5,804 spoken contributions under 12 words (interjections such as “Will the hon. Member give way?”) are hidden. Show them

1. 16 May 2025·Parliament·Tom Tugendhat

   Terminally Ill Adults (End of Life) Bill

   My hon. Friend will remember that in the last Parliament we brought in the National Security Act 2023, which introduced huge controls on the nature of an individual’s liberty. The legislation passed through the House over a period of two years and required an entire Department to prepare it. There were considerations with the judiciary, foreign Governments and other services, including the police. The Bill before us allows the state to kill someone. Does he feel that this legislation is therefore somewhat more constrained than other legislation that would normally have been allowed to pass? And yes, it is correct to say that it allows the state—an actor on behalf of the state, at the request of an individual—to take a life. In the English language, that is called killing.

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2. 16 May 2025·Parliament·Sir Julian Smith

   Terminally Ill Adults (End of Life) Bill

   Will the hon. Lady confirm that those civil servants are 100% comfortable with the impact of the Bill and that people with disability, mental health issues, neurodiversity and other medical conditions will not be coerced or under pressure because of this Bill?

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3. 16 May 2025·Parliament·Sir John Hayes

   Terminally Ill Adults (End of Life) Bill

   That is why new clause 16, tabled by my hon. Friend, is so important. In other jurisdictions that have passed such laws, up to a third of people report that they have taken this step because they feel they are a burden on others. That is the truth of it—it is not always about pain—and that is the kind of autonomy that leads to disaster.

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4. 16 May 2025·Parliament·Sir John Hayes

   Terminally Ill Adults (End of Life) Bill

   I am surprised by the hon. Gentleman’s objections to new clause 16, given that we have been assured throughout that the Bill would apply only to people who were terminally ill with six months to live. Is he really saying, therefore, that he does not want a new clause that would rule out from assisted death people who feel that they would be a burden on others, people with a mental disorder and people with a disability? His argument for choice is exactly the argument that in other jurisdictions has led to the expansion of assisted death to just those kinds of people.

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5. 16 May 2025·Parliament·Sir John Hayes

   Terminally Ill Adults (End of Life) Bill

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

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6. 16 May 2025·Parliament·Sir John Hayes

   Terminally Ill Adults (End of Life) Bill

   The critical point about my right hon. Friend’s amendment, and indeed about new clause 16, is that they would put that on the face of the Bill. He is right to say that codes of practice and statutory guidance can be of value, but it seems to me that what is on the face of the Bill will be of fundamental importance, particularly in respect of coercion.

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7. 16 May 2025·Parliament·Sir Jeremy Wright

   Terminally Ill Adults (End of Life) Bill

   In view of the number of hon. Members who wish to speak in the debate, I will restrict my remarks to amendments 47, 48 and 49, which stand in my name and the names of others. The amendments focus on the stage in the process that involves the multidisciplinary panel established by clause 14, and their purpose is to make that system work better. A panel is intended to be an additional safeguard. The hon. Member for Spen Valley (Kim Leadbeater) has made that very clear, and such panels are the successor to the involvement of a High Court judge assessing the merits of each case. The role of the panel is to determine whether it is satisfied of the matters set out in clause 15(2). Some of those matters are procedural—for example, whether the person seeking the certificate is aged over 18 or is resident in the UK, or whether declarations and assessments that should be made have been made. Others are matters of judgment, including professional judgment, such as whether an illness is terminal or whether the person applying for a certificate of eligibility has the mental capacity to do so. The remaining category of matters to be considered are matters of broader judgment, and I suspect those are likely to be where the panel focuses most of its attention, particularly the final two listed in clause 15(2): first, whether “the person has a clear, settled and informed wish to end their own life” and, secondly, that there is no coercion or pressure from anyone else. On those matters, the panel will hear from the relevant doctors, who will have had to make a judgment on those things, but I do not think that the intent of the Bill is or should be that the panel simply confirms that the doctor has reached a judgment and then adopts that judgment. The panel should, of course, reach its own judgment. It is right that the panel will also hear from the person wishing to die and will make its assessment of them. Particularly on the last matter—the absence of coercion or pressure—it may well be that highly relevant evidence will come from others. It may come from family, friends or others who know the person well, and we are familiar with a least one scenario where a new partner isolated the person in question before they suddenly and unexpectedly changed their view on their own assisted death. The problem is that under the Bill as it stands it is very difficult, and perhaps impossible, for those who know the person seeking a certificate well to know that those proceedings are under way or in prospect. They may not know, and nobody has to tell them, that the person has made the relevant declarations, or even that they have an intention to die, or indeed that there is any reason to submit any evidence they may have. I am not saying that every case in which someone has not told their family and friends of their decision to seek an assisted death will be concerning, but I think it is fair to say that a disproportionate number of the concerning cases will be in that category. In those cases, the panel may be making a judgment in the absence of relevant—perhaps crucial—evidence and they simply cannot do their job properly if that is so.

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8. 16 May 2025·Parliament·Sir Jeremy Wright

   Terminally Ill Adults (End of Life) Bill

   I understand the hon. Lady’s point and I have seen her amendments on the subject, which are very sensible. We need to think about the way in which the panel process will actually unfold. If we believe that this is an important safeguard, as, I think, is a common view, we need to do everything we can to make sure that it is an effective one. Like the hon. Lady’s amendments, my amendment 47 seeks to remedy the problem by ensuring that the assisted dying commissioner notifies anyone they think may have relevant evidence to give so that they can give it. That evidence may, of course, not change the panel’s decision, but in some of the most troubling cases it will, and the opportunity for the panel to consider that evidence, when the stakes are so high, must surely be provided for. I accept that what I am proposing is an infringement of the privacy of the person wishing to die—it is a fetter on their ability to choose to die without informing their family or friends as they may wish—but the Bill is all about balancing the rights of a person to die as they wish with, on the other hand, our duty to protect the vulnerable from abuse. That is exactly why the stages through which a person must go in order to be assisted to die are in this Bill, including obtaining the grant of a certificate from a panel. To be of value, as I say, that must surely add new protections to the other stages.

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9. 16 May 2025·Parliament·Sir Jeremy Wright

   Terminally Ill Adults (End of Life) Bill

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

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10. 16 May 2025·Parliament·Sir Jeremy Wright

    Terminally Ill Adults (End of Life) Bill

    The hon. Gentleman makes a fair point. I think we can expect that the psychiatrist on the panel will subject the requirement on mental capacity, in particular, to some considerable professional scrutiny, but nobody on the panel, whatever their professional competence may be, is capable of doing the job properly if they do not have access to the necessary evidence, so we must make sure they do. The fact that the panel may sit in public is not a sufficient answer to the problem that I am raising. First, that is because there will be many panels considering many cases, and we cannot expect those who have evidence of coercion, for example, to watch the lists in case the person they know happens to appear in them—when, of course, they have no expectation that they will. Secondly, the panel will not sit in public in every case. Paragraph 6 of schedule 2 says: “Panels are to determine referrals in public”. That is the clear presumption, and it is welcome, but paragraph 6(2) says: “The chair of a panel may, at the request of the person to whom a referral relates, decide that the panel is to sit in private.” I can see nothing in the Bill about any grounds on which the panel chair may refuse such a request, so it will occasionally, or perhaps often, be the case that the panel will sit in private, and no one will know what it is doing. The next issue is the way a panel will go about making the judgments it needs to make, which brings me to amendment 48. As we all know, most judicial and quasi-judicial hearings in this country are conducted on an adversarial basis. That is, by the way, a reference not to the tone of proceedings but to the presentation of both sides of an argument so that the tribunal can reach the right conclusion. That is what our judges and lawyers are used to. That matters here because this quasi-judicial stage in the process of seeking assistance to die is being offered as important reassurance that things will be done safely, but that reassurance cannot be offered if panels are asked to adopt a process for which they are ill-equipped. That is not a criticism of those who will sit on the panels. I accept that, under the Bill as it stands, a panel may hear from and question any other person beyond the person seeking the certificate and the relevant doctors, but as I have sought to address in amendment 47, as things stand those other persons will in all likelihood not know about the panel’s proceedings and therefore will not come forward of their own initiative with the evidence. The panel would have to go out and find them, and how exactly is it to do that? How does the panel know who may have relevant evidence to give, and with what resources will it seek them out? The position on what resources will be available more generally for the process under the Bill remains unclear, but the impact assessment suggests that panels will be expected to deal with two cases a day. That suggests that they will spend somewhere between three and four hours on each. That is not much latitude for further investigation. Amendment 48 proposes that the commissioner should notify a designated authority—the Secretary of State can choose the appropriate one—of an application for a certificate. That authority would then supply to the panel an advocate with the responsibility to raise arguments against the grant of the certificate, which the panel would not otherwise hear. I think that is important, because it would ensure that there was another participant in the panel process who could at least help the panel by prompting consideration of concerns, reservations or grounds for further inquiry before decisions were made. My amendment 49 is about what happens once a panel has reached its conclusion. Clause 16 provides for a person seeking a certificate to be able to ask for reconsideration of a panel’s refusal to grant one, but of course the Bill currently provides no equivalent right to challenge the decision to someone who believes that a panel should not have granted a certificate. Anyone in that position would need to resort to judicial review, which is complex and expensive.

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11. 16 May 2025·Parliament·Sir Jeremy Wright

    Terminally Ill Adults (End of Life) Bill

    I certainly am, Madam Deputy Speaker. I am doing my best, I hope as briefly as I can, to explain these technical amendments in a hugely important Bill, in a part of the Bill that the promoter has advocated for because she believes it is a safeguard. I think it is important, Madam Deputy Speaker, that we establish whether it is such a safeguard, and if it can be improved, how it can be improved—but I entirely take your strictures on board and I will come as quickly as I can to a conclusion. This is not an equality of arms point—I accept that these are not opposing parties in the traditional sense—but it is really about the presentation of new evidence. Presumably the advice to someone whose application for a certificate has been refused and who has new evidence to present would be to reapply to the commissioner, but what is someone who has new evidence to challenge the basis for an existing certificate to do? Judicial review is no help. That is about the soundness of the decision already taken, which will be assessed using the evidence already presented to the panel that took the original decision.

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12. 16 May 2025·Parliament·Sir Jeremy Wright

    Terminally Ill Adults (End of Life) Bill

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

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13. 16 May 2025·Parliament·Sir James Cleverly

    Terminally Ill Adults (End of Life) Bill

    I tabled an amendment to ensure that the self-defined responsibility to go for assisted dying did not become a rationale. What is the right hon. Lady’s view on the impact of intersectionality on this issue? We know that, in practical terms, a number of people do not have full control over their lives. The Mother of the House, the right hon. Member for Hackney North and Stoke Newington (Ms Abbott), made the point that people who are often pushed around by their families and their wider society—particularly women from ethnic minorities—will be at particular risk from the gentle advice or suggestions from authority figures to whom they will be overly deferential, which could lead them into a very dangerous position.

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14. 16 May 2025·Parliament·Sir Edward Leigh

    Terminally Ill Adults (End of Life) Bill

    I wish to speak to new clauses 16 and 17. Rather than giving my own views, I think that powerful testimony on behalf of someone who actually runs a care home should be heard by the House. I want to quote, as briefly as possible, Dan Hayes, who runs the Orders of St John Care Trust, which runs care homes in Lincoln generally and in my constituency: “we believe that the Bill as drafted is flawed, and the risks to older, vulnerable people, residing within social care environments are substantial. We believe that any assumption by those drafting the final legislation that it is not intended for use by those living with conditions regarded as part of the ageing process, would be mistaken. Any legislation would be immediately tested and assumed to be accessible to such a cohort of people. To that end we believe that in order to provide the necessary protections to such a vulnerable part of our society, the Bill must be explicit in its reference to older people living in residential services.” That is why these new clauses are so important. He continues: “The Bill must take account of the current unfairness and instability at the heart of our social care system, and question whether such legislation can be introduced whilst such problems exist. The Bill must recognise that an individual health/social care professional’s ability to remove themselves from the process of Assisted Dying is so difficult, that specific exclusion of the care home sector should be a feature of the Bill. In any case, organisations, and sites, should be given the ability to exclude themselves from the act of an assisted death without prejudice to their approval as providers of services to the state.” We have experience of that, with regard to Catholic adoption agencies. There is a real risk that some care homes may feel they have to withdraw from this sector. I will carry on quoting: “Those that fund their own care pay substantial sums, often saved for over a lifetime—including property wealth. These savings will have been set aside for retirement and to pass on to loved ones. Instead, they are used to fund the costs of their own residential care, and to substantially subsidise the state. We see the real prospect that those that might fit the criteria for assisted dying under the Bill, but have no wish to accelerate their death, would feel an immediate dilemma between prolonging their own lives, and the future quality of life of their loved ones. For illustrative purposes, the six-month period stated within the current Bill would equate to between £25,000 and £40,000 of expense borne by an individual paying for their own residential care in the current system. Failings in the system mean that older people who should not be in hospital are held there, causing a burden to the NHS, and Local Authorities face an ever-growing proportion of funding needed to support social care, without a proportionate increase in funding from central government.”

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15. 16 May 2025·Parliament·Sir Edward Leigh

    Terminally Ill Adults (End of Life) Bill

    I wish to be mindful of other people, so I will proceed and make this one simple point on behalf of care homes. Mr Hayes continues: “During the pandemic, we saw the appalling attempts at a widespread use of ‘Do Not Attempt Resuscitation’ arrangements for older people. This is a clear demonstration that an existing broken system places a lower value upon the lives of older people than of others.” This is the important point: “Relationships within residential care for older people are both professional and intimate. Carers, Care Leaders, and Service Managers are all competent health and social care professionals, but they are also friends and confidantes of those that live within social care services. The relationships are familial in the sense of contact for hours each day and the extension of support to ordinary, everyday issues outside the scope of normal healthcare professionals. Our employees deliver loving care and build relationships in a way that residents come to depend upon and take comfort from. Such relationships are key to excellent care provision, and these important relationships enhance and prolong lives by providing a sense of purpose and place to older people.” I have been around these care homes. They are fantastic places, with such love and such care for the most vulnerable in society. My Hayes then continues: “In such a setting, it renders the ability for an individual to refuse to partake…as useless. In an environment such as a care home, there is no way in which a professional could be fully ‘separated’ from assisted dying, should a resident they work with closely seek to enquire about or make a request. Imagine a scenario where an individual living in social care is at the point where they will be provided with the approved substance to bring about their own death: In a care home, this is likely to be in their own room, which will be in close proximity to many other older people who live within that setting. It will be commonplace and understandable that the magnitude of the event will mean that the individual will wish to have company and comfort up to and immediately before/during the period in which the substance is taken. A request for the company of a care professional will create a substantial moral dilemma for that person, profoundly so if they are individually opposed to Assisted Dying.” That is the choice that these loving care workers will have to make—that would be the pressure on them. He goes on to say: “Even where they are not, it will mean that they will intimately witness the death of someone with whom they have a strong bond, with that death having come about through facilitation, rather than naturally.” Imagine the pressure on the workers in that care home.

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16. 16 May 2025·Parliament·Sir Edward Leigh

    Terminally Ill Adults (End of Life) Bill

    The Minister is making a very important point, and this is what I dealt with in my few short remarks. If, according to the Minister, care homes run by religious orders will have to provide this service, those orders will have to get out of care homes altogether.

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17. 16 May 2025·Parliament·Sir Desmond Swayne

    Terminally Ill Adults (End of Life) Bill

    The Bill does allow applicants to shop around for doctors, and it strikes me that there is a danger that some doctors, who might have an ideological view of the Bill, will specialise in the provision of that service, which would give it rather greater scope than the hon. Lady intends.

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18. 16 May 2025·Parliament·Simon Hoare

    Terminally Ill Adults (End of Life) Bill

    The hon. Lady is absolutely right on the matter of eating disorders, but my understanding of the amendment is that it relates to those who effectively starve themselves into a position of becoming terminally ill without having an eating disorder—that is the thrust of the amendment. Does she see that, and how does she intend to respond to it?

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19. 16 May 2025·Parliament·Simon Hoare

    Terminally Ill Adults (End of Life) Bill

    On a point of order, Madam Deputy Speaker. I do not wish to be flippant or to test the patience of the House, but we have just heard an important speech from a former Attorney General on some key legal points. This is still a private Member’s proposal. How can the promoter of the Bill, the hon. Member for Spen Valley (Kim Leadbeater), respond to whether to accept amendments to her proposed legislation if she is not in the Chamber to hear the arguments? Is it not a discourtesy to the House and those who have spent some considerable time working on amendments, on both sides of the argument, for her not to be here to hear what they are advocating?

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20. 16 May 2025·Parliament·Sarah Bool

    Terminally Ill Adults (End of Life) Bill

    I am grateful to speak in this debate, and I will focus on three amendments: new clause 9 and amendments 51 and 38. To save time, so that other Members can speak, I will not take interventions. New clause 9, which is in my name, would essentially establish the standard of proof—namely, the degree of certainty and the amount of evidence—required in decision making under this Bill. Let me put that into context. Various standards of proof are used in law. At the very lowest end of the scale is reasonable belief, which is a belief that would be held by an ordinary person in the same circumstances. There is then the civil standard of proof, known as the balance of probabilities, which is sometimes known as the 50% plus one rule, or “more likely than not”. Finally, we have the most serious standard: the “beyond reasonable doubt” test, which applies for criminal cases. That goes further than the balance of probabilities, and requires the person to be sure. Given the lack of clarity and confusion in Committee about whether the test for doctors should be reasonable belief or the balance of probabilities, I have proposed the new clause. As Members will see, it has three parts. Subsection (1) relates to the assessment by the co-ordinating and independent doctor. As Members will see, it has three parts. Subsection (1) relates to the assessment by the co-ordinating and independent doctor. Here I argue that the balance of probabilities test should be used, because it feels perhaps overly punitive to exclude someone from the process at the initial stage if it is more likely than not that they will meet the test, but there are some doubts. However, under subsection (2), when the assisted dying review panel is making its assessment, it must use the “beyond reasonable doubt” test. Given that, at this stage, it will have all the reports from the doctors and professionals, if it is not sure beyond a reasonable doubt, the application should not be approved. That is an essential safeguard. Subsection (3) relates to the moment of supplying the lethal drugs. The doctor is required to satisfy themselves that the person has capacity and a clear, settled and informed wish to end their life, and is not being coerced. At that point, the “balance of probabilities” test does not suffice; it must be “beyond reasonable doubt”—this is life and death. All hon. Members need to ask themselves whether, without this new clause, they are happy with someone being provided with lethal drugs to end their life by our NHS in circumstances where we are not absolutely certain of their intention. I acknowledge, for the record, that the hon. Member for Solihull West and Shirley (Dr Shastri-Hurst) has made an objection to the use of “beyond reasonable doubt”, asking whether it is right to apply a criminal standard of proof when a civil standard may be flexible enough. However, I note that in the House of Lords in re B case in 2008, Baroness Hale said, “There are some proceedings, though civil in form, whose nature is such that it is appropriate to apply the criminal standard of proof,” and a subsequent 2012 case affirmed that. If we stay silent and let the assisted dying review panel and the courts try to work out whether they should interpret “satisfied” as meaning satisfied to the civil or criminal standard, it would merely result in numerous litigation battles. On a matter as serious as death, Parliament must provide the clarity needed. Without it, the Bill is simply not safe. The second area I am focusing on is informed consent and complications, through amendment 51 to clause 11. The amendment would impose a duty on assessing doctors to inform individuals seeking an assisted death of any reasonable body of medical or scientific opinion indicating that the prescribed substance carries risks of complications, including pain. Clause 11 requires doctors to explain how the drug is expected to bring about death, and to discuss with the individual what ought to be done in the event of complications. However, it omits a critical element identified by the General Medical Council in its guidance on consent: the obligation to communicate known risks of harm and the uncertainty surrounding those risks. A patient cannot be said to give informed consent if they are not made aware of the full range of potential complications, including pain, distress and the possibility that the drug may not act as expected. The state of Oregon’s most recent data shows that complications were recorded in approximately 3% of cases in 2023, but historical data shows a complication rate of 11%. Since the introduction of the law there, there have been nine recorded incidents of patients regaining consciousness after ingesting the prescribed substances, and time to death has ranged from three minutes to 137 hours—that is, more than five and a half days. Canadian studies indicate that around 5% of oral assisted deaths result in a prolonged and often distressing process. In some instances, medical intervention is required. Evidence also suggests that younger adults, particularly those aged 18 to 24, are more likely to experience extended and unpredictable deaths. Furthermore, not all complications may be outwardly evident. High doses of barbiturates, combined with paralytic agents that suppress all voluntary muscle movement, may result in what outwardly appears to be a calm and peaceful death, but that may conceal considerable psychological suffering. The hon. Member for Spen Valley (Kim Leadbeater) talks about offering choice, but a choice made in the absence of information is not true autonomy; it is abdication. Making a meaningful decision requires the individual to be aware of not only what is intended to happen, but what may plausibly go wrong. In both Oregon and California, legislation explicitly requires that patients be informed of any known risks associated with the medication to be administered, so why would we adopt a lesser standard here? The amendment simply calls for honesty. Finally, but briefly, I also want to add my support for amendment 38, which clarifies that an individual who is not already terminally ill under the definition of clause 2(1) cannot qualify by refusing standard treatment or taking steps to induce a terminal condition. I live with type 1 diabetes, which, for the record, is a progressive illness that cannot be reversed by treatment. This condition is managed—or not, in cases of extreme stress—solely by the individual. I therefore recognise that the amendment is an incredibly important protection. Diabetics face multiple daily injections, and have to think about and monitor everything that they do, 24/7, and they can be at risk of diabetic distress, or even develop disordered eating. That could prove fatal if standard treatments are not accepted. They should never be offered assisted suicide; they could recover with the right support. I have spoken to the hon. Member for Spen Valley about my concern that conditions like diabetes may be caught unintentionally. The amendment would be a step to protect those who may be unable to protect themselves using standard means. Diabetes and anorexia have been a reason for assisted suicide in Oregon, so please be aware of what could happen.

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21. 16 May 2025·Parliament·Rebecca Smith

    Terminally Ill Adults (End of Life) Bill

    I tabled amendment 102 in good faith, as I thought it might be workable. I want to reflect on what the Minister said at the beginning of his speech. I do not recall ever being offered an opportunity to pass my amendments to Government officials to ensure that they would be workable. Given the scope of what we are debating this afternoon, it sounds very much like any amendments that have not been tabled by the hon. Member for Spen Valley (Kim Leadbeater) had no chance of being taken forward unless she accepted them.

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22. 16 May 2025·Parliament·Rebecca Paul

    Terminally Ill Adults (End of Life) Bill

    It is a privilege to speak in this place on such an important Bill. Having been part of the Committee that scrutinised it line by line, and, on some occasions, word by word, for several months earlier this year, it is a pleasure to see so many of my colleagues from Committee Room 10 present today—a reunion of sorts. I am here, as always, with the intention of improving the Bill, so that if it does indeed pass, vulnerable people are as protected as they can possibly be from unintended consequences. It is important to remember that on Report and Third Reading we are not voting on whether we agree with the principle of assisting someone to end their own life. Our role is to vote on the law in front of us—on whether the words on the page are clear and do what is intended, on whether the statutory process is safe, and ultimately on whether the provision of assisted dying benefits our community. I am not against assisted dying in principle, but I am against this Bill. I am happy to put it on the record now that I have no personal religious beliefs; I am against the Bill for the simple reason that it will harm far more people than it will help. The people who will be harmed are the most vulnerable in our communities, and I am not willing to accept that collateral damage. Today is important, because we have the opportunity to improve the safeguards in the Bill so that some of those groups are better protected. I urge Members to take that opportunity to the full. It requires very little skill to draft law that works for 90% of cases, but there is much skill in ensuring that the other 10% is catered for as well. I urge everyone to set the highest standards today and think about how we can ensure that those unordinary and unexpected cases are adequately protected, too. It really is life and death, so please do not accept anything that is not good enough.

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23. 16 May 2025·Parliament·Rebecca Paul

    Terminally Ill Adults (End of Life) Bill

    I wholeheartedly agree. There is much to discuss today and there is little time, so I will start at the beginning of the Bill, at the point at which the criteria for eligibility for an assisted death are set. It is there that important safeguards are needed to ensure that those who should never be eligible are excluded. We should not make the mistake of assuming that a doctor will always make the right decision or that they are infallible. It is incumbent on us to put in place law that makes it harder for them to get it wrong—that makes it harder for someone vulnerable to fall between the cracks.

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24. 16 May 2025·Parliament·Rebecca Paul

    Terminally Ill Adults (End of Life) Bill

    The evidence is clear that palliative care does not get better when assisted dying is introduced; we heard that in the Bill Committee. We should absolutely look to address palliative care, because that will benefit more people. I will come to that point later in my speech, so I will not discuss it any further now. I do not want to get ahead of myself. There are many helpful amendments in this vein—namely, new clause 16, new clause 9 and amendments 80, 14, 38, 81, 24, 30 and 31. In simple terms, they seek to tighten and refine the eligibility criteria for an assisted death by setting out when and for what reasons an assisted death should be allowed, and by ensuring that those who are vulnerable are protected from something that may not be in their best interests. Interestingly, on Second Reading the argument put forward for assisted death was that those who are dying should be spared unbearable pain. This is an argument that everyone understands and has full sympathy with. No one in this place wants people to endure pain as they come to the end of their life; I certainly would not want that for my loved ones or indeed for myself when my time comes. But then the arguments being put forward changed. There was less emphasis on pain, and more on choice and autonomy. The word “autonomy” came up again and again in Committee—and autonomy is important, of course, but up to a point. From a proposal to provide a humane end to someone’s pain when it cannot be relieved in the last months of their life, we have moved to a proposal to provide an assisted death service to those who choose it for any reason, even if the pain can be alleviated by palliative care. This approach, however, comes with a cost to others: family, clinicians and broader society. This really is momentous. There is no going back from such a massive shift. A move to autonomy trumping everything else changes everything.

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25. 16 May 2025·Parliament·Rebecca Paul

    Terminally Ill Adults (End of Life) Bill

    I thank my right hon. Friend for making that point; he is absolutely right. I have tabled amendment 80, which would bring the Bill back to its original intentions. It would require that in order to be eligible for an assisted death, the pain and discomfort experienced or expected from a person’s terminal illness could not be reasonably relieved to their satisfaction through palliative care. It seeks to limit assisted death to the very small group of people who may benefit from it, not the larger group who just need adequate palliative care to give them the comfortable, dignified death they deserve.

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26. 16 May 2025·Parliament·Rebecca Paul

    Terminally Ill Adults (End of Life) Bill

    The key point is that we need to improve palliative care. We are spending so much time and effort focusing on this Bill rather than doing the thing that would actually help more people. My amendment 80, in combination with amendments 30 and 31 tabled by my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer), would drive significant improvements to palliative and end-of-life care, getting us closer to consistent and universally available care for all.

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27. 16 May 2025·Parliament·Rebecca Paul

    Terminally Ill Adults (End of Life) Bill

    I agree, and I will come to that point in more detail in the second half of my speech.

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28. 16 May 2025·Parliament·Rebecca Paul

    Terminally Ill Adults (End of Life) Bill

    My hon. Friend makes a good point, and I agree. In the interests of time, I will make some progress. The current situation, whereby fully funded palliative and end-of-life care is not available in certain postcodes, means that those unfortunate patients do not have a real choice. We know that 25% of people who die in this country do not get the palliative care they need—that is more than 100,000 people a year—and if the Bill goes through, they will be offered a fully funded assisted death as the only reliable way to end their pain. That is no choice. I urge Members who want to see improvements in palliative and end-of-life care to vote for my amendment 80, and for amendments 30 and 31, tabled by my hon. Friend the Member for Runnymede and Weybridge, if they are pushed to a vote.

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29. 16 May 2025·Parliament·Rebecca Paul

    Terminally Ill Adults (End of Life) Bill

    I will not because I do not have much time. I will move on to the lack of a best interests test in the Bill, which my new clause 16 seeks to remedy. Patient autonomy is of course important, but it must be balanced against what is in someone’s best interests. In certain situations, when it is in their best interests, treatment can be given against a patient’s will—for example, force-feeding a young girl with anorexia. It is not an easy balance to get right, but in the absence of any best interests test in the Bill, following the process rigidly would lead to devastating results in some cases. The Bill currently prioritises autonomy of the patient in a specific moment of time, rather than what might be in their best interests in the long run. It makes no allowance for the fact that someone may feel a certain way temporarily due to other considerations. For example, when someone has just received a terminal diagnosis, it can understandably cause a depressive state and suicidal feelings, but those feelings do not necessarily last, so it may be in the best interests of the patient to allow a little time to pass, to give them a little breathing space before considering the assisted death route. New clause 16 essentially tries to provide a best interests test by excluding certain reasons, other than the alleviation of pain, that might be driving a patient’s decision. For example, we have heard a great deal about the internal pressure from patients themselves that is driven by their concern not to be a burden, and we heard clearly in Committee that a patient could tell a doctor that they are want an assisted death only for financial reasons, and that would still be approved. We know from the experience of overseas territories that patients will often opt for an assisted death because of social and welfare issues, such as being homeless.

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30. 16 May 2025·Parliament·Rebecca Paul

    Terminally Ill Adults (End of Life) Bill

    I am sorry, but I do not have much time and I wish to get through my points. How can we be happy with a process that does not exclude such reasons? Instead of providing the support that is actually needed, the state is content to put them on a pathway that leads to their death. I hope that the House will recognise that, whether one supports assisted dying in principle or not, it is morally bankrupt not to have some kind of best interests test to protect those who are not seeking death to alleviate pain from a terminal illness. Another group that is particularly vulnerable is those with eating disorders. In Chelsea Roff’s oral evidence, she set out that “at least 60 people around the world have been euthanised or assisted in suicide” with “anorexia nervosa listed by name as a terminal condition.”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 29 January 2025; c. 139, Q175.] To paraphrase her, these were young women who were not terminally ill and had decades of life ahead of them. It is important to make the point that someone suffering—

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31. 16 May 2025·Parliament·Rebecca Paul

    Terminally Ill Adults (End of Life) Bill

    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.

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32. 16 May 2025·Parliament·Rebecca Paul

    Terminally Ill Adults (End of Life) Bill

    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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33. 16 May 2025·Parliament·Neil O'Brien

    Terminally Ill Adults (End of Life) Bill

    I am one of those people who is against the Bill, not in principle but for the reasons set out brilliantly by many articulate Labour Members. When my constituents ask what I think about this, I have no way of telling them; there is no way for me to get into the nuance of my position on it, because there has been no time to have a proper debate, and so many Members will now be unable to say a single thing about this totally transformative Bill.

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34. 16 May 2025·Parliament·Kit Malthouse

    Terminally Ill Adults (End of Life) Bill

    I am grateful to you for that guidance, Madam Deputy Speaker. I am also grateful to the promoter of the Bill, the hon. Member for Spen Valley (Kim Leadbeater), for putting me on the Bill Committee where, in my view, we did some excellent work. Although we have heard an awful lot of claims about the process, I think anybody objective who reads the Bill that is now being reported to the House will recognise that it is a strong piece of work that is measured and seeks to strike a balance in a difficult area of complexity, humanity, compassion and morality. Before I discuss some of the amendments, I want to bring the House back to what we are trying to deal with: a set of people who have been told that their struggle with disease is over, that they are heading towards an inevitable death and that there is nothing more that medical science can do for them. What we are trying to do is to give them the chance to face death on their own terms. That is the simple mission that the House has been set. The second thing I want Members to contemplate as they look at this slew of amendments is that although it is easy to look at each amendment individually and see its merits or demerits, we must bear in mind the machine we are building as a whole, and the fact that we are putting those people through this process at a time when they are facing the end of that struggle. They are thinking about what the nature of their death will be like and they are talking to their friends and family, putting their affairs in order, and being concerned about when that awful day is going to come. We have to have some compassion in the process as well as compassion in the purpose. When Members consider some of the amendments I will highlight, I ask them please to keep in mind that we will have to put these people through a possible two-month process at a moment when their time is severely limited, very often to less than six months. For example, new clause 7 and amendment 50, tabled by my hon. Friend the Member for Meriden and Solihull East (Saqib Bhatti), would restrict the number of patients that doctors can deal with in any 12-month period. That will severely restrict access and may mean that patients who are partway through the process have to change suddenly because their doctor is time limited, pushing them out, notwithstanding the multiple safeguards we already have in the process. My right hon. and learned Friend the Member for Kenilworth and Southam (Sir Jeremy Wright) gave an interesting speech about amendment 47. Again, in that amendment, he would be creating another step, another delay and another set of problems for the dying person to overcome or issues for them to address. In his amendment—I am sure he is a much better lawyer than me—I found it odd that he would effectively be creating an inexhaustive list of individuals who could be called upon in any circumstances who might be “properly interested” in the welfare of that individual. To me, the person who should be the most interested in their future is the person themselves. Any step we take that cuts across their privacy, their autonomy and the alacrity with which they can seek this solution to their impending or perceived agony seems a step too far. I do not understand how, practically, the commission is supposed to ascertain who those individuals are—are they neighbours, friends or just family? What is the definition of family? We need to put that contemplation and how they want to handle their death squarely in the hands of the dying person.

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35. 16 May 2025·Parliament·Kit Malthouse

    Terminally Ill Adults (End of Life) Bill

    The hon. Lady makes a good point, and it was a compelling point made in Committee and is certainly one that we recognise. That is why the amendments on training that she tabled in Committee were adopted—specifically to ensure that everybody involved in the process is sensitised to detecting those issues and to make clear that any doctor in the process, and indeed the panel, might want to know why family are not being informed. That is specifically why a social worker was put on the panel: to understand the psychosocial environment in which the person is taking that decision. Fundamentally, in the end, if I am facing my death in a matter of weeks and decide in my capacity that I do not want to inform my family, that is my choice. That is my decision. I may have to explain my reasons to the doctors, but—

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36. 16 May 2025·Parliament·Kit Malthouse

    Terminally Ill Adults (End of Life) Bill

    I am grateful, Madam Deputy Speaker; I will be swift. That is my choice, and this Bill is rooted in the need to give autonomy to those facing death who have capacity. We should take care to tread carefully upon that right. On the two amendments tabled by my hon. Friend the Member for Reigate (Rebecca Paul), new clause 16 says that somebody cannot be “substantially motivated” by certain considerations. I do not really understand what “substantially motivated” is meant to mean. To me, this misunderstands the complexity of what it must be like to be told that you are dying. The things that might run through your head—the affairs you might have to deal with, the news you have to break to your family, the impact it will have on your small children—form a cocktail of motivations. But the one thing I have learned over the last 10 years from campaigning for and spending lots of time with dying and bereaved people is that towards the end of their life, they have absolute clarity about what they want, because it becomes clear to them towards the end what their death will be like. At the very least, they want to have this card in their back pocket to play if they require it. Remember: these are people who are facing death, who are struggling with death, and we have to give them the power to advance over it.

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37. 16 May 2025·Parliament·Kit Malthouse

    Terminally Ill Adults (End of Life) Bill

    Sorry, but I am conscious of time. Finally, amendment (a) to new clause 10, which we might divide on this afternoon, is difficult. We debated a similar amendment in Committee. As sponsors of the Bill, we are clear that there should be a conscientious objection clause to allow individuals to opt out, and that is strengthened by new clause 10. But allowing an employer—any employer—to say that any employee in their employment cannot participate if that is what they decide seems to me a step too far, and it could prove to have unintended consequences. First, the board of every healthcare trust in the country will become a battle for control between those who oppose and those who do not. As my right hon. Friend the Member for Gainsborough (Sir Edward Leigh) said, people may suddenly find that they have to uproot themselves, after years of living in a care home, and relocate to get the kind of death that they want. In effect, the amendment prioritises the rights of somebody who is providing accommodation over the rights of the dying. As I said on Second Reading, in my view, as they face their end, we should prioritise the rights of the dying.

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38. 16 May 2025·Parliament·Kit Malthouse

    Terminally Ill Adults (End of Life) Bill

    claimed to move the closure (Standing Order No. 36). Question put forthwith, That the Question be now put. The House proceeded to a Division.

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39. 16 May 2025·Parliament·Gregory Stafford

    Terminally Ill Adults (End of Life) Bill

    What concerns me about new clause 11 is that, essentially, people can shop around if one doctor is unwilling. The hon. Lady has given a list of reasons why a doctor might be unwilling, but surely one of the reasons could be that there is a fundamental change in a person’s circumstances and they do not want to do it. Nothing about that is recorded. Is it not a real weakness of new clause 11 that we do not have the passing on of evidence from one doctor to another?

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40. 16 May 2025·Parliament·Gregory Stafford

    Terminally Ill Adults (End of Life) Bill

    On a point of order, Madam Deputy Speaker. I would like your advice. Mr Speaker said that more than 90 people wish to speak in the debate. We have been debating the amendments for an hour and a half and four speeches have been made. If we go to 2 o’clock, that will mean fewer than 20 speakers. I understand that whether a closure motion can be moved is at the discretion of the Chair. If we have not got past, let us say, 20 or 30 Members speaking in the debate, can you give us any indication of whether, if you are still in the Chair, you would accept a closure motion at that point?

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