Lord Shinkwin
Main Page: Lord Shinkwin (Conservative - Life peer)(1 day, 8 hours ago)
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Lord Shinkwin
“(7) If a registered medical practitioner or other health professional raises the subject of the provision of assistance in accordance with this Act with a person, or if a person raises the subject with a registered medical practitioner or other health professional, it must be considered a preliminary discussion and the discussion must be recorded.”
Lord Shinkwin (Con) [V]
My Lords, I make it clear at the outset that I do not intend to press my Amendment 193. I also support the other amendments in this group and look forward to learning and listening, as I am sure the noble and learned Lord does, before I wind up at the end of the debate on this group.
The modest and reasonable nature of my Amendment 193 belies its significance. It is crucial to ensuring transparency and thus trust—the trust of the patients, their families, the medical profession in the widest sense, any relevant legal and regulatory bodies, and, of course, the public. In practical terms, the amendment would require:
“If a registered medical practitioner or other health professional raises the subject of the provision of assistance in accordance with this Act with a person, or if a person raises the subject with a registered medical practitioner or other health professional, it must be considered a preliminary discussion and the discussion must be recorded”.
This is therefore very much a “to be or not to be” amendment, because the noble and learned Lord’s response to it will show whether he wants the assisted dying regime that his Bill would create to operate transparently or in the shadows. It will show whether he recognises that transparency is crucial to engendering at least a modicum of trust in the assisted dying process he proposes, or whether he has something to hide and would much rather plough on regardless.
As a lifelong NHS patient who receives a copy of any post-appointment letter sent by my orthopaedic surgeon to my GP as a matter of course, I find it not just positively Neanderthal but pretty sinister that such a pivotal exchange as a preliminary discussion about assisted dying would not be recorded in a way that explicitly involves the patient after the conversation as well as during it—and that it would implicitly not apply beyond a practitioner from the “person’s GP practice”, to quote the Bill. Surely this begs the question of why any registered medical practitioner or other health professional involved—or indeed the patient—would not want there to be a record of what was said and, furthermore, for that to be made available to both the patient and appropriate stakeholders, such as but not only their GP, within the set timeframe, as provided by amendments in this group that other noble Lords will speak to.
We are assured by Kim Leadbeater in the other place that this Bill provides for the safest assisted dying regime in the world. I beg to differ, but it is good to know none the less that she acknowledges the need for the question of its safety to be addressed. This amendment would do exactly that: its sole purpose is to improve safety. At its heart is the recognition that it is vital to have a written record of the preliminary discussion in the way that my amendment provides, because it would act as a legal gateway to the assisted dying process and provide a permanent trail of evidence for a decision that is final and irreversible.
Maintaining a robust written record of the preliminary discussion, and ensuring it is completed and circulated promptly, is therefore a fundamental safeguard required to ensure the transparency, accountability and clinical safety of the assisted dying process. Without such a record, the preliminary discussion will always be regarded as having been conducted properly, making it impossible, in effect, to regulate the process. So it is not good enough for the noble and learned Lord to point to Clauses 7, 9, 10, and 11 as if to say, “What’s the problem?”, not least because Anna Dixon’s amendment in the other place—which explicitly required a doctor to
“record and document the discussion and the information provided”
and give a copy of the record directly to the patient—was not included in Kim Leadbeater’s new Clause 7 on recording.
The noble and learned Lord may rely on Clause 44 and say that the Secretary of State would have the power to require this. However, that would not put in the Bill that there should be a record of the preliminary discussion or set a minimum standard format or a required level of detail for its contents. The Secretary of State would have the power to require this, according to the Bill, but I draw noble Members’ attention to the Delegated Powers and Regulatory Reform Committee’s recommendation which signalled that this was inadequate. It recommended, instead, that the Bill should be amended to explicitly clarify
“what type of event or other information must be notified or the principles underlying notification”
in primary legislation. That is what this amendment seeks to do.
In closing, I simply highlight that my amendment and the others in this group seek to address what is already, sadly, a known problem in other jurisdictions, including Canada and Australia, resulting in disciplinary action and official findings of non-compliance. Let us learn from them and pay heed to the evidence given to the Bill Select Committee by Dr Michael Mulholland, honorary secretary of the Royal College of General Practitioners. He said:
“If you were having assisted dying conversations, you would want to make sure it was recorded at every point that people were thinking about this on the way through”.
Indeed. Why would you not? I hope the noble and learned Lord will accept my amendment. I beg to move.
Baroness Hollins (CB)
My Lords, I commend the important speech of the noble Lord, Lord Shinkwin. Decisions at the end of life are complex, and a single conversation simply is not enough to capture someone’s physical condition, mental state, and personal and family circumstances. Attempting to record such a complex conversation is quite a daunting prospect.
Requiring a preliminary step also adds an unnecessary layer of stress before a proper evaluation can even begin. Both Clauses 5 and 7 add more steps but not more safeguards. The key protections in this Bill—checking capacity, ensuring that decisions are genuinely voluntary and identifying any coercion—can and would be addressed within a multidisciplinary specialist assessment. As it stands, requiring a preliminary discussion and recording it adequately risks duplication while causing unnecessary delay, when time is of the essence. Instead, a specialist multidisciplinary panel would provide a full and balanced assessment from the outset, and of course it would be properly documented.
The Deputy Chairman of Committees (Baroness Barker) (LD)
My Lords, I remind the Committee that the noble Lord, Lord Shinkwin, is taking part remotely. I invite the noble Lord to reply to the debate.
Lord Shinkwin (Con) [V]
My Lords, I am mindful that noble Lords will be counting down the minutes to the start of a well-earned Easter Recess, so I will keep my remarks as short as I can. I hope I will be forgiven if I do not refer to individual contributions, but I was struck by the strong consensus that record keeping, as would be provided by the amendments in this group, is crucial—not just to engendering trust in the system but for providing for patient safety, especially as conditions towards the end of life will fluctuate, particularly in the case of delirium. I thank noble Lords for their contributions.
Although I disagree with the noble and learned Lord that it is not appropriate to report any discussions about assisted dying, I believe that keeping records on assisted dying is vital. I feel I must thank him, as something he said on 20 March—the 12th day in Committee—made the case for my Amendment 193 and the other amendments in this group perfectly.
Noble Lords may recall that the noble and learned Lord caused the House to be convulsed in laughter by a quip he made when my noble friend Lord Frost appeared in the Chamber after my noble friend Lord Gove had addressed the amendments in the name of the noble Lord, Lord Frost, in his unavoidable absence. According to parliamentlive.tv and the transcript that goes with it, at approximately 4.10 pm on 20 March, on seeing the noble Lord, Lord Frost, return to the Chamber, the noble and learned Lord quipped, “Sorry. Perhaps he shouldn’t have bothered”.
It was brilliant for a number of reasons: its timing, its spontaneity and, in particular, its piercing, if inadvertent, honesty. At a stroke, the noble and learned Lord exposed brilliantly—in the true sense of the word, of shining a light on something—his overall approach to dealing with 14 days of dismissing amendment after amendment and allowing Dignity in Dying and other supporters of the Bill to denigrate noble Lords’ carefully considered and well-intentioned attempts to mitigate the worst dangers posed by the Bill.
Noble Lords would to be forgiven for asking why this is relevant to today’s consideration of this group of amendments. The reason is this: the amendments we are discussing highlight the need for rigorous record-keeping at the preliminary discussion phase and, indeed, beyond, throughout the assisted dying process. Yet noble Lords may be interested to know that, despite it being clearly captured on parliamentlive.tv, both on screen and in the accompanying transcript, as I have already mentioned, there is no record of the noble and learned Lord’s quip in Hansard.
I mean no criticism of our wonderful Hansard team, but I find it rather odd that the official record should be inaccurate in this specific respect. I therefore hope it helps the House, and the noble and learned Lord, that his significant remarks to my noble friend Lord Frost—“Sorry. Perhaps he shouldn’t have bothered”—are now on the record in Hansard. The fact that they were omitted surely provides compelling evidence in support of rigorous record-keeping, as provided for in Amendment 193 and the other amendments in this group. I hope that we can all accept that there is no such thing as too much transparency when it comes to the matters of life and death that we are discussing in relation to the Bill.
In closing, I entirely endorse, as my noble friend Lady Fraser of Craigmaddie, did, the remarks of the noble and learned Baroness, Lady Scotland—that we all like each other a lot, and wish all noble Members a very happy Easter. I beg leave to withdraw the amendment.