Terminally Ill Adults (End of Life) Bill

Lindsay Hoyle Excerpts

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—

[Jim Shannon (Strangford) (DUP)]

rose—

[Mr Speaker]

Order. May I just say to people that if we are going to have continuous interventions, and if they continue to make the same intervention, they should not be shocked if they end up at the bottom of the list? I want to help people, because all this does is soak up time. Jim Shannon will be a good example.

[Jim Shannon]

Mr Speaker, I will always be at the end of the list, so it is important for me to make an intervention. The hon. Member for Spen Valley (Kim Leadbeater) set the scene very well on Second Reading, but since then things have changed. For instance, the Royal College of Psychiatrists has voiced strong concerns in opposition to the Bill about judicial oversight, robust protections against coercion and so on, as well as the effect it will have on vulnerable groups such as those with dementia, Down syndrome or mental illnesses. Does the hon. Lady not respect the viewpoints of my constituents who tell me that they are opposed to the Bill in principle and all the things that are coming forward? The new clause does not address the issues that the hon. Lady is referring to.

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[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.

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[Rebecca Paul]

I would love to give way, but—

[Mr Speaker]

Order. The hon. Lady has said that she is not going to give way. We are aiming for 15 minutes for each speech, but it is going to be 20 minutes if we do not pick up the pace.

[Rebecca Paul]

I apologise, but I do want to get through my speech.

It is important to make the point that someone suffering with anorexia, or indeed any mental condition, is not intended to be eligible for an assisted death. However, in the case of anorexia there are physical manifestations of the illness, such as malnutrition and diabetes, that might mean the patient meets the definition of being terminally ill, and that is the nub of the problem: the Bill does not adequately rule out physical manifestations caused by mental illness. That is why amendment 14, tabled by the hon. Member for Bradford West (Naz Shah), is so important, because it would ensure that anyone who voluntarily stops eating or drinking is ineligible for assisted dying. I support the amendment strongly as it addresses a big risk.

Lastly, on eligibility specifically, I want to talk about capacity. There are such problems with the current approach to determining capacity that I barely know where to start. When it comes to ending one’s own life, a higher standard should be applied. The current definition of capacity was not created with such a monumental decision in mind, and if it were being drafted from scratch today, it would look very different. That is one of the reasons why the Royal College of Psychiatrists does not support the Bill.

Under the Bill, a person is assumed to have capacity in the first instance. A clinician only needs to be over 50% sure that a person has capacity. If the person is making unwise decisions, that is not taken into account, and a person can be “helped” to make a decision—for example, when a patient has learning disabilities. I ask all Members today whether they are happy with that. Does that sound like a robust approach to assessing whether someone has capacity to make the decision to end their own life?

Let us begin with the starting presumption of capacity. That, too, lacks the standard for assisted death decisions. I therefore support amendment 24, tabled by the hon. Member for Bexleyheath and Crayford (Daniel Francis), which would disapply section 1(2) of the Mental Capacity Act 2005 for the purposes of assisted dying. One of the biggest issues for me is the fact that the current approach requires an impairment or disturbance of the brain in order for someone to be considered not to have capacity, irrespective of whether they can make a decision. In the real world, that would mean a doctor could assess a patient who gives the impression of being confused, illogical, erratic, inconsistent—everything about them could scream that they are not in a good place to make this decision at that point in time—but they would still be considered to have capacity if there is no identifiable impairment or disturbance of their mind or brain. That could potentially put those with depression, anxiety, learning disabilities or eating disorders, or even those just experiencing physical pain that is driving them to distraction, in danger of being considered to have capacity when they do not.

So far I have focused on eligibility. I will now talk about hospices.

[Mr Speaker]

Order. Please, I really want to get as many people in as possible. If you can come to a conclusion, that would be helpful.

[Rebecca Paul]

I will therefore speak to my new clauses 17 and 18, which would provide important protections for hospices, which are currently lacking in the Bill. New clause 18 makes it crystal clear that any regulated care home or hospice can decide whether to provide assisted dying on its premises, and new clause 17 makes it clear that they cannot be subject to any detriment for not providing or permitting assisted deaths, and that their public funding cannot be conditional on their providing this service. Whether one is in favour of assisted dying or not, we must preserve the rights of organisations, companies and charities to choose whether to offer it. They must never be forced into it by public funding being conditional on the provision of assisted dying.

I note that new clause 10, tabled by the hon. Member for Spen Valley (Kim Leadbeater), would expand the protection for individuals not to participate in the assisted dying process if they so wish. It seeks to protect employees from being subjected to any detriment for participating or not participating in the provision of assisted dying. This sensible protection would ensure that if an NHS hospital provides an assisted death service, any member of staff who does not want to participate would not have to do so and would suffer no detriment as a result. However, there needs to be a sensible mechanism balancing that against the employer’s right to set their own policy on assisted dying, and that is what my amendment (a) to new clause 10 seeks to do—we have already talked about that, so I will not go over it again.

I did want to talk about process and family, but it looks like I will not have time to do that. I will end there. I thank you for your patience and generosity, Mr Speaker. I am grateful that I have had the chance to speak in support of the amendments, and I look forward to hearing from other Members.

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[Anna Dixon]

On a point of order, Mr Speaker. I appreciate that you and the team have had a very difficult day, but as someone who tabled an amendment but has not had the opportunity to speak to it, I would like clarification that if a closure motion is moved, my amendment, as well as those tabled by other Members who have been unable to speak to them, will not receive further debate.

[Mr Speaker]

To be quite honest with you, the amendments that we have discussed are the ones that we have got through. On the amount of time allocated, in fairness, we are presuming what will come next. I am going to call the Minister; if a closure motion is moved, I will decide at that moment whether to accept it. The fact that many amendments may not have been spoken to is not unusual, which is why consideration will not last for one day, as per the normal procedure; it will continue over further days, on which further amendments will be discussed, and of course there will be Third Reading at a later date. I call the Minister.

[The Minister for Care (Stephen Kinnock)]

Thank you, Mr Speaker, and I thank Members across the House for their excellent contributions to the debate. As Members will know, the Government remain neutral on the passage of the Bill, promoted by my hon. Friend the Member for Spen Valley (Kim Leadbeater), and on the principle of assisted dying, which we have always been clear is a decision for Parliament. I therefore begin by clarifying that I am speaking in today’s debate as the Minister responsible, jointly with my hon. and learned Friend the Member for Finchley and Golders Green (Sarah Sackman), for ensuring that the Bill, if passed, is effective, legally robust and workable. She and I were pleased to be members of the Bill Committee, again to provide advice on the workability and technical effectiveness of the Bill as it went through detailed line-by-line scrutiny.

I will not, therefore, give a Government view on the merits of any individual amendments in terms of their policy intent, as defined by the Member who tabled them, as that is rightly a matter for the House to decide. I will instead focus my remarks on amendments that the Government deem to give rise to significant workability concerns, and those amendments that have been tabled by my hon. Friend the Member for Spen Valley with technical drafting support from the Government, which have been developed to ensure that the Bill is technically and legally workable.

While I will not give an assessment of all the amendments tabled by other Members, I ask the House to note that they have not been drafted on the basis of advice or with technical drafting support from officials. Therefore, the Government are unable to confirm that those amendments are fully workable, effective or enforceable, though I acknowledge the point made by the hon. Member for Bexhill and Battle (Dr Mullan).

I will begin with obligations, duties and protections for medical practitioners. New clause 10 and amendment 52, tabled by my hon. Friend the Member for Spen Valley, replace clause 28 and expand the safeguards to ensure that no person is under any duty to participate. The new clause also clarifies several functions where certain professions or persons are under no duty to participate, including social care workers, pharmacists or persons acting as a proxy or witness. Finally, it provides that certain functions cannot be opted out of—for example, the recording of matters in a personal medical record.

New clause 11 and consequential amendments 64 and 65, also tabled by my hon. Friend, provide for the replacement of the co-ordinating or independent doctor where that doctor is unable or unwilling to continue to carry out their functions under the Bill, other than through illness or death. A number of amendments have been tabled in this area by other Members, and I shall briefly set out the Government’s analysis of them.

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[Kit Malthouse]

claimed to move the closure (Standing Order No. 36).

Question put forthwith, That the Question be now put.

The House proceeded to a Division.

[Mr Speaker]

There is a delay in the No Lobby. Will the Serjeant at Arms please go and inspect?

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The House proceeded to a Division.

[Mr Speaker]

Will the Serjeant at Arms inspect the Aye Lobby, as there appears to be a hold-up?