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

Sarah Green Excerpts

Tuesday 28th January 2025 Public Bill Committees

[Sarah Green (Chesham and Amersham) (LD)]

Q Dr Clarke, what are the existing statutory guidelines on end-of-life practice? How are those decisions logged, recorded and monitored?

Dr Clarke: The fundamental principle is always that, by default, the patient has capacity unless there is clear evidence that they do not. We presume that patients have capacity. As doctors, we are obliged to ensure that patients have informed consent when deciding between different treatments. That means we need to lay out the whole array of treatment options, and the risks and benefits of each, to empower individual patients to make decisions for themselves.

Regarding the issue that has been alluded to of whether doctors should be prohibited from raising the issue of assisted dying, it is my belief that that would fundamentally alter the doctor-patient relationship. If consent is not informed—and it is not informed if we are not laying out all the different options to a patient—we are denying patients the opportunity to make decisions for themselves. A patient is always able to refuse every treatment, and in particular every life-prolonging treatment, that they choose to, provided they have capacity. We, as doctors, may think that a decision is unwise, but that is irrelevant, because those days of bad old paternalistic medicine are gone. The patient makes the choice. If a patient says, “I do not want chemotherapy. I do not want to eat. I do not want anything at all—no treatment”, we respect that, unless they lack capacity.

The elephant in the room with all of this is the capacity assessments. I would suggest that anybody who pretends that those assessments are easy and routinely done well in the NHS has not got enough experience of observing that happening. I teach capacity assessments to doctors and medical students, and it is often the case that they are very poorly conducted. The doctor often does not understand the criteria for assessing capacity. That is if it happens at all. Sometimes, a paternalistic doctor will decide that a patient is dying, and we should stop their antibiotics because they are clearly now at the end of their life. They have a chat with the family, who say, “Yes, we agree,” and nobody talks to 82-year-old Mrs. Smith and asks her what she feels about it, because they assume that she does not have capacity because she is old. I see that regularly. Sometimes, a palliative care team will intervene in those situations, because the professional and legal framework that is meant to guide this practice is just not happening. It is a very fraught and tricky area.

If there is one thing that I would say to the Committee regarding making the Bill as robust, strong and safe as possible, it is: please consider seriously the matter of education and training from day one of medical school onwards. Death is at the periphery of a medical school curriculum. Death and dying are not taught. You might get a week of palliative care in five years, and that has knock-on effects all the way through, at every level of seniority in the medical workforce.

[Sarah Green]

Q I have a follow-up question. The Bill introduces a monitoring and review process, including an annual report by the chief medical officer. Do you have any reflections on whether that needs strengthening?

Dr Clarke: Yes, I think that in the spirit of transparency and making this as safe as possible, it needs to be significantly strengthened. I would suggest that there need to be more safeguards in place. For example, if anyone in a hospital—whether staff, patient or family member—has concerns around a particular case, there should be mechanisms for those to be raised in a proactive way. Just as we have guardians of safe working and freedom to speak up guardians in hospitals, those opportunities to assess and appraise the safety in real time once a Bill is in place—I just do not think they are robust enough at all. The more we can have of that, the more that will allay people’s fears.

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

Q My question is to Dr Ahmedzai. In the paper you produced you talked about specific recommendations regarding the training and experience of the doctors involved in the process. You suggested five years, for instance, and some other experience. Have you got examples elsewhere in the world where such a scheme has been implemented? Do you believe that we have enough trained doctors in the United Kingdom who have that level of experience and would therefore be taking part in this part of the process?

Dr Ahmedzai: You have caught me on the hop, because I cannot quote the level of training that doctors have received elsewhere, except for examples in the Netherlands, where there are additional doctors who are, through their medical association, trained specifically in assisted dying. I cannot tell you the number of years’ experience that doctors have in other countries. I felt that it was self-evident that you would want doctors who are experienced—three years, five years or whatever post qualification—and who have seen real life. It is up to the medical associations to stipulate how much experience, but I would not like the idea of a doctor immediately, having got their certificate of training, going off and making these kinds of decisions. That is why I suggested that ballpark figure.

Oral Answers to Questions

Sarah Green Excerpts

Tuesday 20th February 2024 Commons Chamber

[Laura Farris]

I have also heard very good reports of the work that Gwent police are doing, so I am glad to hear what the hon. Lady says. I must push back very slightly on what has happened since we launched the end-to-end rape review. We are prosecuting more rape cases than we were in 2010. Conviction rates are higher, and perpetrators are going to prison for almost 50% longer than they were in 2010; the average sentence increased from six and a half years to nine and a half years. I accept that the last independent adviser to the rape review went, but last week we announced the appointment of Professor Katrin Hohl, a legal academic who pioneered Operation Soteria, which I think every Member of this House agrees has transformed the way in which police investigate and prosecute rape, and is leading to better criminal justice outcomes for victims.

[Sarah Green (Chesham and Amersham) (LD)]

20. What discussions he has had with Cabinet colleagues on the use of non-disclosure agreements in judicial processes.

[The Parliamentary Under-Secretary of State for Justice (Mike Freer)]

Non-disclosure agreements cannot prevent any disclosure that is required or protected by law; nor can they preclude an individual from asserting statutory rights. The courts and judiciary apply the law in relation to NDAs as appropriate in individual cases and, where necessary, determine whether or not they should be enforceable.

[Sarah Green]

Last year, the Legal Services Board stated that incidents of misconduct by lawyers dealing with non-disclosure agreements were a “cause for concern”, and that there was a strong case for a strengthened and harmonised regulatory approach. Does the Minister agree that there is a need for stronger regulation in this area, and will he support the Bill tabled by my hon. Friend the Member for Oxford West and Abingdon (Layla Moran), which would end the misuse of non-disclosure agreements in the workplace?

[Mike Freer]

I am more than happy to have a discussion with the hon. Lady, but my understanding is that the Solicitors Regulation Authority has already published a warning notice reminding solicitors and law firms that potential professional misconduct by a person or a firm should be reported to the regulator. If she believes that there are still gaps in that warning notice, or that more needs to be done, I am more than happy to have a meeting.

Oral Answers to Questions

Sarah Green Excerpts

Tuesday 12th September 2023 Commons Chamber

[Edward Argar]

I am grateful to my right hon. Friend, who throughout her time in the House, and particularly while Home Secretary, has always taken a keen interest in supporting victims of crime. It is vital that victims get the compensation they are entitled to, be that from the offender or the criminal injuries compensation scheme, which paid out more than £173 million in 2022-23. The making of a compensation order is a matter for the court, and there is no limit on the amount that a court can order an offender to pay.

In respect of the criminal injuries compensation scheme, His Majesty’s Government are consulting on changes following the report of the independent inquiry into child sexual abuse alongside previous consultations. It is important that that can be considered fully, but that will be post-passage of the Victims and Prisoners Bill.

[Sarah Green (Chesham and Amersham) (LD)]

T4. One of my constituents tells me that they are at risk of losing their home because of how long they have had to wait for a benefit decision appeal. Will the Minister outline what steps his Department is taking to reduce the current 33-week waiting time for benefit decision appeals to be heard?

[The Parliamentary Under-Secretary of State for Justice (Mike Freer)]

Across the whole tribunal process, the team will constantly monitor who is performing and who is not, and will share best practice. If the hon. Lady would like to write to me with the details of a particular case, I can investigate the particular cause of delay.

Oral Answers to Questions

Sarah Green Excerpts

Tuesday 27th June 2023 Commons Chamber

[Alex Chalk]

Let me make a couple of points. First, increasing the number of police officers means that there is more resource to try to ensure that the people who commit this crime—and it is not a victimless crime, by the way—are brought to book. Secondly, I am proud of the fact that we have doubled the maximum sentence for assault on an emergency worker, so that defendants can be properly punished where they have assaulted police officers, ambulance staff or potentially people who work in supermarkets, though I would query whether they are in scope.

[Sarah Green (Chesham and Amersham) (LD)]

One of the concerns raised with me by several victims of domestic abuse has been their experience of victim blaming in the criminal justice system. Can the Secretary of State outline what steps his Department is taking to tackle victim blaming and provide better support to survivors of domestic abuse and sexual violence?

[Edward Argar]

Significant work is under way across the system to tackle victim blaming and disproportionate attention on victim credibility. As part of that, we developed Operation Soteria, which ensures that officers and prosecutors are focusing their investigations on the behaviour and offending pattern of suspects, rather than on subjective judgments of victims’ credibility. I am happy to meet the hon. Lady if she would like to discuss this further.

Oral Answers to Questions

Sarah Green Excerpts

Tuesday 28th March 2023 Commons Chamber

[Mike Freer]

My hon. Friend raises a very important and sensitive issue. The Government are reviewing all aspects of family law, particularly in terms of how to ensure that families stay out of court. The extra £15 million for mediation vouchers will help to keep people out of that adversarial situation. It is also about the use of language, to ensure that children are not scarred by the adversarial process. A wraparound process that is family-friendly, with mediation, should address the concerns she has raised.

[Sarah Green (Chesham and Amersham) (LD)]

Over three years, one of my constituents was dragged back to the family court by their ex-partner 25 times. Despite having the bravery to leave an abusive relationship, they faced further trauma as a result of an ex-partner who was able to use the family court system to further control and manipulate them and their child. What steps is the Minister taking to ensure that the family courts cannot be abused in this way?

[Mike Freer]

The hon. Lady raises a point that has been raised before. The Department is reviewing how we can ensure that people caught up in the family court system are protected from such abuse.

Oral Answers to Questions

Sarah Green Excerpts

Tuesday 22nd November 2022 Commons Chamber

[Sarah Green (Chesham and Amersham) (LD)]

The surgeon who caused life-changing injuries by inserting surgical mesh into my constituent Carol recently acted as an expert witness in an unrelated surgical mesh negligence case. The judge was highly critical of his evidence and accused him of cherry-picking parts of the evidence that were supportive of the defendant’s case. Will the Justice Secretary meet me and the victims of surgical mesh to hear directly from them how such conflicts of interest are proving to be a barrier to justice?

[Dominic Raab]

If the hon. Lady writes to me with the details of that case, I will certainly ensure that she has a meeting with the most appropriate Minister.

Assisted Dying

Sarah Green Excerpts

Monday 4th July 2022 Westminster Hall

[Sarah Green (Chesham and Amersham) (LD)]

It is a pleasure to serve under your chairmanship, Mr McCabe, and to hear such powerful contributions. In 2003, John Close, the brother of my constituent Lesley, became the seventh Briton to travel to the Dignitas clinic for help to die. Lesley is sitting in the Public Gallery. Since she lost John, hundreds more have taken the same journey to Dignitas that he did.

Sadly, the financial cost of such a trip means that many terminally ill, mentally capable Britons who want that do not have access to what Lesley described as the “gift” of medically assisted dying. Too many of them take things into their own hands, often in far more distressing ways, as we have heard. It is clear that our country’s current blanket ban on assisted dying is failing. That creates additional torment and suffering at an already painful time for those who have decided to die, along with their loved ones.

Many Members will be familiar with the case of another of my constituents, Ann Whaley, and her husband Geoff. Some may have even had the privilege of meeting Geoff when he visited the House of Commons before his passing. Ann is also sitting in the Gallery. In 2015, the police arrived on Ann and Geoff’s doorstep to investigate an accusation of domestic abuse—something that shocked them both, given they had shared a loving marriage for 52 years. Ann was put in a police car, driven to the station, locked in an interview room and interviewed under caution.

Having never committed a crime in her life, Ann found herself the subject of a criminal investigation for booking flights and organising an appointment at Dignitas, according to Geoff’s wishes: he had been unable to take those actions himself after motor neurone disease had robbed him of the ability to operate his iPad or hold a phone. Having already suffered so much as a result of his illness, Geoff and his family faced further suffering as a result of UK law—our law. It was Ann’s arrest that prompted Geoff to come here to speak to parliamentarians and explain his choice in his own words.

Ann was never prosecuted, but that did not mean that she did not suffer. Director of Public Prosecutions guidelines give some indication of when it is likely that someone will be prosecuted, but that is not enough. While the law imposes a blanket ban, there seems to be an acknowledgement that it will be broken, and even encouragement to break it, as an untidy compromise. That is not good enough. It did not stop Ann, Geoff and their family from going through a horrendous ordeal with the police during the final weeks of Geoff’s life.

Allowing assisted dying would permit terminally ill people to leave this world in the way they have decided to, without the additional pain of knowing that they risk criminalising their loved ones for assisting them in the ultimate act of compassion and love. Last week, Lesley told me that knowing he would have some control over the end of his life was like a weight lifted off her brother’s shoulders. In his open letter to MPs, Geoff described it in the same way, yet for Ann and Geoff, that relief was cruelly marred by anguish and uncertainty over the future legal consequences for Ann. It is clear that our law on assisted dying is broken, and we must be allowed to re-examine it.