Terminally Ill Adults (End of Life) Bill

Debate between Kim Leadbeater and Lindsay Hoyle

Report stage
Friday 13th June 2025 Commons Chamber

[Kim Leadbeater (Spen Valley) (Lab)]

I beg to move, That the clause be read a Second time.

[Mr Speaker]

With this it will be convenient to discuss the following:

Amendment (b) to new clause 13, at end insert—

“(5A) The Secretary of State may only approve a device under subsection (5) if the Medicines and Healthcare products Regulatory Agency has approved the device for that purpose.

(5B) Before making any regulations under this section, the Secretary of State must consult the Medicines and Healthcare products Regulatory Agency.”

This amendment requires that the Medicines and Healthcare products Regulatory Agency be consulted before making regulations and that medical devices can only be approved for self-administration if they have been approved by the MHRA.

Amendment (c) to new clause 13, at end insert—

“(5A) Regulations under subsection (5) must forbid the use of any device used for the self-administration of a gas.”

This requires the Secretary of State to forbid the use of medical devices which cause death by the administration of a gas.

Amendment (a) to new clause 13, leave out subsection (7).

This removes the power to make regulations that may make any provision that could be made by an Act of Parliament (known as Henry VIII power) from this new clause.

New clause 14—Prohibition on advertising—

“(1) The Secretary of State must by regulations make provision prohibiting—

(a) the publication, printing, distribution or designing (anywhere) of advertisements whose purpose or effect is to promote a voluntary assisted dying service;

(b) causing the publication, printing, distribution or designing of such advertisements.

(2) The regulations may contain exceptions (for example, for the provision of certain information to users or providers of services).

(3) Regulations under this section may make any provision that could be made by an Act of Parliament.

(4) But regulations under this section—

(a) may not amend this Act, and

(b) must provide that any offence created by the regulations is punishable with a fine.

(5) In this section “voluntary assisted dying service” means—

(a) any service for or in connection with the provision of assistance to a person to end their own life in accordance with this Act, or

(b) any other service provided for the purposes of any of sections 5 to 27.”

This clause imposes a duty to make regulations prohibiting advertisements to promote services relating to voluntary assisted dying under the Bill.

Amendment (b) to new clause 14, in subsection (2), leave out from “exceptions” to the end of subsection (3) and insert—

“( ) for the following—

communication made in reply to a particular request by an individual for information about a voluntary assisted dying service;

(b) communication which is—

(i) intended for health professionals or providers of voluntary assisted dying services, and

(ii) made in a manner and form unlikely to be seen by potential service users.

(3) Regulations under this section may make provision that could be made by an Act of Parliament, but may not amend this Act or the Suicide Act 1961.”

This amendment would limit the exceptions that can be created to the advertising ban set out in NC14 and also provides that regulations cannot amend the Suicide Act 1961, which includes the offence of assisting and encouraging suicide.

Amendment (a) to new clause 14, leave out subsection (3).

This removes the power to make regulations that may make any provision that could be made by an Act of Parliament (known as Henry VIII power) from this new clause.

New clause 15—Investigation of deaths etc—

“(1) In section 1 of the Coroners and Justice Act 2009 (duty to investigate certain deaths), after subsection (7) insert—

“(7A) In this Chapter a reference to an “unnatural death” does not include a death caused by the self-administration by the deceased of an approved substance, within the meaning of the Terminally Ill Adults (End of Life) Act 2025, that was provided to the deceased in accordance with that Act.”

(2) In section 20 of that Act (medical certificate of cause of death), after subsection (4) insert—

“(4A) Regulations under subsection (1) may make, in respect of cases where assistance was provided or purportedly provided to the deceased under the Terminally Ill Adults (End of Life) Act 2025—

(a) such provision that is similar to, or that corresponds to, provision mentioned in subsection (1) as the Secretary of State considers appropriate;

(b) such further provision as the Secretary of State considers appropriate.

(4B) Regulations under subsection (1) must provide that in cases where the cause of death appears, to the best of the knowledge and belief of the person issuing a certificate under the regulations, to be the self-administration by the deceased of an approved substance (within the meaning of the Terminally Ill Adults (End of Life) Act 2025) that was provided to the deceased in accordance with that Act, the certificate must—

(a) state the cause of death to be “assisted death”, and

(b) contain a record of the illness or disease which caused the person to be terminally ill within the meaning of that Act.”

(3) In Schedule 1 to that Act (suspension of investigations etc), in the definition in paragraph 1(6) of “homicide offence”, after paragraph (d) insert—

“(e) an offence under section 31, 32 or 33 of the Terminally Ill Adults (End of Life) Act 2025;”.”

This new clause provides that references in Chapter 1 of the Coroners and Justice Act 2009 (investigations into deaths) to unnatural deaths do not include deaths caused by self-administration of approved substances provided in accordance with the Bill. It makes offences under clauses 31 to 33 “homicide offences” for the purposes of that Act. It also amends the powers in that Act in respect of medical certificates of cause of death.

Amendment (a) to new clause 15, in subsection (1), leave out from “section” to “(medical” in subsection (2) and insert

“20 of the Coroners and Justice Act 2009”

This amendment ensures that deaths from assisted dying will still fall within the coroner’s duty to investigate deaths under section 1 of the Coroners and Justice Act 2009.

New clause 20—Guidance about operation of Act—

“(1) The Secretary of State must issue guidance relating to the operation of this Act.

(2) The guidance need not (but may) relate to matters about which the Welsh Ministers may issue guidance under subsection (4) (“Welsh devolved matters”).

(3) Before issuing guidance under subsection (1), the Secretary of State must consult—

(a) the Chief Medical Officer for England,

(b) the Chief Medical Officer for Wales,

(c) such persons with learning disabilities and other persons who have protected characteristics as the Secretary of State considers appropriate,

(d) such persons appearing to represent providers of health or care services, including providers of palliative or end of life care, as the Secretary of State considers appropriate,

(e) if any part of the guidance relates to Welsh devolved matters, the Welsh Ministers, and

(f) such other persons as the Secretary of State considers appropriate.

(4) The Welsh Ministers may issue guidance relating to the operation of this Act in Wales, but the guidance must only be about matters within devolved competence.

(5) For this purpose, a matter is “within devolved competence” if provision about it would be within the legislative competence of Senedd Cymru if it were contained in an Act of the Senedd.

(6) Before issuing guidance under subsection (4), the Welsh Ministers must consult—

(a) the Chief Medical Officer for Wales,

(b) the Secretary of State,

(c) such persons with learning disabilities and other persons who have protected characteristics as the Welsh Ministers consider appropriate,

(d) such persons appearing to represent providers of health or care services, including providers of palliative or end of life care, as the Welsh Ministers consider appropriate, and

(e) such other persons as the Welsh Ministers consider appropriate.

(7) When preparing guidance under this section, an appropriate national authority must have regard to the need to provide practical and accessible information, advice and guidance to—

(a) persons (including persons with learning disabilities) requesting or considering requesting assistance to end their own lives;

(b) the next of kin and families of such persons;

(c) the general public.

(8) An appropriate national authority must publish any guidance issued under this section.

(9) In this section—

“appropriate national authority” means the Secretary of State or the Welsh Ministers;

“protected characteristics” has the same meaning as in Part 2 of the Equality Act 2010 (see section 4 of that Act).”

This new clause (which is intended to replace clause 37) makes provision about guidance relating to the operation of the Bill.

New clause 21—Provision about the Welsh language—

“(1) In this section “relevant person” means a person in Wales who wishes to be provided with assistance to end their own life in accordance with this Act.

(2) Subsection (3) applies where the Welsh Ministers make regulations under section 39 (voluntary assisted dying services: Wales).

(3) Regulations under that section must make such provision as the Welsh Ministers consider appropriate for the purpose of ensuring that, where a relevant person indicates that they wish to communicate in Welsh, all reasonable steps are taken to secure that—

(a) communications made by a person providing a voluntary assisted dying service to the relevant person are in Welsh, and

(b) any report about the first or second assessment of the relevant person is in Welsh.

(4) Where a relevant person informs the Commissioner that they wish to communicate in Welsh, the Commissioner must take all reasonable steps to secure that—

(a) communications made by the Commissioner to the relevant person are in Welsh,

(b) each member of the panel to which the relevant person’s case is referred speaks Welsh, and

(c) communications made by that panel to the relevant person are in Welsh,

and any certificate of eligibility issued by that panel must be in Welsh.

(5) Regulations under section 7, 9, 10, 17 or 26 that specify the form of—

(a) a first or second declaration,

(b) a report about the first or second assessment of a person, or

(c) a final statement,

must make provision for the forms to be in Welsh (as well as in English).

(6) Before making regulations in pursuance of subsection (5), the Secretary of State must consult the Welsh Ministers.

(7) In this section—

“panel” and “referred” have the meaning given by paragraph 1 of Schedule 2;

“voluntary assisted dying service” has the meaning given by section 38.”

This new clause (which is intended to replace Clause 47) makes provision about the use of the Welsh language.

New clause 4—Monitoring by Chief Medical Officer—

“(1) The relevant Chief Medical Officer must—

(a) monitor the operation of the Act, including compliance with its provisions and any regulations or code of practice made under it,

(b) investigate, and report to the appropriate national authority on, any matter connected with the operation of the Act which the relevant national authority refers to the relevant Chief Medical Officer, and

(c) submit an annual report to the appropriate national authority on the operation of the Act.

(2) The relevant Chief Medical Officer’s report must include information about the occasions when—

(a) a report about the first assessment of a person does not contain a statement indicating that the coordinating doctor is satisfied as to all of the matters mentioned in section 9(2)(a) to (h),

(b) a report about the second assessment of a person does not contain a statement indicating that the independent doctor is satisfied as to all of the matters mentioned in section 10(2)(a) to (e),

(c) a panel has refused to grant a certificate of eligibility,

(d) the coordinating doctor has refused to make a statement under section 17(6).

(3) An annual report must include information about the application of the Act in relation to—

(a) persons who have protected characteristics, and

(b) any other description of persons specified in regulations made by the Secretary of State.

(4) When preparing an annual report, the relevant Chief Medical Officer must consult—

(a) The Commissioner, and

(b) such persons appearing to the relevant Chief Medical Officer to represent the interests of persons who have protected characteristics as the relevant Chief Medical Officer considers appropriate.

(5) An appropriate national authority must—

(a) publish any report received under this section,

(b) prepare and publish a response to any such report, and

(c) lay before Parliament or Senedd Cymru (as the case may be) a copy of the report and response.

(6) In this section “appropriate national authority” means the Secretary of State or the Welsh Ministers.

(7) In this section “protected characteristics” has the same meaning as in Part 2 of the Equality Act 2010 (see section 4 of that Act).

(8) In this section “relevant Chief Medical Officer” has the meaning given by section 37(5).”

This new clause would require the monitoring, investigation and reporting functions set out in the Bill to be carried out by the Chief Medical Officer instead of the Voluntary Assisted Dying Commissioner.

New clause 5—Implications for civil procedure rules and probate proceedings—

“(1) The Secretary of State must, within six months of the passing of this Act, publish a report setting out the implications of this Act on—

(a) the civil procedure rules, and

(b) probate proceedings.

(2) The report in subsection (1) must include an analysis of likely consequential changes to the civil procedure rules and probate proceedings in consequence of this Act.”

New clause 6—Board to consult communities—

“(1) The Commissioner must, within six months of being appointed under this Act, appoint a consultation board.

(2) The role of the board is to consult communities in order to report to the Commissioner on the impact of the Act on those communities.

(3) The Board must report to the Commissioner and the Secretary of State every 12 months from its appointment on its findings.

(4) The communities that the Board must consult include people from Black, Asian and Minority Ethnic communities.

(5) The Board may consult other groups in addition to those listed in subsection (4) as it considers appropriate.

(6) The Secretary of State must, within 3 months of receiving a report under subsection (3), lay that report before both Houses of Parliament.”

New clause 19—Collection of statistics—

“(1) The Voluntary Assisted Dying Commissioner must ensure that the statistics specified in Schedule (Statistics to be collected) are collected.

(2) The Commissioner must publish a yearly report setting out those statistics.

(3) The Secretary of State may, by regulation, vary the contents of Schedule (Statistics to be collected).”

Amendment 13, in clause 4, page 2, line 22, at end insert—

“(2A) A person may not be appointed under subsection (2) unless the appointment has the consent of the Health and Social Care Select Committee of the House of Commons.

(2B) In this section, references to the Health and Social Care Committee shall—

(a) if the name of that Committee is changed, be taken (subject to paragraph (b)) to be references to the Committee by its new name;

(b) if the functions of that Committee at the passing of this Act with respect to matters relating to the provision of assistance under this Act become functions of a different committee of the House of Commons, be taken to be references to the committee by whom the functions for the time being exercisable.”

Amendment 96, in clause 25, page 21, line 5, at end insert—

“(1A) A drug or other substance may only be approved under this Act if the Secretary of State is reasonably of the opinion that there is a scientific consensus that this drug (or other substance) or combination of drugs (or other substances), is effective at ending someone’s life without causing pain or other significant adverse side effects.”

This amendment ensures that drugs can only be approved if the Secretary of State is reasonably of the opinion that there is a scientific consensus that the drug is effective at ending someone’s life without causing pain or other significant adverse side effects.

Amendment 97, page 21, line 5, at end insert—

“(1A) A drug or other substance may only be approved under this Act if it has been licensed by the Medicines and Healthcare products Regulatory Agency for that purpose.”

This amendment ensures that drugs can only be approved for this purpose if the MHRA has licensed those drugs for that purpose.

Amendment 98, page 21, line 5, at end insert—

“(1A) Nothing in subsection (1) requires the Secretary of State to approve any drugs or other substance if they conclude that there are no appropriate drugs or other substances to approve.”

If the Secretary of State concludes that no drugs or substance is appropriate to be used, then the Secretary of State is not required by subclause 25(1) to approve any.

Amendment 27, page 21, line 7, at end insert—

“(2A) The doses and types of lethal drugs specified in any regulations made under subsection (1) must be licensed by the Medicines and Healthcare products Regulatory Agency.

(2B) The doses and types of lethal drugs to bring about the person’s death must be recommended by the guidelines of either—

(a) the National Institute of Clinical Excellence, or

(b) the All Wales Medicines Strategy Group in Wales, as appropriate, prior to licensing.”

This amendment will require the doses and types of lethal drugs to be licensed by the Medicines and Healthcare products Regulatory Agency and to be recommended by either the National Institute of Clinical Excellence or the All Wales Medicines Strategy Group in Wales as appropriate prior to licensing.

Amendment 99, page 21, line 7, at end insert—

“(2A) The Secretary of State may not lay a draft statutory instrument containing (whether alone or with other provision) regulations under subsection (1) before both Houses of Parliament unless they also lay before both Houses a report setting out all relevant information on the likely time to death, complications (including pain) and likely side effect.”

This amendment requires that a report be provided to Parliament setting out the information available on the proposed drugs, including time to death, complications (including pain) and likely side effects. Such a report is required before Parliament votes to approve the drugs or substance. See consequential Amendment 100.

Amendment 69, page 21, line 8, leave out subsection (3) and insert—

“(3) See section (Regulation of approved substances and devices for self-administration) for powers to make provision about—

(a) approved substances, and

(b) devices for use or used in connection with the self-administration of approved substances.”

This is consequential on NC13.

Amendment 53, line 24, leave out clause 34

This amendment is consequential on NC13.

Amendment 54, line 34, leave out clause 35

This amendment is consequential on NC15.

Amendment 19, in clause 36, page 27, line 17, at end insert—

“(ba) how the provisions of this Act relate to the operation of—

(i) the Government’s strategy on suicide prevention,

(ii) the duties on clinicians and others to secure the right to life, including of those at risk of suicide, under paragraphs 1 and 2 of Article 2 (Right to Life) set out in Schedule 1 of the Human Rights Act 1998,

(iii) the Mental Health Act 1983,

(iv) deprivation of liberty safeguards as set out in Schedule A1 to the Mental Capacity Act 2005, and

(v) liberty protection safeguards as set out in Schedule AA1 to the Mental Capacity Act 2005.”

Amendment 70, page 27, line 20, at end insert—

“(ca) ensuring effective communication in connection with persons seeking assistance under this Act to end their own lives, including the use of interpreters;”

This amendment provides that a code of practice must be issued covering ensuring effective communication in connection with persons seeking assistance under the Bill.

Amendment 108, page 27, line 31, at end insert—

“(h) how the provisions of this Act, including but not limited to section 23, interact with the provisions of the Abortion Act 1967.”

Amendment 71, page 27, line 35, leave out subsection (3).

This amendment is consequential on amendment 70.

Amendment 20, page 28, line 5, leave out subsection (8) and insert—

“(8) If it appears to a court or tribunal conducting any criminal or civil proceedings that—

(a) a provision of a code, or

(b) a failure to comply with a code,

is relevant to a question arising in the proceedings, the provision or failure must be taken into account in deciding the question.”

Amendment 89, page 28, line 7, leave out clause 37.

This amendment is consequential on NC20.

Amendment 34, in clause 37, page 28, line 14, at end insert—

“(ii) persons from Black, Asian and Minority Ethnic communities and advocate groups representing those communities, and

(iii) representatives of the healthcare sector, including persons who work in hospices.”

Amendment 12, clause 38, page 28, line 36, leave out subsections (4) and (5) and insert—

“(4A) Regulations under subsection (1) may not amend, modify or repeal section 1 of the National Health Service Act 2006.”

This amendment would prevent section 1 of the National Health Service Act 2006, which sets out the purposes of the NHS, from being amended by regulations. Its effect would be to require changes to be made by an Act of Parliament instead.

Amendment 105, page 29, line 4, leave out subsection (6).

Amendment 15, page 29, line 5, at end insert—

“(6A) Regulations under this section must provide that, where a body other than a public authority provides voluntary assisted dying services under subsection (1), that body must publish an annual statement that includes information on the following—

(a) the number of persons to whom the body has provided a preliminary discussion under section 5(3);

(b) the number of to persons whom the body has assessed under section 9(1);

(c) the number of persons whom the body has assessed under section 10(1);

(d) the number of persons to whom assistance has been provided under section 23(2);

(e) the cost and revenue associated with providing such assistance; and

(f) any other matter that the Secretary of State may specify.”

This amendment would require private providers of the services permitted under the Act to publish annual statements of the numbers of people to whom they have provided those services. It would also require them to disclose their associated costs and revenue.

Amendment 92, in clause 39, page 29, line 13, leave out from “Wales” to end of line 14.

Amendment 106, page 29, line 16, leave out subsection (2)(a).

Amendment 107, page 29, line 22, leave out subsection (4)(a).

This amendment and amendment 93 ensure that the power under subsection (3) also covers provision securing that arrangements are made for the provision of services, so far as such provision is outside the legislative competence of the Senedd.

Amendment 93, page 29, line 27, at end insert—

“(b) a reference to provision about voluntary assisted dying services includes in particular provision securing that arrangements are made for the provision of such services.”

See the statement for Amendment 92.

Amendment 29, in clause 40, page 30, line 5, at end insert—

“(5) Any notification to the Commissioner made pursuant to regulations under this section must be forwarded by the Commissioner to the relevant Chief Medical Officer.

(6) The relevant Chief Medical Officer may exercise any power granted to the Commissioner under subsection (2).

(7) In this section “relevant Chief Medical Officer” has the meaning given by section 37(5).”

Amendment 21, in clause 43, page 31, line 15, at end insert—

“(4) For the first reporting period referred to under subsection (2) (a) the report must set out an assessment of the state of health services to persons with palliative and end of life care needs and the implications of this Act on those services.

(5) The report under subsection (4) must, in particular, include an assessment of the availability, quality and distribution of appropriate health services to persons with palliative and end of life care needs, including—

(a) pain and symptom management;

(b) psychological support for those persons and their families;

(c) information about palliative care and how to access it.”

This amendment would require the Secretary of State for Health and Social Care to prepare and publish an assessment of the availability, quality and distribution of palliative and end of life care services as part of the first report on implementation of the Act (to be undertaken within 1 year of the Act being passed). This would mirror the assessment already required as part of the 5 year review of the act.

Amendment 28, page 31, line 32, leave out clause 45.

This amendment is linked to NC4.

Amendment 35, clause 45, page 32, line 20, after “characteristics” insert

“, including persons representing Black, Asian and Minority Ethnic communities,”.

Amendment 36, in clause 46, page 33, line 11, after “disabilities” insert

“, and

(ii) persons from Black, Asian and Minority Ethnic communities”.

Amendment 90, page 33, line 18, leave out clause 47.

This amendment is consequential on NC21.

Amendment 39, in clause 47, page 33, line 19, after “provided” insert “in Wales”.

This amendment specifies that this section applies only to services provided in Wales.

Amendment 40, page 33, line 24, at end insert—

“(2A) Any entity providing a service or fulfilling a function under this Act must take all reasonable steps to ensure the particular health professionals providing a service or fulfilling a function under sections 5, 9,10, 12, 15, and 23 have fluent proficiency in the Welsh language, if the services are to be provided to a person in Welsh under subsection (1).

(2B) For the purposes of subsection (2A), “fluent” includes speaking fluent Welsh in order to enable conversations with the person in Welsh.

(2C) The Commissioner must take all reasonable steps to ensure members of Assisted Dying Panels will, if the person to whom the referral relates has asked for services to be provided in Welsh, when hearing from or questioning that person under section 15(4)(b), do so in Welsh.”

Amendment 103, in clause 50, page 34, line 24, leave out from “under” to end of line 29 and insert

“any provision of this Act unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament.”

This amendment would require all statutory instruments in the Act, except commencement orders, to be made by the draft affirmative procedure. It is linked with Amendment 104 which creates the power for the Secretary of State to use the made affirmative procedure in cases of emergency.

Amendment 72, page 34, line 24, after “10(9)”, insert—

“(Regulation of approved substances and devices for self-administration),”.

This amendment provides that regulations under NC13 are subject to the draft affirmative procedure.

Amendment 50, page 34, line 24, after “10(9),” insert “(Doctor independence)”.

This amendment makes regulations under NC7 [Doctor independence] subject to the affirmative procedure.

Amendment 100, page 34, line 24, after “10(9),” insert “25(1)”.

This amendment makes regulations under clause 25(1) subject to the draft affirmative procedure. It is consequential on Amendment 99.

Amendment 73, page 34, line 25, leave out “or 39” and insert—

“39, or (prohibition on advertising)”.

This amendment provides that regulations under NC14 are subject to the draft affirmative procedure.

Amendment 88, page 34, line 25, after “39” insert “or (Collection of statistics)”.

This amendment provides that the changes to NS2 should be made by affirmative regulations, and is consequential to NS2.

Amendment 104, page 34, line 32, at end insert—

“(5A) If they reasonably consider it urgent and necessary for the protection of others, the Secretary of State or the Welsh Ministers may dispense with the requirement to lay a draft statutory instrument.”

This amendment is linked with Amendment 103. It creates the power for the Secretary of State to use the made affirmative procedure in cases of emergency (this means that it would come into effect straight away but there would be a vote afterwards).

Amendment 76, in clause 53, page 36, line 12, at beginning insert “Subject as follows,”.

This amendment is consequential on amendment 77.

Amendment 77, page 36, line 12, at end insert “only.

(2) Sections (Regulation of approved substances and devices for self-administration), (Prohibition on advertising), 50 and 52, this section, and sections 54 and 55 extend to England and Wales, Scotland and Northern Ireland.

(3) Section (No obligation to provide assistance etc)(8) and Schedule (Protection from detriment) extend to England and Wales and Scotland.”

This amendment provides for NC13 (regulation of approved substances etc) and NC14 (prohibition on advertising), and the general provisions of the Bill, to extend to each part of the United Kingdom; and for NC10 (no obligation to provide assistance etc) and NS1 (protection from detriment) to extend to England and Wales and Scotland.

Amendment (a) to amendment 77, in subsection (2), leave out

“(Regulation of approved substances and devices for self-administration),”.

This would provide that NC13 (regulation of approved substances etc…) does not extend to each part of the United Kingdom and only applies, like most of this Bill, to England and Wales.

Amendment (b) to amendment 77, in subsection (3), leave out “and Scotland”.

This amendment would provide that subsection (8) of NC10 (no obligation to provide assistance) and NS1 (protection from detriment) only extend to England and Wales.

Amendment 42, in clause 54, page 36, line 16, leave out subsections (2) to (5) and insert—

“(2) In relation to England, the provisions of this Act not brought into force by subsection (1) come into force on such day or days as the Secretary of State may by regulations appoint.”

This amendment will mean that, except as provided by subsection (1), provisions of the Bill will only commence in England when the Secretary of State makes a commencement order, and not automatically.

Amendment 37, in clause 54, page 36, line 21, leave out subsection (4) and insert—

“(4) Regulations under this section cannot be made unless the Secretary of State has previously—

(a) made a statement to the effect that in their view the provisions of the Act are compatible with the Convention rights; or

(b) made a statement to the effect that although they are unable to make a statement under subsection (4)(a), the Government nevertheless wishes to proceed with commencing provisions of the Act.

(4A) The statement required by subsection (4) must be laid before both Houses of Parliament.

(4B) A statement under subsection (4)(b) must include the steps the Government plans to take to resolve any incompatibility.”

Amendment 3, page 36, line 22, leave out “four” and insert “three”.

Amendment 94, page 36, line 25, leave out “Wales” and insert—

“sections 39(1) and (2) and (Provision about the Welsh language)(2) and (3) which come into force on such day as the Welsh Ministers may by regulations appoint.”

This amendment provides that the Welsh Ministers have power to commence clauses 39(1) and (2) and NC21(2) and (3), and that other provisions of the Bill come into force in accordance with subsections (1) to (4) of this clause.

Amendment 95, page 36, line 26, leave out subsection (6).

This amendment is consequential on Amendment 94.

New schedule 2—Statistics to be collected—

“Characteristics

1 The Voluntary Assisted Dying Commissioner must collect the following information about persons requesting assisted dying—

(a) sex,

(b) age,

(c) self-reported ethnicity,

(d) level of education,

(e) Index of Multiple Deprivation based on postcode,

(f) region of residence,

(g) marital status,

(h) living status (alone, with others, in a care home etc),

(i) main condition leading to “terminal illness” fulfilment,

(j) other medical conditions,

(k) other psychiatric / mental health conditions,

(l) presence of physical disability, and

(m) presence of intellectual disability.

Health and Care Support

2 The Commissioner must collect statistics on the following information about health and care support—

(a) whether the person was, before the request—

(i) under a specialist palliative care team, and

(ii) under a psychiatry team,

(b) whether following the request there has been—

(i) referral to specialist palliative care team, and

(ii) referral to psychiatry team following request.

Information about requests

3 The Commissioner must collect statistics on the following information about the requests for assistance—

(a) the main reason for requesting assisted dying,

(b) any other subsidiary reason for requesting assisted dying,

(c) any previous requests for assisted dying from that patient,

(d) time between first request and subsequent request(s),

(e) number of times a second opinion was requested under section 10, and

(f) number of times the second opinion disagreed with the first.

Information about refused requests

4 The Commissioner must collect statistics following information about requests that are refused—

(a) at what stage of the process was the request refused, and

(b) reasons for refusal.

Information about the process

5 The Commissioner must collect statistics on the following information about the process—

(a) time from initial discussion to first declaration,

(b) time from first declaration to first doctor’s assessment,

(c) time from first doctor’s assessment to second doctor’s assessment,

(d) time from second doctor’s assessment to panel approval,

(e) time from panel approval to second declaration,

(f) time from second declaration to provision of assistance to self-administer lethal drugs,

(g) time from panel approval to death (whether by lethal drug or natural causes),

(h) duration of relationship between patient and coordinating doctor at first request, and

(i) use of a proxy and reason for using proxy.

Information about clinicians and pharmacies

6 The Commissioner must collect statistics on the following information about clinicians and pharmacies—

(a) number of clinicians participating, their speciality, and number of assisted deaths each carries out per year, and

(b) number of participating pharmacies; number of times assisted dying drugs are dispensed.

Information about Assisted Dying Panel processes

7 The Commissioner must collect statistics on the following information about Assisted Dying Panel process—

(a) number of applications made,

(b) number of applications granted and rejected,

(c) reasons for rejection,

(d) whether family members informed of proceedings,

(e) whether family members took part in proceedings,

(f) number of requests for reconsideration made,

(g) number of reconsideration requests granted and rejected, and

(h) reasons for granting requests.

Information on approved substances

8 The Commissioner must collect statistics on the following information about the approved substances—

(a) name of drug(s) used for the assisted death,

(b) whether intravenous or oral self-administration is used,

(c) presence and nature of complications following self-administration of drugs (vomiting, regurgitation, seizures, regained consciousness, other),

(d) time from self-administration to loss of consciousness,

(e) time from self-administration to death,

(f) whether emergency services called at any time following self-administration of drugs,

(g) location of death,

(h) health care professionals present at self-administration,

(i) non-professionals present at self-administration,

(j) health care professionals present at death,

(k) non-professionals present at death.”

Amendment 82, in schedule 2, page 41, line 18, leave out sub-paragraph (1) and insert—

“(1) The Judicial Appointments Commission must make arrangements for the appointments to a list of persons eligible to sit as members of panels.”

This amendment requires that panel members be appointed by the Judicial Appointments Commission. It is linked with Amendments 83, 84, 85 and 86.

Amendment 83, page 41, leave out lines 23 to 26 and insert—

“but has not reached the age specified in section 11 (Tenure of office of judges of Senior Courts) of the Senior Courts Act 1981.”

This amendment requires that the legal member of the Panel is someone who holds high judicial office or has held high judicial office but not yet reached the mandatory retirement age. It is linked with Amendments 83, 84, 85, and 86.

Amendment 41, page 41, line 34, at end insert—

“(2A) In Wales, the Commissioner must take all reasonable steps to ensure each member of a panel has fluent proficiency in the Welsh language if services or functions in the Act are to be provided to an individual in Welsh under section 47(1).

(2B) For the purposes of subsection (2A), “fluent” includes speaking fluent Welsh.”

Amendment 84, page 42, line 2, leave out “or deputy judge”.

This amendment ensures that only High Court judges, and not deputy High Court judges, can chair the panel. It is linked with Amendments 83, 84, 85 and 86.

Amendment 85, page 42, line 2, at end insert—

“(4) All judges of the High Court are automatically on the list and will remain so for the duration of their appointment to the High Court.

(5) If they have not already, all persons on the list (whether as a legal member, psychiatrist member, or social care member) must take the judicial oath.”

This amendment makes all High Court judges automatically eligible to chair panels without needing further application and it requires that the non-legal members take the judicial oath before they can sit. It is linked with Amendments 83, 84, 85 and 86.

Amendment 86, page 43, line 5, at end insert—

“(3) Panels shall have the same powers, privileges and authority as the High Court.”

This amendment gives the panel the same powers as the High Court. It is linked with Amendments 83, 84, 85 and 86.

[Kim Leadbeater]

It is a privilege to open today’s debate and to present to the House the amendments tabled in my name, a number of which relate to issues that I promised to return to when they were raised in Committee. All amendments in my name have been drafted with technical advice and expertise from civil servants from the Department of Health and Social Care and the Ministry of Justice, along with the brilliant Government Legal Department and the Office of the Parliamentary Counsel, in order to make the Bill workable and to give coherence to the statute book, as confirmed by the Minister for Care, my hon. Friend the Member for Aberafan Maesteg (Stephen Kinnock), and the Minister for Courts and Legal Services, my hon. and learned Friend the Member for Finchley and Golders Green (Sarah Sackman), in their recent letter to MPs. Some are technical and drafting amendments, and all are there to strengthen the Bill, so I hope that colleagues will be able to support them, wherever they stand on the principle of assisted dying.

I know that many colleagues wish to speak today, so I will endeavour to speak with brevity. I will speak first to the new clauses that stand in my name, starting with new clause 13. This important new clause and the related amendments would create a regulatory framework and safeguards around the approved substances referred to in the Bill by imposing a duty to make regulations about those substances and a power to make regulations about devices for use in connection with their self-administration.

Amendment 72 provides that the regulations relating to approved substances would be subject to the affirmative procedure, meaning that they must be laid before Parliament and approved by resolution of both Houses, providing important parliamentary oversight. These measures ensure that the substances used in assisted dying are subject to a specific and appropriate regulatory regime.

Terminally Ill Adults (End of Life) Bill

Debate between Kim Leadbeater and Lindsay Hoyle

Friday 16th May 2025 Commons Chamber

[Mr Speaker]

Before we begin, I would like to say a few words about today’s proceedings. New clauses and amendments are grouped in two groups for debate to enable two clear and coherent debates on aspects of the Bill. I will shortly call the Member in charge to move her new clause 10. Debate on the first group will take place on the question that new clause 10 be read a Second time. If that question is agreed to, I am minded to select amendment (a) to new clause 10 in the name of Rebecca Paul for separate decision.

We have more than 90 Members who have indicated that they wish to speak in the first debate, but not all hon. Members will be called. It is not customary to impose a speech time limit on a private Member’s Bill, but I hope that Members in charge of the Bill, and the speakers after them, will restrict themselves in the early part of the debate to no more than 15 minutes in the first instance, including taking interventions. The time limit will have to drop accordingly thereafter, and the Chair will review that guidance as the debate progresses. We need to ask for shorter speeches to enable more Members to contribute. I should make it clear that the Chair retains the right to impose a formal speech time limit, but I would rather colleagues help each other. This is a very important debate that divides in different ways. Today is an opportunity primarily for Back Benchers. I do not expect to call Front Benchers to speak until at least 1.30 pm.

New Clause 10

No obligation to provide assistance etc

“(1) No person is under any duty to participate in the provision of assistance in accordance with this Act.

(2) No registered medical practitioner is under any duty to become—

(a) the coordinating doctor in relation to any person, or

(b) the independent doctor in relation to any person.

(3) No registered medical practitioner, other than the coordinating doctor or the independent doctor, is under any duty to perform any function under or in connection with this Act other than—

(a) a function relating to the giving of notifications, or

(b) a function relating to the recording of matters in a person’s medical records.

(4) No health professional or social care professional is under any duty to respond when consulted under section 11(3)(b) (requirement for assessing doctor to consult professional with relevant qualifications or experience).

(5) No registered pharmacist or registered pharmacy technician is under any duty to participate in the supply of an approved substance to a registered medical practitioner for use in accordance with section 23.

(6) No person is under any duty to—

(a) act as a witness under this Act, or

(b) act as a proxy under this Act.

(7) Nothing in this section affects—

(a) any duty relating to the giving of notifications under this Act or the recording of matters in a person’s medical records,

(b) any duty relating to a requirement to keep records or to provide information, or

(c) any duty of a professional to respond to enquiries made under section 11(2)(b) (enquiries by assessing doctor) relating to health or social care the professional is providing, or has recently provided, to a person seeking assistance under this Act.

(8) Schedule (Protection from detriment) amends the Employment Rights Act 1996 to make provision to protect employees and other workers from being subjected to any detriment for—

(a) exercising (or proposing to exercise) a right under this section not to participate in an activity or perform a function, or

(b) participating in the provision of assistance in accordance with this Act or performing any other function under this Act.

(9) In this section—

(a) a reference to a duty includes any duty, whether arising from any contract, statute or otherwise;

(b) “registered pharmacist” and “registered pharmacy technician” have the same meaning as in the Pharmacy Order 2010 (S.I. 2010/231) (see article 3 of that Order).”—(Kim Leadbeater.)

This new clause, intended to replace clause 28, expands the protection currently provided by that clause by broadening the persons to whom it applies and the functions to which it relates; and it introduces NS1 which makes provision for enforcement of the right not be subject to detriment in connection with the Bill

Brought up, and read the First time.

[Kim Leadbeater (Spen Valley) (Lab)]

I beg to move, That the clause be read a Second time.

[Mr Speaker]

With this it will be convenient to discuss the following:

Amendment (a) to new clause 10, after subsection 8(b), insert—

“(8A) Nothing in Schedule (Protection from Detriment) prevents an employer who has chosen not to participate in the provision of assistance in accordance with this Act from prohibiting their employees or workers from providing such assistance in the course of their employment or work with that employer.”

This amendment ensures that employees who work for an employer who had chosen not to provide assisted dying cannot do so whilst working for that employer.

New clause 11—Replacing the coordinating or independent doctor where unable or unwilling to continue to act—

“(1) This section applies where—

(a) after a first declaration has been witnessed by the coordinating doctor, that doctor is unable or unwilling to continue to carry out the functions of the coordinating doctor, or

(b) after a referral is made under section 9(3)(c) (including a referral to which section 12(4) applies), but before a report under section 10 has been made by virtue of that referral, the independent doctor is unable or unwilling to continue to carry out the functions of the independent doctor,

and in this section such a coordinating or independent doctor is referred to as “the outgoing doctor”.

(2) The outgoing doctor must as soon as practicable give written notice of their inability or unwillingness to continue to carry out their functions under this Act to—

(a) the person seeking assistance,

(b) the Commissioner, and

(c) if the outgoing doctor is the independent doctor, the coordinating doctor.

(3) Any duty or power of the outgoing doctor under this Act that arose in consequence of the declaration or referral mentioned in subsection (1) ceases to have effect from the time the outgoing doctor complies with subsection (2); but this does not apply to any duty under subsection (8) or (9).

(4) The Secretary of State may by regulations make provision relating to the appointment, with the agreement of the person seeking assistance, of a replacement coordinating doctor who meets the requirements of section 7(5) and who is able and willing to carry out the functions of the coordinating doctor.

(5) Regulations under subsection (4) may, in particular, make provision to ensure continuity of care for the person seeking assistance despite the change in the coordinating doctor.

(6) Where the independent doctor gives a notice under subsection (2)—

(a) a further referral may be made—

(i) under section 9(3)(c) (if section 12 does not apply), or

(ii) where section 12 applies, under subsection (2) of that section, and

(b) the registered medical practitioner to whom that referral is made becomes the independent doctor (replacing the outgoing doctor) and sections 10 to 12 (and this section) apply accordingly.

(7) Subsections (8) and (9) apply where the coordinating doctor—

(a) gives a notice under subsection (2) to the person seeking assistance, or

(b) receives a notice under that subsection given by the independent doctor in relation to the person seeking assistance.

(8) Where the coordinating doctor is a practitioner with the person’s GP practice, the coordinating doctor must, as soon as practicable, record the giving of the notice in the person’s medical records.

(9) In any other case—

(a) the coordinating doctor must, as soon as practicable, notify a registered medical practitioner with that practice of the giving of the notice, and

(b) the practitioner notified under paragraph (a) must, as soon as practicable, record the giving of the notice in the person’s medical records.”

This new clause makes provision about the replacement of the coordinating doctor or the independent doctor where the doctor is unable or unwilling to continue to carry out their functions under the Bill.

New clause 12—Report where assistance not provided because coordinating doctor not satisfied of all relevant matters—

“(1) This section applies where a person is not provided with assistance under section 23 because the coordinating doctor is not satisfied as to all of the matters mentioned in section 23(5).

(2) The coordinating doctor must make a report which—

(a) sets out the matters as to which they are not satisfied, and

(b) contains an explanation of why they are not satisfied of those matters.

(3) The Secretary of State may by regulations make provision about the content or form of the report.

(4) The coordinating doctor must give a copy of the report to—

(a) the person,

(b) if the coordinating doctor is not a practitioner with the person’s GP’s practice, a registered medical practitioner with that practice, and

(c) the Commissioner.”

This new clause (intended to be inserted after Clause 27) requires the coordinating doctor to produce a report where assistance is not provided because they are not satisfied of all of the matters mentioned in Clause 23(5).

New clause 1—No health professional shall raise assisted dying first—

“No registered medical practitioner or other health professional shall raise the subject of the provision of assistance in accordance with this Act with a person unless that person has first raised it.”

New clause 2—No health professional shall raise assisted dying with a person under 18—

No registered medical practitioner or other health professional shall raise the subject of the provision of assistance in accordance with this Act with a person under the age of 18.”

New clause 7—Doctor independence—

“(1) Any same two registered medical practitioners may not be involved in the assessment of any one person (whether as co-ordinating doctor or independent doctor) more than three times in any 12-month period.

(2) Where section 13 applies the Commissioner may authorise one additional instance in any relevant 12-month period.

(3) The Secretary of State may, by regulations, modify the time periods specified in subsections (1) and (2) if, in the reasonable opinion of the Secretary of State, such modification is—

(a) necessary to ensure the availability of assisted dying, and

(b) does not compromise the independence of the two assessments.”

This new clause limits the number of times two doctors can both act in the assessment of any one person to three times a year. It allows for the Commissioner to increase that limit in the case of death or incapacity of a doctor. Finally, the Secretary of State is given the power to modify that limit. Amendment 50 is consequential to this and ensures such regulations are made using the affirmative procedure.

New clause 9—Standard of proof—

“(1) Where a registered medical practitioner is required to be satisfied of a matter (other than under section 23(5)), the applicable standard of proof is a balance of probabilities but if they are not satisfied beyond reasonable doubt they must indicate in their report or statement that they are not so satisfied.

(2) Where an Assisted Dying Review Panel is required to be satisfied of a matter, the applicable standard of proof is beyond reasonable doubt.

(3) Where a registered medical practitioner is required to be satisfied of matters arising under section 23(5), the applicable standard of proof is beyond reasonable doubt.”

This new clause would require the co-ordinating and independent doctor to flag if they are unsure whether one of the eligibility requirements is met or not. It also requires that a panel has to be sure that all the eligibility requirements are met. Finally, it requires the doctor administering the lethal substance to be sure that the person has capacity, a clear settled and informed wish to end their life, and is acting voluntarily without coercion and pressure.

New clause 16—Wish to end one’s own life—

“(1) A person does not have a wish to seek assistance to end their own life in accordance with this Act under section 5(5) if they are substantially motivated by—

(a) not wanting to be a burden on others or on public services,

(b) a mental disorder (including depression),

(c) a disability (other than the terminal illness),

(d) financial considerations, including lack of adequate housing,

(e) lack of access, or delayed access, to treatment or other service which a public authority is required (or can reasonably be expected to) provide, or

(f) suicidal ideation.”

This new clause ensures that a wish to end one’s own life that is substantially motivated by the factors listed in the amendment does not qualify for the provision of assistance under this Act.

New clause 17—No detriment for care home or hospice not providing assistance—

“(1) No regulated care home or hospice shall be subject to any detriment by a public authority as a result of not—

(a) providing assistance in accordance with this Act, or

(b) permitting such assistance to take place on their premises.

(2) No funding given by a public authority to a regulated care home or hospice can be conditional on that care home or hospice—

(a) providing assistance in accordance with this Act, or

(b) permitting such assistance to take place on their premises.”

This new clause would mean that regulated care homes and hospices cannot be subject to any detriment for not providing or permitting assistance in accordance with this Act, and that their funding cannot be conditional on them providing or permitting such assistance.

New clause 18—Care Homes and Hospices to decide their own involvement—

“(1) Nothing in this Act prevents any regulated care home or hospice from deciding whether (and if so to what extent) it wishes to provide assistance under this Act or to allow it on its premises.”

This new clause ensures that care homes and hospices are free to decide whether and to what extent they wish to provide assistance under this Act or allow it on their premises.

Amendment 80 to clause 2, page 2, line 4, leave out “and” and insert—

“(aa) As a result of that illness or disease the person is experiencing (or will likely experience) severe pain and discomfort that cannot be reasonably relieved to the person’s satisfaction through palliative care, and”.

This amendment requires that, in order to qualify, the terminal illness causes (or is likely to cause) severe pain and discomfort that cannot reasonably be relieved through palliative care.

Amendment 18, page 2, line 6, leave out from “expected” to end.

This amendment would remove the six-month time limit for a person to be eligible for an assisted death.

Amendment 4, page 2, line 6, leave out “within 6 months” and insert—

“(i) in the case of a neurodegenerative illness or disease, within 12 months; or

(ii) in the case of any other illness or disease, within 6 months.”

Amendment 14, page 2, line 6, at end insert—

“(1A) A person who would not otherwise meet the requirements of subsection (1) shall not be considered to meet those requirements solely as a result of voluntarily stopping eating or drinking.”

This amendment means that someone who is not terminally ill within the meaning of subsection (1) cannot bring themselves within that definition by voluntarily stopping eating or drinking or both.

Amendment 38, page 2, line 6, at end insert—

“(1A) A person who would not otherwise meet the requirements of subsection (1) shall not be considered to meet those requirements solely as a result of refusing standard medical treatment or taking any action intended to bring about a state of terminal illness.”

This amendment clarifies that an individual who is not already terminally ill under the definition in subsection (1) cannot qualify by refusing standard treatment or taking steps to induce a terminal condition.

Amendment 55, page 2, line 8, leave out “, disease or medical condition” and insert “or disease”.

This amendment aligns the wording of subsection (2) with the wording used in subsection (1) (which defines what it means to be “terminally ill” for the purposes of the Bill).

Amendment 81, page 2, line 16, leave out clause 3.

Amendment 24 to clause 3, page 2, line 18, at end insert

“except that section 1(2) of that Act shall not apply”.

This amendment would disapply the presumption that a person has capacity unless the opposite is established.

Amendment 17, page 2, line 18, at end insert—

“(2) For the purposes of the assessment of a person’s capacity under this Act the information relevant to the decision as specified under section 3(1)(a) of the Mental Capacity Act 2005 must include, but is not limited to—

(a) the options for care and treatment of the terminal illness, including—

(i) the extent of prognostic certainty of their illness or condition, and

(ii) the likely effects on day-to-day functioning, symptom management, and pathway to and experience of death of—

(A) relevant and available care and treatment including palliative care, hospice or other care,

(B) withdrawal or absence of care and treatment,

(b) the likely pathway to and experience of death, including relevant risks of complications, following proceeding to self-administer a substance to end their own life under the provisions of this Act,

(c) a decision to proceed under this Act does not prevent or make unavailable any care and treatment provision that would normally be provided,

(d) the person’s decision to proceed under this Act must be theirs alone and not bound or directed by the views or decisions of others,

(e) the person is able to change their mind at any stage of the process for requesting assistance to end their own life under the provisions of this Act, regardless of previous decisions,

(f) a decision to proceed under this Act is a decision to self-administer a substance to end their own life,

(g) the self-administration of such a substance is not a medical treatment for their terminal illness but a personal choice concerning life and death, and

(h) relevant legal consequences from proceeding with a request for assistance to end their own life, including life insurance and categorisation of death certification.”

Amendment 2 to clause 5, page 3, line 5, leave out subsection (2).

This amendment is consequential to NC1.

Amendment 101, page 3, line 7, after “person” insert—

“, unless the person has Down syndrome or a learning disability, in which case a registered medical practitioner must not initiate, suggest, or raise the matter of assisted dying with that person”.

This amendment would disallow medical practitioners from initiating a conversation about assisted dying with a person who has Down Syndrome or a learning disability.

Amendment 102, page 3, line 12, at end insert—

“(3A) Before conducting a preliminary discussion under subsection (2) the registered medical practitioner must ensure that the person has no remediable suicide risk factors which pose a significant risk to their life.”

This amendment would mean that a preliminary discussion could not be held with someone who has remediable suicide risk factors which pose a significant risk to their life.

Amendment 26, page 3, line 20, leave out “, hospice”.

This amendment leaves out reference to a hospice, since this is a setting for the provision of palliative care.

Amendment 56 to clause 7, page 4, line 14, at end insert—

“(2A) The coordinating doctor must give a copy of the first declaration to the Commissioner as soon as reasonably practicable after it has been made.”

This amendment requires the coordinating doctor to give a copy of the first declaration to the Commissioner.

Amendment 57, page 5, line 14, leave out “include training about” and insert “provide that the practitioner must have had training about the following”.

This clarifies that the obligation under subsection (7) is to specify training about certain matters.

Amendment 58, page 5, line 18, leave out—

“specific and up-to-date training on”.

This clarifies that the training is to be about adjustments and safeguards for autistic people and person with a learning disability (rather than training about training about such matters).

Amendment 59, page 5, line 19, at end insert—

“(d) domestic abuse.”

This is a drafting change (moving the duty for the regulations to require the coordinating doctor to have received training on domestic abuse so that it is located with other similar duties). See also amendment 74, which defines “domestic abuse” for the purposes of the Bill.

Amendment 87 to clause 9, page 6, line 2, at end insert—

“(1A) The coordinating doctor must take all reasonable steps, including by asking the person, the Commissioner, and the relevant Chief Medical Officer, to find out whether that person has previously made a first declaration.

(1B) If it appears that the person has previously made a first declaration, the coordinating doctor must obtain all relevant reports relating to that first declaration and, if no reports are available, must speak to the doctor who witnessed it unless that is not reasonably possible.”

Amendment 45, page 6, line 3, leave out from “person” to end of line 16 and insert—

“(1) On completion of the first declaration, the coordinating doctor must convene a clinical panel to carry out the first assessment.

(1A) the “first assessment” is an assessment to determine a person’s eligibility for assistance under this Act.

(1B) The clinical panel must consist of—

(a) a registered social worker,

(b) a registered psychiatrist,

(c) a palliative care consultant, registered on the GMC Specialist Register,

(d) a doctor who is—

(i) a consultant in a specialty of the patient’s diagnosis, if the coordinating doctor is a GP, or

(ii) a GP, if the co-ordinating doctor is a consultant, and

(e) the coordinating doctor.

(1C) All registered health and social worker professionals on the clinical panel must have—

(a) received relevant training as determined by the Secretary of State, and

(b) opted in to determine that they are eligible to be on that panel.

(1D) The Secretary of State may by regulations establish a system for registered health and social worker professionals to opt in under subsection (1B).

(1E) For the first assessment, the clinical panel must establish—

(a) why the person wants to end their life through an assisted death and the alternatives they have considered,

(b) the person’s understanding of their disease or illness and how this can be palliated,

(c) whether there have been any intrinsic or extrinsic coercion which has led to the person seeking an assisted death,

(d) what support is available to the person and their carers for the duration of the person’s life,

(e) that the person—

(i) is terminally ill,

(ii) has capacity to make the decision to end their own life,

(iii) was aged 18 or above at the time the first declaration was made,

(iv) is in England and Wales,

(v) is an ordinary resident in England and Wales and has been so resident for at least 12 months ending with the date of the first declaration,

(vi) is registered as a patient with a general medical practice in England or Wales,

(vii) has a clear, settled and informed wish to end their own life,

(viii) made the first declaration voluntarily and has not been subject to coercion or pressured by any other person into making it,

(ix) is secure in their decision, and

(x) is not having their decision making impacted by their mental health.

(1F) The clinical panel must provide the person with information on the support available for the duration of their life, including future care planning.

(1G) The members of the clinical panel must meet with the patient.

(1H) For the purposes of subsection (1G), the person may meet the clinical panel members separately or as a group, depending on the person’s wishes.

(1I) When all assessments are complete all the members of the clinical panel must meet to discuss the patient’s safety, eligibility and care plan, including referral to specialist services.

(1J) Should the panel come to the view that the criteria set out in subsection (1E)(e) are not met, they must prepare a written statement and a member of the panel must meet the patient to discuss their findings.

(1K) When presenting the report under subsection (1J), the member of the panel must discuss with the person—

(a) the options available to the person, which can include the provision of more information, and

(b) access to the clinical or other support they require.”

Amendment 30, page 6, line 8, at end insert—

“(ca) has relevant and available palliative care options,”.

This amendment would mean that someone is only eligible for assistance in ending their own life under this Act if they have relevant and available palliative care options.

Amendment 46, page 6, line 27, leave out from “if” to “refer” in line 28 and insert—0 “the clinical panel is satisfied of all the matters listed in subsection (1E)(e),”.

Amendment 60, page 7, line 1, at end insert—

“(6) Where—

(a) a referral is made under subsection (3)(c),

(b) the independent doctor dies or through illness is unable or unwilling to act as the independent doctor, and

(c) no report under section 10 has been made by virtue of the referral,

a further referral may be made under subsection (3)(c).

(7) Where a referral is made to a registered medical practitioner by virtue of subsection (6), that practitioner becomes the independent doctor (replacing the registered medical practitioner to whom a referral was originally made) and sections 10 to 12 and (Replacing the coordinating or independent doctor where unable or unwilling to continue to act) apply accordingly.”

This amendment makes provision, corresponding to the provision in clause 12 about the death or illness of a doctor from whom a second opinion is sought, for a further referral to be made where, before reporting, the independent doctor dies or through illness is unable or unwilling to act.

Amendment 32 to clause 10, page 8, line 6, at end insert—

“(aa) is a practitioner approved as having special experience in the diagnosis or treatment of mental disorder for the purposes of subsection (2) of Section 12 (General provisions as to medical recommendations) of the Mental Health Act 1983,”

This amendment would require the independent doctor to have special experience in the diagnosis of mental disorder.

Amendment 61, page 8, line 22, leave out “include training about” and insert “provide that the practitioner must have had training about the following”.

This clarifies that the obligation under subsection (10) is to specify training about certain matters.

Amendment 62, page 8, line 25, at end insert “(c) domestic abuse.”

This is a drafting change.

Amendment 51 to clause 11, page 9, line 10, at end insert—

“(v) whether, according to any reasonable body of medical or scientific opinion, there are risks of complications (including pain), and what those complications are, from the substance to be ingested;”

This amendment requires doctors to inform persons seeking assisted dying of any reasonable medical and scientific opinion according to which the lethal drugs have a risk of complication and what those complications are.

Amendment 33, page 9, line 24, at end insert—

“(fa) ask the person whether they have discussed the request with their next of kin and other persons they are close to and, where they have not done so, discuss their reasons for not doing so.”

This amendment would require the assessing doctors to ask the person whether they have discussed their request for an assisted death with family and friends, and to discuss their reasons if not, in order to decide whether to advise that they should do so under subsection (g).

Amendment 22, page 9, line 28, leave out from “must” to end of line 33 and insert— “consult such other health and social care professionals with qualifications in, or experience of, a matter relevant to the person being assessed, including but not limited to clinical, psychological and social matters.”

This amendment would require the assessing doctor to consult other health professions and other persons as the assessing doctor sees fit on clinical, psychological and social matters relevant to the person.

Amendment 63, page 9, line 44, leave out “, disease or condition” and insert “or disease”.

This amendment aligns the wording used here with the wording used in Clause 2(1) (which defines what it means to be “terminally ill” for the purposes of the Bill).

Amendment 64 to clause 12, page 10, line 40, leave out “section 10 and 11” and insert—

“sections 10, 11 and (Replacing the coordinating or independent doctor where unable or unwilling to continue to act)”.

This amendment is consequential on NC11.

Amendment 65, page 11, line 3, at end insert—

“and section (Replacing the coordinating or independent doctor where unable or unwilling to continue to act)(6)(a)(ii)”.

This amendment is consequential on NC11.

Amendment 47 to clause 14, page 11, line 33, at end insert—

“(2A) The Commissioner must give notice of the referral to any persons who are likely to have an interest in being notified by virtue of being persons properly interested in the welfare of the person to whom the referral relates, and other persons they are close to.

(2B) Those persons may either become parties to the proceedings before the panel or may give evidence to the panel without becoming parties, at the Panel’s discretion.

(2C) The Commissioner must issue a practice direction relating to the matters in subsection (2A) and (2B).”

Amendment 48, page 11, line 33, at end insert—

“(2A) The Commissioner must give notice of the referral to the designated authority and make them a party to the proceedings.

(2B) The designated authority must send a representative or advocate to the panel who will be tasked to make all reasonable arguments to the panel for why a certificate of eligibility should not be granted.

(2C) The designated authority shall be one of the following as chosen by the Secretary of State in regulations—

(a) the Official Solicitor,

(b) the King’s Proctor,

(c) the Attorney General, or

(d) any other body so designated by the Secretary of State.”

Amendment 31 to clause 15, page 12, line 17, at end insert—

“(da) that the person has relevant and available palliative care options,”.

This amendment, which is linked to Amendment 30 would mean that someone is only eligible for assistance in ending their own life under this Act if they have relevant and available palliative care options.

Amendment 5, page 12, line 29, at end insert—

“(j) that there are no psychological, social or environmental factors influencing the person to make the decision.”

This amendment ensures that the panel must be satisfied that no psychological, social or environmental factors are influencing the decision of a person to seek assisted dying.

Amendment 6, page 12, line 33, leave out “may” and insert “must”.

This amendment would require the panel to question the coordinating doctor or the independent doctor.

Amendment 7, page 12, line 35, leave out “may” and insert “must”.

This amendment would require the panel to question the person seeking an assisted death.

Amendment 10, page 12, line 36, at end insert—

“(ba) must ask the person whether they have discussed the request with their next of kin and other persons they are close to and, where they have not done so, discuss their reasons for not doing so;”

This amendment would require the Voluntary Assisted Dying Panel to ask the person whether they have discussed their request for an assisted death with family and friends, and to discuss their reasons if not, in order to determine whether to grant a certificate of eligibility.

Amendment 8, page 12, line 38, at end insert—

“(ca) must consider hearing from and questioning—

(i) persons properly interested in the welfare of the person to whom the referral relates, and other persons they are close to; and

(ii) any other person who has provided treatment or care for the person to whom the referral relates in relation to that person’s terminal illness;”.

This amendment would require the panel to consider hearing from those with an interest in the welfare of the person and those who have provided treatment to them.

Amendment 11, page 13, line 4, leave out subsection (6) and insert—

“(6) If the panel is of the opinion that there are exceptional circumstances which justify not hearing from the person, then the duties under subsections (4)(b) and (4)(ba) do not apply.”

This amendment is connected to Amendment 10.

Amendment 23, page 13, line 14, at end insert—

“(ca) where the person to whom the referral relates is under the age of 25, their next of kin;”.

Amendment 49 to clause 16, page 13, line 23, leave out subsections (1) to (4) and insert—

“(1) The person applying for assisted dying, any parties to the proceedings, or the registered medical practitioners who are treating them may apply to the Commissioner for the Panel’s decision to be reconsidered.

(2) Anyone with evidence, which was not before the Panel, showing that a certificate of eligibility should not have been issued may apply to the Commissioner for the Panel’s decision to be reconsidered.

(3) The Commission must consider, without a hearing, whether an application under subsection (1) or subsection (2) raises an arguable case that the Panel’s decision was—

(a) wrong, or

(b) unjust because of a serious procedural or other irregularity in the proceedings.

(4) Upon receiving an application under subsection (2) the Commissioner must—

(a) if satisfied that there is an arguable case that either of the criteria in subsection (3) are met, refer as soon as reasonably practicable the person’s case to a different Assisted Dying Review Panel for a determination of whether either of the criteria in subsection (3) are met,

(b) in any other case, dismiss the application.

(5) If the new Assisted Dying Review Panel concludes that the either criterion under subsection (3) is met, they must consider the person’s eligibility for a certificate of eligibility application afresh.

(6) The new Assisted Dying Review panel may consider whether either of the subsection (3) criteria are met and the fresh application under subsection (5) together.

(7) An assisted death must not take place for a person whose application for assisted dying is subject to the process under subsections (1) to (6) until the conclusion of that process.”

Amendment 66, to clause 23, page 19, line 21, leave out “subsection (3)” and insert “subsection (2)”.

This is a drafting change.

Amendment 67, page 19, line 32, at end insert—

“(6A) An approved substance may be provided to a person under subsection (2) by—

(a) preparing a device which will enable that person to self-administer the substance, and

(b) providing that person with the device.

In the case of an approved substance so provided, the reference in subsection (3) to the approved substance is to be read as a reference to the device.”

This amendment clarifies how the clause works in cases where an approved substance is provided by preparing a device and providing a person with the device.

Amendment 68, page 19, line 36, leave out paragraph (b).

This amendment is consequential on amendment 67.

Amendment 91 to clause 26, page 21, line 22, leave out paragraph (a) and insert—

“(a) the person’s full name, date of birth, sex, ethnicity, and last permanent address;

(aa) whether, immediately before death, the person had a disability within the meaning of section 6 of the Equality Act 2010 (other than a disability consisting of the illness or disease which caused the person to be terminally ill within the meaning of this Act);”

This amendment expands the duty as regards regulations about final statements so as to provide that certain additional information is included in final statements.

Amendment 52, page 22, line 28, leave out clause 28.

This amendment is consequential on NC10.

Amendment 16 to clause 28, page 22, line 35, insert—

“(3) There is no obligation on any care home or hospice regulated by the Care Quality Commission or the Care Inspectorate Wales to permit the provision of assistance under this Act on their premises.”

This amendment prevents there being any obligation on a care home or hospice which is regulated in England or Wales to permit the provision of assistance under the Act on their premises.

Amendment 74 to clause 52, page 35, line 20, at end insert—

““domestic abuse” has the meaning given by section 1 of the Domestic Abuse Act 2021 (and accordingly includes behaviour that is controlling or coercive or that constitutes economic abuse);”

This amendment defines “domestic abuse” for the purposes of the Bill.

Amendment 75, page 35, line 31, at end insert—

““learning disability” has the meaning given by section 1(4) of the Mental Health Act 1983;”.

This amendment defines “learning disability” for the purposes of the Bill.

New schedule 1—Protection from detriment—

“Schedule

1 The Employment Rights Act 1996 is amended as follows.

2 After section 43M insert—

“43N Provision of assistance under Terminally Ill Adults (End of Life) Act 2025

(1) A worker has the right not to be subjected to any detriment by any act, or any deliberate failure to act, by the worker’s employer done on the ground that the worker has—

(a) exercised (or proposed to exercise) a right conferred on the worker under section (No obligation to provide assistance etc) of the Terminally Ill Adults (End of Life) Act 2025 (no obligation to provide assistance etc), or

(b) participated in the provision of assistance to a person to end their own life in accordance with that Act, or performed any other function under that Act, in accordance with that Act.

(2) Subsection (1) does not apply where—

(a) the worker is an employee, and

(b) the detriment in question amounts to dismissal within the meaning of Part 10.

(3) For the purposes of this section, and of sections 48 and 49 so far as relating to this section, “worker” and “employer” have the extended meaning given by section 43K.”

3 (1) Section 48 (complaints to employment tribunals) is amended as follows.

(2) After subsection (1) insert—

“(1WA) A worker may present a complaint to an employment tribunal that the worker has been subjected to a detriment in contravention of section 43N(1).”

(3) In subsection (2), after “(1)” insert “, (1WA)”.

4 (1) Section 49 (remedies) is amended as follows.

(2) In subsection (1), after “section 48(1)” insert “, (1WA)”.

(3) In subsection (2), after “subsections” insert “(5YA),”.

(4) After subsection (5) insert—

“(5YA) Where—

(a) the complaint is made under section 48(1WA),

(b) the detriment to which the worker is subjected is the termination of the worker’s contract, and

(c) that contract is not a contract of employment,

any compensation must not exceed the compensation that would be payable under Chapter 2 of Part 10 if the worker had been an employee and had been dismissed for a reason specified in section 98C.”

5 After section 98B insert—

“98C Provision of assistance under Terminally Ill Adults (End of Life) Act 2025

An employee who is dismissed is to be regarded for the purposes of this Part as unfairly dismissed if the reason (or if more than one, the principal reason) for the dismissal is that the employee—

(a) exercised (or proposed to exercise) a right conferred on the employee under section (No obligation to provide assistance etc) of the Terminally Ill Adults (End of Life) Act 2025 (no obligation to provide assistance etc), or

(b) participated in the provision of assistance to a person to end their own life in accordance with that Act, or performed any other function under that Act, in accordance with that Act.”

6 In section 105 (redundancy), after subsection (2A) insert—

“(2B) This subsection applies if the reason (or, if more than one, the principal reason) for which the employee was selected for dismissal was one of those specified in section 98C.”

7 In section 108 (qualifying period of employment), in subsection (3), after paragraph (aa) insert—

“(ab) section 98C applies,”.

8 In section 205 (remedy for infringement of certain rights), after subsection (1) insert—

“(1XA) In relation to the right conferred by section 43N(1), the reference in subsection (1) to an employee has effect as a reference to a worker.”

9 In section 230 (definitions of employees, workers etc) in subsection (6)—

(a) after “43K” insert “, 43N(3)”;

(b) after “Part IVA” insert “, section 43N”.”

This new Schedule amends the Employment Rights Act 1996 so as to provide remedies for persons subjected to detriment for exercising or proposing a right conferred by NC10 or for participating in the provision of assistance in accordance with, or performing any other function under, the Bill.

Amendment 78 to schedule 2, page 42, line 26, at end insert—

“, or

(b) abstains from voting on such a decision.”

This amendment ensures that a panel must not grant certificate of eligibility unless all members consider that such a certificate should be granted.

Amendment 79, page 43, line 7, at end insert—

“(2) As soon as reasonably practicable after making a decision, a panel must give the following a document containing its reasons for the decision—

(a) the person to whom the referral in question relates;

(b) the coordinating doctor in relation to the person;

(c) the Commissioner.”

This amendment requires a panel to give the persons mentioned a document containing its reasons for any decision made by the panel.

[Kim Leadbeater]

It is a privilege to open the debate on this next important stage of the Terminally Ill Adults (End of Life) Bill. It seems a long time ago that we held the Second Reading debate in November on what many of us felt was a very proud day for Parliament, when we saw an emotional and passionate but largely respectful debate on a hugely important subject that means so much to so many people.

I know that there are a range of views on the subject of choice at the end of life, and today is not about revisiting the fundamental principle of assisted dying. Before I address the amendments in my name, as the sponsor of the Bill, I will make some brief introductory comments on why we are here. Put simply, if we do not vote to change the law, we are essentially saying that the status quo is acceptable. Over recent months, I have heard hundreds of stories from people who have lost loved ones in deeply difficult and traumatic circumstances that show that that is clearly not the case. Too many have seen their terminally-ill loved ones take their own lives out of desperation or make the traumatic, lonely and costly trip to Switzerland, and then face a police investigation while dealing with their grief and loss.

[John Whitby (Derbyshire Dales) (Lab)]

My hon. Friend mentioned many real stories influencing this debate. I will mention one more: my constituent Mick Murray, who is in the Public Gallery today. Mick helped two close friends, Bob and Ann, to make the painful journey to Dignitas. Both simply wanted to die at home with dignity and surrounded by loved ones; instead, they had to make that journey overseas at great cost and legal jeopardy. Mick said:

“I helped them out of compassion — and I think that is what’s missing from our current law.”

Does my hon. Friend agree—

[Mr Speaker]

Order. We will set the example by following the rules of the House. We will have short interventions, not speeches. There are a load of other Members.

[Kim Leadbeater]

I thank my hon. Friend for that intervention. That was a very powerful point, if slightly long. There are people who face these really traumatic and difficult decisions every day, including Louise Shackleton, who I believe is also with us today.

[Torcuil Crichton (Na h-Eileanan an Iar) (Lab)]

On a point of order, Mr Speaker. I thought this was a debate to discuss amendments, not a general debate.

[Mr Speaker]

It is, but I think this is the opening lead-in to the amendments. I will make that judgment call.

[Kim Leadbeater]

Thank you, Mr Speaker. If I may just finish that point—

--- Later in debate ---

[Kim Leadbeater]

I thank my hon. Friend for that intervention. I have not seen those comments, but it is absolutely right that whatever our views are on this issue, we must remain respectful.

I also want to thank colleagues here in Parliament—MPs and indeed staff—who have shared their personal stories of loss with me over recent months. This is a really important point: these are real people with real stories, and they must always be at the heart of the debate.

Public support for assisted dying in this country has been consistently high for a long time now, and we have seen movement in jurisdictions around the world, including just this week in Scotland. I congratulate colleagues in Holyrood, particularly Liam McArthur MSP, for holding such a compassionate and respectful debate, which I hope we can emulate today.

It is right that we consider this change with great care, as we are doing today. But we should also remember, as with other big social changes such as giving women bodily autonomy on their reproductive rights or allowing gay—

[Mr Speaker]

Order. We did say, when we had the conversation, that there should just be an introduction to the debate very early on. I think this is why Members are beginning to get frustrated; we should now be speaking to the amendments.

[Kim Leadbeater]

Thank you, Mr Speaker. I will move on to the amendments. If I may, I want to acknowledge the work of the Bill Committee in relation to the amendments, because a huge amount of work was done by Members from all parties, with a range of views—

[Mr Speaker]

Order. I am really bothered, because today is a day for amendments, and we really need to understand the views they cover. As the Member in charge of the Bill, you will, I am sure, really want to get into the depth of the amendments and not continue in that way.

[Kim Leadbeater]

I do indeed, Mr Speaker; you are absolutely right. The amendments that we are discussing today build on some of the work of the Committee, and I think that is important. We took a lot of steps to strengthen the Bill in Committee, and I was pleased to work collaboratively with colleagues in that way.

As I come on to the amendments, which have been tabled in my name, let me say that the Government are, of course, neutral on the issue of assisted dying, but have always been clear that workability is essential if the Bill is to pass. I have worked closely with an outstanding team of civil servants from the Department of Health and Social Care and the Ministry of Justice, and it is with their technical advice on making the Bill workable and giving coherence to the statute book that I propose these amendments today.

Terminally Ill Adults (End of Life) Bill

Debate between Kim Leadbeater and Lindsay Hoyle

2nd reading
Friday 29th November 2024 Commons Chamber

[Kim Leadbeater]

On a point of order, Mr Speaker. I seek your guidance on correcting the record. I said in my speech that I have consulted with the highest levels of the judiciary and the medical profession. I have received correspondence from the Judicial Office and wish to clarify my earlier comments. Although I have spoken to lawyers and judges, I should not have implied that the serving judiciary have in some way indicated their agreement with the Bill; they have not. The serving judiciary have been very clear that they have made no public comments about the Bill one way or the other. I apologise if I implied anything to the contrary.

[Mr Speaker]

I thank the hon. Lady for correcting the record.