider family in the discussion. That goes to the broader point: we are imposing a huge obligation on doctors to make very complicated decisions about capacity, coercion and the psychosocial circumstances of the patient. The value of this amendment’s saying, “I think we should involve the family if it is safe to do so”—it might very well not be in certain circumstances—is surely to assist them in having the wider conversation that is necessary.

--- Later in debate ---

[Jake Richards]

As we heard in evidence from the chief medical officer, doctors deal with capacity issues on a day-to-day basis; I am not sure they necessarily need assistance from family members in that regard. However, I appreciate the point—I was going to come to that—

[Daniel Francis]

Will my hon. Friend give way on that point?

[Jake Richards]

I am going to make some progress, because I am not sure that point is crucial to the debate about this amendment; I am sure my hon. Friend will grab me afterwards. I did not mean to mischaracterise the evidence on that point.

I accept that there is a tension here. No man is an island, as the hon. Member for East Wiltshire notes, and of course this process may cause upset to others. Equally, the input of third parties to the assessment of all the issues of eligibility is worth while, but it has to be dealt with in a proportionate way. When we debate clause 12—hopefully shortly—perhaps we can discuss that, and I hope to speak to that point.

However, this amendment is trying to crack that delicate nut with a huge hammer. It fundamentally changes the relationship between doctor and patient, and puts the doctor in a position where they do not have the skills or expertise to make that best interest decision. The amendment therefore fails, and that is why I will vote against it.

[Rebecca Paul]

I am concerned that maybe I am misunderstanding the debate. For clarity, right now clause 9 says that

“in so far as the assessing doctor considers it appropriate,”

they should

“advise the person to consider discussing the request with their next of kin and other persons they are close to.”

It will read very similarly if the amendment is agreed to. Instead, it will say,

“unless the assessing doctor has concluded in good faith, that this would not be in the person’s best interests, advise the person to consider discussing the request with their next of kin and other persons they are close to”.

That is a very subtle change—it is just a little more encouragement to consider contacting the family. No one here is telling the doctor that they must tell the patient to contact the family; it is just a little bit of strengthening to encourage that. I invite the hon. Gentleman to confirm if I have misinterpreted, but that is my understanding of the clause.

[Jake Richards]

I will double check whether this is right, but the explanatory statement suggests that that is not the case. It says:

“This amendment would require the assessing doctor to inform the person’s next of kin that the person wishes to seek assistance to end their own life unless it is not in the person’s best interests.”

[Rebecca Paul]

That is not what it says.

[Jake Richards]

Even if that is not what it says, and even if the explanatory statement is wrong, it is not appropriate for doctors to advise patients what they should do with their family. Yes, they should consider it, but that is what this clause does. I will be voting against this amendment.

--- Later in debate ---

[Juliet Campbell]

I thank my hon. Friend for that explanation.

I move on to amendment 410, which would remove the ability of the court to hear from and question any person other than the person who made the application or the declaration for an assisted death and the assessing doctors. I have strong reservations about using a proxy or giving another person the right to speak on behalf of an individual who wishes to have an assisted death, and I question the scope of those people who could be the proxy to speak on behalf of a person requesting an assisted death. Who exactly would those people be?

One of the arguments we have consistently debated in this Committee is around coercion and patient autonomy. When multiple third parties such as family members or caregivers are allowed to testify, there is an increased risk that an individual might influence the court’s decision in a way that is not aligned to the true wishes of the applicant. In some cases we have talked about pressure from family members or loved ones, for whatever reason—whether their vested interest is financial or something else—to have the applicant hasten their death or have an assisted death. I would not want that kind of pressure to be put on the person and I do not believe any third party should be allowed to speak on their behalf or to be a proxy.

By limiting the scope of the testimony to the applicant and assessing doctors only, the amendment helps to safeguard against such manipulative tactics and ensures that the court focuses solely on the applicant’s own will and the medical assessment of their eligibility, removing the potential for family dynamics or any other outside influence to interfere with the judicial review. It offers a necessary refinement to the Bill for assisted deaths, a request that is both efficient and respectful of the autonomy of all people involved. By limiting the court testimony to the applicant and assessing doctor, the amendment addresses several of the concerns I have spoken about.

[Jake Richards]

I will speak briefly, because many of these issues and themes will be debated in clause stand part and amendments 371 and the others from my hon. Friend the Member for Spen Valley. Amendment 267 was not moved, but I would have opposed it in any event, on the basis that the discretion given there was way too wide and I did not understand the basis of the amendment in any way. Amendments 105 to 107, tabled my hon. Friend the Member for Derby North (Catherine Atkinson), attempt to add an adversarial element to proceedings. Again, I will not comment too much because that issue comes back in the fourth grouping under this clause.

I turn briefly to amendment 410, to which my hon. Friend the Member for Broxtowe just spoke. My understanding is that, although this relates to the High Court—which may be deemed redundant as we move on through this clause—the amendment aims to limit the people that the judge or panel can hear from. In my view that would be wrong and dangerous. The purpose of a judge or a panel is to explore the circumstances in this matter. That must mean that they have discretion to hear from others as well. In my view, this amendment, if passed, would significantly limit the safeguards and be quite dangerous.

As my hon. Friend has already said, amendment 407 has been superseded, and I think we all agree on that.

[The Minister of State, Ministry of Justice (Sarah Sackman)]

It is a pleasure to serve under your chairship, Mrs Harris. As I and my colleague and hon. Friend the Member for Aberafan Maesteg have made clear throughout the debate, the Government continue to remain neutral on this Bill and do not take a position on assisted dying. My remarks will therefore focus on the legal and practical impact of the amendments, to assist the members of this Committee in undertaking line-by-line scrutiny.

Amendments 267 and 105 to107, which have now been withdrawn, deal with the Bill as currently drafted in relation to the High Court. Clause 12 as currently drafted would require the High Court to make a declaration that the requirements of the Bill have been met, following a person’s first declaration to receive assistance to end their own life, with statements from a co-ordinating doctor and an independent doctor. The amendments relate to how the High Court will declare itself satisfied that a person has a clear, settled and informed wish to end their own life and that they have not been coerced or pressured.

Briefly, amendments 407 and 410 seek to change who the High Court—as others have said, we might come on to debate some of these themes relation to the panel—would engage with when considering applications for assistance under the Bill. In determining whether the person has a clear, settled, and informed wish to end their life and that they have not been coerced or pressured, the High Court would be required to hear from and question the person seeking assistance, as opposed to having the option to do so. As my hon. Friend the Member for Spen Valley pointed out, in the later provision in relation to the panel, that has now become a requirement.

As my hon. Friend the Member for Broxtowe made clear, under her amendment 410 the High Court would lose the ability to hear from or indeed question any other party other than the person seeking assistance and the assessing doctors. Removing the ability—whether of the High Court or, as we may come on to debate, of the panel—to hear from and question any other party may limit that body or court’s ability to interrogate wider evidence or points of view.

--- Later in debate ---

[Sarah Olney]

I am grateful for amendment 6 and to my hon. Friend the Member for St Albans for tabling it. I put on record, however, that I do not think that the panel that we are discussing addresses my earlier concerns. I wanted to make that absolutely clear by highlighting the further evidence from the Association for Palliative Medicine. The panel proposed by this group of amendments does not address its concerns, or the concerns of many other people who were saying that there needs to be a multi-professional team.

[Jake Richards]

I rise to speak in support of new clauses 14, 15, 17 and 21 and the accompanying amendments. I hope also to deal with some amendments tabled to new clause 21.

On Second Reading, I and many other hon. Members said that the Bill was the strongest and safest assisted dying law in the world. I want to be clear that I stand by every word of that, but this change will make the Bill far stronger and far more resilient to questions of capacity and coercion and therefore far safer. It will ensure a further independent layer of assurance: a panel of experts chaired by a senior lawyer to hold the process to account, to ensure that every avenue of inquiry has been explored and to hold professionals in our healthcare system to account when it is appropriate to do so.

The change will replace a single High Court judge, a person with no particular expertise in the issues at hand, with a panel that will adopt a more holistic approach. The social worker will delve a little deeper into the personal circumstances of each individual. The psychiatrist will ask any necessary questions about capacity. They will serve alongside a senior lawyer to ensure that the process is necessarily formal and strict. They will have the powers to make further inquiries if they so wish.

On and after Second Reading, there were legitimate questions about the High Court function—what exactly were we asking the judge to do? I maintain that a High Court judge could have overseen the process, but it is far better and more pertinent to the issues at hand to have a multidisciplinary process involving a social worker and a psychiatrist.

This is our lawmaking process working efficiently: debate has pushed my hon. Friend the Member for Spen Valley to think again. Working with the Government —whose role continues to be to ensure that the Bill will be workable if it is to gain Royal Assent, while remaining neutral on the principle—she has been creative in tailoring a process to the matters at hand. That must be welcomed.

This is new law. The change that the Bill would enact is profound and therefore requires a very new safeguarding process. This is the key point. The panel would not be there to adjudicate on a dispute, undertake a trial or undertake an inquiry; it would be there to ensure that the process is safe. A person would come to the panel seeking assistance to which they are entitled under the law, and the panel would ensure that the process through which their eligibility has been decided has been rigorous and safe.

It is also important to note that the panel would simply regulate and scrutinise an ongoing doctor-patient relationship. Even after a certificate of eligibility has been received, there is a period for reflection and continued assessment. That is crucial, because it means that normal rules of appeal are not appropriate—I will come back to some of the amendments in that regard. Even once the panel’s work is done, the co-ordinating doctor and the commissioner will remain available for reconsideration and oversight.

I want to deal with some of the criticisms that have been levelled at the change set out in the amendments tabled to new clause 21 and others. To my mind, the process should not be adversarial, because it is inherently inquisitorial. What is the dispute that is being decided? The person is deemed to have capacity by two doctors, and perhaps a psychiatrist, to make a decision, and is seeking an eligibility certificate. The starting point must surely be that the person should be allowed to do so. To set up some bizarre dispute where none exists would be counterproductive and unsettling to the person at the centre of the process. It would be a waste of public funds, but more importantly it would be a waste of time—time, in the context of a person who is dying.

The process is not analogous to the Court of Protection, where there are disputes as to capacity, best interests and welfare. It is not analogous to a court approval hearing, where there may be legal arguments as to the appropriate nature of an award or the arrangements for it. It is not analogous to a deprivation of liberty order, where in all likelihood a person would seek not to be deprived of their liberty. It is not analogous to private children’s proceedings, where the child’s welfare is paramount. This is a person seeking help for themselves. The principle of choice and autonomy at the end of life means that that process must be patient-centred and begin from an appreciation of those principles.

[Danny Kruger]

The hon. Gentleman is making a very good speech in defence of the change, but could he help me understand something? He said that he supported the previous proposal, involving a High Court judge; he is now suggesting that it would be completely inappropriate to have any sort of judicial oversight of the process. How could it have worked better?

The hon. Gentleman talks about there being no need for any sort of adversarial system, but does he not recognise that there might be another side to the story, and that it would be appropriate for somebody, whether that is a judge or someone else, to hear arguments against the application?

[Jake Richards]

Let me deal with the first point first. A High Court judge could have exercised this function themselves. As I set out in public very soon after Second Reading, I was struck by the fact that we were asking a High Court judge to do this, even though they have no particular expertise in the issues that so concerned hon. Members on Second Reading, whether they voted in favour of the Bill or against it. I thought about the process more, as we are all doing, to try to understand what it would look like in practice. What questions might be asked? Where does a panel or judge need to go? To my mind, psychiatrists and social workers are much better placed than High Court judges to know what avenues to further explore.

I have forgotten the hon. Gentleman’s second question.

[Danny Kruger]

I was making the point that there is surely some value in what the hon. Gentleman describes as an adversarial process, in which the decision maker is required to consider whether there are circumstances that the applicant is not presenting.

[Jake Richards]

I will come on to that issue. First, there are avenues for the panel to have information put before it that will be pertinent to the decision at hand and that may be pivotal to that process. That is not quite adversarial. Secondly, there is always a route for an adversarial contest in this matter through judicial review. I hope that that will be very rare, but it is certainly possible, and that has to be maintained. I think my hon. Friend the Member for Spen Valley and the Minister would accept that that would be an avenue.

The panel will have an array of information to consider. It will have two reports: one from the co-ordinating doctor and one from the independent doctor. In any event, it is often likely to seek medical records. It will speak to the co-ordinating doctor or independent doctor about capacity and any issues of coercion. Crucially, it will speak to the person themselves unless there are extraordinary circumstances that oblige it not to. One can imagine the vast array of circumstances that will come before the panel, but it will have the discretion and freedom to explore as appropriate. That will be a process that is appreciative of the specific facts before the panel.

I made this point earlier, but it is important to remember that this is a very human moment. A person is dying; they come to the panel seeking help. It is right to ensure that there are hurdles to consideration for eligibility, but the idea that a person should be forced to win a trial or a case, or see through complex litigation, is surely not right.

[Kim Leadbeater]

My hon. Friend is making an excellent and powerful speech. I thank him for putting the human being back at the centre of the process; sadly, in this Committee we can forget to do that. Early on, we had Nathaniel Dye here, who is a terminal cancer patient. He has just had a 12-month prognosis. The thought of making that man jump through hoops and over hurdles breaks my heart. I understand that we have to do it, but these are the people that we are actually talking about when we discuss the Bill.

[Jake Richards]

I agree, and I hope to deal with some of the points that my hon. Friend made in her important speech. To mandate that a barrister instructed by the Official Solicitor, or indeed the panel, has to put questions to a person who may have only a few weeks left to live is not only highly inappropriate, but unworkable. What instructions is this barrister working from? Do they have to suppose that somebody who clearly has capacity does not? If not, do they ask questions about the circumstances of the person that would be asked by the panel in any event?

My hon. Friend the Member for Bradford West suggested that the Official Solicitor would be working for the person. Well, the person is coming to this panel seeking assistance, so what on earth is the Official Solicitor or their legal representative going to ask of the person they are taking instructions from? To what extent would they be allowed to go on a fishing expedition, delving deep into a person’s relationships to assess any evidence of coercion? That goes back to my original point: what are their instructions? Who is asking them to do what?

I see the force in the amendments from my hon. Friend as to burden of proof, but I deem them inappropriate. The criminal standard does not fit neatly with the more complex issues at play, such as capacity. The Mental Capacity Act states that where there is a doubt about a person’s capacity, the burden of proof is on the person seeking to establish a lack of capacity, on the balance of probabilities. That is the correct approach. In any event, if the panel has any doubts as to capacity, surely it will be obliged—as is set out in amendment 6 to clause 9, which the Committee has just accepted—to seek further psychiatric assessment. It is important to note that the panel will have powers to instruct further expert assessment and reports.

If we implement the criminal standard, the doctors who are part of the process— not only the co-ordinating doctor and the individual doctor, but treating doctors, because we should always remember that someone who is terminally ill will almost certainly be receiving treatment in the NHS—will be working to a completely different burden of proof from the panel’s. The criminal standard does not fit neatly with the innately inquisitorial nature of the panel’s role. That is important. It is very easy to look at the definition of the balance of probabilities and find weaknesses in it, but when we consider what actually happens in practice, I submit that those weaknesses are not often there.

The panel will have a conversation with the professionals and with the person and will consider the response. If doubts creep in, it will not just stop and make a decision on the balance of probabilities; it will continue to search. The more serious the doubts it encounters, the more evidence it will need for those doubts to be overcome. That is how the law has developed on the balance of probabilities in all other areas, and no doubt it will be the same in this area. Importantly, unlike with many other tribunals or courts, the decision must be unanimous, so if the social worker spots something that the psychiatrist or lawyer does not, the case will go no further.

What about the role of third parties? As I have set out before, this is a personal decision, but I also accept that no man is an island—a phrase often used by the hon. Member for East Wiltshire. The process has to strike a real balancing act: allowing third-party information to be considered, but in a proportionate manner that respects individual autonomy. To my mind, the views of third parties are not relevant. Their views on whether the person is making the best decision for themselves are not relevant. This is not a welfare decision. Equally, it must be right that third parties—family members and others—can ensure that the panel has sight of the relevant information. Even after a certificate of eligibility has been given, the co-ordinating doctor will continue to be responsible for assessing new information, and their duties will continue until the final moments, as the Bill sets out.

[Naz Shah]

Given my hon. Friend’s expertise, does he anticipate JR being allowed in the panel setting? If so, would it be before the death or after? Can the decision by the panel be judicially reviewed?

[Jake Richards]

In my mind, any decision to give a certificate of eligibility could be subject to judicial review.

Third parties can put evidence before the panel to be considered, but it is not right that third parties might challenge the application. As I have set out before, this is not a dispute but a rigorous safeguarding process. If they have information about the person’s capacity, their diagnosis or any other relevant factors, they can and must ensure that the panel—if not the doctors or indeed the police—be seized of the information. Third parties can appeal the decision by way of judicial review. That would provide for a decision that was

“wrong, or…unjust because of a serious procedural or other irregularity in the proceedings”,

per amendment (a) to new clause 17. An injunction would be applied and the matter would have to be dealt with expeditiously. It is worth saying that all the evidence suggests that that would happen incredibly rarely. In Spain—

[Daniel Francis]

My hon. Friend is about to refer to Spain, as am I. Article 10 of the relevant Spanish law gives a right of appeal on a point of law to a higher court. Does he believe that we will be in line with the position in Spain? How long does he envision judicial review taking, given that we are dealing with somebody who is at the end of their life?

[Jake Richards]

The answer to my hon. Friend’s question is yes: judicial review is clearly an exercisable option in this case. I said “expeditiously” because lots of cases are heard expeditiously; High Court judges hear cases in the middle of the night, if there is a certain urgency. In these cases, one might imagine similar circumstances, but I must stress that they would happen incredibly rarely. All the evidence suggests that. In Spain, where a not dissimilar model is in place, such an approach is rarely used by family members. The vast majority of families attend the panel because they want to offer support and love to the person who has made the choice.

[Daniel Francis]

I just want to confirm that either side has the right of appeal in Spain.

[Jake Richards]

Yes.

The other side of the coin is that we must ensure that the process is workable. In Spain, 20% of people die before the panel hears their case. We must be very careful not to create something that is so burdensome as to be completely pointless. I believe that the amendments tabled by my hon. Friend the Member for Spen Valley aim successfully between ensuring flexibility and rigour. Each case will be different—more so than in any other set of proceedings that I can imagine, and I have thought hard. There will no doubt be some that are incredibly complex, in which the panel may require further assessments and hear from relevant experts, but there will be far more that are solemn and serious but straightforward, and that is correct.

Other amendments, such as amendment (d) to new clause 21, in the name of my hon. Friend the Member for Derby North, seek to mandate certain procedural steps. While I have great respect for her as a former colleague, I fundamentally disagree with her amendment, which would require that the panel “must consider” hearing from persons who may be

“interested in the welfare of the person”.

I repeat that this is not a welfare decision. The panel, just like the High Court judge, is not saying, “What do I think is in the best interests of this person?” It is ensuring that the person has made the decision per clause 1, where we started: “settled”, “informed” and “voluntary”. We enter new ground with this law change, and that is why it is a new process, but to my mind it is safer and workable. Colleagues can be reassured, and I urge people to support the change.

[Lewis Atkinson]

I thank my hon. Friend for giving way at the end of an excellent speech. Does he agree that the provision in new schedule 2 that allows the commissioner, who would be a sitting or previous judge, to give guidance and set procedure for the operation of panels would answer some of the concerns raised by those who think that there would not be sufficient judicial input into the procedure of the panels?

[Jake Richards]

That is an important point, because the change, as drafted in the various amendments, provides for real flexibility. That may cause others some concern, but to my mind it is a reassurance, because it will mean that a weighty figure, the commissioner, will be able to set out rules and regulations for the process to make sure that it is rigorous but is not so burdensome as to be pointless.

[Liz Saville Roberts (Dwyfor Meirionnydd) (PC)]

I rise to speak to my amendment (a) to new schedule 2. The assisted dying review panel comprises a legal member and the chair, a psychiatrist member and a social worker member. I welcome this third tier of safeguarding and its range of specialities, as laid out in new clause 21.

My amendment (a) would amend paragraph 4, which concerns membership of panels, by inserting a new paragraph 4(3):

“Each member of a panel must have fluent proficiency in the Welsh language if services or functions in the Act are to be provided to an individual in Welsh.”

I emphasise the “if”, because it is in certain circumstances. I have previously touched on the requirements of the Welsh Language Act 1993 and the Welsh Language (Wales) Measure 2011. It appears that the panel can be defined as a legal proceeding and will therefore be required to follow the pre-devolution 1993 Act. Let us consider whether that is sufficient for the level of safeguarding that all Committee members want to provide.

Section 22(1) of the Welsh Language Act 1993 states:

“In any legal proceedings in Wales the Welsh language may be spoken by any party, witness or other person who desires to use it, subject in the case of proceedings in a court other than a magistrates’ court to such prior notice as may be required by rules of court; and any necessary provision for interpretation shall be made accordingly.”

I quote that as the nearest comparator. That means that the 1993 Act, in the situation we are discussing, enables people to speak Welsh and for interpreters to be provided as necessary. That gives people the right to speak Welsh, but it does not give them the right to be heard in Welsh in their own voice. If the legal personnel do not speak Welsh, their decisions will be based on the interpreted communication. The key question is whether we are content to accept the use of interpreters as intermediaries between the individual and the assisted dying panel.

Dr Sarah Davies, a consultant respiratory physician from Colwyn Bay, has written, with 78 other clinicians from Wales as co-signatories, to parliamentarians about their concerns. She states:

“In practice use of interpreters does not provide full communication of appropriate knowledge from clinician to patients. This is because interpreters are often not experienced and confident enough to discuss such complex and legal issues as assisted dying. Even the best possible practice by interpreters cannot match communicating in the person’s own preferred language. Every person whose preferred or primary language is Welsh and who communicates as a family or socially in Welsh should have access to important health information in Welsh. Any necessary assessment of capacity for purposes of consideration of assisted dying, and any assessment of coercion, must be in person and in Welsh if that is the person’s preferred language.”

Dr Davies further states that it is not possible to confidently assess the decision-making capacity of a Welsh speaker in their second language. Superficial conversations in English often fail to demonstrate that a Welsh speaker with significant health problems is confused or does not have a good understanding of their own health condition and treatment options. The presence of confusion or lack of information may become apparent only during detailed conversations with a Welsh-speaking healthcare professional. It can be extremely challenging to detect the presence of coercion, and the nuances of family dynamics will not be apparent to a non-Welsh-speaking professional when the language spoken in the family is Welsh, so it will not be possible to make any assessment of the presence or absence of coercion. That is what Dr Davies says.

The office of the Welsh Language Commissioner believes that there must be provision in the Bill to ensure that a person’s choice of language is considered, recorded and matched with further provisions, including a Welsh-speaking specialist panel. The commissioner’s office agreed that such an amendment relating to the specialist panel is very important. It stressed that a Welsh-speaking panel will be able to provide the same service in English to individuals who are not receiving assistance through Welsh, so the requirement in amendment (a) should not, in and of itself, necessarily mean recruiting more individuals or more panels. None the less, I feel that I must allay fears that it would require every member of every panel in Wales to be able to speak Welsh. It does not. That is not the intention of the amendment, nor is it in its wording. Fluent proficiency is required of all panel members only when the panel is making a decision in relation to a person whose preferred language is Welsh.

So far, the response I have received from Ministers is that this private Member’s Bill does not require specific requirements on Welsh language rights in it and that these rights are already enshrined in law. The hon. Member for Chesham and Amersham and I have written to the Minister as regards discussing how the legislation should operate in relation to Wales and devolution—he had previously committed to a meeting—but we have yet to receive a response. I have withdrawn previous amendments in anticipation of that very meeting, but in this instance—as the provision of interpreters to communicate between the individual and the people charged with being the final guardians of safeguarding is wrong—I will push the amendment to a vote, because I do not believe that the issue is covered in legislation as things stand.

--- Later in debate ---

[Rachel Hopkins]

rose—

[Jake Richards]

rose—

[Naz Shah]

I am happy to take an intervention from my hon. Friend the Member for Luton South and South Bedfordshire, and then I will come to my hon. Friend the Member for Rother Valley.

--- Later in debate ---

[Naz Shah]

I disagree with my hon. Friend. Subconscious bias operates in society; this is not about being held to account. People are not doing these things deliberately, but because they have a subconscious bias.

[Jake Richards]

My hon. Friend is making a fine speech. She said that High Court judges make mistakes, which is undoubtedly true. She also said that the panel may be guilty of unconscious bias. Is there any layer of scrutiny that would satisfy her? What does she think about jury trials?

[The Chair]

Could the hon. Lady make progress now, please?

Terminally Ill Adults (End of Life) Bill (Twenty-second sitting)

Jake Richards Excerpts

Committee stage
Wednesday 12th March 2025 Public Bill Committees

[Rebecca Paul]

My right hon. Friend makes an important point. I do not think family always know best. There are situations where someone rightly will want to exclude their family from the process, and I totally respect that choice. I am saying that there will be other situations in which family do have something valid to input that could impact the panel’s decision making. My right hon. Friend also mentioned injunctions; I am keen to understand more about how that process works as a protection, so perhaps the Minister could respond on that, because that may well give me some reassurance. I will come to judicial review in a moment.

My right hon. Friend is right that this is not easy. I am not saying that family should be involved in all situations. I am saying there is a balance to be struck, and I do not think we are getting it right, because at the moment it is all about full autonomy. The working assumption is that input from family must always be ignored if the patient wants that. There must be a balance, and it is difficult to say where that should sit, which is why we have such an incredibly difficult job with the Bill.

[Jake Richards (Rother Valley) (Lab)]

I have a genuine question: is the hon. Lady of the view that families’ views about whether the decision is right for the individual should be considered by the panel, tribunal or judge, or is it just their views about eligibility under clause 1?

[Rebecca Paul]

I thank the hon. Gentleman for that important point. My point is that the family should be listened to and should have a route to legally provide information to the panel. Right now, they have no right to do that. In reality, I think most panels would take that information. I would like to think that, 99 times out of 100, if a family member contacted the panel saying, “I have really important information,” it would listen to that. But I am legislating for the one case in 100 or 1,000 in which, for whatever reason, the panel refuses to engage with a family member who has a relevant bit of information, and not having the right information leads to someone’s death.

The amendment is about protecting panel members too. If I were a panel member, I would want this process in place, because it would protect me when I make a decision. I would take great comfort from knowing that a family member with relevant information has a legal right at least to communicate it to the panel.

--- Later in debate ---

[Rebecca Paul]

I thank my right hon. Friend for raising that point, because it gives me a wonderful opportunity to draw everyone’s attention to subsection (3) of my amendment, which states:

“The Commissioner may consider the application without a hearing if they consider it in the interests of justice to dispense with a hearing.”

My right hon. Friend is absolutely right that time is of the essence and that there will be situations in which it is right that things move as quickly as possible. I hope that that goes some way towards reassuring him that I am trying to come up with amendments that are balanced. I am aware that we have two different examples here; I am genuinely trying to make sure that I do not make it harder for those genuine cases, because I totally understand how important it is and I understand that there is a lot of pain and suffering, for all the reasons that have been set out. I hope that I am getting the balance right, but I am always happy to have further discussions.

Sir James Munby was one of the first to criticise the High Court safeguard; the hon. Member for Spen Valley says that she has taken those criticisms on board. His criticisms of the panel seem similarly acute. I hope that the Committee will agree that my amendment answers a real need and recognises the important role of family in the death of a loved one in most situations, although I accept not in all. It has a profound and long-lasting impact on them too, and their needs should not be entirely disregarded in the name of autonomy. The hon. Member for Rother Valley gave a very powerful speech yesterday on the subject, setting out that the amendment is not required because any decision could be judicially reviewed. I am not qualified to opine on whether judicial review would be relevant with this panel, but I look forward to the Minister covering the matter in her closing remarks. We need to be clear on that front.

Judicial reviews are a challenge to the way in which a decision has been made, rather than to the rights and the wrongs of the conclusion reached. It is important that this is understood. A judicial review just checks that the process was followed, not whether the right decision was made. That is why our role in setting the process is so important. If the new clause remains unchanged and there is no requirement for a panel to accept relevant evidence from a family member, there will be no avenue for appeal under judicial review if such information is not taken into consideration when making the decision, because the process will have been followed.

Our role on this Committee is a heavy one. It is about getting it right and setting the process for judicial review to work as it should. We have an appeal process in the new clause for when a panel wrongfully turns down an application, but not for when it wrongfully approves one. Why not, if judicial review is available and suitable? I suspect that it is because, as the hon. Member for Rother Valley is aware, the judicial review is not the best way to do it. It is a long, onerous process involving application for permission and, in some situations, the securing of legal aid, which is fraught with difficulty. I say gently to the hon. Member that if judicial review is not suitable when the panel has wrongfully turned down an application, then why is it suitable when they have wrongfully approved someone for an assisted death?

I think it is clear that my amendment is needed as a safeguard to prevent wrongful deaths under the Bill. It is a helpful safeguard. No panel will ever want to see someone assisted to die who should not have been, just because it did not have all the information. I suggest that the safeguard will help to secure panel members, because they will feel reassured that a process is in place to avoid mistakes. If my amendment is not agreed to, and if wrongful approvals have to rely on judicial review for a remedy, I suggest that the impact assessment will need to take into account the likely impact on socioeconomic groups that rely on legal aid for funding. I suspect that, owing to a lack of funds, they will find themselves with no avenue at all to appeal. I do not think that any of us wants a two-tier system in which rich families can intervene and poor families cannot.

[Jake Richards]

I have been rightly and fairly challenged in the hon. Member’s speech, but the difference is that if a family member has a right to appeal in the internal process, that family member would have to be a party in the original hearing. The whole point of the panel is that a person comes to it with their application. The family have the right to put information before the panel, but they do not have the right to make their case to the panel, because their views on the application are not relevant. Information that they might have is relevant, but their views are not. That is why there is a disparity between the person’s ability to appeal internally against a refusal of their application, and third parties having to take other routes. I hope that that offers some clarity as to why I am comfortable with the difference between the two. I reassure the hon. Member that I have thought about it long and hard as well.

[Rebecca Paul]

I thank the hon. Member. I would just clarify that currently there is no legal right for a family to provide information to the panel, which is part of the issue.

I turn to my amendment (c) to new clause 21. New clause 21 includes provision that, among other things, the panel’s function is to determine whether it is satisfied that the person has capacity, that they have a clear, settled and informed wish to end their life, and that they have not been coerced or pressured. However, it is not entirely clear what “satisfied” means in the new clause. My amendment assumes that, as in a civil court, it means “on the balance of probabilities”.

As I understand it, the leading case on the meaning of “satisfied” is a 1964 House of Lords case, in which the court held that “satisfied” meant “on the balance of probabilities”, rather than the tougher test of “beyond reasonable doubt”. In a later amendment, I will propose that we adopt that tougher standard, but this amendment assumes that the current wording will stand.

My view, as we have already established in lengthy debate, is that the capacity bar is low, because the doctor need only be 51% sure. On the clear, settled and informed wish and coercion test, the standard is only “to the best of the doctor’s knowledge”, which is not a particularly high bar to meet. We are therefore applying a low bar to a low bar. That certainly leaves us with a highly accessible process, but I suggest that that is not a positive or safe thing.

My amendment would bring in a further safeguard. As I have said several times, I would have preferred to see such safeguards in clauses 1 to 3, but as they were not accepted there, I am forced to propose them here, because it is better to have them than not. The amendment would give the panel the ability, if there is a “real risk” that the criteria have not been met, to pause and make further enquiries. They would not be obliged to give a decision that day, but would be obliged to look into the matter further, ask for more testimony, request more documents and consult experts.

The real risk test is taken from the jurisprudence of the European Court of Human Rights. Doctors will already be familiar with it, as they are already required under the Human Rights Act to assess when there is a real risk of suicide. It is not a strange novelty. The objection has been raised that introducing a real risk test to the doctors’ assessments would complicate matters, but the panel stage is a distinct stage with a distinct set of rules. I hope that the amendment will be seen not as introducing a complication but as filling a gap, particularly as this stage is meant to be more akin to a judicial stage.

Difficult situations will not necessarily be as rare as we hope. On coercive control, those with decades of experience of working with the most vulnerable have warned us time and again what the Bill could mean. Jane Monckton-Smith, one of the leading academics in the area, has said:

“Unless we do take this incredibly seriously, this Bill is going to be the worst thing, potentially, that we have ever done to domestic abuse victims.”

The consultant clinical psychologist Sue Smith, who specialises in cancer and palliative care, has submitted written evidence from which I will quote at length, because it vividly brings out the scale of the risk of coercive or controlling behaviour:

“In my clinical experience working with people who have cancer, a cancer diagnosis and treatment effects can amplify CCB…A woman asking for her needs to be seen and met alongside her increased physical and psychological vulnerability creates a change within the couple, which can lead to violent acts or CCB. The seriousness of the cancer diagnosis may be systematically and actively denied or minimised, claims can be made by the male partner that she is attention seeking, or she is accused of making up the effects of treatment, and can be left isolated and alone when in physical need, e.g. managing treatment effects like nausea or pain that restrict the ability to wash, dress and where she is reliant on others for help. At the same time a male partner may also state, ‘You are better off dead anyway,’ ‘Your children don’t care, and no one else in your life cares about whether you die.’ They may also threaten to leave. This pattern is extremely confusing, harmful and threatening. It continues over time, and a woman learns to doubt her reality and experience, and is extremely isolated. This can lead to heightened anxiety, hopelessness and helplessness, and abject despair, which can lead to a person wishing they were dead. The confidence and ability to know what one needs and wants is severely compromised when her reality is continually minimised or denied and will impact informed decision making.”

We can hope that the existing safeguards will catch some of those cases, but they will not catch all cases, so my amendment would go a little way towards improving the safeguards.

Amendment (a) to new clause 21 tries to pin down a missing detail, namely the standard by which the panel makes its decision. In a criminal trial, a jury is sent away to consider its verdict. The members of the jury know that they must be certain, beyond reasonable doubt, of the defendant’s guilt. It is not enough to think it likely on balance, nor is it enough that they have an opinion that they can justify with good reasons. It must meet a high threshold. Why is there such a high standard? Because we have to be sure about the decision, given the grave consequences. We are now considering a similar question: what is the right standard for a decision that will make the difference between life and death?

I turn to subsections (2) and (6) of new clause 21. We are told that the panel must be satisfied that the eligibility criteria have been met. The word “satisfied” is doing a lot of heavy lifting in the Bill. If a question subsequently comes to court, as has happened in Belgium where there was a wrongful assisted suicide, we will be asking the court to rule on whether the panel should have been satisfied. That raises an obvious question, which my amendment is designed to answer: what does “satisfied” mean?

I turn to a real-life example. In a famous case in Oregon, an elderly woman called Kate Cheney sought assisted suicide. She had a terminal cancer diagnosis; she also had dementia, so she was referred to a psychiatrist to establish whether she had capacity. She was accompanied to the appointment with the psychiatrist by her daughter Erika, who seemed extremely assertive about the assisted death. Kate Cheney denied that she was being pressured. However, the psychiatrist noticed that the daughter was coaching her mother. Referring to Kate, the psychiatrist wrote in his report:

“She does not seem to be explicitly pushing for this.”

He concluded that she did not have capacity to make the decision. The daughter was, in her own word, “incensed” that the psychiatrist was casting such a judgment on her mother. Kate applied for a second opinion and was assessed by a clinical psychologist. He found that Kate did have capacity, but he added that her

“choices may be influenced by her family’s wishes, and her daughter, Erika, may be somewhat coercive”.

Nevertheless, he gave the green light to the application and Kate received the go-ahead.

I ask members of the Committee whether they would be satisfied that Kate Cheney was eligible for an assisted death. Are they confident that colleagues would share the same judgment about being satisfied? Can they be sure that every social worker, legal figure and psychiatrist would be satisfied in the same direction? After all, the psychiatrists in Oregon were divided on it.

In written evidence, the most experienced clinicians have urged us to recognise that abuse is difficult to pick up. Sarah Grove, a consultant in palliative medicine, says:

“Over my years in practice, I have witnessed families acting for financial gain and not in their loved one’s best interests but in this kind of situation, this has always been impossible to prove.”

Dr Kathryn Myers, a retired palliative medicine consultant, says:

“I have seen coercion in the contexts of decision-making around the best place of care for patients and of money and property. Perpetrators are usually family members…Occasionally it has been overt and easy to detect, for example, threatening or manipulative words or actions. Most frequently it has been very subtle, one might even say, gentle. It can take skilled clinical nurse specialists highly trained in communication skills and in detecting coercion, who know the person well and who have a relationship of trust with them, several conversations over several days if not weeks to uncover that coercion has occurred.”

In such a case, with limited time, a panel may not be certain whether to give the green light to an application. That uncertainty will be even greater if it does not know what evidential standard to employ.

My amendment would clarify that grey area. It would bring in a standard that has been tried and tested and is well understood. To be clear, “beyond reasonable doubt” merely means that the panel is sure. The courts have said that the two phrases are equivalent, as has the Judicial College in its guide to judges, “The Crown Court Compendium”:

“What is required is a clear instruction to the jury that they have to be satisfied so that they are sure…if an advocate has referred to ‘beyond reasonable doubt’, the jury should be told that this means the same thing as being sure.”

The Crown Prosecution Service says:

“the magistrates or district judge in a magistrates’ court or the jury in a Crown Court must be sure that the defendant is guilty. Sometimes you’ll hear this described as ‘sure beyond a reasonable doubt’ or ‘satisfied so you are sure’.

Importantly, the word “satisfied” by itself is not enough. Juries must be not just “satisfied”, but

“satisfied so you are sure”.

The wording in the amendment would be equally strong. It opts for “beyond reasonable doubt” because it is a better known phrase and more widely understood than

“satisfied so you are sure”.

I do not want to get too hung up on which of those phrases to use. The point is to adopt the tried and tested standard that has worked in the courts. We want the Bill to have the highest standards and to protect people. Amendment (a) to new clause 21 would help to achieve that.

Members will all be delighted to know that I am moving on to the last amendment.

[Jake Richards]

I know that the hon. Lady has been on her feet for some time, but I just want to explore the difference between what a jury is doing and what this panel is doing. Let us, for example, consider the issue of coercion and a case where there is no evidence that the person is being coerced in any way, but of course the panel has not asked everyone in that person’s life. It has not heard evidence from everyone. There is no factual matrix determining what has happened or what has not happened. Can the panel sit there and say, “We are sure,” or do you think it would have to investigate all the circumstances of that person’s life and interview everyone that is in and around their social circle to be sure that they have not been coerced? Can you see why, as I set out in my speech, the “beyond reasonable doubt” burden is not appropriate for the task of this panel?

[The Chair]

Order. Can I gently again remind Members that “you” means me? Please refer to the hon. Lady.

[Jake Richards]

Forgive me, Chair.

[Rebecca Paul]

I thank the hon. Member for sharing that. It is useful to have these debates and conversations, but I would suggest that the panel needs to be sure off the back of the information that it has been given and the witness testimony, which goes back to why it is so important to ensure that we have that coverage and the right things feeding into the panel so it can get to that high threshold. I would expect the threshold to be at court level, given the huge, significant ramifications of this decision for that person.

Terminally Ill Adults (End of Life) Bill (Twenty-seventh sitting)

Jake Richards Excerpts

Committee stage
Wednesday 19th March 2025 Public Bill Committees

[Danny Kruger]

I am conflating the two because they are conflated in reality. A care home where somebody lives is a residence, but it is also a community, a facility and a place where professionals work to support that individual. A clear demarcation between their living arrangements and the support they receive from the institution they live in does not exist in reality. That is why they are living there—because that distinction does not apply in their particular case. They require the support and help of the workers in the place where they live.

I am afraid it is not enough simply to say, “This is their home, and they should have exactly the same rights and freedoms as they would have if they were living alone in their own flat or house.” We have to recognise the reality of the situation, which is that they are living in a community, and what happens in the community affects them all. That is the nature of communal living. This is not individualised healthcare in the way that the hon. Gentleman imagines it is, and that is fundamentally our point of difference. This is separate or adjacent to healthcare, and it is delivered, by definition, by somebody else. By virtue of the Bill, it would have a separate regulatory environment to other healthcare treatments. Of necessity, it should have an appropriate legal framework to protect other people who are impacted by assisted death in a communal setting. That is my crucial point: if someone is living in a communal setting, what they do affects their neighbours.

[Jake Richards (Rother Valley) (Lab)]

Does the hon. Gentleman appreciate that, although this is different from the healthcare services we currently have, we have a legal framework that deals with many of these conflicting issues as and when they arise in lots of different circumstances that are not completely adjacent to these?

[Danny Kruger]

I do not know what those might be, but I would be interested to hear. That might well be the case. I am afraid that no hard-and-fast rules can be clearly applied here; or, rather, we have to apply hard-and-fast rules in the knowledge of the grey areas, the exceptions and the situations in which we might feel that the law is unjust in particular cases. We have heard examples of that, such as the evidence about the lady in Australia cited earlier by the hon. Member for Spen Valley. I can well imagine the distress involved if someone suddenly finds themselves in an institution that does not permit an assisted death, but they want one and are in their last days.

The alternative, however, is a different blanket rule. If we were to have a blanket rule that we can do an assisted death anywhere—that is one situation—there would be significant knock-on effects. Serious moral injury would be suffered by other professionals and residents. I recognise that my amendment could lead to someone having to relocate if they want to have an assisted death—I am sorry for that—but I think that we have to draw the line in a way that makes most sense.

--- Later in debate ---

I understand that Members might be concerned about vexatious litigation but, first, if such claims are meritless there is no need for this provision, as the courts already have the power to deal with vexatious litigation. Secondly, the clause, with or without the amendments, will not be enough to stop vexatious litigation if it occurs. The strongest protection would be to retain the role of the High Court judge. In that way, the fact that the criteria have been met has been established by a court, and that makes it very unlikely that another court would want to reopen the matter. We have not done that, and we are left with this civil liability exemption, which remains too wide. I welcome the amendments in the name of the hon. Member for Spen Valley, but they do not go far enough. I believe the whole clause is unnecessary and should be removed.

[Jake Richards]

I welcome the amendments tabled by my hon. Friend the Member for Spen Valley. As I think she accepts, given that she tabled the amendments, there is an oddity with the Bill as drafted that has to be fixed, and I think the amendments would do that.

I appreciate that there is some force to the argument of the hon. Member for East Wiltshire. I would be interested to hear what the Minister says, but it seems to me that there is a balancing act between ensuring that medical practitioners and clinicians are working in an environment in which they do not constantly feel the heat of a lawyer’s breath on their neck, and ensuring protections. There is some force to the argument for removing the clause altogether, but on balance I see more force in the argument that we should have more clarity.

I want to raise some more issues that need to be considered in the light of the provision for aspects of civil liability in this process. That is why last night I supported the amendment in the name of my hon. Friend the Member for Ipswich, which was not passed, relating to guidance for doctors in certain circumstances during this process. I raise those points about the standard of care and the duty that doctors and clinicians will be working to throughout the process for the record, and so that the Government and my hon. Friend the Member for Spen Valley can take them forward. I raise those questions not because they are unanswerable—I think they are answerable—but because we need to work out exactly what we are asking our doctors to work to, and what form that guidance comes in. Does it need to be legitimised by Parliament, or can it be undertaken by a Minister?

I do not think I need to expand greatly on the point, but we can all imagine circumstances in which clinicians are compromised in their view of the duty of care that they have to the patient. When this process begins in this jurisdiction, it needs to be clear what that is.

[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your chairship, Mr Dowd. Well done for arriving on time, by the way.

These amendments aim to ensure that, if passed, this legislation will be legally and operationally workable. I will offer a technical, factual explanation and rationale for them. Amendments 501, 502 and 503 replace clause 25(1) and instead provide that the provision of assistance in accordance with the Bill will, of itself, not give rise to civil liabilities in certain circumstances. Those circumstances are where an individual provides assistance in accordance with the Bill, where an individual performs any other function under the Bill in accordance with the Bill, and where an individual assists a person seeking to end their life under the Bill, in connection with the doing of anything under the Bill. Proposed new subsection (1A) would create an exception to the exclusion of civil liabilities, providing that civil liabilities can arise in cases when an act is performed dishonestly or otherwise than in good faith, as well as in cases of negligence. Without this amendment, there is the possibility that clause 25(1) could provide blanket immunity to a person from all civil liabilities, even when they may have been negligent in their actions in providing assistance in accordance with the provisions in the Bill.

--- Later in debate ---

[Kim Leadbeater]

That would be my understanding as well, but I am not a lawyer. Fortunately, a lawyer just tried to intervene on me, so he might want to step in.

[Jake Richards]

My intervention is on something completely different. I have been reminded that in Australia, there is a specific clause that relates to the provision in this amendment almost word for word, so I think the hon. Member for East Wiltshire may have been incorrect in his comments.

[Kim Leadbeater]

I thank my hon. Friend for that. Unless the Minister has anything to add on injunctions—

--- Later in debate ---

[Naz Shah]

I apologise, Mr Dowd. I will not refer to them.

I come back to the point made by the hon. Member for East Wiltshire about DPP consent. I will be grateful if the Minister picks up some of these queries. In this place, we make laws. My experience of the law on forced marriage—I was a victim of forced marriage—was that we made a law but never got any convictions. Very little moved on it, because we already had laws in place to prosecute that offence. I am not saying that the same is happening here, but I draw the Committee’s attention to the fact that we may be making a law that already exists. If it already exists in the Suicide Act, are we just making a law for the sake of putting something on the statute book or on the face of the Bill?

We have talked a lot about how we should not complicate things. The word “complication” has been used quite a lot in this Committee. Are we adding another layer of complication by putting this measure in the Bill, when we are not prepared to do so for other things that people feel strongly about? This is also something that already exists.

My understanding is that if we were prosecuting coercion, for which unfortunately the prosecution rate is only 4%, that would not need DPP consent. It would be needed, potentially, for assisting suicide, but not for coercion. Do we need some clarity about the application of the law in this regard? Suppose we had a scenario in which somebody was murdered: it was premeditated, and somebody had thought through how to use this process as an avenue to kill that person. I do not want us to make a law that would allow somebody to literally get away with murder. More thought needs to be given to that. I am not an expert or an eminent lawyer like the Minister, but I am concerned by the comments of the hon. Member for East Wiltshire, having looked more closely at the issue. I would welcome the Minister’s comments.

[Jake Richards]

You intimated, Mr Dowd, that we can speak for as long as we want, but I will not speak for long on this clause, partly because I fear that we are making a mountain out of a molehill. The clause creates new criminal offences; I am not a criminal lawyer, but that is my reading of the clause and the amendments tabled to it by my hon. Friend the Member for Spen Valley. There are an array of reasons why criminal offences are legislated for. One good reason is to provide deterrence against committing such an offence. If the Bill receives Royal Assent, we are entering new ground. We are developing a new process in our healthcare system that will affect how our society and culture works, and creating a new legal process, which we had lengthy discussions about when discussing the provisions that will replace clause 12, in the debate over the panel.

In my mind, it is wholly appropriate to have an offence specifically in this very new area. I cannot see any weight to the argument that it undermines the law of homicide in our country and jurisdiction. Respectfully, I cannot see how Members who have been, understandably, worried about the Bill cannot see that this only strengthens it. I would gently say that the arguments that this somehow undermines the law of murder or homicide are slightly disingenuous. I had hoped that debate on this clause would be straightforward, with the Committee seeing that it clearly strengthens the safeguards around assisted dying.

[Naz Shah]

I have taken your advice, Mr Dowd, because my points would have made for a long intervention. First, I gently remind my hon. Friend the Member for Rother Valley that we have not used the word “disingenuous” in this Committee, so I sincerely wish that he reflects on that. Regardless of the debate we are having, everyone on the Committee is very committed to what we are doing here.

Secondly, my hon. Friend said that we were making a mountain out of a molehill. I refer again to the issue of forced marriage, legislation on which went through the House when police forces already had legislation to prosecute for it. As legislators, we should have ensured that we raised awareness and trained our police officers and communities to apply that—

Terminally Ill Adults (End of Life) Bill (Twenty-ninth sitting)

Jake Richards Excerpts

Committee stage
Tuesday 25th March 2025 Public Bill Committees

[Daniel Francis (Bexleyheath and Crayford) (Lab)]

It is a pleasure to serve under your chairship, Sir Roger. This has been a long process, and we are nearly at the end of it now. Members will recall that at the start of the process, I was very insistent that Mencap should give oral evidence. When it did so, Dan Scorer said:

“Clause 35 is about the review of the Act. The lived experience of people is absolutely vital to that. The Bill says that it will be five years until we have that review. Our view is that that is far too long. If the Bill becomes law and if there are really serious issues and discrimination taking place against people, we will want to know that a lot earlier than in five years’ time, and we will want action to be taken. Our suggestion is that review should be earlier. We would want to see strong representation from patient groups across that, as well as from people who have been involved in the process, such as family members, advocates and clinicians to make sure that if serious issues are being raised, they can be picked up early and addressed.”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 30 January 2025; c. 280, Q367.]

[Jake Richards (Rother Valley) (Lab)]

My hon. Friend is, as ever, making really important points. Is he reassured by the fact that the commissioner will be reporting annually, as per the previous clause, and that the panel will give reasons, which will likely be public?

[Daniel Francis]

The annual reporting does give us some reassurance, but when we accepted some of Mencap’s recommendations last week, I said that I would welcome it if the entirety of its recommendations were accepted—and it wanted an overall review at an early stage in the process.

Amendment 493 to 495, in my name, address those concerns. A consistent concern of mine is how we address issues that come to light from specific communities, particularly those with learning difficulties, and amend the legislation at a reasonable stage in the process.

--- Later in debate ---

[Danny Kruger]

In a moment. The potential—as would happen in other parts of genuine healthcare—is that the more work people do, the more money they get. My concern is that that induces a dangerous incentive into the system. Having a global fee paid to a provider who managed the service would be much safer. The crucial point is that we prevent people being paid for approving and enabling assisted deaths, and that is what my amendment would do.

[Jake Richards]

I appreciate the point that the hon. Member is trying to make and I think it is a fair one, but how does he think this could work? As he said in his own intervention, people might have to be paid for one part of the process, and then for the next. If we appreciate the principle that people get paid for time, there is inevitably more money involved as the process goes on, so can he explain how his amendment would work?

[Danny Kruger]

I intend, in a later debate when we come to the new clause, to try to explain how I think we should have done this. The answer to the hon. Gentleman’s question is that an organisation should be resourced—I think through philanthropy, rather than taxpayers’ money or people paying out of their own pocket, but the point stands however we do it—to deliver the assisted dying service, but crucially it should not be paid more per service, treatment or customer. We should not have the concept of customers in this arrangement; there should be a provider who is resourced to deliver this service. The crucial point is that they should not be paid more per client or for progressing people through the system.

--- Later in debate ---

[Jake Richards]

I rise to speak briefly in support of amendment 548, tabled by my hon. Friend the Member for Spen Valley. I do so fundamentally for two reasons.

First, there may be a lot of support for the principle of assisted dying among members of the Committee and, indeed, Members of the House, but there are also understandable concerns about its implementation. We have been debating all the aspects of that over a lengthy period in Committee, and it is undoubtedly complex. Although my hon. Friend is disappointed that she has had to table the amendment, I commend her for doing so, because it is important to get this right and to be brave by setting longer time limits if necessary. I think that can be reassuring to Members who, while supporting the principle, want to make sure that we get this right. I hope that the amendment will do that.

Secondly, for those people—including those who have been in the Public Gallery today, Committee members and, indeed, other Members of the House—who might be disappointed about the delay, in my mind the amendment is not an obstacle to change. In fact, what we have seen here is the Bill’s promoter working with the Government, who remain neutral on the principle but want to make the Bill deliverable, to come up with a sensible, pragmatic proposal for how and at what speed this profound change is to be implemented. In my mind, that gives a sense of the Executive and the promoter thinking about the practicalities.

I urge those who are desperately seeking this change and have fought for decades to secure it to approach this measure with a sense of optimism. This is serious. This is a once-in-a-generation opportunity to deliver that change. I hope that, both in the Committee and outside it, they will support my hon. Friend the Member for Spen Valley, who has gone to great lengths to build support and to make sure that the Bill is workable. I will be voting for amendment 548 with a great sense of reassurance, but also a great sense of optimism that one day this country will see this change, which is so desperately needed.

[Liz Saville Roberts]

I rise to support amendment 535. I do not intend to say much, because the hon. Member for Richmond Park has made many of the points I wished to make. The amendment recognises that an opinion was stated in a debate in the Senedd in October, which dealt in detail with the principles of this Bill, and that Professor Emyr Lewis told us that one way of recognising that would be to consider different commencement provisions in Wales.

Reference has been made to the different criminal law arrangements in England and Wales to do with smacking children, and during covid there were quite definitely different arrangements between England and Wales. After a quarter of a century of devolution, we have devolution divergence, and we are seeing that in action.

We have already accepted the principle that there are aspects of the Bill that are devolved, responsibility for which must be passed to Welsh Ministers. We are still debating the wording of that, but we are working towards it, and I think we have accepted the principle of it. We should also acknowledge that the Senedd and Welsh Ministers may well be able to make a move that would have the same effect of changing the commencement date, but I support the amendment because it shows that we are acknowledging the consequences and implications of a legislative consent motion. Incidentally, I could often stand up here and talk about the fact that legislative consent motions can be overridden by Westminster, but we are working from the point of view of seeking to respect devolved powers alongside the powers that we have here, so I will be supporting amendment 535.