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I agree with the shadow Minister that the Second Reading debate was Parliament at its best. Would he say that the length of time that we have had to debate the Bill today, given the number of amendments and the number of people who wanted to speak, showed Parliament at its best?
Is the Minister saying that, in his view, it is better that someone who should not die does die, than that someone who should die does not?
Has the Minister any sympathy with the point made by my right hon. and learned Friend the Member for Kenilworth and Southam (Sir Jeremy Wright)? The panel might struggle to get the evidence it needs to make a decision, and there is no mechanism to address a situation in which, in the absence of that evidence, the panel makes a decision, but evidence then comes forward that suggests that its decision was incorrect. Does the Minister have any workable ideas for addressing that issue?
This House is now faced with a responsibility as profound as it is complex: to ensure that this Bill remains clear in its purpose, cautious in its application and compassionate in its impact. That purpose is simple, yet solemn: to grant adults of sound mind with a terminal diagnosis the legal right to seek assistance to end their lives in carefully regulated circumstances through a legal framework in which compassion and control co-exist. With that in mind, I rise to speak against new clauses 1, 2 and 9, which, while no doubt well intentioned, threaten to confuse, dilute or duplicate what is already a well-constructed piece of legislation. I begin with new clauses 1 and 2. New clause 1 would prohibit healthcare professionals from raising the topic of assisted dying unless it is first broached by the patient. While that may be appealing superficially as a safeguard, it represents a fundamental misunderstanding of the doctor-patient relationship. We trust our clinicians every day to raise subjects of great complexity and moral weight.
I am grateful to the hon. Member for that intervention. I fear there is some rhetoric that engenders a fear around the medical profession, which is misplaced.
I will give way in a moment, if I may. Those are not my experiences in clinical practice, nor are they those of family members who have worked in it. We must trust our medical professionals, who are highly trained and capable individuals, to have these difficult and complex conversations, which they do every day on issues such as aggressive chemotherapy or the withdrawal of ventilation.
I am grateful to the hon. Gentleman for his intervention. These are complex conversations that take place up and down the country every day; we know that they are taking place in St Thomas’ hospital at this moment. We are treating our medical professionals as though they do not take their professional obligations seriously. We must recognise the expertise that they bring and the sensitivities in which they have these conversations.
I am grateful to the hon. Lady for her intervention. I commend those family members who are really powerful advocates for their children, parents and relatives in their engagement with the medical profession. We are at real danger of treating our clinicians as though they have no care for their patients—
I am grateful to the hon. Gentleman for his intervention. That is why it is so important that we have the rigorous training and safeguards that are a fundamental part of this Bill.
I will make some progress, if I may. The point is that people cannot have a fully informed discussion and weigh up the balance of the decision if they do not know the full options available to them. That is a part of informed consent.
I will make a little progress, if I may. In respect of new clause 2, those who have had the privilege of meeting a young person living with a terminal illness will know that they often display a maturity and a depth of understanding far beyond their years. To deny them the opportunity of a considered conversation about their future upon reaching adulthood is not an act of compassion, in my view; it is to abandon them. It is to leave them isolated, navigating a complex and deeply personal journey through the filter of online forums, rather than in dialogue with trusted, qualified professionals. We owe them better than that.
I am grateful to the hon. Lady for her intervention. That is a very powerful personal story from Noah, who I think reflects the maturity of many young people when dealing with these challenging issues. By imposing, in effect, a statutory gag in this one area, new clauses 1 and 2 risk infantilising terminally ill patients, creating a chilling effect on communication at the very moment when clarity and compassion are most needed. If anything, new clauses 1 and 2 may result in harm to patients, forcing them to suffer in silence, unaware of lawful options simply because they do not know how to ask. Finally, I turn to new clause 9, which presents a number of issues. In the first instance, subsection (1) would permit there to be, in effect, two different standards of proof. That must be legal nonsense. The boundaries of any legal test or hurdle must be clear. A failure to do so creates a great deal of uncertainty. Furthermore, the proposal to shift the standard of proof from the civil to the criminal, requiring panels to operate on the standard of beyond reasonable doubt, is deeply inappropriate. The balance of probabilities is the cornerstone of medical and civil decision making. To adopt a criminal threshold risks freezing the entire process, creating a very risk-averse system.
I am grateful to the hon. and learned Gentleman for his intervention. These are individuals who are making this ultimate choice for themselves. My fear is that this well-intentioned new clause would make the Bill so unusable as to become ineffective. We are not prosecuting a crime here; we are enabling a choice under tightly prescribed circumstances. While I accept that each of these new clauses in their own way seeks to improve the Bill, we must be cautious about layering protections to the point of paralysis. The Bill as drafted is not a blank cheque—it contains safeguards, panel oversight and rigorous eligibility criteria. Let us not bury its moral clarity under legal clutter. In defending this legislation, we are not abandoning care; we are affirming dignity. Let us do so with confidence and reject these amendments.
With regard to these amendments, we are so blessed to have our precious NHS. At vital stages, the NHS quite rightly delivers care in obstetrics, gynaecology, neonatology and paediatrics, but at the end of life about 70% of care is delivered outside the NHS, largely by charities, and that figure is even higher for children’s palliative and hospice care—so the state pays for how we enter this life, but not for how we depart it. There is something deeply wrong about that for our society. Does my hon. Friend agree that surely we must address that, and the delivery of universal palliative and hospice care, before we go anywhere near the measures in this assisted dying Bill?
As has been the case throughout the Bill’s consideration, His Majesty’s Opposition have not taken a position on the principle of the Bill, and nor do we take a position on any of the amendments before the House. It is not for me to justify or argue against particular amendments. The arguments for and against have been well ventilated by hon. Members today. As we might expect—I know this from my own email inbox—many constituents are considerably more interested in our proceedings than might ordinarily be the case for a Bill’s Report. It might also be the case that there is not a complete understanding of the nature of today’s proceedings, so I hope that I might usefully reiterate what we are and are not doing. I then want to make some remarks focused on the public and campaigners, about how they should reflect carefully on their own obligations to respect the sincerity and freedom of choice of Members. I have come to consider that issue to be important, given some public interventions by high-profile campaigners, experiences with my own constituents and experiences that I know other hon. Members have had when they have been lobbied on the topic and on the way in which they will be voting today.
I will make some remarks about the process. The time allocated today is a matter for the Chair and it would not be appropriate for me to comment, but I accept and understand the concerns raised by the hon. Lady and other hon. Members. Today we have also looked at the procedure for receiving assistance, including safeguards and protections, and issues related to eligibility and mental capacity. As in Committee, some of the proposed amendments would make significant changes. I want to comment on the correspondence from the relevant Ministers regarding the amendments. Their letter to Members quite properly explained that those amendments laid by the Bill’s promoter, the hon. Member for Spen Valley (Kim Leadbeater), were considered workable by the Government, but the same could not be said about other amendments. It is important that the Minister emphasises, in his closing remarks, that that should not be read to mean that those amendments are not workable, which a superficial reading of the letter might imply; it just means that the Government have not given a view. I have sympathy with the concerns raised by the hon. Members for Hackney South and Shoreditch (Dame Meg Hillier) and for Bradford West (Naz Shah) about the challenges for Members seeking to lay amendments without Government support. While all the normal conventions may have been followed, this is not a normal Bill, because of its significance and potential impact.
As I said, I recognise that the Bill is of greater significance than a typical private Member’s Bill, but it has been delivered through the normal procedures of the House, and it is for the House as a whole to make those changes.
Not on that point. We may wish to reflect on how we might change our approach to Bills like this one in the future, given the significant dissatisfaction that has been expressed with the manner in which it has been considered, even though it has been done in the ordinary way. But we are where we are. As on Second Reading, this debate has been a balancing exercise. The promoter of the Bill and others have appropriately reminded us all of the very difficult and tragic experiences faced by the terminally ill and their families, but I respectfully say to the hon. Member for Spen Valley that we should be cautious in saying that opponents of the Bill are happy with the status quo, and I know that she would not have meant to suggest that.
My hon. Friend has added his concerns to those of others about the manner in which the debate has been conducted, but I reiterate that this has been done in the ordinary manner in terms of the Speaker’s discretion and the Standing Orders of the House. Opponents of the Bill are concerned that it will lead to a different set of unacceptable circumstances for different people; it is not that they are happy with how things are at the moment. All MPs have talked about people they care deeply about and how to help them. Whether they referred to disabled people, young people or the terminally ill, MPs have been speaking out in support of or against amendments, out of concern and compassion. I may be tempting fate in saying that we might find consensus on advertising restrictions, but outside of that, Members have undoubtedly expressed a variety of strong views on others’ amendments. It may be that Members vote consistently in line with whether they were originally for or against assisted dying, but other Members who are supportive of the Bill in principle are voting for restrictive amendments because they think that they are necessary. That is because this is a complex moral, legal and societal matter. I understand that Members are considering their votes with a degree of uncertainty. There should be no shame at all in Members’ admitting that they will be daunted by the sheer number of potential changes to the Bill, not to mention the decisions from the Speaker on those we are going to vote on or the challenge of deciding how to vote on each of them, either today or on a future day.
No, I need to make progress. They will be daunted not least because, although we have international examples, we are considering a novel practice in this country in our particular circumstances. Members who are generally supportive or opposed in principle may choose to abstain on a number of amendments on which they feel that they are unable to give a definitive view and are content to vote on the final outcome on Third Reading. That would be understandable. I know that Members have considered how they will vote very carefully, and that they will continue to do so, by taking into account their views and experiences, as well as those of their constituents, other Members whom they respect, and experts and campaigning organisations. We will all be directly accountable to our constituents at the next election for all our votes throughout this Parliament. That brings me to the remarks that I said I would like to finish with on the responsibilities of the public and campaigners towards MPs as they consider our votes. As we are first and foremost public servants, the focus is quite rightly usually almost entirely on the responsibility of MPs to the public, but as with all meaningful relationships, this is, and should always be, a two-way street. I accept the very strong feelings and deeply personal experiences that are brought to bear for those people contacting their MPs, and nothing I say should be taken as diminishing the rights of campaigners to make their cases strongly and consistently, but I and others have experienced lobbying by campaigners whose passion for securing the outcome they want has led them to question the integrity, sincerity or understanding of those MPs seeking a different outcome to them. Some high-profile campaigners have made unhelpful remarks. Although I am not religious, I was concerned to see the clumsy criticism of those whose objections to the Bill are thought to be centred in their religious beliefs, as was mentioned by the hon. Members for Vauxhall and Camberwell Green (Florence Eshalomi) and for Lowestoft (Jess Asato).
I need to make progress. I say that not least because I suspect that a very large number of supporters of the Bill might draw on their Christian or other religious compassion to explain why they want to see it pass. There was widespread reporting of how powerful the Second Reading debate was in showcasing the best of Parliament, with thoughtful debate and a consideration of nuanced and varied viewpoints. If Parliament demonstrates itself at its best, that creates a call for the public to do the same.
I have expressed my views on that matter. I understand why Members are concerned, but it has been in order, and at your discretion, Mr Speaker. MPs who disagree with campaigners’ views for or against assisted dying are not uncaring or lacking in compassion. They have not failed to understand the arguments; they have just inevitably disagreed with at least some of their constituents. I urge campaigners to use their passion and commitment to the cause to fuel their campaigning, as is their right, but to pause and reach understanding before criticising an MP simply because they have reached a different view on a very challenging matter. In a democracy, the public are as important as politicians in determining the quality of our discourse. I hope that my remarks remind people of that, and encourage them to aspire to be the best example of the behaviour that they want to see from their elected representatives, just as we have seen again in the Chamber today.
Persistence pays off. When considering the Bill, I had presumed that the doctor concerned would be a senior clinician—a senior doctor—but page 63 of the impact assessment refers to pre-registration doctors, who have just completed medical school and are on a provisional registration. Will the hon. Lady confirm that it is her intention that the provisions in the Bill may be carried out by the most junior doctors, as well as by more senior consultants and general practitioners?
I rise to support the hon. Lady’s new clause 1. As a doctor, I am very aware of the trust that the public place in doctors and the seriousness with which they take what we say. If a doctor gives somebody information about assisted dying, it is quite reasonable for that person to think that the doctor is suggesting that they should take part in that process, or is hinting that their death will be dreadful and trying to be kind. If doctors are allowed to say, “This is a good process,” more people will take it up than would otherwise have wanted to.
I rise to speak to amendments 18, 30, 31, 17 and 32, which stand in my name. I will start with amendment 18. Many moral arguments on the need for the Bill have been proposed both inside and outside this place. Some of those arguments have addressed the desire for greater control at the end of life, but the vast majority have focused on the prevention of irreversible suffering. The principle of bodily autonomy—which I strongly support in the context of full decision-making capacity, with certain important caveats—is used to justify the rights that the Bill will grant. However, let us put aside the debate surrounding the Bill and focus on the text of the clauses, which is the task that we face on Report. The provisions are silent on suffering, silent on control and silent on all but a terminal illness with a prognosis of fewer than six months. If the principle is that we must prevent irreversible suffering, all those suffering irreversibly should be able to seek physician-assisted suicide. If the principle is that we should give people control—another level of expression of bodily autonomy—all adults who truly and freely consent with full decision-making capacity should be able to seek physician-assisted suicide. If those principles are circumscribed to an arbitrary definition of “terminal illness”, the inexorable conclusion must be that those patients’ suffering or autonomy are more important than those of others, or that their lives have less value. We have seen that position subtly imported into this debate. When requesting an assisted death is not framed as suicide because some perceive it as understandable, the underlying argument is, “If you’re terminally ill, of course you want to die—that’s understandable.” We must ensure that we do not, by accident or otherwise, enshrine in our statute book value judgments on the worth of the lives of the terminally ill or on the protections that they should enjoy like everyone else. I tabled amendment 18 to expand the scope of the Bill as much as I can to reduce the discrimination inherent within it. The maximum I could do was to remove the six-month restriction, but I wish the amendment could go further. I know that some Members will wince at this provision, but I ask them to ask themselves what the principles and values in the Bill are, how they are being applied and whether they are being applied equally. I believe that the Bill as drafted is incoherent and discriminatory. My amendment would introduce some moral clarity to the Bill. If we do not do so, the courts will. I turn to amendments 30 and 31. If we are to rely on the principle of autonomy to authorise physician-assisted suicide for terminal illness, the expressed choice must be true and free. Autonomy needs help, though. A true and free choice needs to be informed; a true and free choice cannot be made under coercion; a true and free choice requires decision-making capacity. I believe that, if we are to rely on the principle of autonomy for the most grave of decisions, there needs to actually be a choice. In the absence of relevant and available palliative care options, where is the choice? How can we rely on autonomy in the absence of choice? The prospect of people choosing physician-assisted suicide not because it meets their needs, but because their needs are unmet owing to a failure in the provision of palliative care, is a moral outrage. My amendments 30 and 31 would ensure that that does not happen.
I am sorry but I really cannot, given the time restrictions. Amendment 17 pertains to the test of decision-making capacity. In English and Welsh law, we use the Mental Capacity Act 2005 to define capacity, and I believe it is right that the functional test of capacity is used in this Bill. We have common law tests of capacity in some circumstances, which arose before we had the Mental Capacity Act. However, the decision to end one’s own life was not permitted in the early case law leading up to that Act. There is no jurisprudence background or guidance. These capacity tests have not been done before. This test needs a bit more of a framework of support. Amendment 17 lays out the minimum information that needs to be understood as part of the functional test of capacity. Critically, that would include information about the current treatment options, about doing nothing and about proceeding under this legislation. It would make clear that physician-assisted suicide is not a medical treatment, but a personal choice about life and death. Without amendment 17, this Bill will fundamentally undermine the doctor-patient relationship. Doctors do not prescribe death, and this Bill must make that clear. I turn finally to my amendment 32. There has been some discussion about the inadequacies of the decision-making capacity test as gatekeeper. In effect, there may be circumstances in which, despite having capacity, the person is otherwise recognised as vulnerable. That is how our courts operate. The impact of depression or personality disorder on decision-making capacity can be subtle and elusive. I know, as I used to be a consultant liaison psychiatrist and did research in the area of decision-making capacity. This is tricky stuff to do, especially in the context of a request for an intervention, rather than a refusal. We should have trained psychiatrists at an early stage assessing capacity. They are expert at picking up these subtle cues and all the other stuff that is going on. A request for physician-assisted suicide should not be taken in isolation, and that needs to be understood and supported. We need someone who knows how to use the Mental Health Act, because if a doctor is doing the assessment, and they have a patient in front of them with a mental disorder, expressing a desire to end their life, they need to make sure that that patient gets the right and appropriate treatment. That may well be using the Mental Health Act. We need to make sure that this happens; I hope it would happen as part of the process as usual, but there is no safeguard in the Bill to make sure that it does. Psychiatrists turning up on the panel at the end is not good enough; they need to be there from the start. Finally, there are broader issues about the interaction with protections to save life, article 2, and a doctor’s duties. I will cover those in the debate on the second grouping, along with the incredible importance of the Bill’s interaction with the suicide prevention strategy.
For reasons of timeliness, I will speak only to amendment 101, which relates to adults with Down syndrome or a learning disability, although the amendment is directly relevant to new clause 1, as the right hon. Member for Hackney North and Stoke Newington (Ms Abbott) spoke about. Amendment 101 would disallow medical practitioners from initiating a conversation about assisted dying with a person who has Down syndrome or a learning disability. I speak primarily from my experience, along with others, on the all-party parliamentary group on Down syndrome and what we have heard from members of that community: people with Down syndrome and their families, and professionals specialising in the condition. Many strong and deeply heartfelt arguments have been put by colleagues, and indeed to all of us by constituents in favour of the Bill, including by families in the most difficult circumstances to imagine—actually, they are sometimes unimaginable circumstances. Nobody could question the conclusions they have come to individually as a result of their circumstances. Equally deeply held and heartfelt points are made to us by people from the other perspective, also informed by their sometimes unimaginable own or family circumstances. Of the arguments put against the Bill, I am particularly drawn to those around coercion. However, it is important to remember that coercion is not entirely a black-and-white matter. At the sharpest end, there are cases where an individual will directly bring pressure to bear on another for their own ends, but there are many gradations below that, and pressure can be felt differently by different people. It may be felt especially by people who worry they are a burden on their family, on caregivers, on the national health service, or indeed more broadly on society. Once assisted dying is an available option, over and above the question of pressure from others, I worry about the effect of pressure from oneself. The Bill stipulates in clause 36 that the Secretary of State will issue a code of practice to ensure that the practitioner establishes that there is a “clear and settled intention” for the person to end their own life, including assessing that that person has “capacity to make such a decision”. That will have material challenges of its own. However, with regard to amendment 101, I am talking about the initiation, suggesting or raising of the matter specifically with an individual who has a learning disability or Down syndrome.
My right hon. Friend is right, of course. When we in this House are told that there will be secondary legislation, guidance or a code of practice, we can only ever take that on trust, and this subject is of such moment that what is on the face of the Bill is that much more important. Given the scale of the decisions that people could make as a result of this legislation, it is right that an additional layer of caution should be applied by legislators. Obviously, it is important not to generalise—every single person is an individual—but it is the case that people with Down syndrome often exhibit distinct social characteristics, including great sociability, empathy, and a strong desire to please others and seek positive social feedback, while also being particularly sensitive to criticism or perceived failure, which can compound issues around communication and comprehension. We do not need to define what can result as coercion to worry about what might happen in that context. Amendment 101 and new clause 1 are about initiating a conversation and ensuring that there are additional safeguards, and I urge the House to apply caution that is commensurate with the gravity of the path that could be embarked upon.
May I gently suggest to the right hon. and learned Gentleman that he might be bringing his remarks to a close? There are many other Members who wish to contribute this afternoon.
I thank the hon. Member for his point of order, but he will know that that is not a matter for the Chair. I remind the House that although there is no formal time limit, many Members wish to contribute in this very important debate and it would be helpful if Members could keep their remarks to within the eight minutes that was suggested.
Order. May I respectfully remind hon. Members that on Report we debate the amendments to the Bill, not the process of how law is made?
Order. Members will be aware that there are still many who wish to contribute to the debate. May I ask that contributions are kept to five minutes?
Order. On that point, I remind Members that we are very short of time.
It would be unprecedented to put a formal time limit on speeches. Please can Members listen to the stricture that we are very short on time? I call Lizzi Collinge.
Order. I urge the few remaining Members who will get in to keep their remarks brief, please.
I thank the hon. Lady for her point of order. She would not wish me to anticipate any decision on a closure motion at the current time, I hope. She makes a valid point that many Members who wish to speak this afternoon will be disappointed, but she will also know that there will be further debate on the second group of amendments.
I reassure the hon. Lady that I have heard her point. I repeat that I will not make a pre-decision on any closure motion that has not yet been moved.
Order. May I just clarify whether the hon. Gentleman was giving way?
It is a pleasure to serve under your chairmanship, Ms Jardine. Let me start by congratulating the hon. Member for Milton Keynes Central (Emily Darlington) on securing this debate. I also pay tribute to my right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell), who is a powerful advocate for global health—I think we can all see why he prefers to be on this side of the dais today rather than where you are, Ms Jardine. Global health is everybody’s health. This year we have significant replenishments for two organisations: Gavi and the Global Fund, which work on the frontline to secure our population against diseases, which do not respect borders. Gavi, the Vaccine Alliance, is a unique alliance of Governments, private sector foundations, civil society organisations and vaccine manufacturers. As we have heard, Gavi has vaccinated more than 1 billion children in 78 low-income countries and saved more than 18.8 million lives. In 2025, Gavi is seeking its eighth replenishment for its five-year strategic period, from 2026 to 2030. It is an impressive organisation; since becoming a shadow Minister in November, I have been pleased to continue to meet Gavi regularly and participate in roundtables as it approaches this crucial milestone. The Global Fund to Fight AIDS, Tuberculosis and Malaria invests in sustainable health systems to eradicate those three diseases. It has saved an estimated 65 million lives. The Global Fund’s eighth replenishment is also happening this year, and it will cover the funding period from 2026 to 2028. Global health is a good example of a positive impact that we can have through aid. If we look, for example, at neglected tropical diseases, we see that our science, technology and research sectors produced both of the world’s first malaria vaccines to be recommended by the World Health Organisation: Mosquirix and R21. During my time as Minister with responsibility for global health, I was fortunate enough to see the UK expertise in infectious diseases at first hand during a visit to the Liverpool School of Tropical Medicine, back in 2020. At the time, it was a Conservative Government who announced £15.5 million to support the Liverpool School of Tropical Medicine in its research on preventing the spread of infectious diseases, such as tuberculosis, and in strengthening health systems in fragile countries. The UK is often cited as a leader in global health. In answers to several of my written questions on the topic—the Minister knows this well—Ministers start by saying: “The UK is one of the largest donors to Gavi”. They then give the reply that many right hon. and hon. Members will be accustomed to—that we need to wait until the spending review, and that all global health investments are being looked at in the round.
The hon. Gentleman is absolutely right that Gavi has the ability to pull in many different donors, but perhaps the specific questions following the ODA cut should be directed to the Minister. Gavi is a good example of how partnership can deliver for the benefit of the most vulnerable. Conservative Governments made significant interventions that contributed to the UK’s reputation as a global health leader. In 2015, we pledged £1.44 billion to Gavi over five years, and in 2020, when we hosted the global vaccine summit, we committed a further £1.65 billion. During the last two Global Fund replenishments, we pledged £1 billion in 2022 and £1.46 billion in 2020. Those pledges to Gavi and the Global Fund were just one part of our leadership and efforts to strengthen global health, and an incredibly important one at that. I note from responses to my written questions that Ministers are often quite keen to highlight our record on global health, but I would like to take this opportunity to ask some questions about the Government’s record to date. Following the reduction in ODA to 0.3% of GNI, I ask the Minister: what does global health now look like from the strategic level of the Foreign, Commonwealth and Development Office? It would be helpful to know where the priorities are and whether the Government plan to continue the emphasis on multilateral NGOs such as Gavi and the Global Fund, or whether other models are to be considered. Although the approach to global health may be changing under this Labour Government, the replenishment periods for Gavi and the Global Fund are rapidly approaching—in fact, Gavi’s is literally weeks away. I would therefore welcome some clarity from the Minister on the discussions he has had with representatives of both funds and other donor nations. I want to press him a little about the absence of any UK pledges to date. I have previously had no luck getting an answer on that through my written questions, so I will have another go today. Has he considered the impact of the UK’s apparent delay in pledging on our international reputation and our standing as a leader in global health?