Terminally Ill Adults (End of Life) Bill

Jeremy Wright Excerpts

Friday 16th May 2025 Commons Chamber

Finally, how should this be done? It should be through separate or joint assessments, and then a panel meeting to deliberate—not a quasi-judicial panel, but evidence-led assessments where real choice is offered. Let us listen to the experts and hear their collective voice: the Bill is unsafe. That is why professional bodies are speaking out against the Bill. My amendments would nudge it to a safer place, but the scale of the concern far exceeds this change. Colleagues, we must follow the experts’ evidence.

[Sir Jeremy Wright (Kenilworth and Southam) (Con)]

In view of the number of hon. Members who wish to speak in the debate, I will restrict my remarks to amendments 47, 48 and 49, which stand in my name and the names of others. The amendments focus on the stage in the process that involves the multidisciplinary panel established by clause 14, and their purpose is to make that system work better.

A panel is intended to be an additional safeguard. The hon. Member for Spen Valley (Kim Leadbeater) has made that very clear, and such panels are the successor to the involvement of a High Court judge assessing the merits of each case. The role of the panel is to determine whether it is satisfied of the matters set out in clause 15(2). Some of those matters are procedural—for example, whether the person seeking the certificate is aged over 18 or is resident in the UK, or whether declarations and assessments that should be made have been made. Others are matters of judgment, including professional judgment, such as whether an illness is terminal or whether the person applying for a certificate of eligibility has the mental capacity to do so.

The remaining category of matters to be considered are matters of broader judgment, and I suspect those are likely to be where the panel focuses most of its attention, particularly the final two listed in clause 15(2): first, whether

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

and, secondly, that there is no coercion or pressure from anyone else. On those matters, the panel will hear from the relevant doctors, who will have had to make a judgment on those things, but I do not think that the intent of the Bill is or should be that the panel simply confirms that the doctor has reached a judgment and then adopts that judgment. The panel should, of course, reach its own judgment. It is right that the panel will also hear from the person wishing to die and will make its assessment of them.

Particularly on the last matter—the absence of coercion or pressure—it may well be that highly relevant evidence will come from others. It may come from family, friends or others who know the person well, and we are familiar with a least one scenario where a new partner isolated the person in question before they suddenly and unexpectedly changed their view on their own assisted death.

The problem is that under the Bill as it stands it is very difficult, and perhaps impossible, for those who know the person seeking a certificate well to know that those proceedings are under way or in prospect. They may not know, and nobody has to tell them, that the person has made the relevant declarations, or even that they have an intention to die, or indeed that there is any reason to submit any evidence they may have.

I am not saying that every case in which someone has not told their family and friends of their decision to seek an assisted death will be concerning, but I think it is fair to say that a disproportionate number of the concerning cases will be in that category. In those cases, the panel may be making a judgment in the absence of relevant—perhaps crucial—evidence and they simply cannot do their job properly if that is so.

[Catherine Atkinson (Derby North) (Lab)]

Is the right hon. and learned Member as concerned as I am that the panel does not even need to consider looking at evidence from family, friends, or those caring for or treating the person? Is he also concerned that although the panel might be required to hear from the person, that will only be in exceptional circumstances and there will be no requirement to ask any questions at all?

[Sir Jeremy Wright]

I understand the hon. Lady’s point and I have seen her amendments on the subject, which are very sensible. We need to think about the way in which the panel process will actually unfold. If we believe that this is an important safeguard, as, I think, is a common view, we need to do everything we can to make sure that it is an effective one. Like the hon. Lady’s amendments, my amendment 47 seeks to remedy the problem by ensuring that the assisted dying commissioner notifies anyone they think may have relevant evidence to give so that they can give it. That evidence may, of course, not change the panel’s decision, but in some of the most troubling cases it will, and the opportunity for the panel to consider that evidence, when the stakes are so high, must surely be provided for.

I accept that what I am proposing is an infringement of the privacy of the person wishing to die—it is a fetter on their ability to choose to die without informing their family or friends as they may wish—but the Bill is all about balancing the rights of a person to die as they wish with, on the other hand, our duty to protect the vulnerable from abuse. That is exactly why the stages through which a person must go in order to be assisted to die are in this Bill, including obtaining the grant of a certificate from a panel. To be of value, as I say, that must surely add new protections to the other stages.

[Sir John Hayes]

We were assured that one of the key safeguards in the Bill’s original incarnation was a legal test. That process—had it been retained, of course—would have enabled the collection of evidence in the very way that my right hon. and learned Friend is describing. It is partly because the safeguards have been weakened that we have the dilemma that his amendments seek to deal with.

[Sir Jeremy Wright]

I understand my right hon. Friend’s point, but I am not sure I entirely agree with him. I think some of the procedural problems I am describing would have existed even with the previous iteration of the Bill, but certainly they are there in its current iteration. At this Report stage, I am seeking to fix the problem that arises from the difficulty for the three qualified individuals who will constitute these panels to express a considered judgment. If we are to have added value in the panel stage of this process, we surely have to enable the panel to make good judgments. Good judgments come from the capacity to assess all the relevant evidence. The Bill, as it stands, makes it very hard for the panel to have access to all that evidence in every case, but perhaps especially in those cases where the additional safeguard is most needed.

[Robin Swann (South Antrim) (UUP)]

On the right hon. and learned Gentleman’s point about the panel, the Royal College of Psychiatrists said in point 5 of its concerns:

“It is not clear what a psychiatrist’s role on a…panel would be”.

[Sir Jeremy Wright]

The hon. Gentleman makes a fair point. I think we can expect that the psychiatrist on the panel will subject the requirement on mental capacity, in particular, to some considerable professional scrutiny, but nobody on the panel, whatever their professional competence may be, is capable of doing the job properly if they do not have access to the necessary evidence, so we must make sure they do.

The fact that the panel may sit in public is not a sufficient answer to the problem that I am raising. First, that is because there will be many panels considering many cases, and we cannot expect those who have evidence of coercion, for example, to watch the lists in case the person they know happens to appear in them—when, of course, they have no expectation that they will.

Secondly, the panel will not sit in public in every case. Paragraph 6 of schedule 2 says:

“Panels are to determine referrals in public”.

That is the clear presumption, and it is welcome, but paragraph 6(2) says:

“The chair of a panel may, at the request of the person to whom a referral relates, decide that the panel is to sit in private.”

I can see nothing in the Bill about any grounds on which the panel chair may refuse such a request, so it will occasionally, or perhaps often, be the case that the panel will sit in private, and no one will know what it is doing.

The next issue is the way a panel will go about making the judgments it needs to make, which brings me to amendment 48. As we all know, most judicial and quasi-judicial hearings in this country are conducted on an adversarial basis. That is, by the way, a reference not to the tone of proceedings but to the presentation of both sides of an argument so that the tribunal can reach the right conclusion. That is what our judges and lawyers are used to. That matters here because this quasi-judicial stage in the process of seeking assistance to die is being offered as important reassurance that things will be done safely, but that reassurance cannot be offered if panels are asked to adopt a process for which they are ill-equipped. That is not a criticism of those who will sit on the panels.

I accept that, under the Bill as it stands, a panel may hear from and question any other person beyond the person seeking the certificate and the relevant doctors, but as I have sought to address in amendment 47, as things stand those other persons will in all likelihood not know about the panel’s proceedings and therefore will not come forward of their own initiative with the evidence. The panel would have to go out and find them, and how exactly is it to do that? How does the panel know who may have relevant evidence to give, and with what resources will it seek them out?

The position on what resources will be available more generally for the process under the Bill remains unclear, but the impact assessment suggests that panels will be expected to deal with two cases a day. That suggests that they will spend somewhere between three and four hours on each. That is not much latitude for further investigation.

Amendment 48 proposes that the commissioner should notify a designated authority—the Secretary of State can choose the appropriate one—of an application for a certificate. That authority would then supply to the panel an advocate with the responsibility to raise arguments against the grant of the certificate, which the panel would not otherwise hear. I think that is important, because it would ensure that there was another participant in the panel process who could at least help the panel by prompting consideration of concerns, reservations or grounds for further inquiry before decisions were made.

My amendment 49 is about what happens once a panel has reached its conclusion. Clause 16 provides for a person seeking a certificate to be able to ask for reconsideration of a panel’s refusal to grant one, but of course the Bill currently provides no equivalent right to challenge the decision to someone who believes that a panel should not have granted a certificate. Anyone in that position would need to resort to judicial review, which is complex and expensive.

[Madam Deputy Speaker (Caroline Nokes)]

May I gently suggest to the right hon. and learned Gentleman that he might be bringing his remarks to a close? There are many other Members who wish to contribute this afternoon.

[Sir Jeremy Wright]

I certainly am, Madam Deputy Speaker. I am doing my best, I hope as briefly as I can, to explain these technical amendments in a hugely important Bill, in a part of the Bill that the promoter has advocated for because she believes it is a safeguard. I think it is important, Madam Deputy Speaker, that we establish whether it is such a safeguard, and if it can be improved, how it can be improved—but I entirely take your strictures on board and I will come as quickly as I can to a conclusion.

This is not an equality of arms point—I accept that these are not opposing parties in the traditional sense—but it is really about the presentation of new evidence. Presumably the advice to someone whose application for a certificate has been refused and who has new evidence to present would be to reapply to the commissioner, but what is someone who has new evidence to challenge the basis for an existing certificate to do? Judicial review is no help. That is about the soundness of the decision already taken, which will be assessed using the evidence already presented to the panel that took the original decision.

--- Later in debate ---

[Stephen Kinnock]

I will give way one final time.

[Sir Jeremy Wright]

I am conscious of the confines of the Minister’s role in the process, but what assessment have the Government made of the capacity of a panel to investigate for itself anything that is not brought before it either by one of the relevant doctors or by the person seeking a certificate? The panel’s capacity to do so is surely important, if any issue that is not raised by either group is relevant to its consideration.

[Stephen Kinnock]

The Government’s position on the relevant clause is that the panel has to be satisfied that the correct steps have been taken, and there is not evidence of the points that the right hon. and learned Gentleman has made. Our view is that the intended effect is already catered for in clause 15.

Amendment 38 would exclude from being provided with assistance a person who is not already terminally ill, as defined under the Bill. The reference to “standard medical treatment” is unclear. This could cause further uncertainty around eligibility, given that treatment could be individually tailored to each patient and their needs.

Amendment 81 would remove the requirement that any references to capacity in the Bill are to be read in accordance with the Mental Capacity Act 2005. That would effectively remove the definition of capacity in the Bill. In the absence of a new definition, the Mental Capacity Act may continue to apply by default. That would, of course, diverge from the familiar concepts in the Mental Capacity Act, which could create confusion for practitioners.

The stated intention of amendment 14 is to exclude a person who would not otherwise meet the definition of “terminally ill” if the person meets that definition solely as a result of voluntarily stopping eating or drinking. Our assessment is that the amendment risks introducing uncertainty over a person’s eligibility for assistance under the Bill. However, the substantive question is a policy choice for Parliament. Recognising the intent of the amendment, we do not believe that it would render the Bill unworkable.

Once again, I thank all hon. Members for their contributions. I hope that these observations have helped them in their consideration of the amendments that have been tabled.