Lords Chamber
Friday 30th January 2026
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10:06
10:06
Lord Bach (Labour)
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Lord Bach (Labour)
retirement with effect from today of the noble Lord Lord Offord of Garvel. Pursuant to section one of Garvel. Pursuant to section one of the House of Lords Reform Act, 2014, on behalf of the House, I should on behalf of the House, I should like to thank the noble Lord for his valued service to the House. Third Reading of the Secure 16 to
10:07
Lord Bach (Labour)
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Lord Bach (Labour)
The question is that this bill be now. The question is that this bill be now. Read a third time. As many of that opinion will say, content contrary, not content. The
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contents have it. To move that this bill do now pass. My Lords, I only intend to say a few words on the motion. say a few words on the motion. Really? To thank those who have been closely involved with this bill as it passed through bill as it passed through Parliament. I start with my hon. Friend Emma Foudy, Member of Parliament for Cramlington and Killingworth, who carefully guided this bill through the other place. I'd also like to thank my noble friend, the Minister, the noble Lady, Lady Levitt, for her assistance and of course, her officials and others at the Ministry of Justice who have made this task easier.
I'd also like to thank all noble Lords who spoke at the Second Reading of this Bill in this House, and to thank the frontbenchers of all parties who have given the Bill the support it needed to become law. In short, this bill will allow us to continue to transform how we detain children and young people in custody by delivering education and intensive support in secure schools. This bill and the establishment of secure schools, has had the support around the house within the with of secure schools within the custodial estate represents, I believe, a pivotal step in reducing offending for some of our most vulnerable children and young people.
And I am delighted, as I hope the House is, that it will soon be on the statute book. I beg to move.
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contents have it. To move that this bill do now pass. My Lords, I only intend to say a few words on the motion. say a few words on the motion. Really? To thank those who have been closely involved with this bill as it passed through bill as it passed through Parliament. I start with my hon. Friend Emma Foudy, Member of Parliament for Cramlington and Killingworth, who carefully guided this bill through the other place. I'd also like to thank my noble friend, the Minister, the noble Lady, Lady Levitt, for her assistance and of course, her officials and others at the Ministry of Justice who have made this task easier.
I'd also like to thank all noble Lords who spoke at the Second Reading of this Bill in this House, and to thank the frontbenchers of all parties who have given the Bill the support it needed to become law. In short, this bill will allow us to continue to transform how we detain children and young people in custody by delivering education and intensive support in secure schools. This bill and the establishment of secure schools, has had the support around the house within the with of secure schools within the custodial estate represents, I believe, a pivotal step in reducing offending for some of our most vulnerable children and young people.
And I am delighted, as I hope the House is, that it will soon be on the statute book. I beg to move.
10:09
The Earl of Effingham (Conservative)
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The Earl of Effingham (Conservative)
The question is that this bill do now pass. do now pass. >> My Lords. Please let me thank the noble Lord Lord Bach for his efforts to take this Bill through efforts to take this Bill through your Lordships House and for his past work on the Back Commission, which strive to improve the legal aid situation within the UK justice system. As I outlined that Second Reading, Secure 16 to 19 Academies Bill conceptualised in Charlie Taylor's review of the Youth Justice System published in 2016, then agreed upon and adopted by His Majesty's Loyal Opposition when we were in government, and will now be made more practicable and effective as a result of this bill.
Secure schools are an ideal founded upon the principle of rehabilitative justice for our youth, with the vision of improving behaviour, mental health and educational attainment. The nature of this aim means that every offender who enters a secure academy will have different requirements, and the academies must therefore be both flexible and adaptable. The bill reduces expenditure funding for the academies from a seven year to a two year horizon. It removes the requirement that the Secretary of State must take into account local schools before accepting the academy, as pupil intake will largely not, if at all, overlap.
And finally, it requires a consultation with local partners instead of local schools, bringing process in line with purpose. My Lords, it is in everyone's interests that secure academies work. Young offenders will be given a second chance and with a fair wind, they will join the workforce and have every chance to succeed. That is why when in government, we supported the proposals and why we continue to do so now, we need more secure academies and this bill will help deliver that goal.
Secure schools are an ideal founded upon the principle of rehabilitative justice for our youth, with the vision of improving behaviour, mental health and educational attainment. The nature of this aim means that every offender who enters a secure academy will have different requirements, and the academies must therefore be both flexible and adaptable. The bill reduces expenditure funding for the academies from a seven year to a two year horizon. It removes the requirement that the Secretary of State must take into account local schools before accepting the academy, as pupil intake will largely not, if at all, overlap.
And finally, it requires a consultation with local partners instead of local schools, bringing process in line with purpose. My Lords, it is in everyone's interests that secure academies work. Young offenders will be given a second chance and with a fair wind, they will join the workforce and have every chance to succeed. That is why when in government, we supported the proposals and why we continue to do so now, we need more secure academies and this bill will help deliver that goal.
10:11
Baroness Levitt, The Parliamentary Under-Secretary of State for Justice (Labour)
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Baroness Levitt, The Parliamentary Under-Secretary of State for Justice (Labour)
My Lords, I'm very pleased to speak at the Third Reading of this private member's bill. And I too, private member's bill. And I too, want to start with thanks. Thanks first of all, to my noble friend Lord Bach for his steering this bill through the House, and to Emma MP for guiding this small but important bill through the other place. The secure school model has been developed in accordance with the best available evidence for what works in addressing the underlying causes of youth offending, offering children small and homely environments with healthcare and education at their heart.
Importantly, secure schools will allow children in custody to gain skills and qualifications, supporting them to return to the community and lead successful and crime free lives. And in turn, this will protect the public from these children reoffending in the future. This bill will help us achieve this aim, and I am pleased to see the support that the Bill has had from across your Lordships' House.
Importantly, secure schools will allow children in custody to gain skills and qualifications, supporting them to return to the community and lead successful and crime free lives. And in turn, this will protect the public from these children reoffending in the future. This bill will help us achieve this aim, and I am pleased to see the support that the Bill has had from across your Lordships' House.
10:12
Lord Bach (Labour)
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Lord Bach (Labour)
I'd like to thank the noble Earl >> I'd like to thank the noble Earl for what he's had to say. And of course, my noble friend, the Minister. I don't think there's any Minister. I don't think there's any need for me to say anything more.
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Order, order. The question is that this bill do now pass, as many that this bill do now pass, as many of that opinion will say, content contrary, not content. The contents have it.
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have it. My Lords, I will make my usual statement before we start proceedings today. I will keep it
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Order, order. The question is that this bill do now pass, as many that this bill do now pass, as many of that opinion will say, content contrary, not content. The contents have it.
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have it. My Lords, I will make my usual statement before we start proceedings today. I will keep it
10:13
Lord Kennedy of Southwark (Labour)
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Lord Kennedy of Southwark (Labour)
proceedings today. I will keep it short to enable debate to start as soon as possible. I would, however, like to thank noble Lords again for their kind words and constructive discussions during the past week. I continue to do my best to strive to find ways to assist the House in its scrutiny, balancing some difficult and often opposing positions. As I set out last week, following the House is clear indication that he wants more time to consider the bill. I will not seek to adjourn the House at 3 p.m.
but rather at around 6 p.m. noble Lords will not be surprised to hear me say that ultimately, it remains in the hands of the House and other colleagues. Noble Lords may seek to adjourn earlier by moving the motion. The House be now resumed, as we did last week. We will adjourn the committee at a convenient point around 1 p.m. for a 40 minute break, to give those participating a chance to eat. I would hope noble Lords can make more progress than on previous days, and trust that noble Lord will continue in the debate with respect for each other's and different views, remembering that opposing views are just as sincerely held as your views are.
We do not take interventions on interventions, and interventions are the opportunity to ask a short question, not to give another speech. And I've asked this particularly to intervene. That happens. Finally, I place on record, on record, on behalf of the whole House, our thanks to the staff of the House for the usual courtesy, professionalism and excellent service that they provide to members, not only today, but every day. With that, my Lords, I think we should move on to the substance of the Bill and continue our debates.
but rather at around 6 p.m. noble Lords will not be surprised to hear me say that ultimately, it remains in the hands of the House and other colleagues. Noble Lords may seek to adjourn earlier by moving the motion. The House be now resumed, as we did last week. We will adjourn the committee at a convenient point around 1 p.m. for a 40 minute break, to give those participating a chance to eat. I would hope noble Lords can make more progress than on previous days, and trust that noble Lord will continue in the debate with respect for each other's and different views, remembering that opposing views are just as sincerely held as your views are.
We do not take interventions on interventions, and interventions are the opportunity to ask a short question, not to give another speech. And I've asked this particularly to intervene. That happens. Finally, I place on record, on record, on behalf of the whole House, our thanks to the staff of the House for the usual courtesy, professionalism and excellent service that they provide to members, not only today, but every day. With that, my Lords, I think we should move on to the substance of the Bill and continue our debates.
10:15
Lord Ahmad of Wimbledon (Conservative)
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Lord Ahmad of Wimbledon (Conservative)
Before the Chief Whip sits down, and I have. I thank him for the and I have. I thank him for the time he gave me yesterday. There were three very brief points I wanted to make. There has been much speculation and indeed discussion outside your Lordship chamber on both procedure principle and the workings of your Lordships' House. Very briefly on procedure. There has been this week, regrettably, much discussion about the use of the Parliament Act when it comes to the workings of this Bill.
I would ask the noble Lord, the Chief Whip, who I know holds the House in great esteem, and fight the cause, that to clarify the fact that the private member's bill that we have in front of us, it would be unprecedented indeed, if the Parliament Act was to be used in this regard, the last time it was utilised, as all noble Lords know, was in 2004 when the Hunting Act, and indeed that was a government bill. So we would be setting a very different precedent if that was to happen.
The second point is on procedure. If this bill was not to pass, and indeed the Parliament Act was invoked, it is not for the proponents of this bill, the supporters of this bill, to actually make that call. That would be, as my understanding is a matter for. Mr. Speaker, after careful consideration. Equally, on reading the two acts, it is also very clear that the House of Lords would still have a role. And let us not forget, if this was to be presented again in the next session, there's still the small issue of the private members ballot in the other place, and I would again ask the noble Lord to clarify the issues of procedure to allow for the effective debate in your Lordships House.
And thirdly, about the House of Lords itself, in terms of who we are and what we are, as many noble Lords will know, I was on the receiving end for a very long time as 12 years in government across communities, the Home Office, transport and indeed with the Sembler Bill and indeed discussions around the EU and Brexit at the Foreign Office. But everything was, as the noble Lord, the Chief Whip, has said, done in a reasoned way. But one thing, and I say this to someone who I respect personally, greatly, the proposer of this bill, the noble and learned Lord.
We listened and he and I joked recently, I've certainly been doing my part in listening during the Committee stage. I've been here for a large part of it, but I'm yet to intervene. Though I'd warn the noble and learned Lord, that doesn't mean I will not. That said, the value of your Lordships House, I think I recall correctly, the noble Lord Carlile said this, that as we're discussing this, the amendments which are being proposed, and I really pay tribute to the noble Lady Baroness Finlay and the noble Lady Baroness Grey-Thompson, amongst others.
It's being done that if this legislation was to become law, that the duty of care that the government has, and I respect what the Minister has said repeatedly and my noble friends on my frontbench, that this is a position on which both the His Majesty's Government and His Majesty's Official Opposition are neutral, that the protection and security of our citizens is paramount. And that's after listening in your Lordships House, is what I've heard from most, if not many, of the amendments which have been proposed.
Therefore, I ask the good offices of the noble Lord, the Chief Whip, and indeed of the Lord Privy Seal, that in any discussions that take place, as I know they will, there will continue to protect the traditions, the conventions and the procedures of your Lordships House.
I would ask the noble Lord, the Chief Whip, who I know holds the House in great esteem, and fight the cause, that to clarify the fact that the private member's bill that we have in front of us, it would be unprecedented indeed, if the Parliament Act was to be used in this regard, the last time it was utilised, as all noble Lords know, was in 2004 when the Hunting Act, and indeed that was a government bill. So we would be setting a very different precedent if that was to happen.
The second point is on procedure. If this bill was not to pass, and indeed the Parliament Act was invoked, it is not for the proponents of this bill, the supporters of this bill, to actually make that call. That would be, as my understanding is a matter for. Mr. Speaker, after careful consideration. Equally, on reading the two acts, it is also very clear that the House of Lords would still have a role. And let us not forget, if this was to be presented again in the next session, there's still the small issue of the private members ballot in the other place, and I would again ask the noble Lord to clarify the issues of procedure to allow for the effective debate in your Lordships House.
And thirdly, about the House of Lords itself, in terms of who we are and what we are, as many noble Lords will know, I was on the receiving end for a very long time as 12 years in government across communities, the Home Office, transport and indeed with the Sembler Bill and indeed discussions around the EU and Brexit at the Foreign Office. But everything was, as the noble Lord, the Chief Whip, has said, done in a reasoned way. But one thing, and I say this to someone who I respect personally, greatly, the proposer of this bill, the noble and learned Lord.
We listened and he and I joked recently, I've certainly been doing my part in listening during the Committee stage. I've been here for a large part of it, but I'm yet to intervene. Though I'd warn the noble and learned Lord, that doesn't mean I will not. That said, the value of your Lordships House, I think I recall correctly, the noble Lord Carlile said this, that as we're discussing this, the amendments which are being proposed, and I really pay tribute to the noble Lady Baroness Finlay and the noble Lady Baroness Grey-Thompson, amongst others.
It's being done that if this legislation was to become law, that the duty of care that the government has, and I respect what the Minister has said repeatedly and my noble friends on my frontbench, that this is a position on which both the His Majesty's Government and His Majesty's Official Opposition are neutral, that the protection and security of our citizens is paramount. And that's after listening in your Lordships House, is what I've heard from most, if not many, of the amendments which have been proposed.
Therefore, I ask the good offices of the noble Lord, the Chief Whip, and indeed of the Lord Privy Seal, that in any discussions that take place, as I know they will, there will continue to protect the traditions, the conventions and the procedures of your Lordships House.
10:18
Lord Pannick (Crossbench)
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Lord Pannick (Crossbench)
To make. >> To make. >> Two points. Could I ask the Chief Whip to confirm that whether the Parliament Act is invoked is entirely a matter for the House of Commons? That's the first point. The second point is, would the Chief Whip agree that the reason why the Parliament Act is being discussed at the moment is because this is day eight of this committee, and we are still on clause one? Yeah, right. Well, the Chief Whip speaks up. I wasn't going to
10:19
Lord Deben (Conservative)
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Lord Deben (Conservative)
intervene, but the reason that we are here is, frankly, we have are here is, frankly, we have received no answers on any of the points that have been raised by the proposals of this bill. We have no proposals of this bill. We have no idea what amendments might be laid if the proposals of this bill were to show themselves much more to show themselves much more willing to listen to the problems that we have, then it may well be that we could move faster.
But I am that we could move faster. But I am a little bit tired of this general campaign, which suggests that this House, in doing its job, is somehow or other behaving badly.
But I am that we could move faster. But I am a little bit tired of this general campaign, which suggests that this House, in doing its job, is somehow or other behaving badly.
10:19
Lord Blunkett (Labour)
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Lord Blunkett (Labour)
Yes, here. >> Yes, here. >> I am before my noble friend responds. Could I just say that I, when I've not been able to sit in the House in committee, I have followed the debate, and would he agree that it would be really helpful if people debated the bill that is before us, not one that is being made up from outside this house?
10:20
Lord Kennedy of Southwark (Labour)
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Lord Kennedy of Southwark (Labour)
Yeah, right. >> David. >> My Lords, can I firstly say that
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My Lords, can I firstly say that I, I love the house very much and I've been here for 16 years. An absolute privilege to be here every absolute privilege to be here every day, both in opposition and in government. And I know the many. We all come here today, every day, to
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work with the best intentions and with the best interests. Of the. House. And the house itself, over many, many years, has always assisted the other place in improving legislation, scrutinising it, making better bills. And we've it, making better bills. And we've all done that. All of us in opposition in government. And I think we should get that on the think we should get that on the record. First of all, can I thank the honourable Lord for his question and other Lords, particularly for coming to see me yesterday.
So I've had a chance to yesterday. So I've had a chance to to go away and look at some of this stuff. And I'm going to put a statement here to read out to colleagues if you let me get to the end of it and then we'll I think then hopefully I've found a way to hopefully assist colleagues. I think it's fair to say that, you know, that this is. Go on the record that I'm not an expert on the Parliament Act 1949, and it probably not surprised how say it is complicated.
OK. I cannot and will not give you whether or not the bill that can be applied to this bill or any other bill, if noble Lords are interested in the detail, I can refer them to paragraphs 30.49 to 30.56 of Erskine May sets out some very helpful background, as does the note from the House of Commons Library published in February 2016. Ultimately, though, my Lords decisions on the application of the act are for the House of Commons, Erskine May makes it clear in paragraph 30.55 that any final decision must be endorsed by Mr Speaker.
I do not advise the House on a complex procedure to avoid that, and to assist all noble Lords. My office has spoken to the clerk assistant soon to our new clerk of the parliaments, and I'm pleased to announce to the House that the House the clerks will arrange a factual briefing on the details of the Parliament Act and this general application. What the briefing will do is not a discussion about this bill. And what if, what if, what if, but actually how how the Parliament works and how it can be applied to legislation.
But I can confirm for the record that the Parliament Act 1911, as amended by the Parliament Act in 1940 1945, applies to all public bills other than money. Bills and bills extended the maximum duration of a Parliament so it can be applied to private members Bills. The act provides that any bill introduced originally in the House of Commons and passed by the Commons in two successive sessions, with at least one year between the first Commons Second Reading and the Commons. Third Reading in the second session can be presented for Royal Assent to the Commons.
Many of the conditions underlying are open for interpretation and what constitutes rejection by the House of Lords. It has not, though, been applied to a Private Member's Bill to date. It has then been used for several Acts of Parliament. Under the 1911 act, it was used for the Government of Ireland Act 2014, the Welsh Church Act 2014 and interestingly, the Parliament Act 1949 and since 1949 it's been used for the War Crimes Act 1911, the European Parliament Elections Act 1999, the Sexual Offences Amendment Act 2020 and the Hunting Act 2004.
So that's where we are. I will arrange for a proper factual briefing to understand how the Act operates, and I will probably attend the briefing myself. But actually, to be clear, it is a matter for the other place. For Mr. Speaker, it has never been used on
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the Prime Minister up to date. And my Lords, I'm very grateful to the noble. I'm very grateful to to the noble. I'm very grateful to the noble Lord Biggar Chief Whip for his, as always, very kind and for his, as always, very kind and helpful explanations. Could I raise a further point, because I think it affects the proceedings of of your affects the proceedings of of your Lordships' House, as we now go on from today? Of course I would defend to the death the noble and defend to the death the noble and learned Lord Lord Fowler right to appear on the today programme.
But I do think that what he said there made it very difficult for the proceedings that are about to ensue, because he said that he threatened, though I don't think it's in his power. He threatened the Parliament Act, he threatened us with the Parliament Act, but more particularly he said that what was going on in all these proceedings was just a filibuster. And it's not just that that is quite untrue, my Lords, as you will witness through these many, many hours of detailed
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My Lords, can I firstly say that I, I love the house very much and I've been here for 16 years. An absolute privilege to be here every absolute privilege to be here every day, both in opposition and in government. And I know the many. We all come here today, every day, to
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work with the best intentions and with the best interests. Of the. House. And the house itself, over many, many years, has always assisted the other place in improving legislation, scrutinising it, making better bills. And we've it, making better bills. And we've all done that. All of us in opposition in government. And I think we should get that on the think we should get that on the record. First of all, can I thank the honourable Lord for his question and other Lords, particularly for coming to see me yesterday.
So I've had a chance to yesterday. So I've had a chance to to go away and look at some of this stuff. And I'm going to put a statement here to read out to colleagues if you let me get to the end of it and then we'll I think then hopefully I've found a way to hopefully assist colleagues. I think it's fair to say that, you know, that this is. Go on the record that I'm not an expert on the Parliament Act 1949, and it probably not surprised how say it is complicated.
OK. I cannot and will not give you whether or not the bill that can be applied to this bill or any other bill, if noble Lords are interested in the detail, I can refer them to paragraphs 30.49 to 30.56 of Erskine May sets out some very helpful background, as does the note from the House of Commons Library published in February 2016. Ultimately, though, my Lords decisions on the application of the act are for the House of Commons, Erskine May makes it clear in paragraph 30.55 that any final decision must be endorsed by Mr Speaker.
I do not advise the House on a complex procedure to avoid that, and to assist all noble Lords. My office has spoken to the clerk assistant soon to our new clerk of the parliaments, and I'm pleased to announce to the House that the House the clerks will arrange a factual briefing on the details of the Parliament Act and this general application. What the briefing will do is not a discussion about this bill. And what if, what if, what if, but actually how how the Parliament works and how it can be applied to legislation.
But I can confirm for the record that the Parliament Act 1911, as amended by the Parliament Act in 1940 1945, applies to all public bills other than money. Bills and bills extended the maximum duration of a Parliament so it can be applied to private members Bills. The act provides that any bill introduced originally in the House of Commons and passed by the Commons in two successive sessions, with at least one year between the first Commons Second Reading and the Commons. Third Reading in the second session can be presented for Royal Assent to the Commons.
Many of the conditions underlying are open for interpretation and what constitutes rejection by the House of Lords. It has not, though, been applied to a Private Member's Bill to date. It has then been used for several Acts of Parliament. Under the 1911 act, it was used for the Government of Ireland Act 2014, the Welsh Church Act 2014 and interestingly, the Parliament Act 1949 and since 1949 it's been used for the War Crimes Act 1911, the European Parliament Elections Act 1999, the Sexual Offences Amendment Act 2020 and the Hunting Act 2004.
So that's where we are. I will arrange for a proper factual briefing to understand how the Act operates, and I will probably attend the briefing myself. But actually, to be clear, it is a matter for the other place. For Mr. Speaker, it has never been used on
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the Prime Minister up to date. And my Lords, I'm very grateful to the noble. I'm very grateful to to the noble. I'm very grateful to the noble Lord Biggar Chief Whip for his, as always, very kind and for his, as always, very kind and helpful explanations. Could I raise a further point, because I think it affects the proceedings of of your affects the proceedings of of your Lordships' House, as we now go on from today? Of course I would defend to the death the noble and defend to the death the noble and learned Lord Lord Fowler right to appear on the today programme.
But I do think that what he said there made it very difficult for the proceedings that are about to ensue, because he said that he threatened, though I don't think it's in his power. He threatened the Parliament Act, he threatened us with the Parliament Act, but more particularly he said that what was going on in all these proceedings was just a filibuster. And it's not just that that is quite untrue, my Lords, as you will witness through these many, many hours of detailed
10:24
Lord Moore of Etchingham (Non-affiliated)
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Lord Moore of Etchingham (Non-affiliated)
debate, which keeps very careful carefully to the specific points. But it seems to me that what the noble and learned Lord said on the today programme prejudices what we're about to do in the next 6 or 7 days. Because if he's saying it's 7 days. Because if he's saying it's all a charade, what is what are his answers going to be in these coming answers going to be in these coming debates? He's he's repeatedly given very helpful and full answers as we've had these debates.
And he's we've had these debates. And he's never he's never mentioned there's any problem here. And he said when he in the Second Reading of the bill, he said, this House will do what we do best, which is to scrutinise. That's what we're doing. And and yet he said that it's all nonsense. So what are we to make of the answers which he will now give over the intervening days to all Lords?
And he's we've had these debates. And he's never he's never mentioned there's any problem here. And he said when he in the Second Reading of the bill, he said, this House will do what we do best, which is to scrutinise. That's what we're doing. And and yet he said that it's all nonsense. So what are we to make of the answers which he will now give over the intervening days to all Lords?
10:25
Lord McLoughlin (Conservative)
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Lord McLoughlin (Conservative)
The government Chief Whip, in his opening statement, said that he's not an expert on the he's not an expert on the Parliament Act. I think he's soon going to become one. The. I wonder if I could ask him a question for to ensure that the briefing covers if if it doesn't already and that is that in the in the event that this bill doesn't make its progress in this House and therefore is reintroduced into the Commons next year, for this to be used by the Parliament Act, would it have to be introduced by a private member, or could the government introduce it, and it then take effect with the Parliament Act, without it being as a result of the private members ballot in the House of Commons?
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Lord Stern very briefly, I, I'd like to put on record my thanks to the noble Lord, the Chief Whip, for the noble Lord, the Chief Whip, for being absolutely helpful to all sides, I think, in this whole procedure. So I really want to say that's been very helpful. Just following on from the noble Lord, following on from the noble Lord, Lord Moore, I wanted to say that in my various public events that I've done recently, in the last week, done recently, in the last week, I've been told by members of the public.
Oh, I see that the bill is going to invoke the Parliament Act. And so what's the point? Some of them have been supporters of the bill. Some of them have been
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Lord Stern very briefly, I, I'd like to put on record my thanks to the noble Lord, the Chief Whip, for the noble Lord, the Chief Whip, for being absolutely helpful to all sides, I think, in this whole procedure. So I really want to say that's been very helpful. Just following on from the noble Lord, following on from the noble Lord, Lord Moore, I wanted to say that in my various public events that I've done recently, in the last week, done recently, in the last week, I've been told by members of the public.
Oh, I see that the bill is going to invoke the Parliament Act. And so what's the point? Some of them have been supporters of the bill. Some of them have been
10:26
Baroness Fox of Buckley (Non-affiliated)
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Baroness Fox of Buckley (Non-affiliated)
worried about the bill. But everybody seems to think that that's what's happening. And it's been done by media briefings. And been done by media briefings. And it's quite demoralising to be in a situation where you're told you're situation where you're told you're effectively wasting your time. In answer to the noble Lord, Lord Blunkett, I'd just like to say that Blunkett, I'd just like to say that in preparing for worrying about getting the wording right on the getting the wording right on the amendments, I want to speak on that.
I have read this bill a number of times, understatement, and have tried to take seriously the role that we are given here. In terms of scrutiny, I have not where it's been impossible to speak and not know anything about it. I just haven't said anything I've done, as has been suggested. Listen. But this is not about an imagined bill. It's about the bill we have before us and gaps in it that some of us are worried about what is not said, what will happen if those gaps aren't filled? I just think it's very important, whatever side we're on in this, to treat each other as though we're acting in good faith, because we are acting in good faith.
And what's discrediting to the House a media briefing suggesting that there's some cynical plot of outside forces that somehow are all influenced by hidden religious views, I think was one phrase that was used. Can I just point out, I think this bill requires us to be deeply moral and ethical, whatever side we're on, because we're talking about life and death issues. We're talking about a change in the constitution of the NHS and so on. I won't go on.
And but we have to assume that we are in good faith because we are in good faith. It's nerve wracking enough taking on an issue like this without then having the media basically being told by the media, as I was last night on Newsnight in the gap, where they said, oh well, you lot are just all being manipulated by forces anyway, I finished.
I have read this bill a number of times, understatement, and have tried to take seriously the role that we are given here. In terms of scrutiny, I have not where it's been impossible to speak and not know anything about it. I just haven't said anything I've done, as has been suggested. Listen. But this is not about an imagined bill. It's about the bill we have before us and gaps in it that some of us are worried about what is not said, what will happen if those gaps aren't filled? I just think it's very important, whatever side we're on in this, to treat each other as though we're acting in good faith, because we are acting in good faith.
And what's discrediting to the House a media briefing suggesting that there's some cynical plot of outside forces that somehow are all influenced by hidden religious views, I think was one phrase that was used. Can I just point out, I think this bill requires us to be deeply moral and ethical, whatever side we're on, because we're talking about life and death issues. We're talking about a change in the constitution of the NHS and so on. I won't go on.
And but we have to assume that we are in good faith because we are in good faith. It's nerve wracking enough taking on an issue like this without then having the media basically being told by the media, as I was last night on Newsnight in the gap, where they said, oh well, you lot are just all being manipulated by forces anyway, I finished.
10:29
The Lord Bishop of Southwark (Bishops)
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The Lord Bishop of Southwark (Bishops)
Can I just finish? I think we actually proposed to me questions to me on the made not debating the to me on the made not debating the bill. So here are some questions. I'll do my best to answer them. >> My Lords. >> I also wish to.
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I also wish to. Speak in good faith. That is what all our committee consideration has been about. Almost every speech I have heard and listened to, and I've made an effort to attend a good number of days in which the committee has been thing, and I'm very grateful to the government Chief Whip for what he has said, and I am also very grateful to the noble Lord, Lord Faulkner, for saying on the today programme that he now anticipates that the Bill will fall.
And so my question is, if and when it does, would it please be factored into consideration the need for a Royal Commission on dying? Well.
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I also wish to. Speak in good faith. That is what all our committee consideration has been about. Almost every speech I have heard and listened to, and I've made an effort to attend a good number of days in which the committee has been thing, and I'm very grateful to the government Chief Whip for what he has said, and I am also very grateful to the noble Lord, Lord Faulkner, for saying on the today programme that he now anticipates that the Bill will fall.
And so my question is, if and when it does, would it please be factored into consideration the need for a Royal Commission on dying? Well.
10:29
Baroness Jay of Paddington (Labour)
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Baroness Jay of Paddington (Labour)
My Lords, I think it's relevant >> My Lords, I think it's relevant to the points which have been made, which is that if the we did which is that if the we did consider this Bill again under the Parliament Act, those amendments which this House passed would have a far on this session, would have a far greater chance of surviving than subsequent proceedings. And therefore it is actually important to those who wish to amend the bill that they amend it now.
And I would Lords.
And I would Lords.
10:30
Lord Carlile of Berriew (Crossbench)
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Lord Carlile of Berriew (Crossbench)
I have a question for the noble Lord, the Chief Whip, which is to ask him whether he will protect the House from what I see as double standards. Yesterday we received the noble and learned Lord, the the noble and learned Lord, the sponsors, in Terrorem declaration that he would do something that he has no power to do, which is invoke the Parliament Act, but at the same time, in credit to the noble and learned Lord, he wrote a letter running into the fourth page, in which, after seven weeks of Committee stage, he accepted a large number of propositions made during Committee stage in your Lordships House, which surely is a demonstration, that Committee stage in your Lordships House matters is useful, and is not evidence for the use of the Parliament Act.
10:31
Baroness Falkner of Margravine (Crossbench)
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Baroness Falkner of Margravine (Crossbench)
My Lords, I will have a very brief question relating to the brief question relating to the Chief Whip's own exhortation to us this morning that, as usual, we this morning that, as usual, we should remain brief. And it is this in the noble and learned Lords interview on the today programme yesterday, he repeatedly said it was a very few number of members of this House who were delaying, filibustering and delaying the passage of the bill. Would the House accept that many of us, many people across this House, would wish to intervene on every amendment, but we hold back to allow those who are more expert than us to to to articulate our concerns in order not to delay the passage of this bill.
It is our self-restraint that makes us arrive at where we are today here.
It is our self-restraint that makes us arrive at where we are today here.
10:32
Lord Blencathra (Conservative)
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Lord Blencathra (Conservative)
And I've sat through every day. Last Friday, I didn't say a single word. word. >> My Lords, for. >> My Lords, following the point. >> Made by the noble and learned
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Made by the noble and learned Lord Lord Carlile I, we seem to be in the extraordinary position that the noble and learned Lord Doyle Falconer has now brought forward a series of large new clauses and amendments. He has admitted the Bill is fundamentally flawed. Yet, on the other hand, he's threatening to drive it through with a Parliament Act, and doing the Be the Parliament Act would mean driving through this bill, which he now admits is fundamentally flawed and needs amendments. Am I saying something illogical there?
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Made by the noble and learned Lord Lord Carlile I, we seem to be in the extraordinary position that the noble and learned Lord Doyle Falconer has now brought forward a series of large new clauses and amendments. He has admitted the Bill is fundamentally flawed. Yet, on the other hand, he's threatening to drive it through with a Parliament Act, and doing the Be the Parliament Act would mean driving through this bill, which he now admits is fundamentally flawed and needs amendments. Am I saying something illogical there?
10:32
Baroness Young of Old Scone (Labour)
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Baroness Young of Old Scone (Labour)
Make one point on behalf of silent backbenchers across the silent backbenchers across the House. The only opportunity, if we're not actively speaking on amendments, to express a view about the elements of this bill, will be when we get to the point where we vote and on the current progress, we're never going to get to the point where we vote. And personally, I feel very disenfranchised by that. And I do wonder whether there is a way we can get to a point where the house as a whole, every individual one of us, can express a view.
That doesn't mean that we're disenfranchised.
That doesn't mean that we're disenfranchised.
10:33
Baroness Berridge (Conservative)
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Baroness Berridge (Conservative)
Yeah. >> Yeah. >> I'm sad to add to the list of
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I'm sad to add to the list of requests to the Chief whip, but I was saddened to hear the allegation was saddened to hear the allegation on the today programme that those opposing the bill are just this sort of random group of religiously motivated people. It's not how I have ever been treated as a Christian in this House. It also came on the back of questioning covered by parliamentary privilege of the representative of the British Association of Social Workers.
The representative was chosen by the professional body to come to us and faced questioning from the noble, from one of the members of our committee that basically said to him, and I summarise that do you have a right to put your views on others as a vicar in any other forum that is a breach of the Equality Act? Had you not got parliamentary privilege? So could I ask the Chief Whip to please look at the Code of Conduct as to whether or not these lazy allegations that somehow religiously motivated people might actually just also be ignorant, should not be made on the today programme or in questioning of witnesses in a select committee of your Lordships House.
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I'm sad to add to the list of requests to the Chief whip, but I was saddened to hear the allegation was saddened to hear the allegation on the today programme that those opposing the bill are just this sort of random group of religiously motivated people. It's not how I have ever been treated as a Christian in this House. It also came on the back of questioning covered by parliamentary privilege of the representative of the British Association of Social Workers.
The representative was chosen by the professional body to come to us and faced questioning from the noble, from one of the members of our committee that basically said to him, and I summarise that do you have a right to put your views on others as a vicar in any other forum that is a breach of the Equality Act? Had you not got parliamentary privilege? So could I ask the Chief Whip to please look at the Code of Conduct as to whether or not these lazy allegations that somehow religiously motivated people might actually just also be ignorant, should not be made on the today programme or in questioning of witnesses in a select committee of your Lordships House.
10:34
Baroness Coffey (Conservative)
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Baroness Coffey (Conservative)
You jester. >> To the Chief Whip, that in addition to the clerk seminar, that noble Lords might want to speak to the noble Lord Lord Spellar he actually a private member's bill didn't proceed in this House, so he used the Parliament Act or started the process that would trigger the Parliament Act if necessary. And therefore, I think he can give you give everybody some practical experience as well as the theoretical from on good clerks.
10:35
Lord Kennedy of Southwark (Labour)
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Lord Kennedy of Southwark (Labour)
Can I firstly say that if I >> Can I firstly say that if I don't cover all the points that my door is open at all times, and I door is open at all times, and I will and generally please come and see me, you know, because I genuinely want to be helpful to the house and to help all members here. A couple of things. I firstly say that the Baroness Coffey I first met Lord Spellar when I was 16, and that's a very good advice.
I've he's been a friend of mine since then, so he's a thoroughly good, noble Lord. I always listened very, very carefully. Can I say just going around the house a few things. The Royal commission, that is not for me, that, you know, that would be a matter for the government to look at in terms of protecting the House's procedures. That is obviously one of my roles, and I try and do that as best as I can to defend the house, defend the house of all members in the House to to have their say.
We are called self-regulated and we all actually treasure our self regulating status. I do also though of course to be self regulating you have to show some self regulation then. So and be mindful of that. Because the alternative, of course, is that we do end up with a House of Commons type procedures, which of course no one would want to see. So we do actually need to think when we are speaking what we are doing or not doing things that we have to ourselves regulate and ensure that that carries on.
In terms of the PM being brought back by the government. The government has no intention of bringing this. This will remain a private member's bill. There'll be no change to the government bringing this in the next session. I'm going to say to the House, I have enough problems getting the government's programme through at the moment, let alone trying to deal with this bill. So I promise you, it's not going to come back as a government bill. At the end of the day, if this bill and this is why I don't want to get into lots of what if, what if, what ifs, you know, if this this bill falls, it may get come back through the house, it may get through.
And then then the parliament may be applied. But that's a matter for the other house. And it's not a matter for me, for any other member of the House to determine what the other House does or what Mr. Speaker does. So that'll be a matter for them if it happens at all. So that's all I can say there. I didn't listen to my friend on the today programme. I'm sorry. I usually do listen, but I actually missed that one. I must get catch on catch up, I think, and see what was said, because clearly it actually has a lot of bearing, a lot of members today.
What I would say at the end of the day, lots of things get get around the media, lots of speculation. There's been pages written in newspapers about this. At the end of the day, this House will decide what he does with this bill, and no one else will decide that it's up to this House now. I think we should make more progress. I think, you know, and as I said earlier, if the Parliament Act would be applied, there are many conditions that would be applied to make that happen.
And they would look at I would suspect they would look at how the House of Lords has dealt with the Bill, but that is a matter for the other place, not for me or any other member here. I think I've covered most issues there, right. You know, but please come and see me if you if you. Oh, sorry.
I've he's been a friend of mine since then, so he's a thoroughly good, noble Lord. I always listened very, very carefully. Can I say just going around the house a few things. The Royal commission, that is not for me, that, you know, that would be a matter for the government to look at in terms of protecting the House's procedures. That is obviously one of my roles, and I try and do that as best as I can to defend the house, defend the house of all members in the House to to have their say.
We are called self-regulated and we all actually treasure our self regulating status. I do also though of course to be self regulating you have to show some self regulation then. So and be mindful of that. Because the alternative, of course, is that we do end up with a House of Commons type procedures, which of course no one would want to see. So we do actually need to think when we are speaking what we are doing or not doing things that we have to ourselves regulate and ensure that that carries on.
In terms of the PM being brought back by the government. The government has no intention of bringing this. This will remain a private member's bill. There'll be no change to the government bringing this in the next session. I'm going to say to the House, I have enough problems getting the government's programme through at the moment, let alone trying to deal with this bill. So I promise you, it's not going to come back as a government bill. At the end of the day, if this bill and this is why I don't want to get into lots of what if, what if, what ifs, you know, if this this bill falls, it may get come back through the house, it may get through.
And then then the parliament may be applied. But that's a matter for the other house. And it's not a matter for me, for any other member of the House to determine what the other House does or what Mr. Speaker does. So that'll be a matter for them if it happens at all. So that's all I can say there. I didn't listen to my friend on the today programme. I'm sorry. I usually do listen, but I actually missed that one. I must get catch on catch up, I think, and see what was said, because clearly it actually has a lot of bearing, a lot of members today.
What I would say at the end of the day, lots of things get get around the media, lots of speculation. There's been pages written in newspapers about this. At the end of the day, this House will decide what he does with this bill, and no one else will decide that it's up to this House now. I think we should make more progress. I think, you know, and as I said earlier, if the Parliament Act would be applied, there are many conditions that would be applied to make that happen.
And they would look at I would suspect they would look at how the House of Lords has dealt with the Bill, but that is a matter for the other place, not for me or any other member here. I think I've covered most issues there, right. You know, but please come and see me if you if you. Oh, sorry.
10:37
Baroness Berger (Labour)
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Baroness Berger (Labour)
Forgive me. I'm. I'm listening very carefully. If I can just ask very carefully. If I can just ask for a point of clarification from my noble friend. I've been listening to you very carefully, and obviously we listened to his and obviously we listened to his advice and guidance and and my noble friend has said twice now that we should be seeking to make more progress. We've had other members during the course of this conversation reflect on the fact that we're only at clause one. Obviously, behind that is 295 amendments that we've considered over the course of the last seven Fridays, which equates to around 7.5 minutes per amendment.
Can I speak my noble friend's guidance on how many minutes we should be seeking to cover during each amendment, and on on the basis that he would like us to make more progress?
Can I speak my noble friend's guidance on how many minutes we should be seeking to cover during each amendment, and on on the basis that he would like us to make more progress?
10:38
Lord Kennedy of Southwark (Labour)
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Lord Kennedy of Southwark (Labour)
But I can't do that. What I what >> But I can't do that. What I what I can say to noble Lady in my 16 years in the house, you know, some groups take longer than others, some go very quickly. And I just think we just need to use all use our best endeavours to actually make some more progress. But you can't actually set a minutes per group. It doesn't work like that sometimes. I've sat here and it's been 2 or 3 minutes in a group dealt with very quickly.
I've sat here for 3 or 4 hours sometimes, you know, but I do just think all of us should try and make more progress. You know, if you sat for five, four, five, six, seven hours and only done 2 or 3 groups, that is, in my opinion, quite slow, and we should look in more more than that. That's all I can help my my noble friend.
I've sat here for 3 or 4 hours sometimes, you know, but I do just think all of us should try and make more progress. You know, if you sat for five, four, five, six, seven hours and only done 2 or 3 groups, that is, in my opinion, quite slow, and we should look in more more than that. That's all I can help my my noble friend.
10:39
Baroness O'Loan (Crossbench)
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Baroness O'Loan (Crossbench)
Can I just say. >> Can I just say. >> That some of those groups have had nearly 100 amendments in, which is quite a lot. But the second is quite a lot. But the second thing I want to say, my Lords, in this week of the Holocaust, when we remember the Holocaust, this house, your Lordships House, which makes law for the whole country, which requires respect for people's rights, including their rights of freedom of religion, this House is compelling us to sit until 6:00.
Our Jewish members are unable to do so, and I have seen them very quietly leaving Friday after Friday. The other thing I would say is that the members of the Muslim community are also adversely affected by the sitting arrangements, and those who have a disability and who can't attend because of the current arrangements are prejudiced. My Lords, we do not do ourselves a service when we discriminate on grounds of religion and disability.
Our Jewish members are unable to do so, and I have seen them very quietly leaving Friday after Friday. The other thing I would say is that the members of the Muslim community are also adversely affected by the sitting arrangements, and those who have a disability and who can't attend because of the current arrangements are prejudiced. My Lords, we do not do ourselves a service when we discriminate on grounds of religion and disability.
10:40
Lord Kennedy of Southwark (Labour)
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Lord Kennedy of Southwark (Labour)
As the noble Lady knows, this has been this issue question raised has been this issue question raised a number of weeks now, and I've met a number of noble Lord Lansley matter. Can I say that? As I've said before, it's up to any noble Lord Hall which they wish to move the house to. Now the house can resume at any time. And when I said I would not come back to 6:00. Of course, the other point is, of course we do set a target for every day to get our members get to.
We get to the target, we can go home. So if we got to target much earlier, we would leave earlier. The 6:00 is a maximum. It's not the actual. We don't have to go to 6:00. We could get to target and go home much earlier if we wanted to, but I've tried to, in my discussion with colleagues, try to put in place procedures that help people who need to leave for for other reasons, such as disability or religion.
We get to the target, we can go home. So if we got to target much earlier, we would leave earlier. The 6:00 is a maximum. It's not the actual. We don't have to go to 6:00. We could get to target and go home much earlier if we wanted to, but I've tried to, in my discussion with colleagues, try to put in place procedures that help people who need to leave for for other reasons, such as disability or religion.
10:41
Baroness Blackstone (Labour)
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Baroness Blackstone (Labour)
My Lords, in response to what my noble friend Chief Whip has said, he has quite rightly pointed to the lack of progress that we're making lack of progress that we're making on this bill. And part of the problem is not how much time we spend on each individual amendment, but the number of amendments that have been put down, which is unprecedented. And I hope that those who are opposed to the Bill will accept that many of us who are in favour of the Bill understand completely the good faith of those who are querying some aspects of it.
But what we're worried about is that we're not going to be able to properly consider this bill because of the amount of time that has been taken on many, many, many amendments, quite often rather absurd ones, and sometimes ones that are completely repeating what have already put forward. And lastly, I want to say, just in defence of my noble friend, the sponsor of this bill, he has responded in these debates with courtesy, consideration and taking seriously what has been said.
And I think it's very unfair to criticise him. He has also responded in a letter, as has already been stated, setting out which amendments he intends to take further and come up with a response at Report stage.
But what we're worried about is that we're not going to be able to properly consider this bill because of the amount of time that has been taken on many, many, many amendments, quite often rather absurd ones, and sometimes ones that are completely repeating what have already put forward. And lastly, I want to say, just in defence of my noble friend, the sponsor of this bill, he has responded in these debates with courtesy, consideration and taking seriously what has been said.
And I think it's very unfair to criticise him. He has also responded in a letter, as has already been stated, setting out which amendments he intends to take further and come up with a response at Report stage.
10:42
Lord Harper (Conservative)
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Lord Harper (Conservative)
Yeah. >> Lords. >> Just before the Chief Whip response to that, responding directly to that point, it is directly to that point, it is indeed true that the noble and learned Lord, Lord Falconer wrote to some members yesterday. Sadly, I didn't receive his letter directly from him, but it was forwarded to me. Part of the problem here, directly relating to the noble Ladies question. The committees of this House reported some months ago the delegated powers Committee, for example, in September.
If this was a government bill, the Minister would have been expected to set out a thorough, detailed response to all of those points. Before we started the Committee stage, we only received a letter yesterday from the noble and learned Lords setting out his points, and in most of the cases, he said the amendments would follow later if that had happened earlier. There are many amendments that would not need to have been tabled. So I think if she's looking to where the reason for delay is, it isn't on just one side of the house.
If this was a government bill, the Minister would have been expected to set out a thorough, detailed response to all of those points. Before we started the Committee stage, we only received a letter yesterday from the noble and learned Lords setting out his points, and in most of the cases, he said the amendments would follow later if that had happened earlier. There are many amendments that would not need to have been tabled. So I think if she's looking to where the reason for delay is, it isn't on just one side of the house.
10:43
Lord Kennedy of Southwark (Labour)
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Lord Kennedy of Southwark (Labour)
Yeah. >> Yeah. >> The all I can say briefly and I we've now been here 30 minutes, so maybe we can get on to the bill fairly shortly. Is that obviously this is not a government bill. It's not going to become a government bill. I think my friend, my noble friend always deals with the House courteously when he deals stuff with his amendments and he sees the House and has got great stamina to stay here. Not always do to deal with all these matters.
Amendments before the House I think that it is an unprecedented number of amendments, but I do think that we can all work together. We can make more progress on this bill going forward, and that's what we should be seeking to do. I think that all members are put down in good faith and we should accept that. But actually, we then should seriously deal with the issues and all members should, you know, work on that basis. And I don't believe anyone is acting in bad faith here.
I would never suggest that. But I do think we do need to work together to make more progress. We have a quite a number of days in committee now and not much progress. And if I was if this was a government bill, I would be very agitated that we were making so little progress on a government bill. So but it's not just I accept that and it won't become a government bill. But I do think at this stage now having 30, nearly 32 minutes now on questions, we actually do need to move on to the substance and try and make more
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progress today. Yeah, yeah. House, do we again in committee on the terminally ill adults end of
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on the terminally ill adults end of life. Bill, Lord Falconer of Thoroton. Beg to me. I, my Lords, I beg
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Beg to me. I, my Lords, I beg leave to move that the House do now resolve itself into a committee on the bill. The question is that the House
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The question is that the House do now again resolve itself into a committee upon the bill, as many of that have been so content, contrary,
Amendments before the House I think that it is an unprecedented number of amendments, but I do think that we can all work together. We can make more progress on this bill going forward, and that's what we should be seeking to do. I think that all members are put down in good faith and we should accept that. But actually, we then should seriously deal with the issues and all members should, you know, work on that basis. And I don't believe anyone is acting in bad faith here.
I would never suggest that. But I do think we do need to work together to make more progress. We have a quite a number of days in committee now and not much progress. And if I was if this was a government bill, I would be very agitated that we were making so little progress on a government bill. So but it's not just I accept that and it won't become a government bill. But I do think at this stage now having 30, nearly 32 minutes now on questions, we actually do need to move on to the substance and try and make more
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progress today. Yeah, yeah. House, do we again in committee on the terminally ill adults end of
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on the terminally ill adults end of life. Bill, Lord Falconer of Thoroton. Beg to me. I, my Lords, I beg
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Beg to me. I, my Lords, I beg leave to move that the House do now resolve itself into a committee on the bill. The question is that the House
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The question is that the House do now again resolve itself into a committee upon the bill, as many of that have been so content, contrary,
10:45
Baroness Grey-Thompson (Crossbench)
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Baroness Grey-Thompson (Crossbench)
believe we'll have an impact on the groupings that we are about to groupings that we are about to debate today. And I did notify the Chief Whip and the clerks of my intention to raise this, and also intention to raise this, and also the noble Lord, Lord Falconer, the noble Lord, Lord Falconer explained in his letter this week which has in his letter this week which has been raised. The recognises the concerns raised about independent advocates and that following discussions with the sponsoring discussions with the sponsoring Another place and their amendments, he has tabled changes.
And the reason I'm raising this now is, I think, the sense of frustration that we aren't getting answers to the amendments that we are tabling in good faith, and I hope he will be able to answer these questions so that we can move a bit more pace. So I would like to propose those changes that he suggested relate to what was agreed in another place. The amendments in the comments were understood to introduce independent advocates as a mandatory safeguard, and this is an area that many of us are concerned about, and reflecting the fact the individuals in scope may have substantial difficulty in understanding the process or communicating their wishes.
And under the noble Lord, Lord Falconer. Amendments, however, a person is treated as having an independent advocate, even if the advocate is not present or involved in the decision making process. The amendments do not require an advocate to be present. When the coordinating or independent doctor meets with the patient, nor when the panel considers the case. Advocacy is therefore satisfied by instruction alone rather than active participation, and in addition, advocacy is made conditional on request. The preliminary discussion may proceed without an advocate and a qualifying person may refuse one.
So could the noble and learned Lord please explain whether he considered this framework to preserve the substance of the Commons concession, or whether he accepts that it represents a shift away from a mandatory safeguard towards a more discretionary model? And in particular, how does the noble and learned Lord address the concern that people who qualify precisely because they struggle to understand are required, unaided, to decide whether to waive one of the bill's central protections at the very outset of the process?
And the reason I'm raising this now is, I think, the sense of frustration that we aren't getting answers to the amendments that we are tabling in good faith, and I hope he will be able to answer these questions so that we can move a bit more pace. So I would like to propose those changes that he suggested relate to what was agreed in another place. The amendments in the comments were understood to introduce independent advocates as a mandatory safeguard, and this is an area that many of us are concerned about, and reflecting the fact the individuals in scope may have substantial difficulty in understanding the process or communicating their wishes.
And under the noble Lord, Lord Falconer. Amendments, however, a person is treated as having an independent advocate, even if the advocate is not present or involved in the decision making process. The amendments do not require an advocate to be present. When the coordinating or independent doctor meets with the patient, nor when the panel considers the case. Advocacy is therefore satisfied by instruction alone rather than active participation, and in addition, advocacy is made conditional on request. The preliminary discussion may proceed without an advocate and a qualifying person may refuse one.
So could the noble and learned Lord please explain whether he considered this framework to preserve the substance of the Commons concession, or whether he accepts that it represents a shift away from a mandatory safeguard towards a more discretionary model? And in particular, how does the noble and learned Lord address the concern that people who qualify precisely because they struggle to understand are required, unaided, to decide whether to waive one of the bill's central protections at the very outset of the process?
10:47
Lord Falconer of Thoroton (Labour)
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Lord Falconer of Thoroton (Labour)
These questions relate to a detailed amendment that I tabled detailed amendment that I tabled yesterday about clause 22, which is providing an independent advocate providing an independent advocate to help people who need assistance. I will read the questions that the noble Baroness has given me. She noble Baroness has given me. She didn't give me notice of the particular questions. I make no complaint about that at all. The appropriate place to deal with these seems to me, when we get to the amendments in relation to clause 22.
10:48
AMDT: 60
Baroness Coffey (Conservative)
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AMDT: 60
Baroness Coffey (Conservative)
amendment 60 in my name. I'm grateful to the noble Lords Lord Harper and MP for signing that. I'll also be speaking to amendment 65 that I've tabled, as well as consideration, consideration of an amendment put forward by the Shadow Front Bench. My Lords, it's slightly disappointing that the Justice Minister has not in her place on the front bench today, because part of what I want to discuss by these amendments is important about the assessments and in consideration of whether or not somebody has capacity, that is actually an act under the basis of which actually the Ministry of Justice is responsible.
And indeed several other aspects of what I prepared to say. My Lords, we are only at clause one on subsection three, but I feel that this is a key element to consider carefully. Basically, what and where do the all these issues have to happen and whether it has to happen face to face. Now, as the Bill reads currently, it suggests that it's only the initial request for assistance. The first declaration, the doctor's assessment, and the second doctor's assessment, and indeed, then the second declaration has to happen while the person requests making all these requests is in the country, no other part of this bill, including preliminary discussions, actually the act itself.
But all these other things don't have to happen in this country, or the person doesn't have to be here. And I think I've made it clear in a series of elements that I've made to the House, my concern about how this becomes not something that just gets decided on the papers, but there's real interaction in trying to understand how this bill will work in practice. And that's why I've added a series of that, of whether or not the person who's making the request, the terminally ill person, has to be in the country.
But we should get into other aspects of whether or not things like the panel has to be here. Now, one of the things that I've put this in place to try and make sure we had a debate earlier in, in the committee's considerations, where I tried a clumsy attempt of how to have people actually in this country, because as I made the point before, you can be ordinarily resident in more than one country at the same time. So that's why I wanted to continue to focus on this.
Being a person patient, I don't really like calling it a patient because I don't consider this to be a health treatment, but a person based process. And for me, a lot of that is about where somebody is and whether or not there is that face to face link. Now, the government in a different policy has recently rightly wants to accelerate and increase substantially the number of face to face assessments being done for consideration of basically eligibility for sickness benefits. A lot of that was changed during Covid because, frankly, it was not practical to undertake that sort of process, and it has been gradually being brought back and needs to be accelerated.
But I think that thinking that is going alongside that policy is critical to the application of this bill. Now, the other, as far as I can see, the way I've interpreted three B is that it's only sections ten and 11 have to be done by persons in England and Wales, and that is the initial assessments. And I put it to the committee, to your Lordships, that a lot more of this should be done face to face.
As Jake the late James Munby pointed out, it's absolutely right that the panel should be considering this process. Looking into this, I'm conscious there'll be medics here who have perhaps even greater understanding of I, of how the variety of assessments should be done face to face. What happens when people making a declaration? Are we sure that somebody isn't in the room giving them the eyes that they'll do the right answers, as opposed to understanding whether coercion can happen or not? And indeed, in a documentary undertaken by ITV, it I think it was the bill's promoter, Kim Leadbeater expressed concern when she saw what happens in Oregon, where a lot of this is done by video.
Link expressed her concerns and indeed I believe considered that she would was uncomfortable and would consider adding an amendment to make clear that consultations with doctors could not be done by video call, and that they should be done in person. Now, that hasn't happened so far by the bill promoters and no explanation has been given. But that's why I've tabled these amendments, because I think they're a very important way of making sure safeguards are there, so that as we go through this novel process to us, I appreciate not novel to the world, but that we have every confidence that a lot of the safeguards on which people are concerned about are going to be appropriately applied.
So one of the things that we started discussing in a different group, brought forward by the nobles, noble Lord Birt, last week gave us a picture of how this could start to look. And indeed, the noble and learned Lord McInnes amendments, I think, have started to touch on aspects of this about how Commissioner can happen. But I can see very quickly, especially bearing in mind some of the amendments last week, which I appreciate, the noble and learned Lord Coaker did not accept.
But this is where almost every day a panel could be meeting. Right now, it could be somebody on holiday in Tenerife, it could be somebody else elsewhere, meeting in a video, a zoom, a teams meeting, whatever. And that feels to me like it could become quite a routine tick box exercise. And the very reason the late Sir James Munby pointed out why this should not be given to judges is to avoid. What is the point of having the judge if it's just going to be tick box exercise? And I think we need to be careful that we do not end up in that situation here.
In terms of specifically, I've suggested what needs to be done face to face. That's in amendment 65. It is the preliminary discussion. It is the request is is in the bill. It is actually the witness. The witness should be there face to face. I think that's seems sensible. We've got the first and second assessment already as, as their I think we could go further. What about the interaction with the independent advocate. Is that just going to be done down the phone.
These are the serious things which I think we need to consider. Should the panel be meeting face to face with the person applying or. I appreciate that, as in the amendment. 320 A the assumption is it should be face to face, but perhaps by exceptions by video link. But again, I think when I initially started observing this at the other end, I did think this would happen. And actually what seems to evolve is a lot of this will just be done remotely.
About the only thing which is in the I haven't included in amendment 65, is that the actual doctor being there and the assessment hopefully happening in this country, although that isn't specified in this bill, I appreciate, but the 25 three does actually say the coordinating doctor has to be there and provide in person, although actually in the following clause that can all be delegated to somebody else. So, my Lords, I don't want to overly labour the point at in consideration, but I hope it does give some thoughts to noble Lords on how they want to see this Bill work in practice.
It may be that people are very happy for this. All just happen in video. When why are we getting in the way? Isn't this just about autonomy? I think this would be sensible amendments to consider in order to make sure that while no Minister yet has said there's a safe bill, but make it as safe as possible, that we need to look at the operation of it, it's certainly the case in other parts of the health system that this a lot of this would not be acceptable.
A lot of this would have to be done face to face. And I don't think it is a case of overengineering this bill or leaving it to regulations. I think we should be clear in Parliament that this is what we are going to do. I am conscious of thinking of amendment 320 A, and I appreciate that. My noble friend Lord Evans of Rainow in 376 has particularly singled out in person for for parts of Paul's 12. I do get it that some people may be so terminally ill.
Perhaps a video link may be there, but I don't. I think that should be exceptionally rare if we are going to go down that route at all. So I'll be looking forward to hearing my noble friend explain why that is the case and how it can be administered. But with that, I beg to move.
**** Possible New Speaker ****
Amendment. Proposed clause one, page one. Line 21. Leave out eight, page one. Line 21. Leave out eight, ten, 11 and 19 and insert as ten, 11 and 19 and insert as printed on the Marshalled List. As having put money into some of these having put money into some of these amendments. In the spirit of what the chief have said are not repeat what Baroness Coffey had to say, what Baroness Coffey had to say, but just gently remind the House that this private member's bill is not normal insofar as most private member's bills are five, six, 7 or
And indeed several other aspects of what I prepared to say. My Lords, we are only at clause one on subsection three, but I feel that this is a key element to consider carefully. Basically, what and where do the all these issues have to happen and whether it has to happen face to face. Now, as the Bill reads currently, it suggests that it's only the initial request for assistance. The first declaration, the doctor's assessment, and the second doctor's assessment, and indeed, then the second declaration has to happen while the person requests making all these requests is in the country, no other part of this bill, including preliminary discussions, actually the act itself.
But all these other things don't have to happen in this country, or the person doesn't have to be here. And I think I've made it clear in a series of elements that I've made to the House, my concern about how this becomes not something that just gets decided on the papers, but there's real interaction in trying to understand how this bill will work in practice. And that's why I've added a series of that, of whether or not the person who's making the request, the terminally ill person, has to be in the country.
But we should get into other aspects of whether or not things like the panel has to be here. Now, one of the things that I've put this in place to try and make sure we had a debate earlier in, in the committee's considerations, where I tried a clumsy attempt of how to have people actually in this country, because as I made the point before, you can be ordinarily resident in more than one country at the same time. So that's why I wanted to continue to focus on this.
Being a person patient, I don't really like calling it a patient because I don't consider this to be a health treatment, but a person based process. And for me, a lot of that is about where somebody is and whether or not there is that face to face link. Now, the government in a different policy has recently rightly wants to accelerate and increase substantially the number of face to face assessments being done for consideration of basically eligibility for sickness benefits. A lot of that was changed during Covid because, frankly, it was not practical to undertake that sort of process, and it has been gradually being brought back and needs to be accelerated.
But I think that thinking that is going alongside that policy is critical to the application of this bill. Now, the other, as far as I can see, the way I've interpreted three B is that it's only sections ten and 11 have to be done by persons in England and Wales, and that is the initial assessments. And I put it to the committee, to your Lordships, that a lot more of this should be done face to face.
As Jake the late James Munby pointed out, it's absolutely right that the panel should be considering this process. Looking into this, I'm conscious there'll be medics here who have perhaps even greater understanding of I, of how the variety of assessments should be done face to face. What happens when people making a declaration? Are we sure that somebody isn't in the room giving them the eyes that they'll do the right answers, as opposed to understanding whether coercion can happen or not? And indeed, in a documentary undertaken by ITV, it I think it was the bill's promoter, Kim Leadbeater expressed concern when she saw what happens in Oregon, where a lot of this is done by video.
Link expressed her concerns and indeed I believe considered that she would was uncomfortable and would consider adding an amendment to make clear that consultations with doctors could not be done by video call, and that they should be done in person. Now, that hasn't happened so far by the bill promoters and no explanation has been given. But that's why I've tabled these amendments, because I think they're a very important way of making sure safeguards are there, so that as we go through this novel process to us, I appreciate not novel to the world, but that we have every confidence that a lot of the safeguards on which people are concerned about are going to be appropriately applied.
So one of the things that we started discussing in a different group, brought forward by the nobles, noble Lord Birt, last week gave us a picture of how this could start to look. And indeed, the noble and learned Lord McInnes amendments, I think, have started to touch on aspects of this about how Commissioner can happen. But I can see very quickly, especially bearing in mind some of the amendments last week, which I appreciate, the noble and learned Lord Coaker did not accept.
But this is where almost every day a panel could be meeting. Right now, it could be somebody on holiday in Tenerife, it could be somebody else elsewhere, meeting in a video, a zoom, a teams meeting, whatever. And that feels to me like it could become quite a routine tick box exercise. And the very reason the late Sir James Munby pointed out why this should not be given to judges is to avoid. What is the point of having the judge if it's just going to be tick box exercise? And I think we need to be careful that we do not end up in that situation here.
In terms of specifically, I've suggested what needs to be done face to face. That's in amendment 65. It is the preliminary discussion. It is the request is is in the bill. It is actually the witness. The witness should be there face to face. I think that's seems sensible. We've got the first and second assessment already as, as their I think we could go further. What about the interaction with the independent advocate. Is that just going to be done down the phone.
These are the serious things which I think we need to consider. Should the panel be meeting face to face with the person applying or. I appreciate that, as in the amendment. 320 A the assumption is it should be face to face, but perhaps by exceptions by video link. But again, I think when I initially started observing this at the other end, I did think this would happen. And actually what seems to evolve is a lot of this will just be done remotely.
About the only thing which is in the I haven't included in amendment 65, is that the actual doctor being there and the assessment hopefully happening in this country, although that isn't specified in this bill, I appreciate, but the 25 three does actually say the coordinating doctor has to be there and provide in person, although actually in the following clause that can all be delegated to somebody else. So, my Lords, I don't want to overly labour the point at in consideration, but I hope it does give some thoughts to noble Lords on how they want to see this Bill work in practice.
It may be that people are very happy for this. All just happen in video. When why are we getting in the way? Isn't this just about autonomy? I think this would be sensible amendments to consider in order to make sure that while no Minister yet has said there's a safe bill, but make it as safe as possible, that we need to look at the operation of it, it's certainly the case in other parts of the health system that this a lot of this would not be acceptable.
A lot of this would have to be done face to face. And I don't think it is a case of overengineering this bill or leaving it to regulations. I think we should be clear in Parliament that this is what we are going to do. I am conscious of thinking of amendment 320 A, and I appreciate that. My noble friend Lord Evans of Rainow in 376 has particularly singled out in person for for parts of Paul's 12. I do get it that some people may be so terminally ill.
Perhaps a video link may be there, but I don't. I think that should be exceptionally rare if we are going to go down that route at all. So I'll be looking forward to hearing my noble friend explain why that is the case and how it can be administered. But with that, I beg to move.
**** Possible New Speaker ****
Amendment. Proposed clause one, page one. Line 21. Leave out eight, page one. Line 21. Leave out eight, ten, 11 and 19 and insert as ten, 11 and 19 and insert as printed on the Marshalled List. As having put money into some of these having put money into some of these amendments. In the spirit of what the chief have said are not repeat what Baroness Coffey had to say, what Baroness Coffey had to say, but just gently remind the House that this private member's bill is not normal insofar as most private member's bills are five, six, 7 or
10:58
Lord Empey (Ulster Unionist Party)
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Lord Empey (Ulster Unionist Party)
8 pages, this one is 51 pages with 59 clauses. So it's a very different animal to what we're used different animal to what we're used to as private members. Bill, I think the amendments in these think the amendments in these groups are there because in many respects, I find this aspect of the respects, I find this aspect of the process deeply disturbing. We're talking here life and death. We're talking here life and death. We're talking about making assessments of a person who is making an application for an assisted death.
You'll be aware that in the committee select committee of this House, Professor Martin J. Vernon, chair of the British Geriatric Society Ethics and Law Special Interest Group. On the 29th of October, said assessing somebody remotely digitally without a face to face assessment, particularly if they have complex health and social care needs, is nigh on impossible. Now I would have thought, to assess somebody's state of mind, to have any sense of judging whether they're being coerced or not coerced.
One of the most obvious things is to see them in front of you, to get the feel for that. How can a psychiatrist judge? The other point I would make, the practicalities. Depending on where you are in this country, you may or may not have the equipment. You may or may not have the capacity to use it. Signals drop off. Inevitably, if somebody is in a very frail and unstable condition, they'll have to be other people present to operate this.
Now, does that mean that a team from the hospital would have to go out to some remote location, or even worse, are we doing stuff on the phone? Can you imagine how people would react? Dial a death. This would be the sort of way people would describe it. I, I find that exceptionally objectionable that somebody in those conditions can be effectively provided. The state can provide a service to assist them to kill themselves on the phone. That's what we're talking about here.
So I have to say that trying to assess people remotely, it's conceivable, I suppose, that there are special circumstances. But like everything else, if we work this thing out properly, we'd have covered a lot of this. I think this part of the bill is fundamentally unsafe. So I take the view that to assess some of these state of mind, what they're settled will, is how a team can do that without seeing them face to face, in the room or in their home.
I find difficulty, we know we do use video links for legal proceedings, but there's a big difference between somebody who's been held on remand for robbery, appearing in court on video, and somebody who's seeking assistance to end their lives. We're not talking in the same sphere of influence or effect at all. So I have to say, very unhappy about the proposals in the bill on this. And I have put my name to some of these amendments and support the comments by the noble Baroness Coffey speak.
You'll be aware that in the committee select committee of this House, Professor Martin J. Vernon, chair of the British Geriatric Society Ethics and Law Special Interest Group. On the 29th of October, said assessing somebody remotely digitally without a face to face assessment, particularly if they have complex health and social care needs, is nigh on impossible. Now I would have thought, to assess somebody's state of mind, to have any sense of judging whether they're being coerced or not coerced.
One of the most obvious things is to see them in front of you, to get the feel for that. How can a psychiatrist judge? The other point I would make, the practicalities. Depending on where you are in this country, you may or may not have the equipment. You may or may not have the capacity to use it. Signals drop off. Inevitably, if somebody is in a very frail and unstable condition, they'll have to be other people present to operate this.
Now, does that mean that a team from the hospital would have to go out to some remote location, or even worse, are we doing stuff on the phone? Can you imagine how people would react? Dial a death. This would be the sort of way people would describe it. I, I find that exceptionally objectionable that somebody in those conditions can be effectively provided. The state can provide a service to assist them to kill themselves on the phone. That's what we're talking about here.
So I have to say that trying to assess people remotely, it's conceivable, I suppose, that there are special circumstances. But like everything else, if we work this thing out properly, we'd have covered a lot of this. I think this part of the bill is fundamentally unsafe. So I take the view that to assess some of these state of mind, what they're settled will, is how a team can do that without seeing them face to face, in the room or in their home.
I find difficulty, we know we do use video links for legal proceedings, but there's a big difference between somebody who's been held on remand for robbery, appearing in court on video, and somebody who's seeking assistance to end their lives. We're not talking in the same sphere of influence or effect at all. So I have to say, very unhappy about the proposals in the bill on this. And I have put my name to some of these amendments and support the comments by the noble Baroness Coffey speak.
11:02
Lord Evans of Rainow (Conservative)
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Lord Evans of Rainow (Conservative)
My amendment. >> To hear. >> The noble Lord, Lord MP I last Friday, like many of your Lordships, I sat here all day and didn't say a I sat here all day and didn't say a word and my amendment was in the following group, but sadly we didn't get to it. But there was an excellent discussion. I want to pay tribute to some of the contributors, Lord Deben and Lord Mawson and indeed the noble Lord, Lord, Lord, Lord Falconer. Lord Falconer said something that rang a bell and he referred to study, diligence and how healthcare professionals and the whole system will study how best to conduct these assessments.
And my Lords, when he said study diligence, it reminded me of some experience that I had as a member of Parliament and helping people in very distressing circumstances with healthcare of of loved ones and trying to navigate the system. And the the thing that struck me was studied neglect, now studied neglect is quite difficult to detect because it's not always obvious. Now, many of us in this house have a routine. That's what makes us get up every day.
And as the older you get, that routine is very important. So you have a good night's sleep. You wake up in the morning, you shower, you clean your teeth, you exercise, you go to work, or you go to functions in the community. You eat well, you eat healthily, you lead a normal life and you can leave that lead, that normal life, as many as many of us do in this House. But something may happen to you may have a fall, slip, trip and fall, and you may find yourself in hospital.
And that, my Lords, is where things can can go wrong. Because if you're out of that routine of a good night's sleep, getting up in the morning for every week that you lie in bed, you lose 10% of your muscle strength. You don't get up, you don't do your routine, you don't shower. You don't clean your teeth. Things start happening to you go downhill very, very, very quickly. And those things can happen through daily life. But the thing that really concerns me about this bill and the reason why I tabled this particular amendment, insisting on face to face diagnosis with the healthcare professionals having to make this decision is based on experience, as I said, as a as an MP, because close family and friends can have a malign influence by slowly but surely.
And this is why I refer to it as studied neglect. Not encouraging a loved one to get out of bed in the morning. That routine so it declines. They stop showering in the morning. They don't go for manicure or pedicure their hair. They start to decline. So people who we always regarded as very, very smart for their age declined very quickly and the loved ones so around them can engineer this, so that when social workers and healthcare professionals meet with these people, it's not obvious what is what is happening.
They're not sleeping properly, they're not looking after themselves properly, they're not eating properly and therefore it declines. The nutrition is very important. You have medication, there's no clear care plan. As one grows older, we take lots more medication and that medication can be increased when it doesn't need to be increased and indeed not given at all. So this is why I'm using the phrase studied neglect to the noble and learned Lord Fuller study diligence. We really do have to look very carefully at these malign forces that I'm afraid, are out there in society, that looks at granny and there's Lord Deben says, the £2 million house sitting there, and slowly but surely, but relatively quickly, they can see the demise of of granny and realise those capital assets.
And that's the reason why I put this amendment forward. Crucial steps in assisted dying process should be undertaken with direct in-person interaction, to increase the likelihood that the individual's request is truly voluntary, informed and free from coercion. The necessity for direct interaction with a person, particularly face to face contact, is driven by the importance of rigorous safeguards and scrutiny, and upholding patient autonomy in a process that culminates in an irreversible outcome called death. I could use many, many more examples, but the interest of time I beg to move this, this amendment.
And my Lords, when he said study diligence, it reminded me of some experience that I had as a member of Parliament and helping people in very distressing circumstances with healthcare of of loved ones and trying to navigate the system. And the the thing that struck me was studied neglect, now studied neglect is quite difficult to detect because it's not always obvious. Now, many of us in this house have a routine. That's what makes us get up every day.
And as the older you get, that routine is very important. So you have a good night's sleep. You wake up in the morning, you shower, you clean your teeth, you exercise, you go to work, or you go to functions in the community. You eat well, you eat healthily, you lead a normal life and you can leave that lead, that normal life, as many as many of us do in this House. But something may happen to you may have a fall, slip, trip and fall, and you may find yourself in hospital.
And that, my Lords, is where things can can go wrong. Because if you're out of that routine of a good night's sleep, getting up in the morning for every week that you lie in bed, you lose 10% of your muscle strength. You don't get up, you don't do your routine, you don't shower. You don't clean your teeth. Things start happening to you go downhill very, very, very quickly. And those things can happen through daily life. But the thing that really concerns me about this bill and the reason why I tabled this particular amendment, insisting on face to face diagnosis with the healthcare professionals having to make this decision is based on experience, as I said, as a as an MP, because close family and friends can have a malign influence by slowly but surely.
And this is why I refer to it as studied neglect. Not encouraging a loved one to get out of bed in the morning. That routine so it declines. They stop showering in the morning. They don't go for manicure or pedicure their hair. They start to decline. So people who we always regarded as very, very smart for their age declined very quickly and the loved ones so around them can engineer this, so that when social workers and healthcare professionals meet with these people, it's not obvious what is what is happening.
They're not sleeping properly, they're not looking after themselves properly, they're not eating properly and therefore it declines. The nutrition is very important. You have medication, there's no clear care plan. As one grows older, we take lots more medication and that medication can be increased when it doesn't need to be increased and indeed not given at all. So this is why I'm using the phrase studied neglect to the noble and learned Lord Fuller study diligence. We really do have to look very carefully at these malign forces that I'm afraid, are out there in society, that looks at granny and there's Lord Deben says, the £2 million house sitting there, and slowly but surely, but relatively quickly, they can see the demise of of granny and realise those capital assets.
And that's the reason why I put this amendment forward. Crucial steps in assisted dying process should be undertaken with direct in-person interaction, to increase the likelihood that the individual's request is truly voluntary, informed and free from coercion. The necessity for direct interaction with a person, particularly face to face contact, is driven by the importance of rigorous safeguards and scrutiny, and upholding patient autonomy in a process that culminates in an irreversible outcome called death. I could use many, many more examples, but the interest of time I beg to move this, this amendment.
11:06
Lord Blencathra (Conservative)
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Lord Blencathra (Conservative)
Alliance. I write. >> Alliance. I write. >> To speak to amendment 320 B and three others in my name in this group, because the first clinical group, because the first clinical gateway in this bill is the most important moment any of us will ever legislate for. That is the moment a doctor begins the process that can lead to a life being ended. That gateway must be treated with the utmost care. It should not be reduced to a convenience driven video call. My amendment is simple and proportionate.
It creates a presumption that the coordinating doctors first assessment takes place in person, and it asks only that if the presumption is displaced, the doctor requires records. Why an in-person meeting was not possible for medical reasons. That is not micromanagement. It is common sense. It is the minimum standard of human contact we should expect before opening a pathway that is irreversible. Why does this matter, my Lords? Well, first, capacity and voluntariness are relative, are relational judgements. Clinicians do not assess capacity from words alone.
They read the faces, they notice the hesitation. They observe the environment and see who else is present. They pick up the small, telling signs of distress or coercion that a screen can hide, a hand hovering off the camera, a whispered instruction, a look that does not match the words. Remote consultations blunt those senses. If we are serious about preventing coercion, the law should make face to face the default, not the exception. Second, this is a narrow safeguard, not a prohibition. The amendment allows remote assessment where it is genuinely impossible for medical reasons.
It recognises that it will be rare cases when a patient is too frail to be seen in person. In those cases, the coordinating doctor must set out the reasons that requirement creates an audit trail and accountability. It deters the normalisation of remote practice for administrative convenience and gives panels the commissioner and, if necessary, later reviewers, a clear record of why the presumption was set aside. Thirdly, the evidence is clear leading geriatricians and psychiatrists have told committees that assessing capacity remotely for complex patients is nigh on impossible.
Telemedicine studies and experience and course show the limits of video for detecting vulnerability. We should legislate to reflect clinical reality, not hope that guidance will be followed uniformly across hundreds of clinicians and thousands of cases. Now, some will say this will delay access or overengineer the process. I disagree, my Lords. A single in-person assessment at the outset is a modest investment of time that dramatically reduces the risk of error. If the system is robust, it will absorb that step without undue delay.
If the system cannot, then speed has been prioritised over safety and that would be a real problem. Finally, on this amendment, my Lords, I put it to noble and learned Lord Lord Falconer of Thoroton will he accept that a life ending pathway should begin with human contact with a clinician who has seen the person in the flesh smell the room, so to speak, and observe the context in which that wish has arisen? Or will he prefer a default of pixels on a screen? My Lords, when the outcome is death, convenience must never trump clinical rigour.
I urge the House to support my amendment 320 be my amendment three four, seven eight ensures that the second assessment, the final medical safeguard, is conducted in person. The bill currently allows the independent doctor to assess the patient entirely by video. That is extraordinary for a life ending decision. Experts told the House of Lords select committee that assessing capacity remotely is, as I said before, nigh on impossible for complex patients. The subtle signs of confusion, fear, coercion or cognitive impairment are often visible only in person.
Remote assessment hides the environment. Who is in the room? Who is influencing the patient, what pressure they are under. I think Kim Leadbeater MP herself said she was uncomfortable watching Oregon's remote assessments, describing them as tick box. If the sponsor is uncomfortable with death by zoom, Parliament should not legislate for it. This amendment of mine is modest, proportionate and essential for safeguarding my amendment. If remote assessments are permitted at all, then my amendment 406 introduces the bare minimum safeguards. The doctor must verify that the patient is alone and speaking freely.
Coercion, as we know, is often silent. Abusers consider off camera patients are coached and Michigan prosecutor famously spotted a domestic abuse victim being coerced during a zoom hearing. If trained lawyers and judges can miss coercion on video, how can a doctor reliably detect it in a single remote consultation? This amendment of mine does not ban remote assessment. It simply prevents the most obvious and dangerous form of abuse. Without it, the bill's coercion safeguards are meaningless. And finally, turning to my amendment 415B.
This ensures that remote assessments are tightly controlled. Use only when appropriate and subject to independent oversight. The bill currently allows remote and even pre-recorded assessments without any statutory framework. A protocol approved by the Commissioner ensures consistency, transparency and accountability. It prevents remote assessment becoming the default due to NHS pressures or simple convenience. Without this amendment, I suggest the bill creates a system where lethal decisions can be made based on pre-recorded video clips. That is indefensible. So, my Lords, in summary, these four amendments of mine from a single focussed package of safeguards to ensure human judgement, not administrative convenience, governs a life ending pathway.
320 B makes the first assessment face to face. By default, the minimum human contact needed to test capacity and support coercion. 347 A extends that presumption to the independent second assessment, so the final clinical check is equally robust. 406 A requires a simple verification when assessments are remote and recorded, confirmation that the patient is alone and speaking freely, and 45B demands a statutory protocol for remote or pre-recorded assessments. So exceptions are tightly controlled and independently verified. My Lords, these are modest, proportionate measures.
They do not block access where an in-person assessment is genuinely impossible, but they stop convenience becoming the norm when the consequences. I put this to the noble and learned Lord, the Lord Falconer of Thoroton. If this bill is to be the safest system in the world, will he accept these targeted protections so that speed and convenience never replace clinical judgement and human scrutiny? I urge the House to support my amendments.
It creates a presumption that the coordinating doctors first assessment takes place in person, and it asks only that if the presumption is displaced, the doctor requires records. Why an in-person meeting was not possible for medical reasons. That is not micromanagement. It is common sense. It is the minimum standard of human contact we should expect before opening a pathway that is irreversible. Why does this matter, my Lords? Well, first, capacity and voluntariness are relative, are relational judgements. Clinicians do not assess capacity from words alone.
They read the faces, they notice the hesitation. They observe the environment and see who else is present. They pick up the small, telling signs of distress or coercion that a screen can hide, a hand hovering off the camera, a whispered instruction, a look that does not match the words. Remote consultations blunt those senses. If we are serious about preventing coercion, the law should make face to face the default, not the exception. Second, this is a narrow safeguard, not a prohibition. The amendment allows remote assessment where it is genuinely impossible for medical reasons.
It recognises that it will be rare cases when a patient is too frail to be seen in person. In those cases, the coordinating doctor must set out the reasons that requirement creates an audit trail and accountability. It deters the normalisation of remote practice for administrative convenience and gives panels the commissioner and, if necessary, later reviewers, a clear record of why the presumption was set aside. Thirdly, the evidence is clear leading geriatricians and psychiatrists have told committees that assessing capacity remotely for complex patients is nigh on impossible.
Telemedicine studies and experience and course show the limits of video for detecting vulnerability. We should legislate to reflect clinical reality, not hope that guidance will be followed uniformly across hundreds of clinicians and thousands of cases. Now, some will say this will delay access or overengineer the process. I disagree, my Lords. A single in-person assessment at the outset is a modest investment of time that dramatically reduces the risk of error. If the system is robust, it will absorb that step without undue delay.
If the system cannot, then speed has been prioritised over safety and that would be a real problem. Finally, on this amendment, my Lords, I put it to noble and learned Lord Lord Falconer of Thoroton will he accept that a life ending pathway should begin with human contact with a clinician who has seen the person in the flesh smell the room, so to speak, and observe the context in which that wish has arisen? Or will he prefer a default of pixels on a screen? My Lords, when the outcome is death, convenience must never trump clinical rigour.
I urge the House to support my amendment 320 be my amendment three four, seven eight ensures that the second assessment, the final medical safeguard, is conducted in person. The bill currently allows the independent doctor to assess the patient entirely by video. That is extraordinary for a life ending decision. Experts told the House of Lords select committee that assessing capacity remotely is, as I said before, nigh on impossible for complex patients. The subtle signs of confusion, fear, coercion or cognitive impairment are often visible only in person.
Remote assessment hides the environment. Who is in the room? Who is influencing the patient, what pressure they are under. I think Kim Leadbeater MP herself said she was uncomfortable watching Oregon's remote assessments, describing them as tick box. If the sponsor is uncomfortable with death by zoom, Parliament should not legislate for it. This amendment of mine is modest, proportionate and essential for safeguarding my amendment. If remote assessments are permitted at all, then my amendment 406 introduces the bare minimum safeguards. The doctor must verify that the patient is alone and speaking freely.
Coercion, as we know, is often silent. Abusers consider off camera patients are coached and Michigan prosecutor famously spotted a domestic abuse victim being coerced during a zoom hearing. If trained lawyers and judges can miss coercion on video, how can a doctor reliably detect it in a single remote consultation? This amendment of mine does not ban remote assessment. It simply prevents the most obvious and dangerous form of abuse. Without it, the bill's coercion safeguards are meaningless. And finally, turning to my amendment 415B.
This ensures that remote assessments are tightly controlled. Use only when appropriate and subject to independent oversight. The bill currently allows remote and even pre-recorded assessments without any statutory framework. A protocol approved by the Commissioner ensures consistency, transparency and accountability. It prevents remote assessment becoming the default due to NHS pressures or simple convenience. Without this amendment, I suggest the bill creates a system where lethal decisions can be made based on pre-recorded video clips. That is indefensible. So, my Lords, in summary, these four amendments of mine from a single focussed package of safeguards to ensure human judgement, not administrative convenience, governs a life ending pathway.
320 B makes the first assessment face to face. By default, the minimum human contact needed to test capacity and support coercion. 347 A extends that presumption to the independent second assessment, so the final clinical check is equally robust. 406 A requires a simple verification when assessments are remote and recorded, confirmation that the patient is alone and speaking freely, and 45B demands a statutory protocol for remote or pre-recorded assessments. So exceptions are tightly controlled and independently verified. My Lords, these are modest, proportionate measures.
They do not block access where an in-person assessment is genuinely impossible, but they stop convenience becoming the norm when the consequences. I put this to the noble and learned Lord, the Lord Falconer of Thoroton. If this bill is to be the safest system in the world, will he accept these targeted protections so that speed and convenience never replace clinical judgement and human scrutiny? I urge the House to support my amendments.
11:13
Baroness Gerada (Crossbench)
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Baroness Gerada (Crossbench)
Amen. I. >> Baroness Coffey that this. >> Issue will never be a routine
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Issue will never be a routine tick box exercise. Can I also say that being in Tenerife rather than Torbay is the choice of the patient? Torbay is the choice of the patient? If at that time they want to spend that time themselves before they die and return to England or the UK, which is not our choice. Videos allow patients and their families to be together for those assessments. This is not an ethical. There is no ethical or clinical reason why an assisted dying request or aspects of their care included in the clauses laid out must be face to face.
What matters is capacity, choice and informed consent, not physical proximity. During Covid, my Lords, I assessed thousands of patients capacity, consent and safeguarding issues remotely with no evidence of increased coercion or harm. Patients, my Lords, can already refuse life sustaining treatments, renal dialysis, withdrawal of feeding or making advanced decisions to remove treatment without face to face legal requirements, face to face requirements assessment, as laid out in these amendments, is a policy choice, not a clinical or ethical necessity.
What protects patients is careful assessment, independent documentation and review, and not the distance between two chairs, my.
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Issue will never be a routine tick box exercise. Can I also say that being in Tenerife rather than Torbay is the choice of the patient? Torbay is the choice of the patient? If at that time they want to spend that time themselves before they die and return to England or the UK, which is not our choice. Videos allow patients and their families to be together for those assessments. This is not an ethical. There is no ethical or clinical reason why an assisted dying request or aspects of their care included in the clauses laid out must be face to face.
What matters is capacity, choice and informed consent, not physical proximity. During Covid, my Lords, I assessed thousands of patients capacity, consent and safeguarding issues remotely with no evidence of increased coercion or harm. Patients, my Lords, can already refuse life sustaining treatments, renal dialysis, withdrawal of feeding or making advanced decisions to remove treatment without face to face legal requirements, face to face requirements assessment, as laid out in these amendments, is a policy choice, not a clinical or ethical necessity.
What protects patients is careful assessment, independent documentation and review, and not the distance between two chairs, my.
11:15
Baroness Butler-Sloss (Crossbench)
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Baroness Butler-Sloss (Crossbench)
Lords, thank you. >> Mainly by the noble Lord, Lord MP. And despite what the noble Lady the Baroness Gerada has just said, the Baroness Gerada has just said, it seems to me that it would be highly desirable that there should be face to face contact if you are having such an enormously important decision made, and I would therefore support that. At both stages there should be face to face contact other than for reasons where it cannot be done.
11:15
The Lord Bishop of Newcastle (Bishops)
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The Lord Bishop of Newcastle (Bishops)
Yeah. What did Lord, I've added >> Yeah. What did Lord, I've added my name. Oh. Sorry, Bishop. >> Thank you. >> My Lords. >> I rise to. >> Speak briefly to this group of
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Speak briefly to this group of think. Seek to highlight the importance of contact with people at the of contact with people at the hardest time in their lives. Times when we must be most vulnerable clinically and personally. And this must not be a process in which anyone is made to feel rushed or that can be completed. I would argue entirely online if we are content to enable access to as slick a service as quickly as possible, then an online service may be acceptable.
But if we are going to continue to take seriously our duties of suicide prevention, of assessing and meeting unmet need and of safeguarding, then the human contact, of being face to face is part of that. My Lords, we heard during the select committee sessions evidence from the chief executives of Mind and Stand Together Against Domestic Abuse, who said that an online or pre-recorded consultation was not an adequate safeguard to assess a person's emotional state. And this must be especially true in complex cases.
And I'd like to remind your Lordships that prisoners are still eligible under the bill. And as we engage with every group, we must consider how the particular issue might play out in a prison context. In this case, all the challenges that we are worried about, including the assessment of unmet need and the presence of an undiagnosed mental disorder. These challenges are more difficult in a prison environment, so I'd be grateful if the noble and learned Lord, Lord Faulkner, could outline whether he thinks in-person assessments should be even more important in a prison context.
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Speak briefly to this group of think. Seek to highlight the importance of contact with people at the of contact with people at the hardest time in their lives. Times when we must be most vulnerable clinically and personally. And this must not be a process in which anyone is made to feel rushed or that can be completed. I would argue entirely online if we are content to enable access to as slick a service as quickly as possible, then an online service may be acceptable.
But if we are going to continue to take seriously our duties of suicide prevention, of assessing and meeting unmet need and of safeguarding, then the human contact, of being face to face is part of that. My Lords, we heard during the select committee sessions evidence from the chief executives of Mind and Stand Together Against Domestic Abuse, who said that an online or pre-recorded consultation was not an adequate safeguard to assess a person's emotional state. And this must be especially true in complex cases.
And I'd like to remind your Lordships that prisoners are still eligible under the bill. And as we engage with every group, we must consider how the particular issue might play out in a prison context. In this case, all the challenges that we are worried about, including the assessment of unmet need and the presence of an undiagnosed mental disorder. These challenges are more difficult in a prison environment, so I'd be grateful if the noble and learned Lord, Lord Faulkner, could outline whether he thinks in-person assessments should be even more important in a prison context.
11:17
Baroness Lawlor (Conservative)
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Baroness Lawlor (Conservative)
I rise because I I've added my name in support of Lord Lord Evans name in support of Lord Lord Evans of Rainow amendment for in-person assessment by the assisting doctor, the first assessment, and the second. And how on earth can any doctor, as has been said, judge the mind, the physical and mental condition of the person to whom he may? He or she may be ticking off to death without being in the room with them, particularly as this doctor may never have treated that person in person.
I know that since Covid, there have been there has been an increase in remote consultations, but it is still the case, my Lords, that the average number of in-person consultations a patient has with a GP, a doctor is three a year. In the case of consultation for assisted suicide, that such an appointment with the doctor is in person matters. As other noble Lords have said, we've already heard a reference to telemedicine from Lord Blencathra, but let's look exactly at what the British Columbia study reported of telemedicine.
It limits ability to observe non-verbal cues, subtle signs of distress, general context it fails to provide the emotional support, the human contact and rapport essential to the therapeutic relationship between what both parties in what is shared, in what is a shared decision. And it also, the study goes on to say, provides limited evidence on long term outcomes, especially with regard to hard data on assessment, quality or adverse consequences. And it goes on to say, ticking boxes rather than an in-person examination risks further streamlining to avoid an impact on scarce medical resources.
We know, for instance, from the Liverpool Care Pathway figures released in 2012 under the Freedom of Information Act, showed two thirds of the trusts had received incentive payments for meeting targets for using the Liverpool Care Pathway, amounting to £12 million. That's in 2012, and telemedicine is also inappropriate for some patients and people with learning disabilities, autism, poor communication or verbal skills, and mental health illness. So I would just conclude by asking the noble and learned Lord, the promoter of the bill, do you does the noble Lord Leonard Lord disagree with Professor Mumtaz Patel, president of the Royal College of Physicians, that face to face assessment really matters.
And he says face to face assessment is really important. And then the wider decision making is to be done as a team through shared decision making and with someone who knows that the patient well, it goes back to continuity. And I'd also ask the noble Lord, the sponsor, Leonard Lord, the sponsor does. Does he agree with the evidence of an off camera abuse example given from the US state of Michigan? A the noble Baroness, lady coffee mentioned this at the very outset of the debate.
The difficulty of detecting on abuse online in Michigan, a prosecutor noticed a domestic abuse victim being carried coerced off camera during a zoom hearing, so I hope
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the noble Lord sponsor could reply to some of. The Lords. I wonder.
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I wonder. If the House would listen, as it were, to the point made by the noble Baroness, Lady Gerada, which noble Baroness, Lady Gerada, which is that she is probably the only person in the house, and certainly the only person who's spoken this morning who has had practical experience of assessing people. She spoke very well about the issues
I know that since Covid, there have been there has been an increase in remote consultations, but it is still the case, my Lords, that the average number of in-person consultations a patient has with a GP, a doctor is three a year. In the case of consultation for assisted suicide, that such an appointment with the doctor is in person matters. As other noble Lords have said, we've already heard a reference to telemedicine from Lord Blencathra, but let's look exactly at what the British Columbia study reported of telemedicine.
It limits ability to observe non-verbal cues, subtle signs of distress, general context it fails to provide the emotional support, the human contact and rapport essential to the therapeutic relationship between what both parties in what is shared, in what is a shared decision. And it also, the study goes on to say, provides limited evidence on long term outcomes, especially with regard to hard data on assessment, quality or adverse consequences. And it goes on to say, ticking boxes rather than an in-person examination risks further streamlining to avoid an impact on scarce medical resources.
We know, for instance, from the Liverpool Care Pathway figures released in 2012 under the Freedom of Information Act, showed two thirds of the trusts had received incentive payments for meeting targets for using the Liverpool Care Pathway, amounting to £12 million. That's in 2012, and telemedicine is also inappropriate for some patients and people with learning disabilities, autism, poor communication or verbal skills, and mental health illness. So I would just conclude by asking the noble and learned Lord, the promoter of the bill, do you does the noble Lord Leonard Lord disagree with Professor Mumtaz Patel, president of the Royal College of Physicians, that face to face assessment really matters.
And he says face to face assessment is really important. And then the wider decision making is to be done as a team through shared decision making and with someone who knows that the patient well, it goes back to continuity. And I'd also ask the noble Lord, the sponsor, Leonard Lord, the sponsor does. Does he agree with the evidence of an off camera abuse example given from the US state of Michigan? A the noble Baroness, lady coffee mentioned this at the very outset of the debate.
The difficulty of detecting on abuse online in Michigan, a prosecutor noticed a domestic abuse victim being carried coerced off camera during a zoom hearing, so I hope
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the noble Lord sponsor could reply to some of. The Lords. I wonder.
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I wonder. If the House would listen, as it were, to the point made by the noble Baroness, Lady Gerada, which noble Baroness, Lady Gerada, which is that she is probably the only person in the house, and certainly the only person who's spoken this morning who has had practical experience of assessing people. She spoke very well about the issues
11:21
Baroness Jay of Paddington (Labour)
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Baroness Jay of Paddington (Labour)
spoke very well about the issues which were raised, which have been raised this morning in relation to the Covid epidemic. And I quote her that there was not a clinical or ethical necessity to see people face to face, to make proper judgements. Now, I really do want the House to accept that someone with that practical experience should be listened to. And I just make one other short point, which is I'm again surprised, frankly, by the number of people who've spoken this morning who, without us, were even mentioning the question of the circumstances of those who are terminally ill and are asking for assistance.
Talk so much about administrative procedures, about the way in which a network may be formed, or the way in which technology could be used. I would like to hear, frankly, a little more from everybody who contributes about the circumstances and problems of those who are actually seeking assisted dying, and may well be those who, frankly, for one reason or another, either because they're physically in a way that they can't do it, or they are perhaps geographically remote, or they have other circumstances which prevent them being able to assess a face to face agreement or a face to face assessment are nonetheless very much wanting.
A terminal sorry, an assisted death for their terminal illness and their concerns, I think, should be the ones which we primarily consider.
Talk so much about administrative procedures, about the way in which a network may be formed, or the way in which technology could be used. I would like to hear, frankly, a little more from everybody who contributes about the circumstances and problems of those who are actually seeking assisted dying, and may well be those who, frankly, for one reason or another, either because they're physically in a way that they can't do it, or they are perhaps geographically remote, or they have other circumstances which prevent them being able to assess a face to face agreement or a face to face assessment are nonetheless very much wanting.
A terminal sorry, an assisted death for their terminal illness and their concerns, I think, should be the ones which we primarily consider.
11:23
Baroness Smith of Newnham (Liberal Democrat)
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Baroness Smith of Newnham (Liberal Democrat)
Yes. >> The noble. >> Lady Baroness Jay. >> Has just asked us to consider the circumstances of those. Who are the circumstances of those. Who are seeking an assisted death. But I would like to give a salutary lesson, and I'm sorry to disagree with the noble Lady Baroness Gerada. My father was taken ill during the Covid pandemic. He didn't have a smartphone. He wasn't able to have a proper an in-person consultation. He had jaundice. And the message he came away with from speaking to a doctor on the telephone, the doctor had never met him.
And the doctor's message or the message my father took away was it's pancreatic cancer. And my father then spent weeks saying goodbye to all his relatives and friends. By the time relevant tests had been done, it was shown that he didn't have pancreatic cancer. But it does demonstrate one of the flaws of doing something remotely, and that is that. What are the messages the doctors aren't getting the queues, and the patient isn't necessarily hearing what the doctor is saying, because I am sure.
That the doctor did not say, Mr. Smith, you have pancreatic cancer. They clearly couldn't have said that. But that was the message that my father heard. And so I would very strongly like to support the amendments in the name of Lord Evans of Rainow and two of the amendments by the noble Lord Lord Blencathra. But I would like to express one serious, serious reservation about Lord Blencathra amendment 406 a that if a discussion has to be taken by video conference, it may not be appropriate to say that in every circumstance, the only person who should be on that call is the patient.
Because we all know if you go to the doctors, you don't hear everything. Even if you're in person, you have capacity. You are a rational person. You don't have any cognitive difficulties. Sometimes if it's a difficult diagnosis, you don't take everything on board. And if you are then being told you've got a terminal diagnosis. So this is not in the false case of my late father, who didn't have a terminal condition at that stage. But if you know you have a terminal diagnosis for some people, we know what their settled will is.
There are several people in your Lordships House who have it very clearly on record in the public domain what their settled will is, but there will be other people where the doctors never spoken to them before. They cannot know whether it's somebody settled will in a way that the legislation requires. And if then there has to be a video, video, conversation or indeed an in-person conversation, it may be appropriate for there to be somebody, an independent advocate or somebody who who would be supporting that person and can actually say, the doctor didn't really say that, you know, and I think we need to think about real life cases.
Yes, we need to understand from the medical profession, and it needs to be from the perspective, from somebody with a terminal diagnosis. But we also need to understand the reality for ordinary people who don't have the advantages of the internet, the accessibility that members of your Lords.
And the doctor's message or the message my father took away was it's pancreatic cancer. And my father then spent weeks saying goodbye to all his relatives and friends. By the time relevant tests had been done, it was shown that he didn't have pancreatic cancer. But it does demonstrate one of the flaws of doing something remotely, and that is that. What are the messages the doctors aren't getting the queues, and the patient isn't necessarily hearing what the doctor is saying, because I am sure.
That the doctor did not say, Mr. Smith, you have pancreatic cancer. They clearly couldn't have said that. But that was the message that my father heard. And so I would very strongly like to support the amendments in the name of Lord Evans of Rainow and two of the amendments by the noble Lord Lord Blencathra. But I would like to express one serious, serious reservation about Lord Blencathra amendment 406 a that if a discussion has to be taken by video conference, it may not be appropriate to say that in every circumstance, the only person who should be on that call is the patient.
Because we all know if you go to the doctors, you don't hear everything. Even if you're in person, you have capacity. You are a rational person. You don't have any cognitive difficulties. Sometimes if it's a difficult diagnosis, you don't take everything on board. And if you are then being told you've got a terminal diagnosis. So this is not in the false case of my late father, who didn't have a terminal condition at that stage. But if you know you have a terminal diagnosis for some people, we know what their settled will is.
There are several people in your Lordships House who have it very clearly on record in the public domain what their settled will is, but there will be other people where the doctors never spoken to them before. They cannot know whether it's somebody settled will in a way that the legislation requires. And if then there has to be a video, video, conversation or indeed an in-person conversation, it may be appropriate for there to be somebody, an independent advocate or somebody who who would be supporting that person and can actually say, the doctor didn't really say that, you know, and I think we need to think about real life cases.
Yes, we need to understand from the medical profession, and it needs to be from the perspective, from somebody with a terminal diagnosis. But we also need to understand the reality for ordinary people who don't have the advantages of the internet, the accessibility that members of your Lords.
11:27
Baroness Keeley (Labour)
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Baroness Keeley (Labour)
It's essential. 483 on this is in a later group. During the Covid 19 pandemic, it was briefly made possible for the making of a will to be witnessed by video link rather than in person. This change could have been made permanent, but instead the government decided the video link provision should cease from January 2024. The law is now again that the witness must have clear line of sight of the person making the will. Are these precautions any less important when assessing whether someone truly wants an assisted death and is not being coerced, than when establishing what should happen to their assets afterwards?
11:27
Baroness Finlay of Llandaff (Crossbench)
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Baroness Finlay of Llandaff (Crossbench)
Lady Baroness Keeley has already alluded to the issue of wills, so I alluded to the issue of wills, so I won't go to that. But there is another legal precedent Devon Partnership NHS trust versus the Secretary of State for Health and Social Care. In 2021, when the High Court ruled that under the Mental Health Act, the phrases personally seen and personally examined require the clinician and approved mental health professional to be physically present with the patient for detention assessments.
Following that, NHS England reviewed their guidance and it underscores the legal and clinical importance of physical co-present evaluation when decisions carry high consequence. Secondly, if I might comment during Covid, I chaired the National Mental Capacity Forum and I was running fast track online seminars for those who were doing remote assessments. Because of the problem of people in care homes. And it was a very difficult time. This was a public health necessity. And since then some remote consultations have certainly continued, as we've already heard.
But the qualitative studies of remote mental health care during the pandemic found that a lack of face to face contact, compromised risk assessment and therapeutic insight. Systemic reviews have noted significant difficulty establishing a therapeutic relationship, identifying risk, and with challenges in picking up non-verbal communication and building rapport coming through as recurrent themes, they caution how remote assessments can be less effective in capturing complex, subtle behaviours nonverbal distress, agitation and contextual pressures, which are crucial in determining voluntariness and for detecting distress or coercion.
Clinicians and carers have reported that non-verbal cues were often unavailable or obscured in remote interactions, particularly telephone consultations, but also by video, and even when remote assessments were used only to triage risk, there was, and delaying face to face evaluation. The effect slowed down accurate identification of deteriorating conditions. Importantly, family members and carers who might normally contribute to a fuller understanding, as has already been pointed out by the noble Lady Baroness May were less able to participate meaningfully in remote consultations, particularly hindering detection of contextual pressures or risk factors, and in the remote assessments, the clinician can't tell whether there's another person in the room standing out of sight behind the camera for such an important decision, face to face assessments should should occur by default, the assessing professional must visit the patient, ensure the patient is comfortable, has all their personal needs met before and before embarking on any type of interview to hear from the person.
If speech is lost, a previous recording could be made and it could be played in the presence of the person watching for non-verbal cues to confirm or otherwise the veracity of the recording, as well as detect coercive influences. So face to face, physically co-present assessments not mediated by technology should probably be the norm on the face of the bill, and where recording a consultation is required. Where, I beg your pardon? Where there is a remote consultation, recording of that should be required because it will be essential for audit and quality control and in the event of legal challenge later.
So this group of amendments should be considered together, reworked and come back to at report.
Following that, NHS England reviewed their guidance and it underscores the legal and clinical importance of physical co-present evaluation when decisions carry high consequence. Secondly, if I might comment during Covid, I chaired the National Mental Capacity Forum and I was running fast track online seminars for those who were doing remote assessments. Because of the problem of people in care homes. And it was a very difficult time. This was a public health necessity. And since then some remote consultations have certainly continued, as we've already heard.
But the qualitative studies of remote mental health care during the pandemic found that a lack of face to face contact, compromised risk assessment and therapeutic insight. Systemic reviews have noted significant difficulty establishing a therapeutic relationship, identifying risk, and with challenges in picking up non-verbal communication and building rapport coming through as recurrent themes, they caution how remote assessments can be less effective in capturing complex, subtle behaviours nonverbal distress, agitation and contextual pressures, which are crucial in determining voluntariness and for detecting distress or coercion.
Clinicians and carers have reported that non-verbal cues were often unavailable or obscured in remote interactions, particularly telephone consultations, but also by video, and even when remote assessments were used only to triage risk, there was, and delaying face to face evaluation. The effect slowed down accurate identification of deteriorating conditions. Importantly, family members and carers who might normally contribute to a fuller understanding, as has already been pointed out by the noble Lady Baroness May were less able to participate meaningfully in remote consultations, particularly hindering detection of contextual pressures or risk factors, and in the remote assessments, the clinician can't tell whether there's another person in the room standing out of sight behind the camera for such an important decision, face to face assessments should should occur by default, the assessing professional must visit the patient, ensure the patient is comfortable, has all their personal needs met before and before embarking on any type of interview to hear from the person.
If speech is lost, a previous recording could be made and it could be played in the presence of the person watching for non-verbal cues to confirm or otherwise the veracity of the recording, as well as detect coercive influences. So face to face, physically co-present assessments not mediated by technology should probably be the norm on the face of the bill, and where recording a consultation is required. Where, I beg your pardon? Where there is a remote consultation, recording of that should be required because it will be essential for audit and quality control and in the event of legal challenge later.
So this group of amendments should be considered together, reworked and come back to at report.
11:31
Baroness Pidgeon (Liberal Democrat)
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Baroness Pidgeon (Liberal Democrat)
My Lord. >> Debate this group of amendments that we keep in mind that the systems we are creating are for people in the last six months of people in the last six months of their lives, and we've got to balance the demands we place on them at this very vulnerable time with what really matters to them during that time. So we've got to stop talking about micro process and really think about the individual and doctor. Jessica Young, during her evidence to the House of Lords inquiry in November, said, I quote a system that is too onerous creates stress among the people it aims to serve.
So we mustn't create a system that's too complex and too protracted for someone who is at the end of their life to deal with now. We've made incredible progress in recent years to facilitate video consultations, and that came on hugely in the pandemic. Are we not in danger of taking a retrograde step with these amendments? I fear particularly that we in this House must be careful with standing in the way of technological process and at times, reading some of these amendments, I wonder whether actually people might just want to put down.
Add in that we write in feather, quills and ink, because it seems that's what this is really about. Amendment 65 mandates that a whole range of steps beyond clinical assessments are undertaken face to face. It also seems to disapply the flexibility provided in this bill. With regards to the person meeting with the panel, is it the intention of this amendment that a person who cannot travel to appointments, whether physically or because of the risk of infection, must be denied a choice over how they die? These amendments will hugely affect those who live in rural areas who live far from their GP, let alone a hospital with a relevant specialist and those who have been compromised.
Their immune systems have been compromised as a result of extensive chemotherapy, and those whose mobility is affected by their terminal illness and find it impossible to travel. Are we not at risk of denying access to these people to travel when such challenges are not unusual, given the nature of what they're experiencing with their terminal illness? Is it the intention that for someone, for practical medical reasons, they are unable to meet with the independent advocate or the panel, but they're able and willing to do so via video link, that they will immediately be ineligible even if they fulfil all other criteria.
I think it's difficult to see the basis upon which this can be justified. I'm just coming to an end. I don't think I don't have to take an intervention. I don't think so. I would like to just finish my point. It seems to me that this is about making the choice of an assisted death to be really difficult and impossible, and I think we just need to think very carefully on the checks we're putting in place here. But for those in the last six months of their lives, we need to make sure it's a system that really will work for them.
So we mustn't create a system that's too complex and too protracted for someone who is at the end of their life to deal with now. We've made incredible progress in recent years to facilitate video consultations, and that came on hugely in the pandemic. Are we not in danger of taking a retrograde step with these amendments? I fear particularly that we in this House must be careful with standing in the way of technological process and at times, reading some of these amendments, I wonder whether actually people might just want to put down.
Add in that we write in feather, quills and ink, because it seems that's what this is really about. Amendment 65 mandates that a whole range of steps beyond clinical assessments are undertaken face to face. It also seems to disapply the flexibility provided in this bill. With regards to the person meeting with the panel, is it the intention of this amendment that a person who cannot travel to appointments, whether physically or because of the risk of infection, must be denied a choice over how they die? These amendments will hugely affect those who live in rural areas who live far from their GP, let alone a hospital with a relevant specialist and those who have been compromised.
Their immune systems have been compromised as a result of extensive chemotherapy, and those whose mobility is affected by their terminal illness and find it impossible to travel. Are we not at risk of denying access to these people to travel when such challenges are not unusual, given the nature of what they're experiencing with their terminal illness? Is it the intention that for someone, for practical medical reasons, they are unable to meet with the independent advocate or the panel, but they're able and willing to do so via video link, that they will immediately be ineligible even if they fulfil all other criteria.
I think it's difficult to see the basis upon which this can be justified. I'm just coming to an end. I don't think I don't have to take an intervention. I don't think so. I would like to just finish my point. It seems to me that this is about making the choice of an assisted death to be really difficult and impossible, and I think we just need to think very carefully on the checks we're putting in place here. But for those in the last six months of their lives, we need to make sure it's a system that really will work for them.
11:34
Baroness Fox of Buckley (Non-affiliated)
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Baroness Fox of Buckley (Non-affiliated)
My Lord. >> My Lords, the. I think we actually should thank the noble Lady Baroness Gerada and the noble Lady Baroness Gerada and the noble Lady Baroness Pidgeon for raising important counters to a lot of the contributions, because it is important that we don't fetishise face to face as infallible. Face to face communication is no guarantee that comprehension happens, that people listen or there isn't misunderstanding. And we should know that because we sit face to face in this committee every Friday and goodness knows, it hasn't guaranteed much of that.
But I've put my name on several amendments because I think that despite what the noble Lady Baroness Pidgeon just said, about six months to live and we must make it as easy as possible, the sponsors of this bill rightly have built into the bill the need for eligibility to be. You can't just wander in and say, I've got six months to live, get rid of me. You have to pass the eligibility assessment. And we're trying to work out whether a default of face to face would be a better way of guaranteeing that there's no abuse, which I think is a reasonable thing.
I remember, actually, that ITV documentary first referenced by the noble Lady Baroness Coffey in when I heard the bill's sponsor in the other place Kim Leadbeater admit that she was uncomfortable by what has been labelled death by Zoom, the model that she was watching in Oregon. And it was actually, despite what the noble Lady Baroness Gerada said it was actually she Kim Leadbeater who rightly noted that it looked too much like tick box, tick box exercise. And I do think that we need to be wary of anything that goes in that direction.
But because that's what I watched on that documentary, I expected that. Therefore, on the face of the bill, there would be a requirement, a basic requirement for face to face unless in exceptional circumstances. And so I would ask the noble and learned Lords to respond as to why the bill still permits so many encounters with doctors, including the panel, to be conducted remotely, which just means that somebody would actually access assisted death without having seen face to face the doctor.
And that just seems at least one might pause. And and despite the virtues of telemedicine and there are many virtues and you can we can all see all the reasons why on occasion it's important, just like we all use zoom meetings and so on. It's a question of whether it's superior or can be relied on. And I think that the noble Lady Baroness Smith of Newnham really described vividly why Baroness Jay contribution, saying at least the Lady Gerada knows what it's like to be the doctor who's doing the consultation.
Well, some of us know what it's like to be the patient on the other end of it. And to be honest, it's not always, as, you know, trust the experts and all that. But and there are absolutely crossed wires hanging around the frustration of it, all sorts of things can go wrong. And I do think when Professor Martin Vernon, chair of the Ethics and law special interest group at the British Geriatrics Society, says, quote, assessing somebody remotely digitally without a face to face assessment, particularly if they have complex health and social care needs, is nigh on impossible.
I also think that there's something in that too, that we should consider non-face to face zoom or phone or whatever. Encounters are particularly challenging for particular groups. Those with communications difficulties, the noble Baroness, Lady Nicholson, reminded us of the difficulties or raised the issues of people with hearing difficulties in a previous group. We all know that there are difficulties of language, and of course, older people are likely to make up the majority of those being assessed for assisted dying and without caricaturing oldies as being technically illiterate.
There's a smidgen of truth there, but I think there's also something else older people on the phone sometimes present their best selves. I mean, they put on their best voice. Isn't it wrong with this? But they're kind of, you know, they're kind of chat away as though everything is fine. And even on zoom, you know, kind of sit there looking their best when you actually see that. I'm not now talking about being a doctor, assessing them. But then when you see them face to face, they're dishevelled, they're pale, they're frail, it's something else happens.
And I do think because the assisted dying decision involves highly emotional and existential issues, remote, purely remote assessments potentially undermine the relationships, the relational aspects of care that will help ensure that decisions are well considered and autonomously made, and that we've got to think about that direct personal interactions, because the noble Lady Baroness Jay is right, it's the last six months of your life, allegedly. But that's what you've been told. People are vulnerable and distressed and not quite sure.
And I all I'm suggesting all these amendments are suggesting is that possibly we better to see the doctor now if you can't get there, that's all. Fine. Nobody's been inhumane. But you go, the doctor sees you and assesses what's going on in order to. It's a necessary, if not sufficient, way of establishing the eligibility criteria. Now, finally, the noble Lord, Lord MP talked about, well, we you know, it might be appropriate for online legal proceedings. That might work. But I think actually, it's worth noting this, and I'm sure the noble and learned Lord will be aware of the evidence in relation to the use of video links in court proceedings and trials in Transform Justice's survey of court users.
Court users 70% of respondents said it was difficult to recognise whether someone who was on video had a disability, while 74% believed that those who had no legal representation were disadvantaged by appearing on video. In other words, the vulnerable always suffer in those instances, and the report similarly found that there were significant issues in assessing evidence and character. And so I think we can learn from other jurisdictions as well or other areas. But the main thing I would say is default should be face to face should be on the face of the bill.
I agree with Kim Leadbeater. That's a headline on that one. I just don't understand why having Kim Leadbeater noted that it's not on the face of the bill. And of course there should be exceptions. If people are too ill or too far away, or having a ball for the last six months in Tenerife. Yes, we get all that, but it's the default point is face to face where possible, as much as possible.
But I've put my name on several amendments because I think that despite what the noble Lady Baroness Pidgeon just said, about six months to live and we must make it as easy as possible, the sponsors of this bill rightly have built into the bill the need for eligibility to be. You can't just wander in and say, I've got six months to live, get rid of me. You have to pass the eligibility assessment. And we're trying to work out whether a default of face to face would be a better way of guaranteeing that there's no abuse, which I think is a reasonable thing.
I remember, actually, that ITV documentary first referenced by the noble Lady Baroness Coffey in when I heard the bill's sponsor in the other place Kim Leadbeater admit that she was uncomfortable by what has been labelled death by Zoom, the model that she was watching in Oregon. And it was actually, despite what the noble Lady Baroness Gerada said it was actually she Kim Leadbeater who rightly noted that it looked too much like tick box, tick box exercise. And I do think that we need to be wary of anything that goes in that direction.
But because that's what I watched on that documentary, I expected that. Therefore, on the face of the bill, there would be a requirement, a basic requirement for face to face unless in exceptional circumstances. And so I would ask the noble and learned Lords to respond as to why the bill still permits so many encounters with doctors, including the panel, to be conducted remotely, which just means that somebody would actually access assisted death without having seen face to face the doctor.
And that just seems at least one might pause. And and despite the virtues of telemedicine and there are many virtues and you can we can all see all the reasons why on occasion it's important, just like we all use zoom meetings and so on. It's a question of whether it's superior or can be relied on. And I think that the noble Lady Baroness Smith of Newnham really described vividly why Baroness Jay contribution, saying at least the Lady Gerada knows what it's like to be the doctor who's doing the consultation.
Well, some of us know what it's like to be the patient on the other end of it. And to be honest, it's not always, as, you know, trust the experts and all that. But and there are absolutely crossed wires hanging around the frustration of it, all sorts of things can go wrong. And I do think when Professor Martin Vernon, chair of the Ethics and law special interest group at the British Geriatrics Society, says, quote, assessing somebody remotely digitally without a face to face assessment, particularly if they have complex health and social care needs, is nigh on impossible.
I also think that there's something in that too, that we should consider non-face to face zoom or phone or whatever. Encounters are particularly challenging for particular groups. Those with communications difficulties, the noble Baroness, Lady Nicholson, reminded us of the difficulties or raised the issues of people with hearing difficulties in a previous group. We all know that there are difficulties of language, and of course, older people are likely to make up the majority of those being assessed for assisted dying and without caricaturing oldies as being technically illiterate.
There's a smidgen of truth there, but I think there's also something else older people on the phone sometimes present their best selves. I mean, they put on their best voice. Isn't it wrong with this? But they're kind of, you know, they're kind of chat away as though everything is fine. And even on zoom, you know, kind of sit there looking their best when you actually see that. I'm not now talking about being a doctor, assessing them. But then when you see them face to face, they're dishevelled, they're pale, they're frail, it's something else happens.
And I do think because the assisted dying decision involves highly emotional and existential issues, remote, purely remote assessments potentially undermine the relationships, the relational aspects of care that will help ensure that decisions are well considered and autonomously made, and that we've got to think about that direct personal interactions, because the noble Lady Baroness Jay is right, it's the last six months of your life, allegedly. But that's what you've been told. People are vulnerable and distressed and not quite sure.
And I all I'm suggesting all these amendments are suggesting is that possibly we better to see the doctor now if you can't get there, that's all. Fine. Nobody's been inhumane. But you go, the doctor sees you and assesses what's going on in order to. It's a necessary, if not sufficient, way of establishing the eligibility criteria. Now, finally, the noble Lord, Lord MP talked about, well, we you know, it might be appropriate for online legal proceedings. That might work. But I think actually, it's worth noting this, and I'm sure the noble and learned Lord will be aware of the evidence in relation to the use of video links in court proceedings and trials in Transform Justice's survey of court users.
Court users 70% of respondents said it was difficult to recognise whether someone who was on video had a disability, while 74% believed that those who had no legal representation were disadvantaged by appearing on video. In other words, the vulnerable always suffer in those instances, and the report similarly found that there were significant issues in assessing evidence and character. And so I think we can learn from other jurisdictions as well or other areas. But the main thing I would say is default should be face to face should be on the face of the bill.
I agree with Kim Leadbeater. That's a headline on that one. I just don't understand why having Kim Leadbeater noted that it's not on the face of the bill. And of course there should be exceptions. If people are too ill or too far away, or having a ball for the last six months in Tenerife. Yes, we get all that, but it's the default point is face to face where possible, as much as possible.
11:42
Baroness Coussins (Crossbench)
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Baroness Coussins (Crossbench)
My Lords, my Lords, if we are to >> My Lords, my Lords, if we are to have remote assessments, I do think that it's very important that we that it's very important that we have an exception for one group of people who might be seeking assisted dying, and those are the people who require the services of a public service interpreter. Now, elsewhere in this bill, the provision of interpreters is acknowledged and provided for. And this is one situation where I think face to face consultations is essential.
During Covid, there was a huge rise in remote interpreting in the criminal justice system and a number of studies, including a very robust piece of research by the Magistrates Association. They all showed that there were problems with remote interpreting down to a whole range of reasons, ranging from dodgy technology through to miscues because of body language. And so I think in this, in these circumstances, more than anything else, a face to face consultation or assessment is right and appropriate where the services of a public service interpreter is needed for the benefit of the person seeking help.
During Covid, there was a huge rise in remote interpreting in the criminal justice system and a number of studies, including a very robust piece of research by the Magistrates Association. They all showed that there were problems with remote interpreting down to a whole range of reasons, ranging from dodgy technology through to miscues because of body language. And so I think in this, in these circumstances, more than anything else, a face to face consultation or assessment is right and appropriate where the services of a public service interpreter is needed for the benefit of the person seeking help.
11:43
11:43
11:44
Baroness O'Loan (Crossbench)
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Baroness O'Loan (Crossbench)
core of what we're discussing today. And it's not just the doctor who needs to be able to see and needs to be able to see and understand. It is the patient who needs to be able to see and understand and to interact with the understand and to interact with the doctor. My brother during Covid, tried for six months to get to see tried for six months to get to see his doctor. There were regular telephone calls on each occasion. He was told that his symptoms were He was told that his symptoms were resulting from cardiac problems, other problems which he'd had, and that all he needed to do was take painkillers.
When he finally presented to A&E six months later, he had stage four lung cancer and bone cancer. My Lord. Remote consultations do not always protect and because this is a matter of life and death, because this is a situation in which someone is seeking death, we need to be very sure of what we're doing, and face to face consultations aren't required by the bill. There has been a lot of talk about the the fact that the person alone in the room may not be alone in the room, and the various interactions which may be taking out of vision of the consulting doctor at the time.
And we do accept, I mean, I would fully accept that patients may be reluctant for a variety of reasons to travel, but that is not the only criteria to be considered. The noble Baroness Baroness Fox referred to the Transform Justice report on how video links endanger communication. Really. In court trials, 70% of respondents finding it difficult to understand whether someone on a video had a disability. That's a fairly sort of basic starting point, and the inability to observe non-verbal cues, things like that, is also a major problem with virtual consultations.
Now, it may be argued that coercion is a criminal offence under the bill, but any prosecution actually could come too late for the person who is being coerced into seeking assisted dying. And I think our duty as legislators is to provide safeguards to prevent that happening where possible and therefore to ensure face to face consultations on every occasion on which those are possible. I note the intention of the noble Lord noble and learned Lord. Lord Wolfson's amendment 320 a the first assessment must be undertaken in person, except in circumstances where this is not reasonably practicable, where it may be conducted by live video or audio link.
I think the test of reasonable practicability. Practicability may be too uncertain. So my. Because my question is what might make a face to face diagnosis not reasonably practicable? The doctor lives a long way away. There's a tube strike. Patient can't travel because of that. Doctor can't travel because of that. They would be able to travel the next day, but that would then disrupt the doctor's existing diary, where he may have other points with other patients seeking assisted death. I think some more specific test is required to prevent a failure to ensure that in all but the most exceptional circumstances, the meeting must be face to face.
Now, I haven't put down a further amendment to this because I think we have the opportunity to discuss the issue today. The noble Lord, noble Baroness Baroness Coffey, talked about assessments taking place in the UK, and I think the significance of these is that they then enable the regulatory regimes of the various professions to operate effectively, they enable proper consideration and investigation, where necessary, to enable recourse to civil law where necessary, and so that criminal law offences. Would apply to the actions in question.
And in addition to this, the designation of the lethal drugs to be used to kill the regulations governing their prescribing, dispensing, transporting, storage, handling, etc. are all subject to secondary legislation powers. We really need controls in place within the jurisdiction before the system can operate safely, and the issue to the sorry the duty to issue codes of practice relating to the operation and integrity of the act, capacity, assessment, coercion, etc. is again conferred on the Secretary of State or the Welsh Ministers.
The process must operate in England and Wales. My Lords, when a person makes an altruistic kidney donation, all the staff repeatedly asked the person before they go into surgery what are they doing and do they understand the consequences face to face? All the consultations which precede the donations are done face to face for obvious reasons. If those requirements exist to ensure a person is acting without coercion and in full understanding of what they are doing when they undergo the surgery, surely, my Lords, it would be essential that a person who is contemplating ending their own life with assistance should be protected by carefully conducted, professional face to face consultations, which can be arranged in a location in the UK which is convenient for the patient but which should never be conducted on video.
My Lord, we really do need absolute clarity as to how these processes must operate. And can the noble Lord, the noble Lord, Lord Faulkner, explain how doctors and the panels can operate or could operate safely without seeing the patient? The psychiatrist who said they can't assess capacity remotely. The limitations of remote assessment in the justice and healthcare system are well known. How is the panel to verify matters if it does not see the patient, at least in most cases? And can the noble Lord noble and learned Lord explain what safeguards exist to stop the panel becoming a Sir Nicholas Mostyn said a symbolic rubber stamp.
Saint James Mumby also pointed out that the impact assessment expects the panel to meet for three hours a case, and he said that will put pressure on the panel to conclude the first case in time so it can move on to the second case. If ever there is a tribunal which should be under no pressure of time, surely it's a tribunal dealing with matters of life and death. Now, the the amendment 65 does provide a list of activities which must take place face to face, and I have no difficulty in in supporting this amendment because I think the situations which are provided for in those, in those subclauses are of fundamental importance.
After the bill's sponsor in the Commons, Kim Leadbeater MP, witnessed the tick box online assessment in Oregon, she did tell ITV, as others have said, that the assessment should be in person, face to face. The bill still permits exactly those death by doom assessments. Death by zoom assessments. My Lords, in the absence of amendments such as these, how can the noble Lord noble and learned Lords Minister ensure that Parliament is discharging its most important responsibilities to the people of this country? And if he doesn't accept the need for these amendments, will the noble and learned Lord Faulkner of Worcester introduce amendments to address the very serious problems which have been identified in this group?
When he finally presented to A&E six months later, he had stage four lung cancer and bone cancer. My Lord. Remote consultations do not always protect and because this is a matter of life and death, because this is a situation in which someone is seeking death, we need to be very sure of what we're doing, and face to face consultations aren't required by the bill. There has been a lot of talk about the the fact that the person alone in the room may not be alone in the room, and the various interactions which may be taking out of vision of the consulting doctor at the time.
And we do accept, I mean, I would fully accept that patients may be reluctant for a variety of reasons to travel, but that is not the only criteria to be considered. The noble Baroness Baroness Fox referred to the Transform Justice report on how video links endanger communication. Really. In court trials, 70% of respondents finding it difficult to understand whether someone on a video had a disability. That's a fairly sort of basic starting point, and the inability to observe non-verbal cues, things like that, is also a major problem with virtual consultations.
Now, it may be argued that coercion is a criminal offence under the bill, but any prosecution actually could come too late for the person who is being coerced into seeking assisted dying. And I think our duty as legislators is to provide safeguards to prevent that happening where possible and therefore to ensure face to face consultations on every occasion on which those are possible. I note the intention of the noble Lord noble and learned Lord. Lord Wolfson's amendment 320 a the first assessment must be undertaken in person, except in circumstances where this is not reasonably practicable, where it may be conducted by live video or audio link.
I think the test of reasonable practicability. Practicability may be too uncertain. So my. Because my question is what might make a face to face diagnosis not reasonably practicable? The doctor lives a long way away. There's a tube strike. Patient can't travel because of that. Doctor can't travel because of that. They would be able to travel the next day, but that would then disrupt the doctor's existing diary, where he may have other points with other patients seeking assisted death. I think some more specific test is required to prevent a failure to ensure that in all but the most exceptional circumstances, the meeting must be face to face.
Now, I haven't put down a further amendment to this because I think we have the opportunity to discuss the issue today. The noble Lord, noble Baroness Baroness Coffey, talked about assessments taking place in the UK, and I think the significance of these is that they then enable the regulatory regimes of the various professions to operate effectively, they enable proper consideration and investigation, where necessary, to enable recourse to civil law where necessary, and so that criminal law offences. Would apply to the actions in question.
And in addition to this, the designation of the lethal drugs to be used to kill the regulations governing their prescribing, dispensing, transporting, storage, handling, etc. are all subject to secondary legislation powers. We really need controls in place within the jurisdiction before the system can operate safely, and the issue to the sorry the duty to issue codes of practice relating to the operation and integrity of the act, capacity, assessment, coercion, etc. is again conferred on the Secretary of State or the Welsh Ministers.
The process must operate in England and Wales. My Lords, when a person makes an altruistic kidney donation, all the staff repeatedly asked the person before they go into surgery what are they doing and do they understand the consequences face to face? All the consultations which precede the donations are done face to face for obvious reasons. If those requirements exist to ensure a person is acting without coercion and in full understanding of what they are doing when they undergo the surgery, surely, my Lords, it would be essential that a person who is contemplating ending their own life with assistance should be protected by carefully conducted, professional face to face consultations, which can be arranged in a location in the UK which is convenient for the patient but which should never be conducted on video.
My Lord, we really do need absolute clarity as to how these processes must operate. And can the noble Lord, the noble Lord, Lord Faulkner, explain how doctors and the panels can operate or could operate safely without seeing the patient? The psychiatrist who said they can't assess capacity remotely. The limitations of remote assessment in the justice and healthcare system are well known. How is the panel to verify matters if it does not see the patient, at least in most cases? And can the noble Lord noble and learned Lord explain what safeguards exist to stop the panel becoming a Sir Nicholas Mostyn said a symbolic rubber stamp.
Saint James Mumby also pointed out that the impact assessment expects the panel to meet for three hours a case, and he said that will put pressure on the panel to conclude the first case in time so it can move on to the second case. If ever there is a tribunal which should be under no pressure of time, surely it's a tribunal dealing with matters of life and death. Now, the the amendment 65 does provide a list of activities which must take place face to face, and I have no difficulty in in supporting this amendment because I think the situations which are provided for in those, in those subclauses are of fundamental importance.
After the bill's sponsor in the Commons, Kim Leadbeater MP, witnessed the tick box online assessment in Oregon, she did tell ITV, as others have said, that the assessment should be in person, face to face. The bill still permits exactly those death by doom assessments. Death by zoom assessments. My Lords, in the absence of amendments such as these, how can the noble Lord noble and learned Lords Minister ensure that Parliament is discharging its most important responsibilities to the people of this country? And if he doesn't accept the need for these amendments, will the noble and learned Lord Faulkner of Worcester introduce amendments to address the very serious problems which have been identified in this group?
11:51
Baroness Blackstone (Labour)
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Baroness Blackstone (Labour)
My Lords. >> We are discussing? >> I am a chair of one of the
**** Possible New Speaker ****
I am a chair of one of the Medical Royal Colleges trusts. I want to speak to this amendment to this group of amendments, taking this group of amendments, taking into account the medical profession. I entirely agree, and the vast majority of doctors, I'm sure, will also entirely agree that it is better to have face to face consultations in this circumstances. However, nearly all those who have spoken in favour of face to face consultations have admitted or agreed that there will be exceptions and there will be quite a lot of exceptions.
We have to remember that many people who are terminally ill are bedbound. They're not able to get up and go to a face to face consultation, even if it's quite near to where they live. And I think the vast majority of doctors would want to discuss with their patients whether a face to face appointment is acceptable, possible and desirable, and if not, to have an online consultation with them. That seems to me the right approach. Moreover, I really do wonder whether we should be putting on the face of the bill a clause that will constrain doctors in a way that I think unacceptable.
We must accept that the vast majority of doctors will go into this work with utter commitment to doing the best possible job they can, and I find it a bit disconcerting that the constant reference to a tick box approach. My Lord, you can have a tick box approach based on faith, or you can have a tick box approach in a consultation online. It doesn't seem to me a relevant and important point to make. What I would like to suggest is, rather than putting this on the face of the bill, given that given that, I'm sure there is a very strong case for face to face consultations normally that it should instead be part of a code of practice for the medical profession.
That will certainly have to be developed if and when this bill is enacted.
**** Possible New Speaker ****
I am a chair of one of the Medical Royal Colleges trusts. I want to speak to this amendment to this group of amendments, taking this group of amendments, taking into account the medical profession. I entirely agree, and the vast majority of doctors, I'm sure, will also entirely agree that it is better to have face to face consultations in this circumstances. However, nearly all those who have spoken in favour of face to face consultations have admitted or agreed that there will be exceptions and there will be quite a lot of exceptions.
We have to remember that many people who are terminally ill are bedbound. They're not able to get up and go to a face to face consultation, even if it's quite near to where they live. And I think the vast majority of doctors would want to discuss with their patients whether a face to face appointment is acceptable, possible and desirable, and if not, to have an online consultation with them. That seems to me the right approach. Moreover, I really do wonder whether we should be putting on the face of the bill a clause that will constrain doctors in a way that I think unacceptable.
We must accept that the vast majority of doctors will go into this work with utter commitment to doing the best possible job they can, and I find it a bit disconcerting that the constant reference to a tick box approach. My Lord, you can have a tick box approach based on faith, or you can have a tick box approach in a consultation online. It doesn't seem to me a relevant and important point to make. What I would like to suggest is, rather than putting this on the face of the bill, given that given that, I'm sure there is a very strong case for face to face consultations normally that it should instead be part of a code of practice for the medical profession.
That will certainly have to be developed if and when this bill is enacted.
11:53
Lord Birt (Crossbench)
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Lord Birt (Crossbench)
Lord. make in their lives. It's important for the individual, and it's important also for the state. I think it is appropriate to ask that these the critical meetings with the medical practitioners should be face to face because it allows a degree of intimacy and nuance, which, frankly, however valuable the world of teams is, it doesn't always allow allow So I think at the very least the there are three process set out in the bill and at the very least the the second doctor who's going to coordinate the process.
At the very least, I think it's reasonable to require that that meeting be face to face.
At the very least, I think it's reasonable to require that that meeting be face to face.
11:54
Baroness Berger (Labour)
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Baroness Berger (Labour)
My Lords, I wish to. >> Rise very briefly to support the amendment that is calling for face to face consultations to take place, to face consultations to take place, rather than in only exceptional cases. And I just want to reflect on on why this matters. One is because we know from other jurisdictions that many of these assessments are being done online. And I think it's a it's a really important question for us to consider whether we would want that in our country, and if not, it should be on the face of the bill.
But in addition to which my comments are informed by the evidence that we were presented with at the Select committee, and also drawn from my experience, having met a number of elderly constituents over the course of nearly a decade as a member of Parliament, and I reflect particularly on the women I met in their 70s, 80s and 90s who shared with me their experiences of domestic abuse and why this conversation and why this, these amendments matter, is because this legislation doesn't happen in a vacuum.
The Labour government today is absolutely, rightly concerned with addressing the public health emergency of violence against women and girls in our country, and has an important landmark mission and goal of halving violence against women and girls over the next decades. The NHS is playing its part and is enhancing its efforts in tackling violence against women and girls, focusing particularly on early identification. And there's a lot of other very important work going on via training and investment, and I commend the work of many colleagues who are dealing with this on a daily basis.
It was the experts that told us that in order to identify coercion, undue influence and pressure, doctors and other professionals need to look at someone's body language. It's not just the words we say, how we say it, the volume or the tone. It's our non-verbal cues. It's what our body says. It's the things that we don't say that often share an important message. I've listened very carefully to the to the counter challenge of noble Lords so far. I don't think there's anything to stop this bill from stipulating that in exceptional circumstances, the doctors or the independent applicants or the panel members can go and visit an individual.
But I would much rather prefer that we had legislation that supports the government's important aim to reduce violence against women and girls, rather than something that will exacerbate the very serious problem that we know that too many women in our country face, particularly at the at their most vulnerable moments, which includes the end of life.
But in addition to which my comments are informed by the evidence that we were presented with at the Select committee, and also drawn from my experience, having met a number of elderly constituents over the course of nearly a decade as a member of Parliament, and I reflect particularly on the women I met in their 70s, 80s and 90s who shared with me their experiences of domestic abuse and why this conversation and why this, these amendments matter, is because this legislation doesn't happen in a vacuum.
The Labour government today is absolutely, rightly concerned with addressing the public health emergency of violence against women and girls in our country, and has an important landmark mission and goal of halving violence against women and girls over the next decades. The NHS is playing its part and is enhancing its efforts in tackling violence against women and girls, focusing particularly on early identification. And there's a lot of other very important work going on via training and investment, and I commend the work of many colleagues who are dealing with this on a daily basis.
It was the experts that told us that in order to identify coercion, undue influence and pressure, doctors and other professionals need to look at someone's body language. It's not just the words we say, how we say it, the volume or the tone. It's our non-verbal cues. It's what our body says. It's the things that we don't say that often share an important message. I've listened very carefully to the to the counter challenge of noble Lords so far. I don't think there's anything to stop this bill from stipulating that in exceptional circumstances, the doctors or the independent applicants or the panel members can go and visit an individual.
But I would much rather prefer that we had legislation that supports the government's important aim to reduce violence against women and girls, rather than something that will exacerbate the very serious problem that we know that too many women in our country face, particularly at the at their most vulnerable moments, which includes the end of life.
11:57
Lord Hamilton of Epsom (Conservative)
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Lord Hamilton of Epsom (Conservative)
Committee recall last week that she told the House that 23% of she told the House that 23% of diagnoses of the six months to live turned out to be wrong, and people lived longer. Does that not make the whole position of face to face diagnosis much more important? When
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doctors so often get it wrong? Technology has gone a long way
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Technology has gone a long way to helping disabled people leave inclusive and integrated lives in inclusive and integrated lives in British society, and I generally support the use of it. But for many of us who worked on the coronavirus legislation where we had to make
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doctors so often get it wrong? Technology has gone a long way
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Technology has gone a long way to helping disabled people leave inclusive and integrated lives in inclusive and integrated lives in British society, and I generally support the use of it. But for many of us who worked on the coronavirus legislation where we had to make
11:58
Baroness Grey-Thompson (Crossbench)
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Baroness Grey-Thompson (Crossbench)
legislation where we had to make very quick decisions, the speed with which we went online seemed as if, as a society, we'd moved decades forward from having to only meet in person. Even you Lordships chamber managed to meet and vote online, but I think it comes with a set of challenges. And I do think we have to look at what happened during Covid. On the huge increase in domestic abuse. Now, it wasn't just because we didn't have to ask people to turn their cameras on, it was deemed that actually that would be upsetting.
So we couldn't see if somebody had been domestically abused. But if I think about and the the impact of increased domestic abuse also was because there was more recording. But I think when you look at the technology that we even have in your Lordships chamber, it is not foolproof. I was on a call yesterday in my office. The system crashed twice, and the people I was speaking to on teams didn't even realise and carried on talking. So I think we have to think very carefully about how we would use technology now.
Age UK have said about 2.4 million older people don't have access to technology in this country. Just under 2 million don't have a mobile phone, let alone a smartphone. So if we're going to do this, I think we need to think very carefully about what other provisions can be in place. And I agree with the noble Lady, Lady Burger that actually, why can't the panel go and visit the individual? Because I do think there is something about being in their own home. And you know what happens.
Noble Lady, lady pigeon raised about rural areas. What if people don't have the technology? What is going to be put in place to ensure that there would be a suitable online option? I'm also pleased, quoting evidence that was given, Doctor young gave evidence as a noble Lady. Lady pigeon said I understand that she has a PhD in sociology. I've been contacted by Professor Charlotte Wilson Jones, professor of Psychology, Education and Innovation, and she is incredibly worried about moving to online assessments as as a given.
And this is an individual who has high level training in both palliative care and psychiatry. And she said to me that if you're not in the room, it's very difficult to understand what is going on behind the camera. And also, she's worked with a significant number of terminally ill people looking at mental illness and capacity assessments. And she said to me that this takes time. It doesn't necessarily it can't necessarily be done in a single appointment. And then you add in layers of communication and difficulty in talking.
It makes it very difficult to do a proper assessment in this case and in the bill. You know, yes, there are doctors, but it could be a very newly qualified doctor who doesn't have experience in these matters, who may not have a postgraduate in psychology. And carrying out this role, which consultant psychiatrists are saying hard to do, I think throws up another set of challenges. And of course, Professor Mumtaz Patel for Royal College of Physicians talked about how important that connection was.
And I looked at a study of the impact of Covid on 11 of the jurisdictions where assisted suicide is legal. And in each of those jurisdictions, it found that telemedicine had pushed the boundaries and rules have been blurred. And in some cases, rules were broken because it was becoming much quicker to do an assessment. Now, we haven't got on to how people are going to be paid, or whether there's going to be remuneration or even the appointment of those individuals. But my concern with telemedicine or, you know, by video, it incentivises people to push through the assessments and do it quickly.
And as other noble Lords have raised, the hon. Member for Batley and Spen, Miss Leadbeater, said she was uncomfortable with the Oregon model. I think where the noble Lady, Baroness Blackstone and I probably do agree with each other. None of it should be a tick box exercise, but my concern with with doing it online is that it does become that. So does the noble and learned Lord agree with Miss Leadbeater's concerns over it becoming a tick box exercise? And I know the noble Lord can't speak for Mr.
Lord Bates, so I am going to write to her. I would like to understand why she didn't amend the bill to include this. After saying that she felt really uncomfortable, unlike the noble Lady Baroness Fox, I have had online assessments in Covid. I had a breast exam online to see whether I needed to go for a mammogram, and I would argue that is relatively easily having to Sharpie under my arms to show where the lumps were is slightly different from someone making an assessment about whether I could take drugs, as the noble and learned Lord used last week poison to to end their lives.
And I one other example in terms of my real worry about this process. My husband was unwell. We had an online assessment. Everything that the doctor said was that my husband had an ear infection, and it's only because I am probably quite a difficult expert patient that I pushed back quite hard and explained that he was on permanently on antibiotics. So the antibiotics that were being prescribed for any infection were the ones he was taking, and I gave the amounts that he was taking, and I kept being told it was an infection.
I pushed back and I pushed back. This is where he'd had a stroke. And without that, I'm not sure me me forcing, you know, the issue and getting to hospital. I'm not sure he would be with me. Now. My final point I wish to raise, and it's another question to the noble and learned Lord, and I would be grateful if you could answer it. I don't want to assume on his answer, but I'm probably expecting him to say that, you know, criminal law would be there to punish coercion.
But surely our job is to prevent coercion, not to put someone through the court system when coercion has or may be spotted. So how will the noble and learned Lord, through either the face of the bill or answering today, explain how coercion will be prevented, and we will be able to make sure that people don't, unwittingly or through force, choose to end their lives when that is not what they want.
So we couldn't see if somebody had been domestically abused. But if I think about and the the impact of increased domestic abuse also was because there was more recording. But I think when you look at the technology that we even have in your Lordships chamber, it is not foolproof. I was on a call yesterday in my office. The system crashed twice, and the people I was speaking to on teams didn't even realise and carried on talking. So I think we have to think very carefully about how we would use technology now.
Age UK have said about 2.4 million older people don't have access to technology in this country. Just under 2 million don't have a mobile phone, let alone a smartphone. So if we're going to do this, I think we need to think very carefully about what other provisions can be in place. And I agree with the noble Lady, Lady Burger that actually, why can't the panel go and visit the individual? Because I do think there is something about being in their own home. And you know what happens.
Noble Lady, lady pigeon raised about rural areas. What if people don't have the technology? What is going to be put in place to ensure that there would be a suitable online option? I'm also pleased, quoting evidence that was given, Doctor young gave evidence as a noble Lady. Lady pigeon said I understand that she has a PhD in sociology. I've been contacted by Professor Charlotte Wilson Jones, professor of Psychology, Education and Innovation, and she is incredibly worried about moving to online assessments as as a given.
And this is an individual who has high level training in both palliative care and psychiatry. And she said to me that if you're not in the room, it's very difficult to understand what is going on behind the camera. And also, she's worked with a significant number of terminally ill people looking at mental illness and capacity assessments. And she said to me that this takes time. It doesn't necessarily it can't necessarily be done in a single appointment. And then you add in layers of communication and difficulty in talking.
It makes it very difficult to do a proper assessment in this case and in the bill. You know, yes, there are doctors, but it could be a very newly qualified doctor who doesn't have experience in these matters, who may not have a postgraduate in psychology. And carrying out this role, which consultant psychiatrists are saying hard to do, I think throws up another set of challenges. And of course, Professor Mumtaz Patel for Royal College of Physicians talked about how important that connection was.
And I looked at a study of the impact of Covid on 11 of the jurisdictions where assisted suicide is legal. And in each of those jurisdictions, it found that telemedicine had pushed the boundaries and rules have been blurred. And in some cases, rules were broken because it was becoming much quicker to do an assessment. Now, we haven't got on to how people are going to be paid, or whether there's going to be remuneration or even the appointment of those individuals. But my concern with telemedicine or, you know, by video, it incentivises people to push through the assessments and do it quickly.
And as other noble Lords have raised, the hon. Member for Batley and Spen, Miss Leadbeater, said she was uncomfortable with the Oregon model. I think where the noble Lady, Baroness Blackstone and I probably do agree with each other. None of it should be a tick box exercise, but my concern with with doing it online is that it does become that. So does the noble and learned Lord agree with Miss Leadbeater's concerns over it becoming a tick box exercise? And I know the noble Lord can't speak for Mr.
Lord Bates, so I am going to write to her. I would like to understand why she didn't amend the bill to include this. After saying that she felt really uncomfortable, unlike the noble Lady Baroness Fox, I have had online assessments in Covid. I had a breast exam online to see whether I needed to go for a mammogram, and I would argue that is relatively easily having to Sharpie under my arms to show where the lumps were is slightly different from someone making an assessment about whether I could take drugs, as the noble and learned Lord used last week poison to to end their lives.
And I one other example in terms of my real worry about this process. My husband was unwell. We had an online assessment. Everything that the doctor said was that my husband had an ear infection, and it's only because I am probably quite a difficult expert patient that I pushed back quite hard and explained that he was on permanently on antibiotics. So the antibiotics that were being prescribed for any infection were the ones he was taking, and I gave the amounts that he was taking, and I kept being told it was an infection.
I pushed back and I pushed back. This is where he'd had a stroke. And without that, I'm not sure me me forcing, you know, the issue and getting to hospital. I'm not sure he would be with me. Now. My final point I wish to raise, and it's another question to the noble and learned Lord, and I would be grateful if you could answer it. I don't want to assume on his answer, but I'm probably expecting him to say that, you know, criminal law would be there to punish coercion.
But surely our job is to prevent coercion, not to put someone through the court system when coercion has or may be spotted. So how will the noble and learned Lord, through either the face of the bill or answering today, explain how coercion will be prevented, and we will be able to make sure that people don't, unwittingly or through force, choose to end their lives when that is not what they want.
12:05
Lord Carlile of Berriew (Crossbench)
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Lord Carlile of Berriew (Crossbench)
My Lord, I just. >> Wish to make two points about whether these consultations should be face to face. For the first, I'd be face to face. For the first, I'd like to remind the House of the General Medical Council's remote General Medical Council's remote consultation diagram, which is in the GMC guidance. It's not absolutist about whether doctors should see patients remotely or face to face, but it sets out guidance. Remote treatment may be appropriate when first box the patient's clinical need or treatment request is straightforward.
Well, we're not talking about straightforward clinical needs or treatment requests here. And on the other side of the diagram it says face to face treatment may be preferable when the patient has complex clinical needs or is requesting higher risk treatments. As I've said previously and it is historic, I was at one time a lay member of the General Medical Council for ten years, and I was involved in helping to draft GMC guidance, as well as dealing with conduct and health cases.
It is unimaginable to me that the General Medical Council would create guidance in which they would accept the proposal that saving the most exceptional circumstances, based on the clearest evidence such consultations should be done remotely. The second point I wanted to make is that the medical profession are not the only ones who have to give important advice to their patients, clients or customers. Unlike a few other members of your Lordships House here today, I have often had to give advice to people in absolutely critical situations when they faced possibly spending the rest of their life in custody.
And I recall one particular case in which, in the middle of a longish murder trial, the client asked to see me, to ask me a very simple question how do you think it's going, sir? The answer to the question had to be robust, had to be realistic, and was very difficult. And it changed the whole course of the case, which came to a very quick end shortly afterwards. And the result was a minor advantage to the client. He did not spend the whole of the rest of his life in prison, just a substantial proportion of it.
But that was very important to him. And I would say to you, to your Lordships that, you know, whereas with doctors these days it's actually unless you go to a private doctor, quite difficult to see a doctor, and it's also quite difficult to say, see the same doctor twice, even if you have seen a doctor in the legal profession, although there are remote hearings in certain circumstances for the sort of very important decisions I've been describing, it is actually unthinkable to us, the professional lawyers who do these cases, that such consultations should not be face to face.
Now, that's a qualitative analysis based on two examples, but I hope your Lordships find it convincing.
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My Lords, I. Can be truly short here, and
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Can be truly short here, and it's further to a point made by the noble Lady Baroness Grey-Thompson. And that's this we are concerned, And that's this we are concerned, or at least many of us are, about subtle pressure and coercion. Yes, subtle pressure and coercion. Yes, whether it be in all cases. But it will be in some, and there will be legitimate concerns. The presence, if it's online, the doctors are unlikely to know whether there is someone else present in the room or
Well, we're not talking about straightforward clinical needs or treatment requests here. And on the other side of the diagram it says face to face treatment may be preferable when the patient has complex clinical needs or is requesting higher risk treatments. As I've said previously and it is historic, I was at one time a lay member of the General Medical Council for ten years, and I was involved in helping to draft GMC guidance, as well as dealing with conduct and health cases.
It is unimaginable to me that the General Medical Council would create guidance in which they would accept the proposal that saving the most exceptional circumstances, based on the clearest evidence such consultations should be done remotely. The second point I wanted to make is that the medical profession are not the only ones who have to give important advice to their patients, clients or customers. Unlike a few other members of your Lordships House here today, I have often had to give advice to people in absolutely critical situations when they faced possibly spending the rest of their life in custody.
And I recall one particular case in which, in the middle of a longish murder trial, the client asked to see me, to ask me a very simple question how do you think it's going, sir? The answer to the question had to be robust, had to be realistic, and was very difficult. And it changed the whole course of the case, which came to a very quick end shortly afterwards. And the result was a minor advantage to the client. He did not spend the whole of the rest of his life in prison, just a substantial proportion of it.
But that was very important to him. And I would say to you, to your Lordships that, you know, whereas with doctors these days it's actually unless you go to a private doctor, quite difficult to see a doctor, and it's also quite difficult to say, see the same doctor twice, even if you have seen a doctor in the legal profession, although there are remote hearings in certain circumstances for the sort of very important decisions I've been describing, it is actually unthinkable to us, the professional lawyers who do these cases, that such consultations should not be face to face.
Now, that's a qualitative analysis based on two examples, but I hope your Lordships find it convincing.
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My Lords, I. Can be truly short here, and
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Can be truly short here, and it's further to a point made by the noble Lady Baroness Grey-Thompson. And that's this we are concerned, And that's this we are concerned, or at least many of us are, about subtle pressure and coercion. Yes, subtle pressure and coercion. Yes, whether it be in all cases. But it will be in some, and there will be legitimate concerns. The presence, if it's online, the doctors are unlikely to know whether there is someone else present in the room or
12:09
Lord Sandhurst (Conservative)
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Lord Sandhurst (Conservative)
with the door open, listening to with the door open, listening to and nodding to an encouraging the applicant. I can call the person that to make their request. If at that to make their request. If at least one. Of the panel is present least one. Of the panel is present in the room, then they will be able to see and counter that. It is to see and counter that. It is really important that there is one of these people, preferably the panel, the very least if we're to prevent that, that is an important safeguard and if it's done online, it will be missed.
And my my recollection is that in Canada at least, there have been instances where afterwards people have raised legitimate questions, including coroners.
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My Lords, I want to pick up just two points. Made in this debate. Very briefly.
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Very briefly. The first one concerned Baroness Gerada comment, and I think I heard Gerada comment, and I think I heard it correctly to say that there wasn't really a distinction in her wasn't really a distinction in her advocating online usage, but there really wasn't a distinction between whether the person requesting requesting permission was in Torbay or in Tenerife. And I think that's
And my my recollection is that in Canada at least, there have been instances where afterwards people have raised legitimate questions, including coroners.
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My Lords, I want to pick up just two points. Made in this debate. Very briefly.
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Very briefly. The first one concerned Baroness Gerada comment, and I think I heard Gerada comment, and I think I heard it correctly to say that there wasn't really a distinction in her wasn't really a distinction in her advocating online usage, but there really wasn't a distinction between whether the person requesting requesting permission was in Torbay or in Tenerife. And I think that's
12:10
Baroness Falkner of Margravine (Crossbench)
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Baroness Falkner of Margravine (Crossbench)
a profoundly important legal point that I hope the noble and learned Lord, in summing up, will cover. Lord, in summing up, will cover. And it is this that could we have a situation if a person is in a foreign jurisdiction, whether online and where it subsequently transpires that there was coercion? Noble Lords around the House chamber have given us several chamber have given us several examples about that. It could happen. What would happen if that coercion came from a foreign citizen? Assuming that the patient returned to the UK and carried out their wish to be assisted to die? Yet the coercion came from a foreign citizen in a foreign jurisdiction.
When the online meeting took place, what would be the legal position in terms of the criminal law? My final and second point and final point is relates to what Baroness Berger said about home assessments. I don't have the impact assessment to hand, but I recall that the that the number of people who were likely to seek assisted dying in the impact assessment was not an enormously large number of people running into many thousands per year, and therefore the possibility of home visits should be something, if only, let's say, 10% of people were unable to have face to face consultations, then surely the impact assessment should cover that small minority of people and the cost or the practicalities of then requiring home assessments.
When the online meeting took place, what would be the legal position in terms of the criminal law? My final and second point and final point is relates to what Baroness Berger said about home assessments. I don't have the impact assessment to hand, but I recall that the that the number of people who were likely to seek assisted dying in the impact assessment was not an enormously large number of people running into many thousands per year, and therefore the possibility of home visits should be something, if only, let's say, 10% of people were unable to have face to face consultations, then surely the impact assessment should cover that small minority of people and the cost or the practicalities of then requiring home assessments.
12:12
Lord Polak (Conservative)
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Lord Polak (Conservative)
I, I support the amendments in this group, especially a law Lord this group, especially a law Lord Evans of Sealand. I wasn't going to speak, but actually I was moved by Baroness Smith in what she said Baroness Smith in what she said about her father. My Lord, I'm not a Luddite. My my mother passed away a Luddite. My my mother passed away in July 23rd from brain cancer. And this debate here has reminded me of the zoom call that we had to look at the next stage of her treatment.
I was here in London. My sister was with my mother in Liverpool, where she was lying in bed, unable to speak. The nurse, who was looking at the next stage of treatment for her was in Margate, had never met my mother and was asking questions over an hour where my mother could not reply, and so. I just listening to to this whole debate. And if we can't actually put face to face consultation on the face of the bill, I think we're doing a great injustice to so many people.
Yeah, yeah,
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And earlier on debate, Barnes J
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And earlier on debate, Barnes J intervened and said she could not understand why how we were talking understand why how we were talking so much, and yet we hadn't actually talked about terminal illness. Well, talked about terminal illness. Well, if the noble Lady remains in her place, group five actually is on place, group five actually is on terminal illness. And so therefore there certainly will be a lot of speaking about that issue, and therefore certainly was one. And in actual fact, we're bringing up and speaking on that group of medicines now, we would be told by the chief whip or the whip in the House that
I was here in London. My sister was with my mother in Liverpool, where she was lying in bed, unable to speak. The nurse, who was looking at the next stage of treatment for her was in Margate, had never met my mother and was asking questions over an hour where my mother could not reply, and so. I just listening to to this whole debate. And if we can't actually put face to face consultation on the face of the bill, I think we're doing a great injustice to so many people.
Yeah, yeah,
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And earlier on debate, Barnes J
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And earlier on debate, Barnes J intervened and said she could not understand why how we were talking understand why how we were talking so much, and yet we hadn't actually talked about terminal illness. Well, talked about terminal illness. Well, if the noble Lady remains in her place, group five actually is on place, group five actually is on terminal illness. And so therefore there certainly will be a lot of speaking about that issue, and therefore certainly was one. And in actual fact, we're bringing up and speaking on that group of medicines now, we would be told by the chief whip or the whip in the House that
12:14
Lord McCrea of Magherafelt and Cookstown (Democratic Unionist Party)
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Lord McCrea of Magherafelt and Cookstown (Democratic Unionist Party)
we were to address the actual amendments that were before us at amendments that were before us at this moment. Also, the noble Lady that was advocating the online that was advocating the online assessment, I would just say gently to her that in my experience as a to her that in my experience as a person who deals with the general public from another side, as a Minister, if everything is so perfect with online assessments, why are so many mistakes being made? Or do we just dismiss those mistakes? The proposer and supporters of this bill argue that this offers the safest system in the world, and then they go on to say is deeply patient centred now, yet they defend provisions that allow doctors and pounds to never see the person about to take a decision that has life and death implications.
But when taken, there is no return for the person. But they are assured from time into eternity. Now, a virtual assessment scheme. Without a discussion or proper face to face consultation has got to be considered. What discussion or consultation has been held about? What would be this virtual assessment scheme? What does it actually mean? And if those discussions have and consultations have taken place, with whom have they taken place? Surely remote assessment undermines detection or coercion and indeed coercion that is often very subtle and very carefully crafted.
Indeed, the abuser could actually be sitting in the very room listening to the conversation. Of course not visible. My Lord's coercion is very difficult to detect at the best of times, and in the past, serious mistakes have been made without seeing the person. No pounds should be called upon to grant the stamp of approval to someone availing themselves of assisted suicide. If assisting capacity remotely is possible for professional or as impossible for professional psychiatrists.
Therefore, what makes it OK for these families? Surely parliamentarians cannot fail to protect the public and to suggest the issue should be left to guidance or secondary legislation rather than in primary legislation is wrong. This is not something that's someone filling in some technical details. It is the pathway to a death sentence. Now it is right to repeat that in the other place. The proposer of this legislation admitted and it has been quoted. But we must not forget this, she admitted.
Kim Leadbeater admitted that the death by zoom model witnessed in Oregon was uncomfortable to her, and she said looks like a tick box exercise, if that's what she thought. And yet nothing was done to stop such a tick box exercise. Why should it be acceptable to us to just simply let it pass through? And that is why I believe that this bill should permit the first assessment, the second assessment and the interview to be conducted face to face at the sponsor of the bill is uncomfortable with it.
The zoom death by zoom. Why should we simply represent it? Can the noble and learned Lord tell us if he thinks that this is patient? A patient centred bill? How can the doctor never see or never look the patient in the eyes and assess properly all the issues that have seemingly brought the person to the decision to seek an assisted suicide? Because there can be many facets in that decision. Surely the whole purpose of the assessment process is to be preventative when assessing, for example, the mental capacity of the person, the noble Lord and learned Lord suggests the Mental Capacity Act is tried and tested, yet expert evidence from Professor Martin Vernon says that assessing capacity remotely, especially a person with mental needs, is nigh on impossible.
He is a professor. I would suggest that probably he too has some experience in this league. In his oral evidence to the Select committee on the 29th of October, he said assessing someone remotely without face to face assessment, practically, if they are, if they have complex health and social care needs, is nigh on impossible, do we dismiss the professor's statement? Sir James Murphy said that without hearing from and questioning the patient in person, a psychiatrist cannot be professionally satisfied of capacity.
Is he to dismissed? I believe Lord Faulkner, the learned Lord and noble Lord, contends that suggesting face to face assessment is possibly overengineering the process. But does the noble and learned Lord consider seeing a patient face to face before prescribing legal drugs as really overengineering? Must it not be proven beyond any reasonable doubt? And as a learned lawyer, he would know that phrase that a patient is not being coerced into making this decision. Amendment 65 has my wholehearted support.
This amendment provides for advice, declarations, and other matters to be only undertaken face to face with a terminally ill person seeking to take their own life with assistance. It has been suggested that indeed, that may not be possible because the doctor and the patient person may not meet face to face. You know, I come from a period of life when the patient wasn't able to go to the doctor. The doctor used to go to the patient.
That's not surely asking too much, especially when we're talking about the end of life. Now. Lord Wolfson the noble and learned Lord, in clause or amendment 320A and that clause ten, page six, line 31. At the end he says, insert the first assessment must be taken in person, except in circumstances where this is not reasonably practicable, when it might be conducted by a live video and audio link. My Lords, the National Health Service is under extreme pressure and remote appointments are becoming the norm because of the demand for efficiency.
My honest fear is that reasonably practicable will become administratively convenient. Surely the grave danger here is putting a fishing site over the safety of the extremely vulnerable. When our society. My Lords, if a registered medical practitioner conducts a preliminary discussion, they surely must explain to and discuss the person's diagnosis, prognosis, available treatment, palliative care options and surely that person must
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understand what has been said. Very briefly. Follow on, for the noble Lord has just spoken on the noble Lord has just spoken on the issue of overengineering. I had great sympathy with the words of great sympathy with the words of the noble Baroness, Lady Blackstone, and I suspect that there's widespread support in the House that face to face consultations should general practice and in the norm be what happens in these circumstances. I think we get into great difficulty when we micro legislate to cover every single circumstance that might occur.
A code of practice is a more reasonable and flexible document to deal with. This noble Lord shakes his head, but he just spoke about the dangers of having anyone else in the room with a consultation because of the possibility of coercion. But I listened to the noble Baroness Baroness Miller spoke potently about how important it was for there to be a family member or support, or someone who
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could hear. I was not speaking against someone being in the room. I'm someone being in the room. I'm speaking about someone in the room. Whenever it is on zoom, it is on Whenever it is on zoom, it is on camera and not in person because you do not know that that person in
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you do not know that that person in the room is coercing privately, secretly, that person. The noble Lord, was talking
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The noble Lord, was talking about a subset of consultations.
But when taken, there is no return for the person. But they are assured from time into eternity. Now, a virtual assessment scheme. Without a discussion or proper face to face consultation has got to be considered. What discussion or consultation has been held about? What would be this virtual assessment scheme? What does it actually mean? And if those discussions have and consultations have taken place, with whom have they taken place? Surely remote assessment undermines detection or coercion and indeed coercion that is often very subtle and very carefully crafted.
Indeed, the abuser could actually be sitting in the very room listening to the conversation. Of course not visible. My Lord's coercion is very difficult to detect at the best of times, and in the past, serious mistakes have been made without seeing the person. No pounds should be called upon to grant the stamp of approval to someone availing themselves of assisted suicide. If assisting capacity remotely is possible for professional or as impossible for professional psychiatrists.
Therefore, what makes it OK for these families? Surely parliamentarians cannot fail to protect the public and to suggest the issue should be left to guidance or secondary legislation rather than in primary legislation is wrong. This is not something that's someone filling in some technical details. It is the pathway to a death sentence. Now it is right to repeat that in the other place. The proposer of this legislation admitted and it has been quoted. But we must not forget this, she admitted.
Kim Leadbeater admitted that the death by zoom model witnessed in Oregon was uncomfortable to her, and she said looks like a tick box exercise, if that's what she thought. And yet nothing was done to stop such a tick box exercise. Why should it be acceptable to us to just simply let it pass through? And that is why I believe that this bill should permit the first assessment, the second assessment and the interview to be conducted face to face at the sponsor of the bill is uncomfortable with it.
The zoom death by zoom. Why should we simply represent it? Can the noble and learned Lord tell us if he thinks that this is patient? A patient centred bill? How can the doctor never see or never look the patient in the eyes and assess properly all the issues that have seemingly brought the person to the decision to seek an assisted suicide? Because there can be many facets in that decision. Surely the whole purpose of the assessment process is to be preventative when assessing, for example, the mental capacity of the person, the noble Lord and learned Lord suggests the Mental Capacity Act is tried and tested, yet expert evidence from Professor Martin Vernon says that assessing capacity remotely, especially a person with mental needs, is nigh on impossible.
He is a professor. I would suggest that probably he too has some experience in this league. In his oral evidence to the Select committee on the 29th of October, he said assessing someone remotely without face to face assessment, practically, if they are, if they have complex health and social care needs, is nigh on impossible, do we dismiss the professor's statement? Sir James Murphy said that without hearing from and questioning the patient in person, a psychiatrist cannot be professionally satisfied of capacity.
Is he to dismissed? I believe Lord Faulkner, the learned Lord and noble Lord, contends that suggesting face to face assessment is possibly overengineering the process. But does the noble and learned Lord consider seeing a patient face to face before prescribing legal drugs as really overengineering? Must it not be proven beyond any reasonable doubt? And as a learned lawyer, he would know that phrase that a patient is not being coerced into making this decision. Amendment 65 has my wholehearted support.
This amendment provides for advice, declarations, and other matters to be only undertaken face to face with a terminally ill person seeking to take their own life with assistance. It has been suggested that indeed, that may not be possible because the doctor and the patient person may not meet face to face. You know, I come from a period of life when the patient wasn't able to go to the doctor. The doctor used to go to the patient.
That's not surely asking too much, especially when we're talking about the end of life. Now. Lord Wolfson the noble and learned Lord, in clause or amendment 320A and that clause ten, page six, line 31. At the end he says, insert the first assessment must be taken in person, except in circumstances where this is not reasonably practicable, when it might be conducted by a live video and audio link. My Lords, the National Health Service is under extreme pressure and remote appointments are becoming the norm because of the demand for efficiency.
My honest fear is that reasonably practicable will become administratively convenient. Surely the grave danger here is putting a fishing site over the safety of the extremely vulnerable. When our society. My Lords, if a registered medical practitioner conducts a preliminary discussion, they surely must explain to and discuss the person's diagnosis, prognosis, available treatment, palliative care options and surely that person must
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understand what has been said. Very briefly. Follow on, for the noble Lord has just spoken on the noble Lord has just spoken on the issue of overengineering. I had great sympathy with the words of great sympathy with the words of the noble Baroness, Lady Blackstone, and I suspect that there's widespread support in the House that face to face consultations should general practice and in the norm be what happens in these circumstances. I think we get into great difficulty when we micro legislate to cover every single circumstance that might occur.
A code of practice is a more reasonable and flexible document to deal with. This noble Lord shakes his head, but he just spoke about the dangers of having anyone else in the room with a consultation because of the possibility of coercion. But I listened to the noble Baroness Baroness Miller spoke potently about how important it was for there to be a family member or support, or someone who
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could hear. I was not speaking against someone being in the room. I'm someone being in the room. I'm speaking about someone in the room. Whenever it is on zoom, it is on Whenever it is on zoom, it is on camera and not in person because you do not know that that person in
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you do not know that that person in the room is coercing privately, secretly, that person. The noble Lord, was talking
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The noble Lord, was talking about a subset of consultations.
12:25
Baroness Hayman (Crossbench)
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Baroness Hayman (Crossbench)
But this is my point. In any process, I think he accepted that there might be exceptional there might be exceptional circumstances where a consultation was not in person. And I'm just saying that in those, even in that narrow set, there might be a reason for another person to be in the room. But this I'm not talking about that specific point. I'm trying in general, to suggest that trying in general, to suggest that we should try and lay down some principles, but not try to over engineer and cover every possible circumstance.
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Baroness Meyer I responded to the noble Baroness Blackstone, which seemed to express a kind of which seemed to express a kind of common sense view that, of course, we're all agreed it's much better to have face to face interviews and to have face to face interviews and all sorts of evidence this morning from the medical profession, from the legal profession, how this is, the legal profession, how this is, of course, much better. But the noble Baroness thinks that there should be a code of practice.
And I should be a code of practice. And I also agree there should be a code of practice. But surely that code of practice should be about where there are exceptions, and that it would be much safer to have a bill in which it should be specified, that it should be face to face, except for certain exceptions which except for certain exceptions which would be laid out in a code of practice. Surely it should be that way round in order that we have a way round in order that we have a safer bill as possible.
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Baroness Meyer I responded to the noble Baroness Blackstone, which seemed to express a kind of which seemed to express a kind of common sense view that, of course, we're all agreed it's much better to have face to face interviews and to have face to face interviews and all sorts of evidence this morning from the medical profession, from the legal profession, how this is, the legal profession, how this is, of course, much better. But the noble Baroness thinks that there should be a code of practice.
And I should be a code of practice. And I also agree there should be a code of practice. But surely that code of practice should be about where there are exceptions, and that it would be much safer to have a bill in which it should be specified, that it should be face to face, except for certain exceptions which except for certain exceptions which would be laid out in a code of practice. Surely it should be that way round in order that we have a way round in order that we have a safer bill as possible.
12:27
Lord Harries of Pentregarth (Crossbench)
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Lord Harries of Pentregarth (Crossbench)
Lord Hutton the point about codes of practice, he makes a really valid point about codes of practice. Codes of practice are sometimes are not statutory, so it would need to be statutory code. And apart from all of that, we also know that codes of practice become outdated. In another area of my expertise, a code of Statutory Code of Practice was agreed in 2011. Although it is unlawful today, it has still not been withdrawn by the government. Well.
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Far easier. To develop a code of practice over time. Change it in practice over time. Change it in the context of changes in the environment. It's much more difficult to change. A law by statute means it's got to be statute means it's got to be brought back into both houses of Parliament. So I don't really think that the point that the noble Lady
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that the point that the noble Lady has just made is valid. Yeah.
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I am struck, having listened to this debate, there does seem to be a fair bit of consensus, and if I may say, thinking back to the debate we had, or the discussion on the business of the House at the beginning of this debate about the pace, I have listened to the number of people that quoted Kim Leadbeater and her
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Far easier. To develop a code of practice over time. Change it in practice over time. Change it in the context of changes in the environment. It's much more difficult to change. A law by statute means it's got to be statute means it's got to be brought back into both houses of Parliament. So I don't really think that the point that the noble Lady
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that the point that the noble Lady has just made is valid. Yeah.
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I am struck, having listened to this debate, there does seem to be a fair bit of consensus, and if I may say, thinking back to the debate we had, or the discussion on the business of the House at the beginning of this debate about the pace, I have listened to the number of people that quoted Kim Leadbeater and her
12:28
Lord Harper (Conservative)
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Lord Harper (Conservative)
uncomfortableness about making these decisions on zoom. It does strike me that if she'd followed through on that uncomfortableness through on that uncomfortableness and had actually put into the bill a clear presumption that these a clear presumption that these decisions should be taken face to face with, with some exceptions, and I'll elaborate that on in a and I'll elaborate that on in a minute. We wouldn't have needed this debate, and we would be moving at a faster pace. There's perhaps a lesson there for the noble and learned Lord that if actually more more cognisance have been taken about some of these concerns at an earlier stage, actually we would have moved faster pace.
The reason why this group of amendments exists, and the reason why we've debated them and the noble Lord Birt referenced how important a decision this is to get right. If that had. The only reason why we're doing that is because this issue hasn't already been addressed. So I'll just leave that there as a possible reason why there are as many amendments as there are to this lengthy bill, and the reason why the debate is necessary to take place, because it hasn't already been done.
And we'll just leave that for noble Lords to think about. Now, I've listened carefully to to the of course.
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One note of question about we're all quoting Kim Leadbeater and how she felt about the Oregon examples, she felt about the Oregon examples, but in fact, it may not be that she was talking about the issue of video linking. She was talking about the issue of assessments that were solely done on the basis of were solely done on the basis of paperwork. And I think we do need to find out exactly what Kim Leadbeater was saying before we jumped to conclusions as to whether the promoters of this bill have been neglectful in the way that
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they've dealt with that issue. She, the noble Lady, makes a very good point, which illustrates the importance, actually, of being able to ask people questions directly rather than rather than hearing reports of what they've said or seeing it on on video call. said or seeing it on on video call. That's the importance of actually in-person conversation and the ability to ask questions and hear ability to ask questions and hear answers so that you actually know what people think. So I think she's illustrated an evidenced by point extraordinarily well, and I'm grateful for her intervention.
Now, at the beginning of this, the noble Lady, Lady Gerada referred to medical assessments. And she she's right in saying that many of them can be done very well remotely. I think that's an excellent thing. I'm a great supporter of technology. We don't all believe in quills and pens, and I don't think that Lady Pigeon was entirely suggesting that we were. She might want to just reflect on on that remark, whether that was entirely, well, well intentioned, given what the Chief Whip said to us about treating us all with courtesy and respect.
I do support the use of technology where it's appropriate. The problem here is that the noble Lady, Lady Gerard, has said that we could all rest. Assured that doctors would never view this as a routine exercise. Now, I think the problem is, in other jurisdictions, I'm afraid there's quite a lot of evidence that they actually do, and I think there are there's a lot of evidence in this country that whilst it's true, as I think Baroness Blackstone said, the vast majority of doctors will approach this absolutely right.
We know there was an example just yesterday of a paediatrician who had an appalling record at Great Ormond Street. I'm afraid not all doctors are perfect, and what we have to do is to make sure the law is there, to make sure that patients are properly protected in all cases, not just in the vast majority of them. And where I would disagree with this is this is a this is a policy decision. It is not a medical decision whether assessment should be face to face, either in every case or the presumption should be that is a policy decision, rightly for Parliament, not for clinicians, but it should be informed by listening to clinicians.
But it should also be informed by listening to evidence from the patient experience so ably set out by the noble Lady Lady Smith, and also by Lady Burgess. And I was also very struck, and I think without knowing everybody's background, I think the noble and learned Lady Butler-sloss, who from her own testimony has actually had to make decisions in these cases. I was very struck by her view that we should certainly have a presumption that these decisions should be taken face to face, and I was very struck by her from listening to her on previous occasions.
Her experience on these matters carries a lot of weight. I also listened very carefully to the noble and learned Lord Carlile when he set out what the GMC's own advice was, and it seemed to me, decisions for patients with a terminal illness where the decision is about a course of action which will lead to the end of their life, absolutely seem to me to fall squarely within the set of cases where you would want a face to face appointment. But equally, I felt that it was a very good counsel for us and challenge from the noble Ladies at Baroness Jay, Baroness Pidgeon and Baroness Blackstone to think of the patient, the person who's got the terminal illness, who wants a decision.
They were right to challenge us on that. And that's why I think if you look at the balance of amendments in this group, they're very helpful because they set out a span of choices for your Lordships from saying that every decision has to be taken in person, which I think would be wrong for the reasons that the three noble Baroness set out, that you have to look at the patient's views. But equally, I think the present wording is too loose and doesn't set out a presumption that they should be face to face.
And it seems to me, listening to the debate and this, I would be very grateful to the noble and learned Lord Hall Falconer's views on where he thinks he's likely to settle, because that will be helpful for all of us about whether we have to bring forward further amendments. It seems to me a presumption that it's face to face, but with a very limited set of circumstances where it can be not face to face, but also, I think we shouldn't we shouldn't accept the presumption in a patient centred model that the patient always has to go and see the panel or the doctors.
I think it should absolutely be, particularly because so many people in these circumstances are going to be of poor health, that we think of a system which makes sure that at least when it comes to the panel, at least one member of the panel, an independent person, is physically present. And the reason why that's important, my Lords, is if you look at the the bill in clause 17, there's two parts to it which these amendments touch on, which I think are very important.
The first one is on section six, which says that the duty under subsection four to hear from four, b to hear from the person to whom the referral relates does not apply. If the panel is of the opinion that there are exceptional circumstances which justify not hearing from the person, that means there are circumstances where the panel doesn't have to hear from the person at all. Not by video link, not in person, not by pre-recorded video, not at all. And that was confirmed to me when the noble Lord, Lord Falconer, I were doing a media programme where I challenged him on this, I think on the Westminster Hour or on the week in Westminster.
I think it was when he confirmed that there were circumstances where somebody, a decision could be taken for someone to seek assistance. Suicide with a panel would never have to see them at all. And I don't think that is right. And the other section is on section five, which these amendments touch on, says where the panel considers it appropriate for medical reasons, it may make provision for the use of pre-recorded audio or video material. Now that was inserted in the House of Commons on a Backbench Amendment, it wasn't very well debated.
The fact it's pre-recorded means it gets rid of any opportunity for questioning or challenge. And the problem I have with the language there where it says medical reasons, it doesn't say medical reasons pertaining to the patient. And so this is my last
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point. The experience we had during the pandemic, of course. Thank you.
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Thank you. For forgetting. We can use the telephone in this circumstance. So it's not even that you would have it's not even that you would have sight of the person, but you could
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have a pre-recorded telephone call. The final point I wanted to make is we had experience during the is we had experience during the pandemic, and we had an experience of vulnerable people, people with learning disabilities. Too many of them had do not resuscitate notices were put on them by doctors. And I do not want to see a system where if we had a similar circumstance, again, with these sorts of decisions would be taken remotely at speed. And we know from our own deliberations, both in this House and my experience in the other place, there is no substitute for doing these things face to face, where you can challenge people, ask questions, put people under that challenge and get good answers decisions.
And I commend this set of amendments to Lordships, and I look forward to hearing from the noble and learned Lord Doyle
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Falconer about his response. Provide a brief clarification on the back of what the noble Lord the back of what the noble Lord Lord Harper said. And in terms of the points raised on Miss Leadbeater's comments about feeling uncomfortable, it came from a report on ITV on the 6th of March report on ITV on the 6th of March 2025, and exactly what you were talking about in terms of an assessment was taking place with
The reason why this group of amendments exists, and the reason why we've debated them and the noble Lord Birt referenced how important a decision this is to get right. If that had. The only reason why we're doing that is because this issue hasn't already been addressed. So I'll just leave that there as a possible reason why there are as many amendments as there are to this lengthy bill, and the reason why the debate is necessary to take place, because it hasn't already been done.
And we'll just leave that for noble Lords to think about. Now, I've listened carefully to to the of course.
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One note of question about we're all quoting Kim Leadbeater and how she felt about the Oregon examples, she felt about the Oregon examples, but in fact, it may not be that she was talking about the issue of video linking. She was talking about the issue of assessments that were solely done on the basis of were solely done on the basis of paperwork. And I think we do need to find out exactly what Kim Leadbeater was saying before we jumped to conclusions as to whether the promoters of this bill have been neglectful in the way that
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they've dealt with that issue. She, the noble Lady, makes a very good point, which illustrates the importance, actually, of being able to ask people questions directly rather than rather than hearing reports of what they've said or seeing it on on video call. said or seeing it on on video call. That's the importance of actually in-person conversation and the ability to ask questions and hear ability to ask questions and hear answers so that you actually know what people think. So I think she's illustrated an evidenced by point extraordinarily well, and I'm grateful for her intervention.
Now, at the beginning of this, the noble Lady, Lady Gerada referred to medical assessments. And she she's right in saying that many of them can be done very well remotely. I think that's an excellent thing. I'm a great supporter of technology. We don't all believe in quills and pens, and I don't think that Lady Pigeon was entirely suggesting that we were. She might want to just reflect on on that remark, whether that was entirely, well, well intentioned, given what the Chief Whip said to us about treating us all with courtesy and respect.
I do support the use of technology where it's appropriate. The problem here is that the noble Lady, Lady Gerard, has said that we could all rest. Assured that doctors would never view this as a routine exercise. Now, I think the problem is, in other jurisdictions, I'm afraid there's quite a lot of evidence that they actually do, and I think there are there's a lot of evidence in this country that whilst it's true, as I think Baroness Blackstone said, the vast majority of doctors will approach this absolutely right.
We know there was an example just yesterday of a paediatrician who had an appalling record at Great Ormond Street. I'm afraid not all doctors are perfect, and what we have to do is to make sure the law is there, to make sure that patients are properly protected in all cases, not just in the vast majority of them. And where I would disagree with this is this is a this is a policy decision. It is not a medical decision whether assessment should be face to face, either in every case or the presumption should be that is a policy decision, rightly for Parliament, not for clinicians, but it should be informed by listening to clinicians.
But it should also be informed by listening to evidence from the patient experience so ably set out by the noble Lady Lady Smith, and also by Lady Burgess. And I was also very struck, and I think without knowing everybody's background, I think the noble and learned Lady Butler-sloss, who from her own testimony has actually had to make decisions in these cases. I was very struck by her view that we should certainly have a presumption that these decisions should be taken face to face, and I was very struck by her from listening to her on previous occasions.
Her experience on these matters carries a lot of weight. I also listened very carefully to the noble and learned Lord Carlile when he set out what the GMC's own advice was, and it seemed to me, decisions for patients with a terminal illness where the decision is about a course of action which will lead to the end of their life, absolutely seem to me to fall squarely within the set of cases where you would want a face to face appointment. But equally, I felt that it was a very good counsel for us and challenge from the noble Ladies at Baroness Jay, Baroness Pidgeon and Baroness Blackstone to think of the patient, the person who's got the terminal illness, who wants a decision.
They were right to challenge us on that. And that's why I think if you look at the balance of amendments in this group, they're very helpful because they set out a span of choices for your Lordships from saying that every decision has to be taken in person, which I think would be wrong for the reasons that the three noble Baroness set out, that you have to look at the patient's views. But equally, I think the present wording is too loose and doesn't set out a presumption that they should be face to face.
And it seems to me, listening to the debate and this, I would be very grateful to the noble and learned Lord Hall Falconer's views on where he thinks he's likely to settle, because that will be helpful for all of us about whether we have to bring forward further amendments. It seems to me a presumption that it's face to face, but with a very limited set of circumstances where it can be not face to face, but also, I think we shouldn't we shouldn't accept the presumption in a patient centred model that the patient always has to go and see the panel or the doctors.
I think it should absolutely be, particularly because so many people in these circumstances are going to be of poor health, that we think of a system which makes sure that at least when it comes to the panel, at least one member of the panel, an independent person, is physically present. And the reason why that's important, my Lords, is if you look at the the bill in clause 17, there's two parts to it which these amendments touch on, which I think are very important.
The first one is on section six, which says that the duty under subsection four to hear from four, b to hear from the person to whom the referral relates does not apply. If the panel is of the opinion that there are exceptional circumstances which justify not hearing from the person, that means there are circumstances where the panel doesn't have to hear from the person at all. Not by video link, not in person, not by pre-recorded video, not at all. And that was confirmed to me when the noble Lord, Lord Falconer, I were doing a media programme where I challenged him on this, I think on the Westminster Hour or on the week in Westminster.
I think it was when he confirmed that there were circumstances where somebody, a decision could be taken for someone to seek assistance. Suicide with a panel would never have to see them at all. And I don't think that is right. And the other section is on section five, which these amendments touch on, says where the panel considers it appropriate for medical reasons, it may make provision for the use of pre-recorded audio or video material. Now that was inserted in the House of Commons on a Backbench Amendment, it wasn't very well debated.
The fact it's pre-recorded means it gets rid of any opportunity for questioning or challenge. And the problem I have with the language there where it says medical reasons, it doesn't say medical reasons pertaining to the patient. And so this is my last
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point. The experience we had during the pandemic, of course. Thank you.
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Thank you. For forgetting. We can use the telephone in this circumstance. So it's not even that you would have it's not even that you would have sight of the person, but you could
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have a pre-recorded telephone call. The final point I wanted to make is we had experience during the is we had experience during the pandemic, and we had an experience of vulnerable people, people with learning disabilities. Too many of them had do not resuscitate notices were put on them by doctors. And I do not want to see a system where if we had a similar circumstance, again, with these sorts of decisions would be taken remotely at speed. And we know from our own deliberations, both in this House and my experience in the other place, there is no substitute for doing these things face to face, where you can challenge people, ask questions, put people under that challenge and get good answers decisions.
And I commend this set of amendments to Lordships, and I look forward to hearing from the noble and learned Lord Doyle
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Falconer about his response. Provide a brief clarification on the back of what the noble Lord the back of what the noble Lord Lord Harper said. And in terms of the points raised on Miss Leadbeater's comments about feeling uncomfortable, it came from a report on ITV on the 6th of March report on ITV on the 6th of March 2025, and exactly what you were talking about in terms of an assessment was taking place with
12:38
Baroness Grey-Thompson (Crossbench)
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Baroness Grey-Thompson (Crossbench)
assessment was taking place with Doctor Jess Khan, who I believe family members were there and then asked the patient's family to leave the room so that she could privately ask the patient whether it was a settled wish. Now the patient said, yes, it was, but I quote directly from the ITV website for Kim Leadbeater. The virtual consultations did not make for comfortable viewing, she says. It's made her think about adding an amendment to make clear that consultations with doctors cannot be done via video call, and that they should be done in person.
12:39
Earl Howe (Conservative)
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Earl Howe (Conservative)
My Lords, in the interests of time, I don't propose to summarise the many points and questions that have been raised in this debate. However, I do wish to speak briefly to amendment 320 A in the name of my noble friend Lord Wolfson, the amendment seeks to set out the presumption that the first assessment by the coordinating doctor should be carried out in person, unless, in the circumstances this is not reasonably practicable. It's very plain. From everything that we've heard in the debate, that the first assessment is a pivotal moment in the process set out in this bill.
It is the point at which a coordinating doctor must satisfy themselves not only of the diagnosis and prognosis, but also of the patient's capacity and will, and, crucially, the absence of coercion or pressure, which is set out in clause ten. These are human judgements which depend not simply on what a patient says, but on the way that they they say it on physical cues and on the broader context in which the conversation takes place. I listen carefully to the noble Baroness, Lady Findlay in particular, as I did to other noble Lords.
An in-person assessment undoubtedly allows a clinician to observe matters that may not be apparent on a screen. For example, who else is is present in the room, whether the individual appears comfortable speaking freely, whether there are signs, however subtle, of hesitation or external influence. At the same time, we do, I suggest, need to be patient, focussed as well as doctor focussed, which is why my Noble Friend's amendment seeks to recognise practical realities. There will surely, from time to time, be circumstances, particularly, perhaps in late stage illness, when a person may be in acute distress, where an in-person, in-person assessment is genuinely not possible.
Now, the reasons for that could be several. But in those cases, we need to ask ourselves the question as to whether a live video and audio leak would be preferable to a delay, or even a complete exclusion from the process. Now, I emphasise that the amendment is a probing one. If we do decide that provision should be made for certain cases, that would surely be a classic area for guidance or codes of practice. But the key test in every instance would be what is reasonable in the circumstances.
My noble friend wants to be clear that this amendment is about setting the right default for arguably the most consequential clinical judgement in the entire scheme of the bill, whilst preserving professional discretion in response to the needs of the patient. Where circumstances require flexibility. I've deliberately spoken in general terms when talking about what not, what might not be reasonably practicable. The question is really one posed by the noble Baroness, Lady Harman, namely, how rigid do we wish the Bill to be in prescribing how the system should should work? My hope, the noble and learned Lord Doyle Faulkner, could set out how his vision of this mechanism.
His vision of how this mechanism will work in, in, in practice, and how he would ensure that the safeguards that we all want to see can still be maintained.
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If an in-person assessment wasn't possible. My Lords.
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My Lords. I'm grateful to all noble Lords for their contributions in this for their contributions in this debate. And as ever, I will keep my comments limited to amendments on which the government has major which the government has major legal, technical or operational workability concerns. So I would first like to draw attention of your Lordships House to operational workability concerns in relation to amendment 60 and 65, and turning first to amendment 60. Under this amendment, professionals delivering the service would be responsible for checking whether the person is in England or Wales on multiple, multiple occasions before carrying out their duties, even if it had been confirmed that the person is ordinarily resident in England or Wales, this would place a significant burden on professionals delivering an assisted Dying service.
Amendment 65, also tabled by the noble Lady Baroness Coffey, requires certain steps under the bill to be carried out face to face. If accepted, this amendment could have workability impacts on the bill. For example, it could introduce internal inconsistency with clause 17 five, which provides that where the panel considers it appropriate for medical reasons, it may make provision for the use of pre-recorded audio or audio, or it may make provision for the use of pre-recorded audio or video material for the purposes of carrying out its duties, requiring all steps in the bill to be carried out.
Face to face could also give rise to legal challenge on the basis of article 14, when read with article eight of the EC, for example. For example, excluding people who may have difficulties meeting face to face from accessing assisted dying may amount amount to indirect discrimination on the basis of disability or age, as certain groups may find it more difficult to meet face to face. Any differential treatment would need to be objectively and reasonably justified to be lawful with regard to amendment 37 six, as tabled by the noble Lord, Lord Evans.
The stated aim is to require that assessments by the coordinating doctor and independent doctor are carried out in person and not remotely. It is possible that requiring an in-person assessment could have some workability risks, given that there are some circumstances in which it is not possible for an in-person assessment to take place. I make no comment on other amendments in this group. As noble Lords are aware, the amendments have not had technical drafting support from officials.
Therefore, further revision and corresponding amendments would need to be would need to provide consistent and coherent terminology throughout the bill.
It is the point at which a coordinating doctor must satisfy themselves not only of the diagnosis and prognosis, but also of the patient's capacity and will, and, crucially, the absence of coercion or pressure, which is set out in clause ten. These are human judgements which depend not simply on what a patient says, but on the way that they they say it on physical cues and on the broader context in which the conversation takes place. I listen carefully to the noble Baroness, Lady Findlay in particular, as I did to other noble Lords.
An in-person assessment undoubtedly allows a clinician to observe matters that may not be apparent on a screen. For example, who else is is present in the room, whether the individual appears comfortable speaking freely, whether there are signs, however subtle, of hesitation or external influence. At the same time, we do, I suggest, need to be patient, focussed as well as doctor focussed, which is why my Noble Friend's amendment seeks to recognise practical realities. There will surely, from time to time, be circumstances, particularly, perhaps in late stage illness, when a person may be in acute distress, where an in-person, in-person assessment is genuinely not possible.
Now, the reasons for that could be several. But in those cases, we need to ask ourselves the question as to whether a live video and audio leak would be preferable to a delay, or even a complete exclusion from the process. Now, I emphasise that the amendment is a probing one. If we do decide that provision should be made for certain cases, that would surely be a classic area for guidance or codes of practice. But the key test in every instance would be what is reasonable in the circumstances.
My noble friend wants to be clear that this amendment is about setting the right default for arguably the most consequential clinical judgement in the entire scheme of the bill, whilst preserving professional discretion in response to the needs of the patient. Where circumstances require flexibility. I've deliberately spoken in general terms when talking about what not, what might not be reasonably practicable. The question is really one posed by the noble Baroness, Lady Harman, namely, how rigid do we wish the Bill to be in prescribing how the system should should work? My hope, the noble and learned Lord Doyle Faulkner, could set out how his vision of this mechanism.
His vision of how this mechanism will work in, in, in practice, and how he would ensure that the safeguards that we all want to see can still be maintained.
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If an in-person assessment wasn't possible. My Lords.
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My Lords. I'm grateful to all noble Lords for their contributions in this for their contributions in this debate. And as ever, I will keep my comments limited to amendments on which the government has major which the government has major legal, technical or operational workability concerns. So I would first like to draw attention of your Lordships House to operational workability concerns in relation to amendment 60 and 65, and turning first to amendment 60. Under this amendment, professionals delivering the service would be responsible for checking whether the person is in England or Wales on multiple, multiple occasions before carrying out their duties, even if it had been confirmed that the person is ordinarily resident in England or Wales, this would place a significant burden on professionals delivering an assisted Dying service.
Amendment 65, also tabled by the noble Lady Baroness Coffey, requires certain steps under the bill to be carried out face to face. If accepted, this amendment could have workability impacts on the bill. For example, it could introduce internal inconsistency with clause 17 five, which provides that where the panel considers it appropriate for medical reasons, it may make provision for the use of pre-recorded audio or audio, or it may make provision for the use of pre-recorded audio or video material for the purposes of carrying out its duties, requiring all steps in the bill to be carried out.
Face to face could also give rise to legal challenge on the basis of article 14, when read with article eight of the EC, for example. For example, excluding people who may have difficulties meeting face to face from accessing assisted dying may amount amount to indirect discrimination on the basis of disability or age, as certain groups may find it more difficult to meet face to face. Any differential treatment would need to be objectively and reasonably justified to be lawful with regard to amendment 37 six, as tabled by the noble Lord, Lord Evans.
The stated aim is to require that assessments by the coordinating doctor and independent doctor are carried out in person and not remotely. It is possible that requiring an in-person assessment could have some workability risks, given that there are some circumstances in which it is not possible for an in-person assessment to take place. I make no comment on other amendments in this group. As noble Lords are aware, the amendments have not had technical drafting support from officials.
Therefore, further revision and corresponding amendments would need to be would need to provide consistent and coherent terminology throughout the bill.
12:47
Baroness Merron, The Parliamentary Under-Secretary for Health and Social Care (Labour)
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Baroness Merron, The Parliamentary Under-Secretary for Health and Social Care (Labour)
Before the noble Minister says fine and referring reference to a fine and referring reference to a response to amendment 60. If I picked her up correctly. She said that establishing where an individual was in the world would individual was in the world would be putting a burden on the medical people involved. Surely if they're in touch with them, they can ask in touch with them, they can ask them at least where they are. I do understand that, but it's
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about verifying that. My Lords.
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My Lords. I express my gratitude to everybody who has taken part in the debate. Could I make a special mention of Baroness Smith of Newnham and Lord Polak? I spoke Newnham and Lord Polak? I spoke about the death of their father and mother, and I like everybody else. I'm very grateful for what may be
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about verifying that. My Lords.
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My Lords. I express my gratitude to everybody who has taken part in the debate. Could I make a special mention of Baroness Smith of Newnham and Lord Polak? I spoke Newnham and Lord Polak? I spoke about the death of their father and mother, and I like everybody else. I'm very grateful for what may be
12:47
Lord Falconer of Thoroton (Labour)
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Lord Falconer of Thoroton (Labour)
I'm very grateful for what may be something that is quite difficult to contribute to the debate. With that, and I hope I haven't left anybody else out who's done that. These amendments for effectively into two categories. The first of all, the England and Wales category. What have you got to be in England and Wales to do? And then secondly and separately, in what circumstances are a face to face meeting between either the patient and the doctors or the patient and the panel are required? May I deal, first of all with the position of England and Wales, which is raised by the noble Baroness Baroness Coffey amendment Amendment number 60, currently, under the provisions of the Bill, the first declaration made by the patient, the second declaration made by the patient, the first assessment of the patient.
The second assessment of the patient, and assistance being given to the patient all have to take place in England and Wales. There were a range of other things that the noble Baroness Baroness Coffey wished to take place whilst the patient was in England and Wales, for example, switching from one doctor to another, which is a process for my own part. I think the bill has broadly got right when you've got to be in England and Wales, having listened very carefully to what the noble Baroness, Baroness Coffey, has said, I'm not minded to suggest an amendment in relation to that.
And I note it was not picked up as an issue by other people. May I deal with the face to face issues, which were much more what the house, if I may say so, were interested in in relation to the course of this debate. And can I indicate that the effect of the debate has been in effect to identify four possibilities? First of all, each of the occasions, namely the two doctors and the panel has always got to involve a face to face meeting, which is amendment 65.
Secondly, that there should be a face to face meeting unless there are, and I use this phrase without intending to pick up all of the amendments, unless there are exceptional circumstances or there are practicability issues. Thirdly, the noble Lord Lord Blencathra Third amendment that he referred to, which is that there should be and this is his language, a statutory protocol defining where there where there where there can be remote accepting that the norm is face to face.
And fourthly, simply rely on the existing provisions of the bill, which is that codes of practice can be issued by the Minister under the various provisions of the bill, saying when face to face is appropriate and when face to face is not. The testimony, because that's what it felt like given of cases where remote has gone wrong, have enormous power, and I think we're all aware of circumstances where face to face will lead to much greater and better communication.
The other side of the coin, which was referred to by Baroness Pidgeon Baroness Jay Baroness Hayman Baroness Blackstone, was there will be circumstances and the Earl Howe where there will be circumstances where if you insist on face to face, you are in effect excluding some people from this right when they should have it. There are arguments on both sides. I come away with the strongest possible feeling that the house thinks face to face where possible is best, but there will be circumstances where it's not appropriate.
I think that brings me to my possibility three or possibility four? I think it is. It is wrong and dangerous to try to use a phrase like reasonably practicable or exceptional. I think more is required and I think there should be guidance given. And I do not think, and this is not a criticism, this is a congratulation. I don't think the words statutory protocol are right, but I get from what the noble Lord Lord Blencathra is saying that he wants something that has the force of regulations or something similar that says this is what we have got in mind, whether that's a code of practice or whether that's a statutory protocol.
I'm not sure. I'm sure it's not what's called a protocol, but I'm sure it might be something quite like that. I think the right course for me is to go away and bring back to the house something that satisfies the house, that there is going to be something, a statutory protocol or a code of guidance that indicates when face to face is appropriate or face to face should normally be the norm. But here the circumstances. But it wouldn't because I get the sense of anxiety about that.
I hope in the
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light of that approach, noble Lords would feel able. To.
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Withdraw their amendments. But I can't quite understand why the Noble and learned is so the Noble and learned is so unwilling actually to have on the face of the Bill that the presumption should be that it should be face to face, with, of course, exceptions and exceptions written into protocol. Why is he
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written into protocol. Why is he objecting to have it that way round? Is a lawyer going for a presumption is wrong? I think the right thing to do is say something like the norm is face to face, but there could be circumstances in which you can't. I think you should give. You should give maximum flexibility in relation to that noble Lord Lord Harper.
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Perhaps to the noble and learned Lord, why people are so nervous in the Commons at Second Reading. For much of the Committee stage, MPs much of the Committee stage, MPs were told that the panel would have to speak to the patient and then to speak to the patient and then amendments were tabled. Subsequent to that, which were the ones I talked about, which then allowed talked about, which then allowed the panel to accept pre-recorded video and waive hearing from the applicant entirely in those applicant entirely in those undefined exceptional circumstances.
So I think if he were to just reflect a little bit further, if I absolutely accept you don't want to have a blanket position, but if there was a presumption, a rebuttable presumption, that in that it should be face to face, and then there was some circumstances set out which which can be developed with case law, I think that would be something which it seems to me, listening to the debate would command wide support from the House and would deal with the both, both the concerns people have got, but also, rightly, the
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patient centred approach. The three noble Baroness Shah set out for your noble Lords in relation to the. Point that the noble Lord Lord
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Point that the noble Lord Lord Harper makes about the the imposition of of clause six in the imposition of of clause six in the bill. What the bill currently says about the panel is the panel must, subject to subsection six, hear subject to subsection six, hear from and may question the person to whom the referral relates. So they've got to question the person, though it's not necessarily that though it's not necessarily that it's got to be in person. Sub six the one he referred to.
The duty to hear from that person does not apply. If the panel is of the opinion that there are exceptional circumstances which justify not hearing from that person was added in during the course of the Committee stage of the debate, because a particular member of the committee described the circumstances of his own. I think it was his mother, and that's why it happened. But I will note what
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he says. I don't think I will go for a presumption, but I hear what he says. Sits down the point five, though, that this is important because I that this is important because I think he's slightly misspoke. He talked about questioning the problem with section five. It says if the panel considers it appropriate for medical reasons, it may make provision for the use of may make provision for the use of pre-recorded audio or video material. And the problem with that is you lose any ability to be able is you lose any ability to be able to ask questions.
And I think that is critical. That was added in afterwards after people had heard these concerns and it went backwards. So I think can you just reflect on that? And if he's going to bring an amendment forward, then I think make sure it's one that reflects the debate that he's heard
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this morning in your Lordships House. The noble Lord is making, because obviously you can't ask questions under clause six. So it's questions under clause six. So it's exactly the same point, the point that is being made in five and six that is being made in five and six is they recognise that there are circumstances where questioning is not possible, and I don't know quite what the additional point he
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was making was. I'm very grateful to noble Lord. I acknowledge that he's accepted that something else needs to be added to the bill, possibly along the lines I was suggesting, but and of course, that comes on top of the dozen new clauses he's already planning to add to the bill. Would he therefore help me understand if the Lord Lord is therefore admitting the bill is fundamentally flawed to a greater or lesser extent, and it needs to be amended? How, therefore, can you reconcile that with what he said a couple of days ago that he would seek to drive through the bill as unamended from the House of Commons? The bill that is so fundamentally flawed is now trying to move amendments to correct it.
But I'm grateful for the noble Lords concession this morning.
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I wouldn't look a gift horse in the mouth if I were you. As far as far as as far as the point. Is the far as as far as the point. Is the bill fundamentally flawed? I do not regard accepting amendments in the House of Lords at Committee stage as indicating that a Bill is fundamentally flawed. I regard that as listening and making appropriate as listening and making appropriate changes. Secondly, in relation to the question of the Parliament Act, the last thing I want is for it to the last thing I want is for it to happen through the Parliament Act.
What I want is for this House to do the job that it's supposed to do, which is due scrutiny, and then send it back to the Commons. I gave in detail my reasons why I thought we were not going about it properly. In the debate on the 8th of January, 2026, and I thought the House agreed with me when they said we need to move quicker. The problem is not that everybody has not got good ideas. The problem is it's taking not just far too long, but disproportionately long.
My experience of the Lords is that we can do this and we can do it much, much, much quicker than we are doing it. And there's still be quality. That was the point I made on the 8th of January, and that was the point I understood. The House
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accepted. The emotion put before the House
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The emotion put before the House on the 8th of January, if I remember correctly, was a motion that more time was required. Not that the House needed to race that the House needed to race through this bill and proceed more quickly. The House did not say the quickly. The House did not say the motion, did not say that we need to move more quickly. It said we need more time. That is what the House agreed to.
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agreed to. The motion said that more time should be given so that we could complete its stages, so that it had sufficient time to get back to the Commons. I was particularly impressed during the course of that debate by what my noble friend, the Baroness Butler-sloss, said, that we've got to get through this and
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we are not getting through it. My Lords, the noble Lord makes the point that I make that I was the point that I make that I was making. We were saying we agreed because we didn't vote against him, because we didn't vote against him, that more time was required. But, my Lords, the discussion earlier on this morning was about the fact that the House must not rush at this, that we are talking about life and death, and particularly we're talking about the life and we're talking about the life and death of very vulnerable people and people who are marginalised, you know, living in poverty and all those things.
And these things do require the kind of consideration which has occurred this morning, which is reflected in the noble Lords response.
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I understand his comments about reasonably practicable in relation to this group of amendments, but to this group of amendments, but the Bill actually has reasonably practicable written many times practicable written many times clauses ten, 11, 16, 18, 47 and 50, in relation to the length of time a in relation to the length of time a doctor should take to write a written report. I have amendments written report. I have amendments to shorten that length of time, and I'll just be very interested if if the noble Lord doesn't think, and I'm sure he's probably going to say, we'll discuss that when we get on to those amendments to to those groupings.
But why is reasonably practicable not suitable in this situation, but it's suitable in
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situations of the length of time it takes doctors to write a report. Very valid point in relation to
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Very valid point in relation to this particular amendment. The reason why I think some sort of reason why I think some sort of regulatory process from the Secretary of State Code of Practice or something similar is better, is because you can give much, much because you can give much, much more detail and give much more examples. You shouldn't be just relying on a particular two word
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legal test. My Lords, that's been. Quite a. Really revealing debate.
The second assessment of the patient, and assistance being given to the patient all have to take place in England and Wales. There were a range of other things that the noble Baroness Baroness Coffey wished to take place whilst the patient was in England and Wales, for example, switching from one doctor to another, which is a process for my own part. I think the bill has broadly got right when you've got to be in England and Wales, having listened very carefully to what the noble Baroness, Baroness Coffey, has said, I'm not minded to suggest an amendment in relation to that.
And I note it was not picked up as an issue by other people. May I deal with the face to face issues, which were much more what the house, if I may say so, were interested in in relation to the course of this debate. And can I indicate that the effect of the debate has been in effect to identify four possibilities? First of all, each of the occasions, namely the two doctors and the panel has always got to involve a face to face meeting, which is amendment 65.
Secondly, that there should be a face to face meeting unless there are, and I use this phrase without intending to pick up all of the amendments, unless there are exceptional circumstances or there are practicability issues. Thirdly, the noble Lord Lord Blencathra Third amendment that he referred to, which is that there should be and this is his language, a statutory protocol defining where there where there where there can be remote accepting that the norm is face to face.
And fourthly, simply rely on the existing provisions of the bill, which is that codes of practice can be issued by the Minister under the various provisions of the bill, saying when face to face is appropriate and when face to face is not. The testimony, because that's what it felt like given of cases where remote has gone wrong, have enormous power, and I think we're all aware of circumstances where face to face will lead to much greater and better communication.
The other side of the coin, which was referred to by Baroness Pidgeon Baroness Jay Baroness Hayman Baroness Blackstone, was there will be circumstances and the Earl Howe where there will be circumstances where if you insist on face to face, you are in effect excluding some people from this right when they should have it. There are arguments on both sides. I come away with the strongest possible feeling that the house thinks face to face where possible is best, but there will be circumstances where it's not appropriate.
I think that brings me to my possibility three or possibility four? I think it is. It is wrong and dangerous to try to use a phrase like reasonably practicable or exceptional. I think more is required and I think there should be guidance given. And I do not think, and this is not a criticism, this is a congratulation. I don't think the words statutory protocol are right, but I get from what the noble Lord Lord Blencathra is saying that he wants something that has the force of regulations or something similar that says this is what we have got in mind, whether that's a code of practice or whether that's a statutory protocol.
I'm not sure. I'm sure it's not what's called a protocol, but I'm sure it might be something quite like that. I think the right course for me is to go away and bring back to the house something that satisfies the house, that there is going to be something, a statutory protocol or a code of guidance that indicates when face to face is appropriate or face to face should normally be the norm. But here the circumstances. But it wouldn't because I get the sense of anxiety about that.
I hope in the
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light of that approach, noble Lords would feel able. To.
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Withdraw their amendments. But I can't quite understand why the Noble and learned is so the Noble and learned is so unwilling actually to have on the face of the Bill that the presumption should be that it should be face to face, with, of course, exceptions and exceptions written into protocol. Why is he
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written into protocol. Why is he objecting to have it that way round? Is a lawyer going for a presumption is wrong? I think the right thing to do is say something like the norm is face to face, but there could be circumstances in which you can't. I think you should give. You should give maximum flexibility in relation to that noble Lord Lord Harper.
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Perhaps to the noble and learned Lord, why people are so nervous in the Commons at Second Reading. For much of the Committee stage, MPs much of the Committee stage, MPs were told that the panel would have to speak to the patient and then to speak to the patient and then amendments were tabled. Subsequent to that, which were the ones I talked about, which then allowed talked about, which then allowed the panel to accept pre-recorded video and waive hearing from the applicant entirely in those applicant entirely in those undefined exceptional circumstances.
So I think if he were to just reflect a little bit further, if I absolutely accept you don't want to have a blanket position, but if there was a presumption, a rebuttable presumption, that in that it should be face to face, and then there was some circumstances set out which which can be developed with case law, I think that would be something which it seems to me, listening to the debate would command wide support from the House and would deal with the both, both the concerns people have got, but also, rightly, the
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patient centred approach. The three noble Baroness Shah set out for your noble Lords in relation to the. Point that the noble Lord Lord
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Point that the noble Lord Lord Harper makes about the the imposition of of clause six in the imposition of of clause six in the bill. What the bill currently says about the panel is the panel must, subject to subsection six, hear subject to subsection six, hear from and may question the person to whom the referral relates. So they've got to question the person, though it's not necessarily that though it's not necessarily that it's got to be in person. Sub six the one he referred to.
The duty to hear from that person does not apply. If the panel is of the opinion that there are exceptional circumstances which justify not hearing from that person was added in during the course of the Committee stage of the debate, because a particular member of the committee described the circumstances of his own. I think it was his mother, and that's why it happened. But I will note what
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he says. I don't think I will go for a presumption, but I hear what he says. Sits down the point five, though, that this is important because I that this is important because I think he's slightly misspoke. He talked about questioning the problem with section five. It says if the panel considers it appropriate for medical reasons, it may make provision for the use of may make provision for the use of pre-recorded audio or video material. And the problem with that is you lose any ability to be able is you lose any ability to be able to ask questions.
And I think that is critical. That was added in afterwards after people had heard these concerns and it went backwards. So I think can you just reflect on that? And if he's going to bring an amendment forward, then I think make sure it's one that reflects the debate that he's heard
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this morning in your Lordships House. The noble Lord is making, because obviously you can't ask questions under clause six. So it's questions under clause six. So it's exactly the same point, the point that is being made in five and six that is being made in five and six is they recognise that there are circumstances where questioning is not possible, and I don't know quite what the additional point he
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was making was. I'm very grateful to noble Lord. I acknowledge that he's accepted that something else needs to be added to the bill, possibly along the lines I was suggesting, but and of course, that comes on top of the dozen new clauses he's already planning to add to the bill. Would he therefore help me understand if the Lord Lord is therefore admitting the bill is fundamentally flawed to a greater or lesser extent, and it needs to be amended? How, therefore, can you reconcile that with what he said a couple of days ago that he would seek to drive through the bill as unamended from the House of Commons? The bill that is so fundamentally flawed is now trying to move amendments to correct it.
But I'm grateful for the noble Lords concession this morning.
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I wouldn't look a gift horse in the mouth if I were you. As far as far as as far as the point. Is the far as as far as the point. Is the bill fundamentally flawed? I do not regard accepting amendments in the House of Lords at Committee stage as indicating that a Bill is fundamentally flawed. I regard that as listening and making appropriate as listening and making appropriate changes. Secondly, in relation to the question of the Parliament Act, the last thing I want is for it to the last thing I want is for it to happen through the Parliament Act.
What I want is for this House to do the job that it's supposed to do, which is due scrutiny, and then send it back to the Commons. I gave in detail my reasons why I thought we were not going about it properly. In the debate on the 8th of January, 2026, and I thought the House agreed with me when they said we need to move quicker. The problem is not that everybody has not got good ideas. The problem is it's taking not just far too long, but disproportionately long.
My experience of the Lords is that we can do this and we can do it much, much, much quicker than we are doing it. And there's still be quality. That was the point I made on the 8th of January, and that was the point I understood. The House
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accepted. The emotion put before the House
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The emotion put before the House on the 8th of January, if I remember correctly, was a motion that more time was required. Not that the House needed to race that the House needed to race through this bill and proceed more quickly. The House did not say the quickly. The House did not say the motion, did not say that we need to move more quickly. It said we need more time. That is what the House agreed to.
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agreed to. The motion said that more time should be given so that we could complete its stages, so that it had sufficient time to get back to the Commons. I was particularly impressed during the course of that debate by what my noble friend, the Baroness Butler-sloss, said, that we've got to get through this and
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we are not getting through it. My Lords, the noble Lord makes the point that I make that I was the point that I make that I was making. We were saying we agreed because we didn't vote against him, because we didn't vote against him, that more time was required. But, my Lords, the discussion earlier on this morning was about the fact that the House must not rush at this, that we are talking about life and death, and particularly we're talking about the life and we're talking about the life and death of very vulnerable people and people who are marginalised, you know, living in poverty and all those things.
And these things do require the kind of consideration which has occurred this morning, which is reflected in the noble Lords response.
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I understand his comments about reasonably practicable in relation to this group of amendments, but to this group of amendments, but the Bill actually has reasonably practicable written many times practicable written many times clauses ten, 11, 16, 18, 47 and 50, in relation to the length of time a in relation to the length of time a doctor should take to write a written report. I have amendments written report. I have amendments to shorten that length of time, and I'll just be very interested if if the noble Lord doesn't think, and I'm sure he's probably going to say, we'll discuss that when we get on to those amendments to to those groupings.
But why is reasonably practicable not suitable in this situation, but it's suitable in
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situations of the length of time it takes doctors to write a report. Very valid point in relation to
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Very valid point in relation to this particular amendment. The reason why I think some sort of reason why I think some sort of regulatory process from the Secretary of State Code of Practice or something similar is better, is because you can give much, much because you can give much, much more detail and give much more examples. You shouldn't be just relying on a particular two word
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legal test. My Lords, that's been. Quite a. Really revealing debate.
13:01
Baroness Coffey (Conservative)
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Baroness Coffey (Conservative)
I think in many ways. And actually, for the trying to go with the spirit of getting on with this the spirit of getting on with this bill, I could have easily broken that group into just consideration about what should be physically in the country and then what should be face to face, but I, I thought bringing that debate together could have been and has been, I think, of benefit to your Lordships. Now, one of the things I think is has come up in the noble and learned Lord has recognised that the concept of face to face being largely default, I think has been well received.
I think there's been a few other issues though, where I think the contribution from the noble Baroness, Lady Pigeon, gave a series of examples where I've been informed by barristers it would be actually required for clinicians to do the home visits and to go and visit the patient. In some of the examples that she's done, I'm particularly struck by the speech, by several speeches. I'm not going to repeat them. All of the noble Baroness Baroness Keeley, Lady Healey, about something as straightforward as a will is, certainly the legal protections are there.
So one of the things that I think going forward into Report stage, I think it's from my perspective, I am clear that I do believe that a lot of these panels, all these different operations or activities should happen in this country, rather than the psychiatrist or or whoever. It is the case being abroad in Tenerife, never mind anybody else. And I think it isn't sufficient to simply rely on statutory guidance. I gave the example last week when we talked about Montgomery.
The GMC only changed their guidance. That was referred to five years after the legal ruling. So it didn't happen straight away. And the other thing about statutory guidance, it doesn't have to come to Parliament. So it's simply what the Minister can put out. So for me, there's deficiencies in that approach, although I understand the
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flexibility. But the whole point is that we're doing, of course. Whether it has to come to Parliament depends upon the provision, doesn't it?
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provision, doesn't it? Well, as. It stands, I don't think there are. There seems to be a variety are. There seems to be a variety around this bill on whether or not there's that 40 day pre-laying. So there's that 40 day pre-laying. So it just seems to vary. A standard legislation would not require, unless Parliament specifically or unless Parliament specifically or the government inserted that specifically in the bill. So I think overall I've of course, I think there's still a lot to be discussed.
And I particularly would like to seek a meeting with the Minister on the response that somehow article eight is engaged, then linking it to article 14 on how, in particular, amendment 16 and 65 was not operable in that
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regard. But with that, I beg to withdraw amendment 16. Is it your Lordships pleasure
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Is it your Lordships pleasure that the amendment be withdrawn? Amendment is withdrawn. My Lords will come to a number of amendments will come to a number of amendments which have already been debated. 61 Baroness Coffey not moved, 62 Baroness Coffey not moved, 62 Baroness Fraser moved 63 Baroness Coffey not moved 64 Baroness Coffey not moved 64 Baroness Hollins. Moved 65 Baroness Coffey.
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Not moved. My Lords. We've. Agreed Noble. Lords would benefit from a short. Lunch break. I therefore beg to move that the Committee do now adjourn for 40 minutes. You will
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therefore return to the bill at 1342 44. Thank you. The committee stands adjourned
I think there's been a few other issues though, where I think the contribution from the noble Baroness, Lady Pigeon, gave a series of examples where I've been informed by barristers it would be actually required for clinicians to do the home visits and to go and visit the patient. In some of the examples that she's done, I'm particularly struck by the speech, by several speeches. I'm not going to repeat them. All of the noble Baroness Baroness Keeley, Lady Healey, about something as straightforward as a will is, certainly the legal protections are there.
So one of the things that I think going forward into Report stage, I think it's from my perspective, I am clear that I do believe that a lot of these panels, all these different operations or activities should happen in this country, rather than the psychiatrist or or whoever. It is the case being abroad in Tenerife, never mind anybody else. And I think it isn't sufficient to simply rely on statutory guidance. I gave the example last week when we talked about Montgomery.
The GMC only changed their guidance. That was referred to five years after the legal ruling. So it didn't happen straight away. And the other thing about statutory guidance, it doesn't have to come to Parliament. So it's simply what the Minister can put out. So for me, there's deficiencies in that approach, although I understand the
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flexibility. But the whole point is that we're doing, of course. Whether it has to come to Parliament depends upon the provision, doesn't it?
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provision, doesn't it? Well, as. It stands, I don't think there are. There seems to be a variety are. There seems to be a variety around this bill on whether or not there's that 40 day pre-laying. So there's that 40 day pre-laying. So it just seems to vary. A standard legislation would not require, unless Parliament specifically or unless Parliament specifically or the government inserted that specifically in the bill. So I think overall I've of course, I think there's still a lot to be discussed.
And I particularly would like to seek a meeting with the Minister on the response that somehow article eight is engaged, then linking it to article 14 on how, in particular, amendment 16 and 65 was not operable in that
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regard. But with that, I beg to withdraw amendment 16. Is it your Lordships pleasure
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Is it your Lordships pleasure that the amendment be withdrawn? Amendment is withdrawn. My Lords will come to a number of amendments will come to a number of amendments which have already been debated. 61 Baroness Coffey not moved, 62 Baroness Coffey not moved, 62 Baroness Fraser moved 63 Baroness Coffey not moved 64 Baroness Coffey not moved 64 Baroness Hollins. Moved 65 Baroness Coffey.
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Not moved. My Lords. We've. Agreed Noble. Lords would benefit from a short. Lunch break. I therefore beg to move that the Committee do now adjourn for 40 minutes. You will
**** Possible New Speaker ****
therefore return to the bill at 1342 44. Thank you. The committee stands adjourned
13:44
Baroness Coffey (Conservative)
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Baroness Coffey (Conservative)
I Lords, I'm conscious that I might be accused of referring a quill and pen other than perhaps the latest technology in the latest technology in consideration of where we are with amendment 66, but recognising how amendment 66, but recognising how artificial intelligence is emerging, I thought I'd put down quite a blunt amendment to at least allow us to have a debate, because inevitably, in variety of both legal and health situations, we will start to see artificial intelligence being used routinely.
There's quite a recent legal ruling where it turns out a judge had completely relied on AI and gave a completely inaccurate ruling on the basis of it. So it's not about simply about what would be considered by the medical practitioners. But I do worry about judgement. Now, we've already heard reasonably that trying to predict when somebody will pass away due to a terminal illness is a bit of science, but largely an art. Perhaps I'm being ungenerous in that regard, but certainly if the DWP one of the reasons we moved actually to issues to do with accelerated access to benefits, we actually moved it being from six month consideration to 12 months, simply because routinely the NHS doesn't doesn't require its practitioners to assess six months.
It is much more accurate at assessing it 12 months. So it's quite interesting in a way. How would this bill is focussed on six months, when routinely the NHS does not use it? However, I'm diverting slightly from the point of artificial intelligence. So one of the things that I am concerned about is that I'm somewhat interested by the previous debate, where there seemed to be, I won't say consensus, but perhaps a majority who felt that face to face was an important part of this happening in practice.
But I'm still was still a significant number of people who seem to be quite happily using a variety of technology. And for some of the interactions. And forgive me for fast forwarding, I do see this whole issue becoming pretty routine, actually. And what I want to avoid is almost outsourcing. It is strikes me how much people rely on Wikipedia and think that they're actually dealing with the Encyclopaedia Britannica, when a lot of what is on Wikipedia is a complete load of garbage.
What's even more worrying is that many of the AI mechanisms use sources like Wikipedia and the like. Or simply put two and two together and come up with 22. I saw this from my own not that long ago, when I was trying to find something on when I'd been on the Treasury Select Committee interrogating the FCA about something, all of a sudden, the first thing that came out of Jack Beatty is that somehow I've become a non-executive director of FCA. If only that certainly wasn't the case.
But it's it's is overreliance is my concern on what might start to happen in this consideration. Now, as I say, I want to avoid a world of chat bots, of removing that human element. And this is why I do keep coming back to a different theme about presence, about face to face, about being in this country, about it becoming a very personal element. And I'm conscious, as I say, that the NHS and other practitioners, legal practitioners will continue to evolve.
I'm I'm not stuck in some dinosaur age, but I feel that the issues on which those of us concerned about this bill will continue to reiterate, completely understand why people might want to do this, but we want to make sure that the safeguards, particularly on coercion, are as safe as possible. So that is why I've raised for the debate that we should consider whether, as a matter of principle, artificial intelligence is not used in the deployment of this act. And as I say, there may be evolution when it comes to medicine.
We see that's already happening. I don't know to what extent the government has confidence in the use of AI in diagnosis of life spans, nor in the its assessment of whether it can consider it's quite a new evolution within government that it's now starting to, which might get tested actually in court at some point on whether or not it's a meaningful way to handle consultations. It's certainly a cost efficient way of handling consultations. Sorry. For the point being, I think under the Wednesbury ruling, you're supposed to have an element of a proper consultation, not just a tick box exercise.
So I'm not going to dwell on this particular element, but I'd be very interested to hear not only from sponsor but from the government, its consideration of artificial intelligence in some of the practicality and the operability in terms of this act. If this bill, if it were to become
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law, I beg to move. Sorry. Hold on, hold on. Sir. Amendment proposed clause one,
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Amendment proposed clause one, page one, line 24 to insert the words on the Marshalled List.
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words on the Marshalled List. So this amendment 66, in the name of the noble Baroness Baroness Coffey. The bill makes no allowance at present for any restriction on the possibility of the use of the possibility of the use of non-human assessment and automated administration devices during the application and decision making process for assisted death. I mean, obviously AI will be used in things like recording meetings and stuff
There's quite a recent legal ruling where it turns out a judge had completely relied on AI and gave a completely inaccurate ruling on the basis of it. So it's not about simply about what would be considered by the medical practitioners. But I do worry about judgement. Now, we've already heard reasonably that trying to predict when somebody will pass away due to a terminal illness is a bit of science, but largely an art. Perhaps I'm being ungenerous in that regard, but certainly if the DWP one of the reasons we moved actually to issues to do with accelerated access to benefits, we actually moved it being from six month consideration to 12 months, simply because routinely the NHS doesn't doesn't require its practitioners to assess six months.
It is much more accurate at assessing it 12 months. So it's quite interesting in a way. How would this bill is focussed on six months, when routinely the NHS does not use it? However, I'm diverting slightly from the point of artificial intelligence. So one of the things that I am concerned about is that I'm somewhat interested by the previous debate, where there seemed to be, I won't say consensus, but perhaps a majority who felt that face to face was an important part of this happening in practice.
But I'm still was still a significant number of people who seem to be quite happily using a variety of technology. And for some of the interactions. And forgive me for fast forwarding, I do see this whole issue becoming pretty routine, actually. And what I want to avoid is almost outsourcing. It is strikes me how much people rely on Wikipedia and think that they're actually dealing with the Encyclopaedia Britannica, when a lot of what is on Wikipedia is a complete load of garbage.
What's even more worrying is that many of the AI mechanisms use sources like Wikipedia and the like. Or simply put two and two together and come up with 22. I saw this from my own not that long ago, when I was trying to find something on when I'd been on the Treasury Select Committee interrogating the FCA about something, all of a sudden, the first thing that came out of Jack Beatty is that somehow I've become a non-executive director of FCA. If only that certainly wasn't the case.
But it's it's is overreliance is my concern on what might start to happen in this consideration. Now, as I say, I want to avoid a world of chat bots, of removing that human element. And this is why I do keep coming back to a different theme about presence, about face to face, about being in this country, about it becoming a very personal element. And I'm conscious, as I say, that the NHS and other practitioners, legal practitioners will continue to evolve.
I'm I'm not stuck in some dinosaur age, but I feel that the issues on which those of us concerned about this bill will continue to reiterate, completely understand why people might want to do this, but we want to make sure that the safeguards, particularly on coercion, are as safe as possible. So that is why I've raised for the debate that we should consider whether, as a matter of principle, artificial intelligence is not used in the deployment of this act. And as I say, there may be evolution when it comes to medicine.
We see that's already happening. I don't know to what extent the government has confidence in the use of AI in diagnosis of life spans, nor in the its assessment of whether it can consider it's quite a new evolution within government that it's now starting to, which might get tested actually in court at some point on whether or not it's a meaningful way to handle consultations. It's certainly a cost efficient way of handling consultations. Sorry. For the point being, I think under the Wednesbury ruling, you're supposed to have an element of a proper consultation, not just a tick box exercise.
So I'm not going to dwell on this particular element, but I'd be very interested to hear not only from sponsor but from the government, its consideration of artificial intelligence in some of the practicality and the operability in terms of this act. If this bill, if it were to become
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law, I beg to move. Sorry. Hold on, hold on. Sir. Amendment proposed clause one,
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Amendment proposed clause one, page one, line 24 to insert the words on the Marshalled List.
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words on the Marshalled List. So this amendment 66, in the name of the noble Baroness Baroness Coffey. The bill makes no allowance at present for any restriction on the possibility of the use of the possibility of the use of non-human assessment and automated administration devices during the application and decision making process for assisted death. I mean, obviously AI will be used in things like recording meetings and stuff
13:50
Baroness O'Loan (Crossbench)
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Baroness O'Loan (Crossbench)
like that, but I think it's a I'm like that, but I think it's a I'm not a pen and paper person on to that extent. But AI has already been proposed for use to kill been proposed for use to kill patients in the Netherlands, where doctors are unwilling to participate. My Lords, the Data Use participate. My Lords, the Data Use and Access Act of 2025 establishes a new regulatory architecture for a new regulatory architecture for automated decision making and data interoperability operability within the NHS, and it provides that meaningful human involvement is maintained for significant decisions, decisions which may affect legal status, rights or health outcomes.
And of course, assisted death would come within that definition and that reflects the purpose of the NHS. Actually, we talked about its constitution. I looked at it, I looked at the Constitution and I looked at the guidance. And it says that the purpose of the NHS is to improve our health and wellbeing, supporting us to keep mentally and physically well, to get better when we are ill and when we cannot fully recover. To stay as well as we can to the end of our lives.
And I know that the noble Lord, noble Lord, Lord Faulkner, I think, is going to put some kind of amendment down, or there's going to be some suggestion that the Constitution will have to be amended as well as the guidance. But the current situation is that that is the purpose of the NHS. So the assisted suicide of patients is certainly not provided for in the NHS, nor should AI be used in the crucial assessment and decision making of the assisted dying process. Given the extreme difficulties in identifying coercion, assessing nuanced capacity and the irreversible nature of death.
So what plans does the noble and learned Lord, Lord Faulkner have to address this? In the Commons, amendments were passed allowing the Secretary of State to regulate devices for self-administration. The amendment was not put to a vote. In fact, only 70 of the 80 non Ledbetter amendments were permitted by the speaker. Seven votes on over 80 non Ledbetter amendments were permitted by the speaker, so the Commons have accepted the devices will be used for self-administration. And of course, the assisted suicide bill does require self-administration.
Nothing in the bill prohibits a device that uses AI to verify identity or capacity at the final moment. If a machine makes the final go no go decision based on an eye blink or a voice command, have we not outsourced the most lethal decision making in a person's life to technology? And the question I have to ask is, is this safe? Public education campaigns about assisted suicide are explicitly allowed for in clause 43 of the bill, and the government has said that there will be an initial education campaign to ensure health and social care staff are aware of the changes, and that there would likely be a need to provide information to a much wider pool of people, including all professionals professionals who are providing or have recently provided health or social care to the person, as well as family members, friends, unpaid carers and other support organisations and charities that that only controls government activity.
And the other observation I would make about that is that I presume that the public education campaign will also inform families that they have no role in a person's decision to choose assisted death, and that the first they may know of an assisted death is when they receive the phone call to tell the person that they're dead. I think it'd be profoundly important that people know this. There's nothing to prevent an AI chatbot or a search algorithm from helpfully informing a patient about assisted dying services, and from prioritising assisted dying over palliative care search results.
And I think that by legalising the service, the bill will feed the training data that makes these AI suggest death as a solution. And I would ask the noble and learned Lord Maude Faulkner how he intends to police that situation. There is also a risk of algorithmic bias if prognostic AI is trained on biased datasets, and we know the unreliability of the prognosis of life expectancy, it could disproportionately label certain demographics as terminal, subtly influencing the care options, including assisted dying presented to them.
The National Commission into the regulation of AI in healthcare, established by the MHRA in 2025, is currently reviewing these risks to ensure that patient safety is at the heart of regulatory innovation. Will that work cover assisted dying? I ask the noble Lord, the Minister, Baroness, the Minister, the AI Security Institute's Frontier AI trends report on December 25th highlights the fact that the persuasiveness of AI models is increasing with scale, and that targeted post training can increase persuasive capabilities further. In a healthcare context, this raises the risk of automated coercion, where the person interacting with a chatbot or an AI voice agent might be subtly persuaded towards certain end of life choices.
The ISI has said that safeguards won't prevent all AI misuse. We have to remember, my Lords, that there will be financial incentives to provide assisted suicide. After all, the assisted suicide. After all, the CEO of Marie Stopes received between 490,000 and 490 9000 in 2024. There is big money even though this will be charitable or NHS work. Clause five allows doctors to direct the person to where they can obtain information and have preliminary discussion. That sort of information could be an AI or chatbot at the present time.
Doctor Sarah Hughes, giving evidence to the Lords select committee, said there was a real risk of online coercion. With the newly developed AI functions and chatbots. We already know there are cases all around the world of individuals being coerced into all sorts of different behaviours, practices and decision making. There's also an issue of misinformation around diagnosis and prognosis. And Hannah. Questioned who has ultimate responsibility if the technology fails. She said in traditional euthanasia situations, a doctor is accountable.
But in AI driven scenarios, accountability could become ambiguous, potentially resting between manufacturers, healthcare providers and even the patient. AI's also have a record of encouraging suicide, and we know that, and we have seen terrible cases among young people. They have no regard for human life, my Lord. Evidence shows that doctors only suspect 5% of elder abuse cases. Detecting subtle coercion requires, as was said in the previous group, professional judgement to interpret things like nonverbal cues, body language, discomfort AI systems are ill equipped to handle these nuanced, non-quantifiable elements.
My Lords, it's imperative for trust in the system that the individual circumstances of each request for assisted death is recorded and is available for interrogation, or even potentially a criminal investigation by the panel or other regulatory authority. The only insight as to what happened in the consulting room will come from these records. The patient will be dead. The current provision in the bill does not provide any protection against the use of AI, which has algorithmic bias to protect an individual in these circumstances.
And can the noble and learned Lord, Lord Falconer explain how he proposes to deal with these concerns?
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My Lords, I would only add a very short sentence to my noble friend's excellent speech. And it friend's excellent speech. And it is what AI says about AI. AI is technically capable of providing technically capable of providing advice or information relating to suicide, it says, but it is suicide, it says, but it is critically dangerous to rely on it
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critically dangerous to rely on it for this purpose. Enough said. I rise to thank the. Noble Baroness Coffey for raising a very important issue in this amendment. However, I'm concerned that as it stands, as the noble Baroness has already said, this amendment is too blunt an instrument. It is important that we distinguish between AI tools and the more dangerous artificial, general or superintelligence. The use of AI in medical diagnostics in patient care is already commonplace. AI tools are currently used to read scans and X-rays, and will frequently perform as well as, if not better than, clinicians to exclude the use of AI altogether
And of course, assisted death would come within that definition and that reflects the purpose of the NHS. Actually, we talked about its constitution. I looked at it, I looked at the Constitution and I looked at the guidance. And it says that the purpose of the NHS is to improve our health and wellbeing, supporting us to keep mentally and physically well, to get better when we are ill and when we cannot fully recover. To stay as well as we can to the end of our lives.
And I know that the noble Lord, noble Lord, Lord Faulkner, I think, is going to put some kind of amendment down, or there's going to be some suggestion that the Constitution will have to be amended as well as the guidance. But the current situation is that that is the purpose of the NHS. So the assisted suicide of patients is certainly not provided for in the NHS, nor should AI be used in the crucial assessment and decision making of the assisted dying process. Given the extreme difficulties in identifying coercion, assessing nuanced capacity and the irreversible nature of death.
So what plans does the noble and learned Lord, Lord Faulkner have to address this? In the Commons, amendments were passed allowing the Secretary of State to regulate devices for self-administration. The amendment was not put to a vote. In fact, only 70 of the 80 non Ledbetter amendments were permitted by the speaker. Seven votes on over 80 non Ledbetter amendments were permitted by the speaker, so the Commons have accepted the devices will be used for self-administration. And of course, the assisted suicide bill does require self-administration.
Nothing in the bill prohibits a device that uses AI to verify identity or capacity at the final moment. If a machine makes the final go no go decision based on an eye blink or a voice command, have we not outsourced the most lethal decision making in a person's life to technology? And the question I have to ask is, is this safe? Public education campaigns about assisted suicide are explicitly allowed for in clause 43 of the bill, and the government has said that there will be an initial education campaign to ensure health and social care staff are aware of the changes, and that there would likely be a need to provide information to a much wider pool of people, including all professionals professionals who are providing or have recently provided health or social care to the person, as well as family members, friends, unpaid carers and other support organisations and charities that that only controls government activity.
And the other observation I would make about that is that I presume that the public education campaign will also inform families that they have no role in a person's decision to choose assisted death, and that the first they may know of an assisted death is when they receive the phone call to tell the person that they're dead. I think it'd be profoundly important that people know this. There's nothing to prevent an AI chatbot or a search algorithm from helpfully informing a patient about assisted dying services, and from prioritising assisted dying over palliative care search results.
And I think that by legalising the service, the bill will feed the training data that makes these AI suggest death as a solution. And I would ask the noble and learned Lord Maude Faulkner how he intends to police that situation. There is also a risk of algorithmic bias if prognostic AI is trained on biased datasets, and we know the unreliability of the prognosis of life expectancy, it could disproportionately label certain demographics as terminal, subtly influencing the care options, including assisted dying presented to them.
The National Commission into the regulation of AI in healthcare, established by the MHRA in 2025, is currently reviewing these risks to ensure that patient safety is at the heart of regulatory innovation. Will that work cover assisted dying? I ask the noble Lord, the Minister, Baroness, the Minister, the AI Security Institute's Frontier AI trends report on December 25th highlights the fact that the persuasiveness of AI models is increasing with scale, and that targeted post training can increase persuasive capabilities further. In a healthcare context, this raises the risk of automated coercion, where the person interacting with a chatbot or an AI voice agent might be subtly persuaded towards certain end of life choices.
The ISI has said that safeguards won't prevent all AI misuse. We have to remember, my Lords, that there will be financial incentives to provide assisted suicide. After all, the assisted suicide. After all, the CEO of Marie Stopes received between 490,000 and 490 9000 in 2024. There is big money even though this will be charitable or NHS work. Clause five allows doctors to direct the person to where they can obtain information and have preliminary discussion. That sort of information could be an AI or chatbot at the present time.
Doctor Sarah Hughes, giving evidence to the Lords select committee, said there was a real risk of online coercion. With the newly developed AI functions and chatbots. We already know there are cases all around the world of individuals being coerced into all sorts of different behaviours, practices and decision making. There's also an issue of misinformation around diagnosis and prognosis. And Hannah. Questioned who has ultimate responsibility if the technology fails. She said in traditional euthanasia situations, a doctor is accountable.
But in AI driven scenarios, accountability could become ambiguous, potentially resting between manufacturers, healthcare providers and even the patient. AI's also have a record of encouraging suicide, and we know that, and we have seen terrible cases among young people. They have no regard for human life, my Lord. Evidence shows that doctors only suspect 5% of elder abuse cases. Detecting subtle coercion requires, as was said in the previous group, professional judgement to interpret things like nonverbal cues, body language, discomfort AI systems are ill equipped to handle these nuanced, non-quantifiable elements.
My Lords, it's imperative for trust in the system that the individual circumstances of each request for assisted death is recorded and is available for interrogation, or even potentially a criminal investigation by the panel or other regulatory authority. The only insight as to what happened in the consulting room will come from these records. The patient will be dead. The current provision in the bill does not provide any protection against the use of AI, which has algorithmic bias to protect an individual in these circumstances.
And can the noble and learned Lord, Lord Falconer explain how he proposes to deal with these concerns?
**** Possible New Speaker ****
My Lords, I would only add a very short sentence to my noble friend's excellent speech. And it friend's excellent speech. And it is what AI says about AI. AI is technically capable of providing technically capable of providing advice or information relating to suicide, it says, but it is suicide, it says, but it is critically dangerous to rely on it
**** Possible New Speaker ****
critically dangerous to rely on it for this purpose. Enough said. I rise to thank the. Noble Baroness Coffey for raising a very important issue in this amendment. However, I'm concerned that as it stands, as the noble Baroness has already said, this amendment is too blunt an instrument. It is important that we distinguish between AI tools and the more dangerous artificial, general or superintelligence. The use of AI in medical diagnostics in patient care is already commonplace. AI tools are currently used to read scans and X-rays, and will frequently perform as well as, if not better than, clinicians to exclude the use of AI altogether
13:59
The Lord Bishop of Hereford (Bishops)
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The Lord Bishop of Hereford (Bishops)
might deprive patients who are considering assisted dying of considering assisted dying of valuable diagnostic assistance and care at a very vulnerable time. However, it would not be acceptable However, it would not be acceptable for a still to be developed, general purpose artificial general purpose artificial artificial intelligence to be part of the decision making process. We of the decision making process. We debated earlier on the importance of face to face diagnostics. In the last group of amendments were this bill to pass, it will be vital that decisions about assisted dying would require the combination of intelligence, wisdom and love as defined by Thomas Aquinas, as to will the good of the other.
These are distinctive and uniquely human qualities. However sophisticated AI becomes, it can never replace human interaction and judgement, and should not do so now. I hope that the sponsors of this amendment might consider a redraughting that takes account of these fundamental differences, retaining access to helpful diagnostic tools whilst excluding are still to be developed. General purpose superintelligent AI from a decision making process that properly resides in human agency. Well, essentially I agree with right reverend Prelate, the Bishop
These are distinctive and uniquely human qualities. However sophisticated AI becomes, it can never replace human interaction and judgement, and should not do so now. I hope that the sponsors of this amendment might consider a redraughting that takes account of these fundamental differences, retaining access to helpful diagnostic tools whilst excluding are still to be developed. General purpose superintelligent AI from a decision making process that properly resides in human agency. Well, essentially I agree with right reverend Prelate, the Bishop
14:01
Lord Stevens of Birmingham (Crossbench)
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Lord Stevens of Birmingham (Crossbench)
of Hereford. I could really almost leave it there. But just very briefly to say, I think the in the spirit to which the amendments put spirit to which the amendments put forward, the movers are right to raise general concerns about the raise general concerns about the possibility of abuse through bias, as we've heard from Baroness O'Loan hallucination. After all, I think hallucination. After all, I think we've had the first high profile resignation of a public sector leader in the form of the Chief leader in the form of the Chief Constable of the West Midlands, praying in aid, the fabrication of a non-existent football match as to being the reason why Parliament was was misled.
And in addition to bias and hallucination, there is also the risk of what is called scheming. And if you look at some of the results from some of the LMS published, for example, in the journal Nature in October and UQs pretty disturbing examples. The article headed AI models that lie, cheat and plot murder are examples where models have attempted to write self-propagating worms, fabricating legal documentation, leaving hidden notes to future instances themselves. And the sort of punch line essentially is that for some of these technologies, we are apparently as a world in a lucky period in which the models are currently smart enough to scheme, but not smart enough to escape monitoring.
Which is scary because in five years time that may no longer be true. So there are good reasons for generalised concerns about wanting to circumscribe the role that AI might play in this legislation. However, for the reasons that others have briefly mentioned, I suspect the noble Baroness, Lady Coffey herself, would accept this probing amendment. It is written too broadly. It actually says that AI must not be used to carry out any functions in any section or schedule of this act, given that, for example, clause five five and 12 two, a doctor is having to discuss with a person their diagnosis, their prognosis, any treatments available, the likely effects of it, palliative, hospice and other care.
It is highly likely that those will be informed by machine learning interpreting, for example, CT scans or MRIs. AI tools to personalise and optimise therapies, and potentially predictive AI for better prognosis. So I think we're this to come back at report, there would be a good case for ensuring greater precision in the firepower that is aimed at this particular concern. But all of that finally should not in any way excuse or divert us from an equivalent worry, which is that we must not we must not kid ourselves that the gold standard is human expert judgement when it comes to many of the questions that are posed by this bill.
Clause 21B we've discussed requires an assessment as to whether or not somebody with a terminal illness is going to live longer than six months. And unfortunately, that turns out, as we've heard, to be a clinically irrelevant threshold where it is very hard for expert judgement to get it right. I've just pulled the data from a large study looking at 98,000 people across London over the last decade, looking at prognostic accuracy, and the answer was that clinicians were able to be accurate as to whether somebody was going to live for two weeks with about a 74% accuracy, they were able to be accurate as to whether somebody was going to live more than a year with 83% accuracy, but in terms of being able to predict whether somebody is going to survive for weeks or months, accuracy was only 32%.
So whatever our concerns about AI, human expert judgement which underpins this bill is itself highly fallible.
And in addition to bias and hallucination, there is also the risk of what is called scheming. And if you look at some of the results from some of the LMS published, for example, in the journal Nature in October and UQs pretty disturbing examples. The article headed AI models that lie, cheat and plot murder are examples where models have attempted to write self-propagating worms, fabricating legal documentation, leaving hidden notes to future instances themselves. And the sort of punch line essentially is that for some of these technologies, we are apparently as a world in a lucky period in which the models are currently smart enough to scheme, but not smart enough to escape monitoring.
Which is scary because in five years time that may no longer be true. So there are good reasons for generalised concerns about wanting to circumscribe the role that AI might play in this legislation. However, for the reasons that others have briefly mentioned, I suspect the noble Baroness, Lady Coffey herself, would accept this probing amendment. It is written too broadly. It actually says that AI must not be used to carry out any functions in any section or schedule of this act, given that, for example, clause five five and 12 two, a doctor is having to discuss with a person their diagnosis, their prognosis, any treatments available, the likely effects of it, palliative, hospice and other care.
It is highly likely that those will be informed by machine learning interpreting, for example, CT scans or MRIs. AI tools to personalise and optimise therapies, and potentially predictive AI for better prognosis. So I think we're this to come back at report, there would be a good case for ensuring greater precision in the firepower that is aimed at this particular concern. But all of that finally should not in any way excuse or divert us from an equivalent worry, which is that we must not we must not kid ourselves that the gold standard is human expert judgement when it comes to many of the questions that are posed by this bill.
Clause 21B we've discussed requires an assessment as to whether or not somebody with a terminal illness is going to live longer than six months. And unfortunately, that turns out, as we've heard, to be a clinically irrelevant threshold where it is very hard for expert judgement to get it right. I've just pulled the data from a large study looking at 98,000 people across London over the last decade, looking at prognostic accuracy, and the answer was that clinicians were able to be accurate as to whether somebody was going to live for two weeks with about a 74% accuracy, they were able to be accurate as to whether somebody was going to live more than a year with 83% accuracy, but in terms of being able to predict whether somebody is going to survive for weeks or months, accuracy was only 32%.
So whatever our concerns about AI, human expert judgement which underpins this bill is itself highly fallible.
14:05
Lord Markham (Conservative)
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Lord Markham (Conservative)
I think really following on from that, and my noble friend said right at the beginning, it was right at the beginning, it was absolutely to stimulate this sort of debate that it was put down in such a blunt fashion. But I think what's been really useful from this what's been really useful from this is I think there's a broad degree of consensus that actually AI can be valuable as an input to the decision making, but it shouldn't be used as the output, as the final decision maker.
So as as mentioned, you know, AI can actually detect the progression of cancers and probably can do better prognosis or improve, especially over time that we're looking at here, so that you can get better assessments of how long someone is likely to to live. I would say actually, the AI and the chat box are very, very many instances where actually it could be very, very useful in terms of detecting coercion if they're talking to someone over a number of over quite a long period of time.
And so I think what we see in all of this is actually as inputs to, to the decision making process. AI actually does have a valuable part to play. But I think we would also absolutely agree as the final decision maker in terms of an output, clearly that's got to be a human armed with obviously the inputs from the the AI, but it's the human who's making the final decision. And I think that's what the bill does. If I if I'm correct in terms of it's very clear that the decision makers, the panels, the doctors and everything are those people.
But at the same time, I guess it's silent, but it obviously enables the the AI as an input to it. So I think where this debate hopefully is useful is actually it's showing a degree of consensus and showing that in this instance we've probably got the right balance. But again, I'd be interested to hear from the bill sponsor in his response if that's the case.
So as as mentioned, you know, AI can actually detect the progression of cancers and probably can do better prognosis or improve, especially over time that we're looking at here, so that you can get better assessments of how long someone is likely to to live. I would say actually, the AI and the chat box are very, very many instances where actually it could be very, very useful in terms of detecting coercion if they're talking to someone over a number of over quite a long period of time.
And so I think what we see in all of this is actually as inputs to, to the decision making process. AI actually does have a valuable part to play. But I think we would also absolutely agree as the final decision maker in terms of an output, clearly that's got to be a human armed with obviously the inputs from the the AI, but it's the human who's making the final decision. And I think that's what the bill does. If I if I'm correct in terms of it's very clear that the decision makers, the panels, the doctors and everything are those people.
But at the same time, I guess it's silent, but it obviously enables the the AI as an input to it. So I think where this debate hopefully is useful is actually it's showing a degree of consensus and showing that in this instance we've probably got the right balance. But again, I'd be interested to hear from the bill sponsor in his response if that's the case.
14:07
Baroness Gerada (Crossbench)
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Baroness Gerada (Crossbench)
So this amendment as it stands, we would have patients who could not have computerised records not have computerised records because we have AI sitting behind every computer. The AI starts at the beginning. It starts with our the beginning. It starts with our telephone system. So in fact, the patient wouldn't even be able to use the telephone to to access us. use the telephone to to access us. They would have to come in or a relative would have to come in. They certainly wouldn't be allowed to have computerised records because of the digital and AI systems that we have in order to to pick out diseases, to make sure that we're safe practising.
They also wouldn't be able to in many ways have electronic prescribing because electronic prescribing also at the pharmacy end, uses AI to make sure that patients aren't being overmedicated the drug interactions, etcetera, etcetera. So with respect, and also if they were in using a computer system, we also use AI to, to, to digitally scribe consultations. So I understand the essence of this. I think the essence of this, as many have said, is to stop us or to not allow AI to to decision, make somebody at the end of their life.
But as it stands, I have to warn you that it's unworkable in clinical practice. And I'm grateful to my noble.
They also wouldn't be able to in many ways have electronic prescribing because electronic prescribing also at the pharmacy end, uses AI to make sure that patients aren't being overmedicated the drug interactions, etcetera, etcetera. So with respect, and also if they were in using a computer system, we also use AI to, to, to digitally scribe consultations. So I understand the essence of this. I think the essence of this, as many have said, is to stop us or to not allow AI to to decision, make somebody at the end of their life.
But as it stands, I have to warn you that it's unworkable in clinical practice. And I'm grateful to my noble.
14:08
Baroness Berridge (Conservative)
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Baroness Berridge (Conservative)
Friend for laying such a broad amendment. And I agree, obviously, with much of what the right with much of what the right reverend Prelate has said. And it is interesting that this is coming straight after face to face conversations, because we're all used to ticking that I'm not a robot box, but actually AI does now have the ability to create persons, and it is often very difficult if you're not face to face to. Is that person on screen actually a person? I can't believe we've got there quite so quickly, but I think it's also important to consider about public confidence and understanding at the moment.
This is, as we keep saying, such an important life or death decision. And when one considers the fact that there is just a lack of understanding, people are potentially worried about these implications, often for employment for other purposes. So as I was preparing this, for instance, it made me reflect as the noble Lady, Lady Gerada says, you know, your GP is using AI. But when patches told me recently that the NHS guidance that I shouldn't take an over-the-counter drug for more than two weeks.
So I queried it, but was the answer I only thought yesterday was that answer actually from my GP? Or was it from an AI tool sitting behind the system? And I think we really need to be careful with the level of public understanding and awareness of its use. Now, this use of AI is, I think, also one step on and connected to clause 42 of the bill, which is in relation to advertising. And I am grateful to the noble and learned Lord that he is going to be bringing forward some amendments on that clause.
And I do hope that the connection with AI, as well as the Online Safety Act, have been considered. But I was disappointed that we him correctly, no assurance that those amendments will be with us by the end of Committee stage. When the Noble and learned law gave evidence on the 22nd of October of last year, accepting that there was additional work to be done on clause 42. And in relation to this Bill, I think I said at Second Reading that I think it is currently drafted for an analogue age.
So I'm not wanting to take us back to some kind of quill and no use of AI situation. It obviously is. Other noble Lords have said it doesn't deal not only with the pressure or coercion not being from a human being in certain parts of the bill, but it doesn't also consider that coercion can actually be more hidden with now the use of AI. It doesn't deal with the bill, doesn't deal with people, for instance, being able to learn answers by watching YouTube.
And you can learn how to answer certain tools. And therefore, we could be in a situation where someone who wouldn't qualify if there was a face to face non AI system would actually learn how to do those answers and would qualify. There is as well good studies to say that the use in GP practices has had obviously some inaccuracies and of course in many circumstances tracing where the decision has come from, there's a lack of transparency and and potentially accountability. My Lords, we don't even understand the algorithms that are sending us advertisements for different shops, let alone understanding how it could be connected to a decision like these.
This. But finally, my Lords, and I think my biggest concern is that it's been accepted, I think on numerous occasions in your Lordships' House that there will be a limited number of practitioners who will want to participate in this process. So I've put on it's a public letter, for instance, that was written on the 12th of June of last year. All Plymouth senior palliative medicine doctors were signatories to a letter basically saying that, warning us of the risks of the bill and saying that the changes would significantly worsen the delivery of our current health services in Plymouth.
Through the complexity of the conversations required. When patients ask us about the option of assistance to die. And I think that is relevant for two reasons. Number one, if we've got a shortage of practitioners in parts of the country, like potentially the southwest, if their opposition to the bill translates into not being involved and therefore an increased temptation to resort to more use of AI. But I do hope that the noble and learned Lord or the noble Lady, the Minister, can actually help on this point.
Many of these systems, and I am speaking as a, I think, an ordinary layperson here, rely on groups of data and information within the system, and it's created from the learning is creating from that. If you've got a very small pool of practitioners, if we do have some form of AI being used, does that not affect the creation of the AI tool itself? I hope I've explained that correctly, but with such a small group doing it, will that not affect the technology itself?
This is, as we keep saying, such an important life or death decision. And when one considers the fact that there is just a lack of understanding, people are potentially worried about these implications, often for employment for other purposes. So as I was preparing this, for instance, it made me reflect as the noble Lady, Lady Gerada says, you know, your GP is using AI. But when patches told me recently that the NHS guidance that I shouldn't take an over-the-counter drug for more than two weeks.
So I queried it, but was the answer I only thought yesterday was that answer actually from my GP? Or was it from an AI tool sitting behind the system? And I think we really need to be careful with the level of public understanding and awareness of its use. Now, this use of AI is, I think, also one step on and connected to clause 42 of the bill, which is in relation to advertising. And I am grateful to the noble and learned Lord that he is going to be bringing forward some amendments on that clause.
And I do hope that the connection with AI, as well as the Online Safety Act, have been considered. But I was disappointed that we him correctly, no assurance that those amendments will be with us by the end of Committee stage. When the Noble and learned law gave evidence on the 22nd of October of last year, accepting that there was additional work to be done on clause 42. And in relation to this Bill, I think I said at Second Reading that I think it is currently drafted for an analogue age.
So I'm not wanting to take us back to some kind of quill and no use of AI situation. It obviously is. Other noble Lords have said it doesn't deal not only with the pressure or coercion not being from a human being in certain parts of the bill, but it doesn't also consider that coercion can actually be more hidden with now the use of AI. It doesn't deal with the bill, doesn't deal with people, for instance, being able to learn answers by watching YouTube.
And you can learn how to answer certain tools. And therefore, we could be in a situation where someone who wouldn't qualify if there was a face to face non AI system would actually learn how to do those answers and would qualify. There is as well good studies to say that the use in GP practices has had obviously some inaccuracies and of course in many circumstances tracing where the decision has come from, there's a lack of transparency and and potentially accountability. My Lords, we don't even understand the algorithms that are sending us advertisements for different shops, let alone understanding how it could be connected to a decision like these.
This. But finally, my Lords, and I think my biggest concern is that it's been accepted, I think on numerous occasions in your Lordships' House that there will be a limited number of practitioners who will want to participate in this process. So I've put on it's a public letter, for instance, that was written on the 12th of June of last year. All Plymouth senior palliative medicine doctors were signatories to a letter basically saying that, warning us of the risks of the bill and saying that the changes would significantly worsen the delivery of our current health services in Plymouth.
Through the complexity of the conversations required. When patients ask us about the option of assistance to die. And I think that is relevant for two reasons. Number one, if we've got a shortage of practitioners in parts of the country, like potentially the southwest, if their opposition to the bill translates into not being involved and therefore an increased temptation to resort to more use of AI. But I do hope that the noble and learned Lord or the noble Lady, the Minister, can actually help on this point.
Many of these systems, and I am speaking as a, I think, an ordinary layperson here, rely on groups of data and information within the system, and it's created from the learning is creating from that. If you've got a very small pool of practitioners, if we do have some form of AI being used, does that not affect the creation of the AI tool itself? I hope I've explained that correctly, but with such a small group doing it, will that not affect the technology itself?
14:13
Lord Deben (Conservative)
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Lord Deben (Conservative)
I come to this amendment with a I'm sorry with with a good deal of suspicion, because I'm always worried when the House of Lords worried when the House of Lords decides that it's getting worried about some new thing that's coming along, so we better do something about it. And I think in Baroness Coffey explanation of this, she did explain that it was a broad demand in order that we should concentrate on the important bit of it. And I do recommend to those in the House who were not here for the debate on super clever AI, if I may put it like that last night, to read it, because it really does explain why we should be concerned about this.
And if I won't embarrass him, I hope that the House would read with care the speech by the Lord Bishop of Hereford, which brought his scientific knowledge and his moral concern together in the most interesting and I think perceptive way. And if his quoting of Saint Thomas Aquinas interests people, there is a remarkable book called Why Saint Thomas Aquinas Matters Now, which is well worth reading in the context of this particular bill. But I do suggest to the House that we do have to have something in the bill, which makes clear that the developing side of AI must not be used in place of human beings to make these various decisions.
And the reason I rise is merely to say, I don't think it's good enough just to say, well, we can't deal with this because obviously AI is used in all these normally technical ways. I think what we do have to say to the noble and learned Lord, that we look to him to find a way of just making sure, and I finish by saying the reason for that is not just because it's right, it is because all the way through this bill, I think we should be thinking about what the public reaction to the various parts of it is, and the public is worried about the way they feel increasingly manipulated by AI.
And therefore, to show that we have thought that through, and we have made sure that the AI is used in the proper sense and not in any improper sense, seems to me to be valuable for the supporters of this bill to ensure that people understand that they have faced up to the very natural reactions that so many people have, and which I think I have, which is that I feel I live in a society where I constantly have to watch out as to whether I'm being manipulated on that, as some have said, by advertisements or whatever else it is.
And if we got this right, I think it would help a very large number of people.
And if I won't embarrass him, I hope that the House would read with care the speech by the Lord Bishop of Hereford, which brought his scientific knowledge and his moral concern together in the most interesting and I think perceptive way. And if his quoting of Saint Thomas Aquinas interests people, there is a remarkable book called Why Saint Thomas Aquinas Matters Now, which is well worth reading in the context of this particular bill. But I do suggest to the House that we do have to have something in the bill, which makes clear that the developing side of AI must not be used in place of human beings to make these various decisions.
And the reason I rise is merely to say, I don't think it's good enough just to say, well, we can't deal with this because obviously AI is used in all these normally technical ways. I think what we do have to say to the noble and learned Lord, that we look to him to find a way of just making sure, and I finish by saying the reason for that is not just because it's right, it is because all the way through this bill, I think we should be thinking about what the public reaction to the various parts of it is, and the public is worried about the way they feel increasingly manipulated by AI.
And therefore, to show that we have thought that through, and we have made sure that the AI is used in the proper sense and not in any improper sense, seems to me to be valuable for the supporters of this bill to ensure that people understand that they have faced up to the very natural reactions that so many people have, and which I think I have, which is that I feel I live in a society where I constantly have to watch out as to whether I'm being manipulated on that, as some have said, by advertisements or whatever else it is.
And if we got this right, I think it would help a very large number of people.
14:16
Baroness Finlay of Llandaff (Crossbench)
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Baroness Finlay of Llandaff (Crossbench)
My Lord. >> Very good. >> Had an interesting discussion about the importance of face to about the importance of face to face, and I think came to the conclusion that the noble and learned Lord would bring forward amendments that would make face to face the default mechanism, but accepting that there are exceptions to it. And at that point, I did raise the question of recorded statements made by someone who then couldn't speak. And it is important to remember that speech can be faked now, and can sound exactly like the person.
And I hope that in drawing up those amendments that we've discussed previously, he will be able to encompass some protection to ensure that actually, if a presentation is made of a recording that seems to be in somebody's voice and in their words, that we are still protecting against abuse, against coercion, and against those with mal intent who may have faked it, because unfortunately, we're already hearing stories of criminal activity where such fake voice recordings are used, and do find that people believe them as being as if they're from the person when actually they've been part of a criminal activity.
So I think that this amendment has been really important because it's actually made us think on a very much wider scale, accepting, of course, that it's only a probing amendment.
And I hope that in drawing up those amendments that we've discussed previously, he will be able to encompass some protection to ensure that actually, if a presentation is made of a recording that seems to be in somebody's voice and in their words, that we are still protecting against abuse, against coercion, and against those with mal intent who may have faked it, because unfortunately, we're already hearing stories of criminal activity where such fake voice recordings are used, and do find that people believe them as being as if they're from the person when actually they've been part of a criminal activity.
So I think that this amendment has been really important because it's actually made us think on a very much wider scale, accepting, of course, that it's only a probing amendment.
14:18
Baroness Fox of Buckley (Non-affiliated)
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Baroness Fox of Buckley (Non-affiliated)
And the government's ten year health plan for England seeks to health plan for England seeks to make the NHS, quote, the most AI enabled health system in the world. And like others, I think that's an incredibly exciting prospect. I don't want to be dystopian, and I think the right reverend Prelate and the Bishop of Hereford makes a very important point to warn us against going completely over the top. However, I do think it's important that this amendment has been tabled because it makes us think about what the possible problems are and they've been well expressed by others.
I just want to say that despite my excitement about what AI might do, actually, even in terms of treatments, there's very wonderful possibilities in terms of helping people walk in terms of what's happening with brain, with the brain and so on. We just don't want to be naive. So the question is just for the noble and learned Lord, as the NHS digitises doctors become increasingly reliant on AI for notes and diagnostics, as the diagnosis is so important in a life or death situation.
In this instance, how can we just ensure that a time poor doctor doesn't use AI as an assessment tool or as a shortcut, and we will be naive to imagine it doesn't happen elsewhere. We'll only have to think of politics. But I mean, people use AI now to avoid doing research in a wide range of instances, and I just don't want that to be translated over. I only just wanted to add a little bit on turning to the patients, because algorithms, which are, you know, supremely impressive, can take things that have happened on Facebook or TikTok or indeed, whether you've been on a teams meeting or zoom or all sorts of indications that can then detect chronic illness conversations, and then the algorithms can push, for example, pro assisted dying content such as the Switzerland adverts or positive end of life options.
Now, the interesting thing here is, is that when we're discussing banning social media for under 16, which I completely disapprove of, by the way, or we brought in the Online Safety Act, which I argued against. Everybody kept saying to us, algorithms, algorithms, oh my goodness, algorithms. They can do all these things. I do at least think that we should consider not because chatbots are malevolent, but because I tend to agree with people via the algorithms as somebody, to quote one Psychology Today paper, when everyone has a yes man in their pocket.
So if you say you're interested in something, they'll just say yes. Here are your options. And I do think that's something to be concerned about. And it will come up when we're discussing advertising. But just then to finish with that story that that in the BBC from August, in which a California couple are suing OpenAI over the death of their teenage son, alleging that chatbot ChatGPT encouraged him to take his own life, and they produced the chat logs between Adam, who died last April, and ChatGPT the show, explaining his suicidal thoughts, and they argue that the program validates his most harmful and self-destructive thoughts.
I'm just saying, AI is a wonderful, human, man made solution to many problems, but if we pass a bill like this without considering the potential negative possible outcomes, we would be irresponsible.
I just want to say that despite my excitement about what AI might do, actually, even in terms of treatments, there's very wonderful possibilities in terms of helping people walk in terms of what's happening with brain, with the brain and so on. We just don't want to be naive. So the question is just for the noble and learned Lord, as the NHS digitises doctors become increasingly reliant on AI for notes and diagnostics, as the diagnosis is so important in a life or death situation.
In this instance, how can we just ensure that a time poor doctor doesn't use AI as an assessment tool or as a shortcut, and we will be naive to imagine it doesn't happen elsewhere. We'll only have to think of politics. But I mean, people use AI now to avoid doing research in a wide range of instances, and I just don't want that to be translated over. I only just wanted to add a little bit on turning to the patients, because algorithms, which are, you know, supremely impressive, can take things that have happened on Facebook or TikTok or indeed, whether you've been on a teams meeting or zoom or all sorts of indications that can then detect chronic illness conversations, and then the algorithms can push, for example, pro assisted dying content such as the Switzerland adverts or positive end of life options.
Now, the interesting thing here is, is that when we're discussing banning social media for under 16, which I completely disapprove of, by the way, or we brought in the Online Safety Act, which I argued against. Everybody kept saying to us, algorithms, algorithms, oh my goodness, algorithms. They can do all these things. I do at least think that we should consider not because chatbots are malevolent, but because I tend to agree with people via the algorithms as somebody, to quote one Psychology Today paper, when everyone has a yes man in their pocket.
So if you say you're interested in something, they'll just say yes. Here are your options. And I do think that's something to be concerned about. And it will come up when we're discussing advertising. But just then to finish with that story that that in the BBC from August, in which a California couple are suing OpenAI over the death of their teenage son, alleging that chatbot ChatGPT encouraged him to take his own life, and they produced the chat logs between Adam, who died last April, and ChatGPT the show, explaining his suicidal thoughts, and they argue that the program validates his most harmful and self-destructive thoughts.
I'm just saying, AI is a wonderful, human, man made solution to many problems, but if we pass a bill like this without considering the potential negative possible outcomes, we would be irresponsible.
14:22
Lord Hamilton of Epsom (Conservative)
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Lord Hamilton of Epsom (Conservative)
I'm also very much supported AI for as long as I can remember, and I think it is the future for this country. And if we're looking for improvements in productivity, there's no doubt about it that we should look to the National Health Service and the public sector for where we can see AI having its greatest effect and improving the whole health of the economy of this country. But we are, my Lords in early days when it comes to AI, although it has been with us for some time, and I think we've got to be very careful that we don't rely on it for too many things which should be done by human beings.
And the noble Lord Stevens has already referred to the appalling rate of misdiagnosis. And we said, look at these statistics and we say, well, it's only a small number that are misdiagnosed. Yes, but in the case of my noble friend Lord Polak, he was misdiagnosed as only going to live for six months, and he's still with us 32 years later. You've got to start to think about this, because if you get misdiagnosis badly wrong, it completely undermines the whole basis of this bill that we're looking at at the moment.
And therefore, we've got to be very careful that AI doesn't contribute to that as well. I pay tribute to the right reverend Prelate. It's quite right that AI is having a tremendous effect in the health service and is helping very large number of people get better, and it may well be that because AI actually introduces cures for people that have actually been written off at the moment by their doctors and wrongly written off, because actually we may find cures for them.
So we mustn't dismiss AI, but we must be very wary about where it leads us, because there will be an awful lot of bumps in the road. Before we get to the fact that AI is something in which we can all have complete confidence and that we believe will actually deliver better outcomes
**** Possible New Speaker ****
than human beings. Well, it's just a few remarks I
**** Possible New Speaker ****
Well, it's just a few remarks I would like to make. We live in an age, in actual fact, where it is hard to get a human to interact hard to get a human to interact with any more. And we lift the phone and we're speaking to a voice, and if you want one thing, press and if you want one thing, press one. And if you want something else, you press two. Is that what we're heading to? I fear sometimes. Do heading to? I fear sometimes.
Do you want a death? Just press a
And the noble Lord Stevens has already referred to the appalling rate of misdiagnosis. And we said, look at these statistics and we say, well, it's only a small number that are misdiagnosed. Yes, but in the case of my noble friend Lord Polak, he was misdiagnosed as only going to live for six months, and he's still with us 32 years later. You've got to start to think about this, because if you get misdiagnosis badly wrong, it completely undermines the whole basis of this bill that we're looking at at the moment.
And therefore, we've got to be very careful that AI doesn't contribute to that as well. I pay tribute to the right reverend Prelate. It's quite right that AI is having a tremendous effect in the health service and is helping very large number of people get better, and it may well be that because AI actually introduces cures for people that have actually been written off at the moment by their doctors and wrongly written off, because actually we may find cures for them.
So we mustn't dismiss AI, but we must be very wary about where it leads us, because there will be an awful lot of bumps in the road. Before we get to the fact that AI is something in which we can all have complete confidence and that we believe will actually deliver better outcomes
**** Possible New Speaker ****
than human beings. Well, it's just a few remarks I
**** Possible New Speaker ****
Well, it's just a few remarks I would like to make. We live in an age, in actual fact, where it is hard to get a human to interact hard to get a human to interact with any more. And we lift the phone and we're speaking to a voice, and if you want one thing, press and if you want one thing, press one. And if you want something else, you press two. Is that what we're heading to? I fear sometimes. Do heading to? I fear sometimes.
Do you want a death? Just press a
14:24
Lord McCrea of Magherafelt and Cookstown (Democratic Unionist Party)
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Lord McCrea of Magherafelt and Cookstown (Democratic Unionist Party)
button. But, you know, I have no doubt in my mind if this legislation is passed as it is in legislation is passed as it is in the fullness of time, the near future, we will head towards AI future, we will head towards AI assessment procedures. And it's not where we start in this process. It's actually my concern is where It's actually my concern is where this is all going to lead and we're at end now. I am informed it has at end now.
I am informed it has been proposed for use. AI has been proposed for use to kill patients in the Netherlands, where the whether the doctors are unwilling to participate and indeed it is suggested using AI could potentially be less prone to human errors. Surely crucial assessments and decision making process for a person seeking assistance suicide could not identify subtle coercion, assess neurones capacity and the irreversible nature of the outcome. There are concerns, my Lords, of the risk of coercion or encouragement by AI.
It should be especially noted that the newly developed AI functions in chat box. There are already cases globally of individuals being coerced into all sorts of different behaviours, practices and decision making. Clause five allows doctors to direct the person to where they can obtain information and have the preliminary discussion. That source of information could be an AI or chat box. Is there anything in the bill that will prevent this? And I would ask just in conclusion, AI in my opinion, undermines accountability.
If the technology fails, who bears the responsibility? Because the traditional thing in health service, the doctor would bear responsibility. It was I who bears the responsibility.
I am informed it has been proposed for use. AI has been proposed for use to kill patients in the Netherlands, where the whether the doctors are unwilling to participate and indeed it is suggested using AI could potentially be less prone to human errors. Surely crucial assessments and decision making process for a person seeking assistance suicide could not identify subtle coercion, assess neurones capacity and the irreversible nature of the outcome. There are concerns, my Lords, of the risk of coercion or encouragement by AI.
It should be especially noted that the newly developed AI functions in chat box. There are already cases globally of individuals being coerced into all sorts of different behaviours, practices and decision making. Clause five allows doctors to direct the person to where they can obtain information and have the preliminary discussion. That source of information could be an AI or chat box. Is there anything in the bill that will prevent this? And I would ask just in conclusion, AI in my opinion, undermines accountability.
If the technology fails, who bears the responsibility? Because the traditional thing in health service, the doctor would bear responsibility. It was I who bears the responsibility.
14:26
Baroness Lawlor (Conservative)
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Baroness Lawlor (Conservative)
Just to add to what has been said, AI is based on large language models which involve big data, sets of data. And the question I would like to ask your Lordships to consider is whether such large data banks, based on this assessment of data for a a snippet to assist diagnosis is a good way of assessing individual patients. It wasn't designed to assess individual patients. Every doctor will tell you that individual.
Every individual case is different and that diagnosis can vary. And I was very grateful to the noble Lord Lord Stevens for sharing the results. Of the 98,000 cases, which were assessed for accuracy, and therefore, I'm not sure that it is a suitable tool to use for assessment and diagnosis of the individual case.
Every individual case is different and that diagnosis can vary. And I was very grateful to the noble Lord Lord Stevens for sharing the results. Of the 98,000 cases, which were assessed for accuracy, and therefore, I'm not sure that it is a suitable tool to use for assessment and diagnosis of the individual case.
14:28
Lord Wolfson of Tredegar (Conservative)
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Lord Wolfson of Tredegar (Conservative)
And I. >> My Lord, I will speak briefly to this amendment, and I approach it in a largely exploratory spirit because it raises an interesting, because it raises an interesting, and I think, increasingly relevant question about the role that artificial intelligence might play in the operation of legislation of this kind. That's because much of the what this bill requires involves assessments of different natures. And we have discussed a number of these at length in committee questions of capacity, voluntariness, the presence or absence of coercion.
And these are judgements that are normally understood as being made by human decision makers who draw on their professional experience, and they have a direct interaction with the individual concerned. At the same time, we do live in 2026 and we are all aware that artificial intelligence is becoming more prevalent across the civil service and even in government departments. I have to say, sometimes in relation to the latter, I am reminded of the line of Imelda Marcos better nouveau riche, the nouveau riche at all, perhaps better artificial intelligence than no intelligence at all.
But the concern is that the use of AI is often incremental, and it is not the result of a conscious policy, decision or choice, I should say, in response to my noble friend, I'm not aware of an entire judgement which was put together by artificial intelligence. I am aware that sometimes judgements have been found to, so to speak, dipped in to artificial intelligence, to a to assist so far as judicial review and consultations are concerned. My understanding is that you can use AI to assist in assessing responses to a consultation provided always, you abide by the principles set out by Stephen Sedley QC, then was in Crown and Brent London Borough Council, ex parte gunning, approved by the Supreme Court in ex parte Mosley in 2014.
But in the NHS, I am aware that in September last year the NHS launched a commission and I quote, to accelerate NHS use of AI. And that's why, it seems to me it is reasonable to pause and reflect on whether there is the possibility that AI could be used in processes of this sensitivity, even at a supporting or administrative level, and if so, whether that is appropriate. And that seems to me to be the key question. And therefore, I do think this is a point on which some clarity would be helpful.
I look forward to the noble and learned Lord commenting on whether he envisage any circumstances in which AI might be used in the application of the act, and then, importantly, if so, how he views the appropriateness or otherwise of that possibility. But I would also be grateful to hear from the noble Lord, the Minister, what consideration Ministers have given to the possible use of AI in their work to establish the workability of the bill, because I am very conscious that that is the focus of the Minister's work on this bill.
But it seems to me, if you're thinking about how will this bill work, you must necessarily surely have reached at least a provisional view on whether AI will or will not be part of those processes, and if so, therefore whether that is appropriate. And so for those reasons, I look forward to the contributions of those noble Lords.
And these are judgements that are normally understood as being made by human decision makers who draw on their professional experience, and they have a direct interaction with the individual concerned. At the same time, we do live in 2026 and we are all aware that artificial intelligence is becoming more prevalent across the civil service and even in government departments. I have to say, sometimes in relation to the latter, I am reminded of the line of Imelda Marcos better nouveau riche, the nouveau riche at all, perhaps better artificial intelligence than no intelligence at all.
But the concern is that the use of AI is often incremental, and it is not the result of a conscious policy, decision or choice, I should say, in response to my noble friend, I'm not aware of an entire judgement which was put together by artificial intelligence. I am aware that sometimes judgements have been found to, so to speak, dipped in to artificial intelligence, to a to assist so far as judicial review and consultations are concerned. My understanding is that you can use AI to assist in assessing responses to a consultation provided always, you abide by the principles set out by Stephen Sedley QC, then was in Crown and Brent London Borough Council, ex parte gunning, approved by the Supreme Court in ex parte Mosley in 2014.
But in the NHS, I am aware that in September last year the NHS launched a commission and I quote, to accelerate NHS use of AI. And that's why, it seems to me it is reasonable to pause and reflect on whether there is the possibility that AI could be used in processes of this sensitivity, even at a supporting or administrative level, and if so, whether that is appropriate. And that seems to me to be the key question. And therefore, I do think this is a point on which some clarity would be helpful.
I look forward to the noble and learned Lord commenting on whether he envisage any circumstances in which AI might be used in the application of the act, and then, importantly, if so, how he views the appropriateness or otherwise of that possibility. But I would also be grateful to hear from the noble Lord, the Minister, what consideration Ministers have given to the possible use of AI in their work to establish the workability of the bill, because I am very conscious that that is the focus of the Minister's work on this bill.
But it seems to me, if you're thinking about how will this bill work, you must necessarily surely have reached at least a provisional view on whether AI will or will not be part of those processes, and if so, therefore whether that is appropriate. And so for those reasons, I look forward to the contributions of those noble Lords.
14:32
Baroness Merron (Labour)
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Baroness Merron (Labour)
My Lords, I. their contributions on this debate on artificial intelligence. It does follow on from the debate yesterday follow on from the debate yesterday as referred to by the noble Lord, Lord deben, and the purpose of amendment 66, tabled by the noble Lady Baroness Coffey, is to prohibit artificial intelligence from being used to carry out function under any section or schedule to the bill. This amendment is likely to have major workability impacts that could render the bill unworkable and or deliverable, and on this point, in respect of considerations about the use of AI in practice, whilst this is a policy matter, let me refer to points.
Just pick up points that have already been made. In fact, that very broadly, artificial intelligence is absolutely in use in a number of pathways. It was indeed referred to in the ten year health plan and the ways it's being used in includes imaging and diagnosis. And this amendment would preclude an improvement of speed and would preclude an improvement of quality of care for patients. Looking at it as it stands. So in respect of workability impact, it would incur an administrative burden.
Which follows on from my comments just now, likely to increase over time as AI is indeed increasingly used across the economy and public services, including in the NHS, as set out in the ten year health plan. As drafted, the effect of the amendment is very broad in prohibiting this use of AI in carrying out any functions under the bill. At a point in the future when AI is so integrated into NHS systems across the board, it may well be difficult or indeed impossible to quarantine systems used in relation to functions under the bill.
Additionally, this may risk creating a parallel system where voluntary assisted dying services are left behind and potentially are less safe for patients.
Just pick up points that have already been made. In fact, that very broadly, artificial intelligence is absolutely in use in a number of pathways. It was indeed referred to in the ten year health plan and the ways it's being used in includes imaging and diagnosis. And this amendment would preclude an improvement of speed and would preclude an improvement of quality of care for patients. Looking at it as it stands. So in respect of workability impact, it would incur an administrative burden.
Which follows on from my comments just now, likely to increase over time as AI is indeed increasingly used across the economy and public services, including in the NHS, as set out in the ten year health plan. As drafted, the effect of the amendment is very broad in prohibiting this use of AI in carrying out any functions under the bill. At a point in the future when AI is so integrated into NHS systems across the board, it may well be difficult or indeed impossible to quarantine systems used in relation to functions under the bill.
Additionally, this may risk creating a parallel system where voluntary assisted dying services are left behind and potentially are less safe for patients.
14:34
Lord Falconer of Thoroton (Labour)
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Lord Falconer of Thoroton (Labour)
I'm grateful to the noble Baroness Baroness Coffey for raising the issue of artificial raising the issue of artificial intelligence. There was a broadly, I think, a consensus around the House, which is and this was supported by the Baroness Coffey, which is that the amendment itself which is that the amendment itself is is much too blunt. But as the noble Baroness said fairly, it gives us an opportunity to talk about AI. Could I also pick on the contribution of the Right reverend Bishop of Hereford, who rightly says, and it's been echoed around the House as well.
There's been huge benefits for patients in relation to AI. Could I identify what I think are the four concerns that were raised during the process or during the debate? First of all, will AI affect decision making? And I think the underlying question here is we don't want machines to make the decisions that are referred to in the bill. We want human beings to make the decisions that are referred to in the bill, and in particular, the decisions I have in mind are the decision of the first doctor, the decision of the second doctor, the decision of the panel, and then the decision of the doctor at the point that the assistance has been given that the conditions are still satisfied.
Everybody around the room wants that to be decided by a doctor or a panel, depending on which it is. And I completely and unreservedly endorse that and accept that. Do does that need to be made even clearer in the bill? I will consider it, but I don't think that it does. And the acid test for me in relation to that is that if you fail to comply with your obligations as a doctor or as a panel, then you can go to prison for up to five years.
And it's very difficult to imagine how you could put a machine in prison. So I think it's pretty clear that these decisions have to be made by a human being. And from my part, and for everybody supporting the bill, that has got to remain the position. The second one is advertising, which the noble Baroness Baroness Berridge referred to. And she's absolutely right. I've made it clear that I will bring forward amendments, those amendments that are almost finally drafted make provision specifically in relation to digital advertising.
They don't specifically refer to AI, but I think we do need to address that in the advertising provision. And I will lay these so that the consider them. So advertising was the second concern reflected. The third concern reflected was and this is this is this is a slightly generalised concern, which is that AI is very persuasive, particularly in persuading people to do things that they don't necessarily want to do. The first thing in relation to that is there is a wider societal requirement to try to address the pervasive impacts of AI in a whole range of things, and we should all try and contribute to that.
More focussed in relation to this is the question of the safeguards, because the safeguards in relation to the Bill then become incredibly important, and what in particular the safeguards require is that there is doctor to patient discussion in relation to the decision for that patient that are specifically required, both in the preliminary conversation, the first conversation and the second conversation. And it is those safeguards that one has got to look at to see as the antidote to the persuasive aspect of AI.
But I completely accept what people are saying in relation to that. And then the fourth, so it's decision making, advertising persuasive aspect of the fourth issue, touched on very briefly, was the operation of devices. And that, I think, was referring to the fact that quite a number of medical devices can be operated by, for example, the blink of an eye or something that is that is quite a minor thing. And again, that needs to be properly safeguarded. I think those problems may not necessarily be AI problems, but the problems of other sorts of developments in technology.
So thank you to the Baroness Coffey for raising it. I think all the points that she made, we need to consider at the moment, apart from the advertising amendment which I bring forward, I am not sure that
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it requires amendment to the bill. Noble and learned Lord sits down.
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Noble and learned Lord sits down. Is there a guarantee that we will see those amendments at Committee stage? Because it is important. It's a very different procedure at Committee stage that we can go back and forth and query amendments than
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at Report stage. Do my best. I can't.
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I can't. My Lords. I think it was an interesting debate. I was actually also struck by the contribution by the or the question by the noble Baroness, Lady Finlay, about fake voices. I thought that was really interesting thing for us to consider. And yes, it was quite a blunt amendment that I put in. But part of this is I remember there are sorry, sounds like I'm going to name drop, but the briefing at the Cabinet table we had once was we had a whole session on it, and it was like artificial artificial intelligence has learned to lie.
And a classic example was I'm not a robot. Artificial intelligence will just pick press in effect, that element that's saying I've got accessibility issues. And if you do that, you don't have to do any more verification. But there's a whole series here. And the noble Lord Lord McCrea referred to an article. It is worth reading AI ethics volume five from last year. But one of the things that I had wondered and hoped that the Minister might have raised would be the commission by the MHRA, which was started last year.
Specifically considering about artificial intelligence. If she hasn't already, I think it would be worthwhile sending an instruction to the MHRA to start considering this aspect. Ultimately, a lot of I'll appreciate there are noble Lords who do not want us to talk about the detail of how this might work. I think it's absolutely critical that we, as
There's been huge benefits for patients in relation to AI. Could I identify what I think are the four concerns that were raised during the process or during the debate? First of all, will AI affect decision making? And I think the underlying question here is we don't want machines to make the decisions that are referred to in the bill. We want human beings to make the decisions that are referred to in the bill, and in particular, the decisions I have in mind are the decision of the first doctor, the decision of the second doctor, the decision of the panel, and then the decision of the doctor at the point that the assistance has been given that the conditions are still satisfied.
Everybody around the room wants that to be decided by a doctor or a panel, depending on which it is. And I completely and unreservedly endorse that and accept that. Do does that need to be made even clearer in the bill? I will consider it, but I don't think that it does. And the acid test for me in relation to that is that if you fail to comply with your obligations as a doctor or as a panel, then you can go to prison for up to five years.
And it's very difficult to imagine how you could put a machine in prison. So I think it's pretty clear that these decisions have to be made by a human being. And from my part, and for everybody supporting the bill, that has got to remain the position. The second one is advertising, which the noble Baroness Baroness Berridge referred to. And she's absolutely right. I've made it clear that I will bring forward amendments, those amendments that are almost finally drafted make provision specifically in relation to digital advertising.
They don't specifically refer to AI, but I think we do need to address that in the advertising provision. And I will lay these so that the consider them. So advertising was the second concern reflected. The third concern reflected was and this is this is this is a slightly generalised concern, which is that AI is very persuasive, particularly in persuading people to do things that they don't necessarily want to do. The first thing in relation to that is there is a wider societal requirement to try to address the pervasive impacts of AI in a whole range of things, and we should all try and contribute to that.
More focussed in relation to this is the question of the safeguards, because the safeguards in relation to the Bill then become incredibly important, and what in particular the safeguards require is that there is doctor to patient discussion in relation to the decision for that patient that are specifically required, both in the preliminary conversation, the first conversation and the second conversation. And it is those safeguards that one has got to look at to see as the antidote to the persuasive aspect of AI.
But I completely accept what people are saying in relation to that. And then the fourth, so it's decision making, advertising persuasive aspect of the fourth issue, touched on very briefly, was the operation of devices. And that, I think, was referring to the fact that quite a number of medical devices can be operated by, for example, the blink of an eye or something that is that is quite a minor thing. And again, that needs to be properly safeguarded. I think those problems may not necessarily be AI problems, but the problems of other sorts of developments in technology.
So thank you to the Baroness Coffey for raising it. I think all the points that she made, we need to consider at the moment, apart from the advertising amendment which I bring forward, I am not sure that
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it requires amendment to the bill. Noble and learned Lord sits down.
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Noble and learned Lord sits down. Is there a guarantee that we will see those amendments at Committee stage? Because it is important. It's a very different procedure at Committee stage that we can go back and forth and query amendments than
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at Report stage. Do my best. I can't.
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I can't. My Lords. I think it was an interesting debate. I was actually also struck by the contribution by the or the question by the noble Baroness, Lady Finlay, about fake voices. I thought that was really interesting thing for us to consider. And yes, it was quite a blunt amendment that I put in. But part of this is I remember there are sorry, sounds like I'm going to name drop, but the briefing at the Cabinet table we had once was we had a whole session on it, and it was like artificial artificial intelligence has learned to lie.
And a classic example was I'm not a robot. Artificial intelligence will just pick press in effect, that element that's saying I've got accessibility issues. And if you do that, you don't have to do any more verification. But there's a whole series here. And the noble Lord Lord McCrea referred to an article. It is worth reading AI ethics volume five from last year. But one of the things that I had wondered and hoped that the Minister might have raised would be the commission by the MHRA, which was started last year.
Specifically considering about artificial intelligence. If she hasn't already, I think it would be worthwhile sending an instruction to the MHRA to start considering this aspect. Ultimately, a lot of I'll appreciate there are noble Lords who do not want us to talk about the detail of how this might work. I think it's absolutely critical that we, as
14:40
Baroness Coffey (Conservative)
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Baroness Coffey (Conservative)
parliamentarians, set out for the future of any potential guidance. future of any potential guidance. Sis, whatever legal rulings on what we expect or how we expect this act we expect or how we expect this act to deploy algorithmic bias is a concern, there's no doubt about that. And so that's why I think, that. And so that's why I think, although I don't entirely agree with the noble and learned Lord, with the noble and learned Lord, that we might not revisit an amendment at Report stage referring
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to AI, I thank the noble Lords for this debate and I beg to move to withdraw. Is it. Your Lordships.
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Your Lordships. Pleasure that this amendment be withdrawn? Amendment by leave withdrawn? Amendment by leave withdrawn. Amendment 67 Baroness Grey-Thompson not moved. Amendment 68 not moved. Baroness 68 not moved. Baroness Grey-Thompson not moved. Amendment 68 a Baroness Coffey not moved. The question is then, that clause one stand part of the bill.
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to AI, I thank the noble Lords for this debate and I beg to move to withdraw. Is it. Your Lordships.
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Your Lordships. Pleasure that this amendment be withdrawn? Amendment by leave withdrawn? Amendment by leave withdrawn. Amendment 67 Baroness Grey-Thompson not moved. Amendment 68 not moved. Baroness 68 not moved. Baroness Grey-Thompson not moved. Amendment 68 a Baroness Coffey not moved. The question is then, that clause one stand part of the bill.
14:42
CL 1 S/P
Baroness Coffey (Conservative)
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CL 1 S/P
Baroness Coffey (Conservative)
My Lords, I did put in my opposition generally, and just as opposition generally, and just as as we said on the first day of debate, it's not certainly my intention to move a division on this. We'll we'll leave these things to the Report stage. But the I guess I put in my statement and I think we have debated clause one extensively, but the opportunity to potentially revisit or to try and get some more answers on certain issues if we feel they haven't been covered.
I know on day one, noble Lords thought that was filibustering by talking about Wales, but for me, devolution is a really important part of this bill and I have to say, I was not satisfied by the answers of the Minister at the time and increasingly, and pretty much every freedom of information request has been rejected, and I do not think that is helping Parliament. The Cabinet Office is telling us that it is forming policy. Government is forming policy on this in anticipation, but it's not in the public interest to share that.
Now, I find this really challenging, and it's no surprise that we've spent so much time on clause one, because it is the key clause. Let's not pretend otherwise. But even when I put I didn't put this request in, but somebody did for the briefing pack of an official who gave oral evidence to to to the select committee of your Lordships that was turned down for release. It was a person. It was a decision made personally by the justice Minister. And again, it keeps coming back to it's not in the interest.
I'm really going to work with the sponsor. My Lords, genuinely, I think we would make more progress if we had better understanding and more shared information as we consider one of the most significant changes that we have to law. But with that, I it's not the case that I withdraw, but I would be pressing to a division.
I know on day one, noble Lords thought that was filibustering by talking about Wales, but for me, devolution is a really important part of this bill and I have to say, I was not satisfied by the answers of the Minister at the time and increasingly, and pretty much every freedom of information request has been rejected, and I do not think that is helping Parliament. The Cabinet Office is telling us that it is forming policy. Government is forming policy on this in anticipation, but it's not in the public interest to share that.
Now, I find this really challenging, and it's no surprise that we've spent so much time on clause one, because it is the key clause. Let's not pretend otherwise. But even when I put I didn't put this request in, but somebody did for the briefing pack of an official who gave oral evidence to to to the select committee of your Lordships that was turned down for release. It was a person. It was a decision made personally by the justice Minister. And again, it keeps coming back to it's not in the interest.
I'm really going to work with the sponsor. My Lords, genuinely, I think we would make more progress if we had better understanding and more shared information as we consider one of the most significant changes that we have to law. But with that, I it's not the case that I withdraw, but I would be pressing to a division.
14:44
Lord Rooker (Labour)
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Lord Rooker (Labour)
Lord, sir, I just want to make a couple of points. I agree with clause one. If there was a vote for it, I'd vote for it. I may not carry the house with me, but I want to say, having sat through the Committee stage and one day of Second Reading, which I couldn't do, the first one, I just feel we've reached the point where we've dealt with if the bill was a tree, we've dealt with the trunk, and I think we've got to a point where we now look at the branches and the Commons is a message to the Commons in a way they need to know.
But once we have the bill, sponsors reaction and proposals following the debate on clause one, we can move at pace. And I'm absolutely convinced in some ways that the control of progress on speed of the bill is now completely in the hands of my noble and learned friend, not in the house. It's in his hands, and we have positive responses to the issues raised on clause one. Rather than simply saying I disagree with them with positive responses by way of amendments, I suspect hundreds of the amendments will disappear.
I don't speak for any of the sponsors. I haven't discussed this with them, but the fact is they wouldn't be needed because we've got the clarity we need on the issues raised because we've gone well beyond, you know, I don't say we've done the Second Reading again, but we've dealt with a really meaty part of the bill, and I understand I'm not devaluing the rest of the bill, but this is a meaty part of the bill. And therefore we get a report quickly because, as my noble friend earlier on, Baroness Laing said, we are heading for the fact that this House will never be able to express an opinion on this bill.
We'll never get to the point where we can have a vote, and therefore, I think we need to get to report as quickly as possible. And I think that can be aided by my noble friend. But of course, as Lord MP said more than once, but we need to know the colour of the sponsor's money, and we don't at the moment. We haven't got a clue, not a clue. And it has to be done within our scrutiny process. But in the amendments, I saw the letter about three days ago, which then transposed into a set of supplementary amendments today all starred, so they weren't available for debate today.
They could have been tabled earlier in the week, but they weren't available. Even if they fitted in our programme, they weren't available because they were only tabled yesterday and that's just not good enough. So we can get to the point where if the sponsor is prepared to move, we can really speed up the process of the bill. Now, those noble Lords who are previous members of the Commons did not come to the Lords to undermine the elected House.
Nobody does that. We're here to check on what we receive from the other House. And that's in a way the debate on clause one has been all about I deeply regret, I know it's a private member's bill, so the normal rules didn't apply. But the big mistake was the programme motions in the other place in 1997. But the fact of the matter is, we got to look at what we've received, and we've received this bill some months ago. Unlike the Commons, it's my final point.
Unlike the Commons, we have the benefit of two specialist committees the delegated powers, etc. but in the Constitution Committee now, the Commons should be as concerned about the delegated powers as the Lords for what they are, because not to put too fine a point on it, the delegated powers are the powers government take from Parliament that the powers the government take from Parliament, and it's been so bad in recent years. The two committees of this House produced reports, one titled Democracy Denied and the other government by diktat.
Now, both those reports were debated in 2003. And I said to my noble friend, the whip is not here, but it would be unfortunate because of what was said by people who are now on the government front bench in that debate would be quite embarrassing if they reminded of it today. Now, Lord Falconer, my noble friend, we're both members of the New Labour government. He in a much more senior role. He can wipe out many of the amendments, including those he's actually tabled by operating the policy of what? What was the general policy of the new Labour government, which was generally in different departments, to accept the recommendations of delegated powers.
I did four departments in this House, two in the other of those for Northern Ireland didn't count, really, because they're not legislation. But the fact is, in two of them, on day one briefings, the point was made that we generally accept the recommendations of delegated powers. Now, I fully accept that in the last 14 years, that hasn't always been the case. And of course, we've got the point is that if it went wrong and we ended up with some foolhardy attempt to use the Parliament Act or the Henry the Eighth powers that are in the bill which should come out, will be legislated for by the House of Commons.
I mean, it's absolutely preposterous what they would be asked to say. So I say to my noble and only friend, he can wipe out many of the amendments. He can wipe out the ones he's actually tabled by operating the policy of the government that he was a member of. So clause one stands apart with I agree, it's a major junction of the bill, and from now on, the sponsor can get up to speed and get the bill ready for the Commons, or he can run out of time.
It's his call,
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not ours. The question is that. Sorry.
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My Lords. Let me just. I hadn't intended to say anything, but I was provoked. anything, but I was provoked. Provoked in a nice way by the noble Lord, Lord Rooker, just on his advice, which was well meant, I advice, which was well meant, I think, to the noble and learned Lord, Lord Falconer, the the sponsor of of the Bill, and I and I agree with him, actually, but I but I think a bit more work is required. So I referred earlier to the letter that the noble and learned Lord sent to members of the House.
I would just urge him to test his his mailing list because it didn't go to all members. I only received a copy of it from a from another member, and it would be helpful if we all received a copy. And I'd say, and I hear from my noble friend Lord Deben, he's not received it at all. I just say two things. First of all, I absolutely agree with the noble Lord Lord Rooker about the Delegated Powers Committee's recommendations. They had. They were pretty scathing about the number of powers in the bill that had been given to Ministers, with very little oversight now.
If I'm being fair, the noble and learned Lord Filkin has engaged extensively with the recommendations of the committee in what he set out. That's the good bit, but I don't think he's really taken on board. The point they were making, because he's largely as I as I see his amendments set out, he's preserved the bill's delegated skeletal architecture. And rather than actually limiting executive power and putting safeguards and limits on the face of the bill, he's added in all sorts of things at the back end, things like scrutiny and consultation and things like that, rather than actually getting the point, which is that the bill shouldn't have delegated powers in the first place.
So. So I would humbly suggest accepting the points exactly as Lord Rooker said, accepting what the committee said and following its recommendations, I think would be helpful. The second point is just a point on on pace. So it was explicit in the noble and learned Lord, Lord Falconer's letter delegated Powers Committee reported in September last year, and we only get a letter halfway through the Committee stage, setting out the noble and learned Lords response to it. And as I said, certainly my experience when when I was a Minister was if we'd received that sort of report from the Delegated Powers Committee, I would have been expected, as the Minister would have had that ready at the start of committee, or frankly, members of your Lordships' House would have stood up and said some very disobliging things.
Of course I'll give way.
But once we have the bill, sponsors reaction and proposals following the debate on clause one, we can move at pace. And I'm absolutely convinced in some ways that the control of progress on speed of the bill is now completely in the hands of my noble and learned friend, not in the house. It's in his hands, and we have positive responses to the issues raised on clause one. Rather than simply saying I disagree with them with positive responses by way of amendments, I suspect hundreds of the amendments will disappear.
I don't speak for any of the sponsors. I haven't discussed this with them, but the fact is they wouldn't be needed because we've got the clarity we need on the issues raised because we've gone well beyond, you know, I don't say we've done the Second Reading again, but we've dealt with a really meaty part of the bill, and I understand I'm not devaluing the rest of the bill, but this is a meaty part of the bill. And therefore we get a report quickly because, as my noble friend earlier on, Baroness Laing said, we are heading for the fact that this House will never be able to express an opinion on this bill.
We'll never get to the point where we can have a vote, and therefore, I think we need to get to report as quickly as possible. And I think that can be aided by my noble friend. But of course, as Lord MP said more than once, but we need to know the colour of the sponsor's money, and we don't at the moment. We haven't got a clue, not a clue. And it has to be done within our scrutiny process. But in the amendments, I saw the letter about three days ago, which then transposed into a set of supplementary amendments today all starred, so they weren't available for debate today.
They could have been tabled earlier in the week, but they weren't available. Even if they fitted in our programme, they weren't available because they were only tabled yesterday and that's just not good enough. So we can get to the point where if the sponsor is prepared to move, we can really speed up the process of the bill. Now, those noble Lords who are previous members of the Commons did not come to the Lords to undermine the elected House.
Nobody does that. We're here to check on what we receive from the other House. And that's in a way the debate on clause one has been all about I deeply regret, I know it's a private member's bill, so the normal rules didn't apply. But the big mistake was the programme motions in the other place in 1997. But the fact of the matter is, we got to look at what we've received, and we've received this bill some months ago. Unlike the Commons, it's my final point.
Unlike the Commons, we have the benefit of two specialist committees the delegated powers, etc. but in the Constitution Committee now, the Commons should be as concerned about the delegated powers as the Lords for what they are, because not to put too fine a point on it, the delegated powers are the powers government take from Parliament that the powers the government take from Parliament, and it's been so bad in recent years. The two committees of this House produced reports, one titled Democracy Denied and the other government by diktat.
Now, both those reports were debated in 2003. And I said to my noble friend, the whip is not here, but it would be unfortunate because of what was said by people who are now on the government front bench in that debate would be quite embarrassing if they reminded of it today. Now, Lord Falconer, my noble friend, we're both members of the New Labour government. He in a much more senior role. He can wipe out many of the amendments, including those he's actually tabled by operating the policy of what? What was the general policy of the new Labour government, which was generally in different departments, to accept the recommendations of delegated powers.
I did four departments in this House, two in the other of those for Northern Ireland didn't count, really, because they're not legislation. But the fact is, in two of them, on day one briefings, the point was made that we generally accept the recommendations of delegated powers. Now, I fully accept that in the last 14 years, that hasn't always been the case. And of course, we've got the point is that if it went wrong and we ended up with some foolhardy attempt to use the Parliament Act or the Henry the Eighth powers that are in the bill which should come out, will be legislated for by the House of Commons.
I mean, it's absolutely preposterous what they would be asked to say. So I say to my noble and only friend, he can wipe out many of the amendments. He can wipe out the ones he's actually tabled by operating the policy of the government that he was a member of. So clause one stands apart with I agree, it's a major junction of the bill, and from now on, the sponsor can get up to speed and get the bill ready for the Commons, or he can run out of time.
It's his call,
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not ours. The question is that. Sorry.
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My Lords. Let me just. I hadn't intended to say anything, but I was provoked. anything, but I was provoked. Provoked in a nice way by the noble Lord, Lord Rooker, just on his advice, which was well meant, I advice, which was well meant, I think, to the noble and learned Lord, Lord Falconer, the the sponsor of of the Bill, and I and I agree with him, actually, but I but I think a bit more work is required. So I referred earlier to the letter that the noble and learned Lord sent to members of the House.
I would just urge him to test his his mailing list because it didn't go to all members. I only received a copy of it from a from another member, and it would be helpful if we all received a copy. And I'd say, and I hear from my noble friend Lord Deben, he's not received it at all. I just say two things. First of all, I absolutely agree with the noble Lord Lord Rooker about the Delegated Powers Committee's recommendations. They had. They were pretty scathing about the number of powers in the bill that had been given to Ministers, with very little oversight now.
If I'm being fair, the noble and learned Lord Filkin has engaged extensively with the recommendations of the committee in what he set out. That's the good bit, but I don't think he's really taken on board. The point they were making, because he's largely as I as I see his amendments set out, he's preserved the bill's delegated skeletal architecture. And rather than actually limiting executive power and putting safeguards and limits on the face of the bill, he's added in all sorts of things at the back end, things like scrutiny and consultation and things like that, rather than actually getting the point, which is that the bill shouldn't have delegated powers in the first place.
So. So I would humbly suggest accepting the points exactly as Lord Rooker said, accepting what the committee said and following its recommendations, I think would be helpful. The second point is just a point on on pace. So it was explicit in the noble and learned Lord, Lord Falconer's letter delegated Powers Committee reported in September last year, and we only get a letter halfway through the Committee stage, setting out the noble and learned Lords response to it. And as I said, certainly my experience when when I was a Minister was if we'd received that sort of report from the Delegated Powers Committee, I would have been expected, as the Minister would have had that ready at the start of committee, or frankly, members of your Lordships' House would have stood up and said some very disobliging things.
Of course I'll give way.
14:53
Lord Harper (Conservative)
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Lord Harper (Conservative)
Or. >> Or. >> Would have had a whole department and civil servants behind him. At that time.
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behind him. At that time. I'd make two points to that intervention from the noble Lady. The first point is, on several The first point is, on several occasions now, the noble and learned Lords made reference to actually quite a significant number of officials that he's had working with him on, on helping him, draft clauses and so forth. If if the argument is that's still not enough resource that rather just supports my contention, which I've made from the beginning, that the extent of this legislation, the nature of it, is that it's absolutely not suitable for a private member's bill, and it should have been a government bill.
But but I said, I think the noble Lords had extensive support from, from not just one, but a number of government departments helping him draft it. The second point, my final point is on the issues that have arisen so far during committee, and particularly the issues that have arisen in clause one, which I think is why it's relevant to bring it up on a clause one stand part at the moment. The noble and learned Lords referenced them in his letter, but he's he's not been in a position yet to set out what his amendments are going to be, and he said he will make those available as soon as he possibly can.
Now that that's good and I welcome that. But of course, until we see them, we're not in a position to know whether further amendments need to be tabled for later during Committee stage or during reports. So I would say I finish by saying I agree with Lord Rooker. The extent to which we can now make progress is going to be largely governed by the extent to which the Noble and learned law, the sponsor of the bill, engages with. I think, the very fair criticisms that have been made across the House and will listen very carefully to what he says in response to this debate and in subsequent groups.
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My Lords, I think it's right as the noble Lord. Lord, my noble friend, has said that at the end of friend, has said that at the end of this clause, once done part of it, it is an opportunity for a reset it is an opportunity for a reset and a rethink about how we are approaching the bill and the way, in fact, we are prioritising the arguments. Well, I take issue with my noble friend slightly, is I don't think it's helpful to
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behind him. At that time. I'd make two points to that intervention from the noble Lady. The first point is, on several The first point is, on several occasions now, the noble and learned Lords made reference to actually quite a significant number of officials that he's had working with him on, on helping him, draft clauses and so forth. If if the argument is that's still not enough resource that rather just supports my contention, which I've made from the beginning, that the extent of this legislation, the nature of it, is that it's absolutely not suitable for a private member's bill, and it should have been a government bill.
But but I said, I think the noble Lords had extensive support from, from not just one, but a number of government departments helping him draft it. The second point, my final point is on the issues that have arisen so far during committee, and particularly the issues that have arisen in clause one, which I think is why it's relevant to bring it up on a clause one stand part at the moment. The noble and learned Lords referenced them in his letter, but he's he's not been in a position yet to set out what his amendments are going to be, and he said he will make those available as soon as he possibly can.
Now that that's good and I welcome that. But of course, until we see them, we're not in a position to know whether further amendments need to be tabled for later during Committee stage or during reports. So I would say I finish by saying I agree with Lord Rooker. The extent to which we can now make progress is going to be largely governed by the extent to which the Noble and learned law, the sponsor of the bill, engages with. I think, the very fair criticisms that have been made across the House and will listen very carefully to what he says in response to this debate and in subsequent groups.
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My Lords, I think it's right as the noble Lord. Lord, my noble friend, has said that at the end of friend, has said that at the end of this clause, once done part of it, it is an opportunity for a reset it is an opportunity for a reset and a rethink about how we are approaching the bill and the way, in fact, we are prioritising the arguments. Well, I take issue with my noble friend slightly, is I don't think it's helpful to
14:55
Baroness Andrews (Labour)
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Baroness Andrews (Labour)
don't think it's helpful to apportion blame. I think we are where we are with this bill now, and I think we are all absolutely under the clear impression and instruction. If the House wants to change the bill, whether it's from those who oppose it or those who support it. We have to get it into report so that we can do that and send it back to the Commons. Improved and amended on the question of delegation. And I worked with and I will call my noble friend Lord Blencathra on those reports and delegated legislation, and they were extremely important.
What we've discovered in this bill, as the amendments have been put forward, is there is a difficult balance to be achieved between what goes on the face of the bill in terms of principle and design, because our task in this House is to make every bill workable, and what has been left to delegation. And because of the nature of the bill, the behavioural issues that are raised by the Bill, the extraordinarily personal and exceptional circumstances that we are dealing with people in the last months of their life, we which we should never, ever lose sight of, no matter what we are debating and how technical and process driven it is, we have to think about the balance between what is workable because it is on the face of the bill and will stand in law, and what has to be left to delegation going forward, and therefore can be amended as circumstances change.
And that is the situation the Australians find themselves in. And we have a lot to learn. As we have already learned from Australian medics who have told us how they are managing the bill and what an extraordinary benefit it has been, and that is well on the public record. So all I would say I was before Lord Blencathra opposes me. Possibly, I hope not, is that this is an opportunity to look at the amendments that are coming forward, the priorities we are attaching, can we triage them in some way? Because I think Lord Rooker is right.
A lot of them can fall away because we have addressed the principle of it. In so many of these early amendments, can we focus on what it will take now to agree to improve the bill going forward so that we can have a shared trust across the House, that this is about improving the bill and not delaying it to the point where it will never become law. Yes, my Lords.
What we've discovered in this bill, as the amendments have been put forward, is there is a difficult balance to be achieved between what goes on the face of the bill in terms of principle and design, because our task in this House is to make every bill workable, and what has been left to delegation. And because of the nature of the bill, the behavioural issues that are raised by the Bill, the extraordinarily personal and exceptional circumstances that we are dealing with people in the last months of their life, we which we should never, ever lose sight of, no matter what we are debating and how technical and process driven it is, we have to think about the balance between what is workable because it is on the face of the bill and will stand in law, and what has to be left to delegation going forward, and therefore can be amended as circumstances change.
And that is the situation the Australians find themselves in. And we have a lot to learn. As we have already learned from Australian medics who have told us how they are managing the bill and what an extraordinary benefit it has been, and that is well on the public record. So all I would say I was before Lord Blencathra opposes me. Possibly, I hope not, is that this is an opportunity to look at the amendments that are coming forward, the priorities we are attaching, can we triage them in some way? Because I think Lord Rooker is right.
A lot of them can fall away because we have addressed the principle of it. In so many of these early amendments, can we focus on what it will take now to agree to improve the bill going forward so that we can have a shared trust across the House, that this is about improving the bill and not delaying it to the point where it will never become law. Yes, my Lords.
14:58
Baroness Falkner of Margravine (Crossbench)
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Baroness Falkner of Margravine (Crossbench)
My Lords, I have a related point, to the point that the noble Lord, to the point that the noble Lord, Lord Harper made, which is about impact assessments and noble Lords impact assessments and noble Lords will be aware that I'm a former chair of the Equality and Human Rights Commission. I gave evidence on this bill when it was being examined in the other place. Once it was introduced in your Lordships House, I recused myself from Ehrc's involvement on the bill, as I anticipated participating on the basis of being a member of this House.
So that is the background. Should anyone detect any conflict of interest in my part, a senior Ehrc commissioner, Alastair Henderson, who is himself a barrister, has since represented the Ehrc on this bill. On 22nd January, nearly 60 members in. I wrote to the Minister calling on the government to update its equality impact assessment. This was to pick up the argument from Ehrc, which was put nearly three months ago. So it's had a the government has had a substantial amount of time to think about it, that the current EIA contains several gaps and focuses primarily on access to an assisted death, rather than safeguarding risks and the potential for coercion.
That letter has been circulated to the whole House. Yesterday I received a reply declining the request from the noble Lady. The Minister Parliament will only receive an updated impact assessment, an equality impact assessment and, I quote, should the Bill received Royal assent and I quote again, once detailed implementation work has been completed, end quote. In other words, the House is told that it must legislate blind. The government is directly, therefore contravening contravening its own guidance from the Cabinet Office's Guide to Making Legislation 2025.
This states clearly at paragraph 45.41 that the government accepts a responsibility to put private member's bills, which are likely to pass into good order, a neutral or opposing position must always be read. Subject to this elsewhere, at point 45.25, it says the government needs to make drafting changes to ensure that the bill is technically correct. This is because the government has a duty of care to the statute book, end quote. Moreover, the section on impact assessments are clearly laid out and they must be kept current.
That's the government's own guidance. Cabinet office guidance, the Minister says in her reply. While it would be ideal to cover the full range of issues that have been raised on the matters contained within the bill, we have had to focus on those areas where we believe it is possible to produce helpful evidence. Helpful, of course, being a subjective word, my Lords, it isn't just ideal, it is essential. This bill is one of the most ethically consequential pieces of legislation to be debated, not just in this Parliament, but in decades.
It requires a thorough assessment of the issues and identification of the gaps in data, not just to focus on some areas, leaving highly consequential aspects to be covered at some later point without any substantial scrutiny. As is the case with Statutory Instruments or codes of practice. The letter also refers to the possibility of generating comparable evidence on the wider matters, but that would not have produced sufficiently robust or relevant conclusions. It doesn't answer the matters raised, which
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were. I just slightly puzzled as to
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I just slightly puzzled as to what I mean. I read. The noble Ladies letters. Of course I have, but I'm not quite course I have, but I'm not quite sure why the noble Lady is speaking about these. In the middle of a discussion about clause stand part. discussion about clause stand part. Is she supporting clause, or is she not supporting clause stand part. Surely that's a debate we're Surely that's a debate we're supposed to be having. Yes.
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My Lords, perhaps my reference to the companion will help reduce the confusion that the noble Lady suffers in. In terms of my speech, suffers in. In terms of my speech, the companion says that that once the chair has put the question, a general debate on the clause may take part. I am highlighting take part. I am highlighting problems with the clause, because clause one is the substance of the bill, and an equality impact assessment is fundamental to our understanding of whether clause one should stand part of the bill.
The letter also refers coming back to the letter. The letter also refers to the possibility of generating comparative evidence on the wider matters, but that wouldn't have produced sufficiently robust conclusions. The matters raised was that the EIA didn't deal with any detail of all of those certain protected characteristics that it focussed on, because they focus on access to assisted dying and access to assisting. Dying is not not relevant to the safeguarding risks that we have all spent some eight days in committee debating, the letter says.
We intend to update both the impact assessment and the equality Impact Assessment should the Bill received Royal Assent. Once detailed implementation work has been completed, that will be too little, too late. It is of no assistance to Parliament in considering the Bill and its potential consequences. Indeed, the whole point of an EIA is that it is done before or at the time a decision is taken. I refer again to the Cabinet Office Guide to Making Legislation a failure to undertake a comprehensive EIA means a failure to comply with the public sector equality duty, as post hoc analysis cannot generally cure a failure to have due regard to equality implications at the time a decision is being made.
That is what the courts consistently emphasise. So in R versus Blundell versus Secretary of State for Work and Pensions 2021, it noted that a post decision equality analysis is not sufficient to fulfil the duty, as it is supposed to be a real, open minded consideration of the equality implications conducted with substance and rigour, not a rearguard box ticking exercise. So in concluding, I'd say to the government an accurate assessment of how the bill impacts people who share each of the nine protected characteristics does not betray that position of neutrality.
In fact, it is the converse withholding information is not an act of neutrality, but the opposite of that. The Select Committee on the Constitution published a report on this bill on 11th September, lamenting that supporting documents, including the EIA, were issued late or were not available in other places. Ministers gave the excuse that the bill was highly dynamic and likely to undergo significant changes during scrutiny, so it was important to wait until the committee concluded its work so the government knew what we're assessing the impact of now.
We're told that there is insufficient evidence to produce conclusions that are sufficiently robust. I suggest that the noble Lady, the Minister, might review what both the Ehrc and the letter submitted by 59 members of this House have asked her to do, and come back with some more positive news at an earlier date.
So that is the background. Should anyone detect any conflict of interest in my part, a senior Ehrc commissioner, Alastair Henderson, who is himself a barrister, has since represented the Ehrc on this bill. On 22nd January, nearly 60 members in. I wrote to the Minister calling on the government to update its equality impact assessment. This was to pick up the argument from Ehrc, which was put nearly three months ago. So it's had a the government has had a substantial amount of time to think about it, that the current EIA contains several gaps and focuses primarily on access to an assisted death, rather than safeguarding risks and the potential for coercion.
That letter has been circulated to the whole House. Yesterday I received a reply declining the request from the noble Lady. The Minister Parliament will only receive an updated impact assessment, an equality impact assessment and, I quote, should the Bill received Royal assent and I quote again, once detailed implementation work has been completed, end quote. In other words, the House is told that it must legislate blind. The government is directly, therefore contravening contravening its own guidance from the Cabinet Office's Guide to Making Legislation 2025.
This states clearly at paragraph 45.41 that the government accepts a responsibility to put private member's bills, which are likely to pass into good order, a neutral or opposing position must always be read. Subject to this elsewhere, at point 45.25, it says the government needs to make drafting changes to ensure that the bill is technically correct. This is because the government has a duty of care to the statute book, end quote. Moreover, the section on impact assessments are clearly laid out and they must be kept current.
That's the government's own guidance. Cabinet office guidance, the Minister says in her reply. While it would be ideal to cover the full range of issues that have been raised on the matters contained within the bill, we have had to focus on those areas where we believe it is possible to produce helpful evidence. Helpful, of course, being a subjective word, my Lords, it isn't just ideal, it is essential. This bill is one of the most ethically consequential pieces of legislation to be debated, not just in this Parliament, but in decades.
It requires a thorough assessment of the issues and identification of the gaps in data, not just to focus on some areas, leaving highly consequential aspects to be covered at some later point without any substantial scrutiny. As is the case with Statutory Instruments or codes of practice. The letter also refers to the possibility of generating comparable evidence on the wider matters, but that would not have produced sufficiently robust or relevant conclusions. It doesn't answer the matters raised, which
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were. I just slightly puzzled as to
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I just slightly puzzled as to what I mean. I read. The noble Ladies letters. Of course I have, but I'm not quite course I have, but I'm not quite sure why the noble Lady is speaking about these. In the middle of a discussion about clause stand part. discussion about clause stand part. Is she supporting clause, or is she not supporting clause stand part. Surely that's a debate we're Surely that's a debate we're supposed to be having. Yes.
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My Lords, perhaps my reference to the companion will help reduce the confusion that the noble Lady suffers in. In terms of my speech, suffers in. In terms of my speech, the companion says that that once the chair has put the question, a general debate on the clause may take part. I am highlighting take part. I am highlighting problems with the clause, because clause one is the substance of the bill, and an equality impact assessment is fundamental to our understanding of whether clause one should stand part of the bill.
The letter also refers coming back to the letter. The letter also refers to the possibility of generating comparative evidence on the wider matters, but that wouldn't have produced sufficiently robust conclusions. The matters raised was that the EIA didn't deal with any detail of all of those certain protected characteristics that it focussed on, because they focus on access to assisted dying and access to assisting. Dying is not not relevant to the safeguarding risks that we have all spent some eight days in committee debating, the letter says.
We intend to update both the impact assessment and the equality Impact Assessment should the Bill received Royal Assent. Once detailed implementation work has been completed, that will be too little, too late. It is of no assistance to Parliament in considering the Bill and its potential consequences. Indeed, the whole point of an EIA is that it is done before or at the time a decision is taken. I refer again to the Cabinet Office Guide to Making Legislation a failure to undertake a comprehensive EIA means a failure to comply with the public sector equality duty, as post hoc analysis cannot generally cure a failure to have due regard to equality implications at the time a decision is being made.
That is what the courts consistently emphasise. So in R versus Blundell versus Secretary of State for Work and Pensions 2021, it noted that a post decision equality analysis is not sufficient to fulfil the duty, as it is supposed to be a real, open minded consideration of the equality implications conducted with substance and rigour, not a rearguard box ticking exercise. So in concluding, I'd say to the government an accurate assessment of how the bill impacts people who share each of the nine protected characteristics does not betray that position of neutrality.
In fact, it is the converse withholding information is not an act of neutrality, but the opposite of that. The Select Committee on the Constitution published a report on this bill on 11th September, lamenting that supporting documents, including the EIA, were issued late or were not available in other places. Ministers gave the excuse that the bill was highly dynamic and likely to undergo significant changes during scrutiny, so it was important to wait until the committee concluded its work so the government knew what we're assessing the impact of now.
We're told that there is insufficient evidence to produce conclusions that are sufficiently robust. I suggest that the noble Lady, the Minister, might review what both the Ehrc and the letter submitted by 59 members of this House have asked her to do, and come back with some more positive news at an earlier date.
15:06
Lord Jackson of Peterborough (Conservative)
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Lord Jackson of Peterborough (Conservative)
My Lords, I beg the indulgence of the committee to raise what I of the committee to raise what I think is an important point I hadn't intended to, and I hope your hadn't intended to, and I hope your Lordships House doesn't think it a pedantic point. I hadn't intended to speak, but I was prompted to to speak, but I was prompted to very much. Following on from the excellent speech of the noble Baroness Falkner, and particularly my noble friend Baroness Coffey, in her reference earlier to the lack of insight provided by not, not.
I will not criticise the sponsor, the noble and learned Lord Falconer of Thoroton, but the government, because this is a moveable feast. Our deliberations and scrutiny and oversight of this bill, and therefore we need information in real time. And my specific point is not just about freedom of information, but about written questions that the government have received and have not answered. And I very briefly mention it's on the Order Paper today. The question raised a very reasonable question by my noble friend Lord Kempsell to ask His Majesty's Government with regard to the Bill, its impact assessment, what assessment they have made of the effectiveness of judicial approval as a safeguard in countries with assisted suicide regimes, including the proportion of applications refused in those countries, and the reasons for that refusal.
Two months on, that question has not been answered, and I don't think that's acceptable, because scrutiny and oversight does demand us to have all the information at our hands, including comparative, legal, regulatory and medical regimes, by comparison. And I don't want to embarrass him because he's in the chair. But the very sensible question by the noble Lord Viscount Stansgate asking about the use of the Parliament Bill, which was asked on the 26th of January, was answered promptly on the 29th of January.
So I do think there has the point has to be, my Lords, that there should be equality and a level playing field on questions asked, irrespective of what each individual noble Lords position on this bill is.
I will not criticise the sponsor, the noble and learned Lord Falconer of Thoroton, but the government, because this is a moveable feast. Our deliberations and scrutiny and oversight of this bill, and therefore we need information in real time. And my specific point is not just about freedom of information, but about written questions that the government have received and have not answered. And I very briefly mention it's on the Order Paper today. The question raised a very reasonable question by my noble friend Lord Kempsell to ask His Majesty's Government with regard to the Bill, its impact assessment, what assessment they have made of the effectiveness of judicial approval as a safeguard in countries with assisted suicide regimes, including the proportion of applications refused in those countries, and the reasons for that refusal.
Two months on, that question has not been answered, and I don't think that's acceptable, because scrutiny and oversight does demand us to have all the information at our hands, including comparative, legal, regulatory and medical regimes, by comparison. And I don't want to embarrass him because he's in the chair. But the very sensible question by the noble Lord Viscount Stansgate asking about the use of the Parliament Bill, which was asked on the 26th of January, was answered promptly on the 29th of January.
So I do think there has the point has to be, my Lords, that there should be equality and a level playing field on questions asked, irrespective of what each individual noble Lords position on this bill is.
15:09
Lord Blencathra (Conservative)
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Lord Blencathra (Conservative)
Here I'm another member who had not intended to say a single word on clause stand part. I'm rather on clause stand part. I'm rather relaxed about it, but the government whips must blame their their noble friend Lord Rooker, who their noble friend Lord Rooker, who provoked me into commenting because I agree once again with every single wise word he said. Now he referenced the delegated powers. He was, I think, a distinguished member of Delegated Powers Committee. At one point I was the chair of the committee when we produced the the the report on on Democracy Denied.
And that report highlighted the fact that every government for the last 30 years Tory, Labour, Lib Dem and Conservative, Lib Dem, Labour, Tory again took more and more powers away from Parliament via delegated powers. And I think it is the delegated powers in this, in this bill are quite excessive and have been rightly criticised. But the noble Lady is also right. No government in the world, in any democracy, can function unless there are delegated powers. Not everything can be in the face of the bill.
And the question here is how many delegated powers are appropriate, and what will and what will they contain? And the trouble is, my Lords, I think we've got about over 40. Is it 48 possible delegated powers, including Henry the Eighth powers? That does seem excessive. And I pay tribute to the noble and learned Lord Maude Faulkner for producing some amendments which implement the delegated powers recommendations. But I think the noble Lord knows that if he didn't produce those this House, that report would would implement every single one of the delegated powers recommendations.
We would cut out those bits of the bill which didn't implement them. So although he has generously provided some some delegated powers recommendations, he knows full well that this House will implement all of them in any case. So, my Lords, that's all I wanted to say on this bill that delegated powers under all governments have been increasing and ought to be diminished. And I, I whilst I have some concerns about the contents on the face of the bill, I have many more concerns about the contents.
The 48 powers, which will be written by civil servants in the Department of Health, and at the moment they are unable to tell the difference between a man and a woman. I do not want them writing up how I will die in future.
And that report highlighted the fact that every government for the last 30 years Tory, Labour, Lib Dem and Conservative, Lib Dem, Labour, Tory again took more and more powers away from Parliament via delegated powers. And I think it is the delegated powers in this, in this bill are quite excessive and have been rightly criticised. But the noble Lady is also right. No government in the world, in any democracy, can function unless there are delegated powers. Not everything can be in the face of the bill.
And the question here is how many delegated powers are appropriate, and what will and what will they contain? And the trouble is, my Lords, I think we've got about over 40. Is it 48 possible delegated powers, including Henry the Eighth powers? That does seem excessive. And I pay tribute to the noble and learned Lord Maude Faulkner for producing some amendments which implement the delegated powers recommendations. But I think the noble Lord knows that if he didn't produce those this House, that report would would implement every single one of the delegated powers recommendations.
We would cut out those bits of the bill which didn't implement them. So although he has generously provided some some delegated powers recommendations, he knows full well that this House will implement all of them in any case. So, my Lords, that's all I wanted to say on this bill that delegated powers under all governments have been increasing and ought to be diminished. And I, I whilst I have some concerns about the contents on the face of the bill, I have many more concerns about the contents.
The 48 powers, which will be written by civil servants in the Department of Health, and at the moment they are unable to tell the difference between a man and a woman. I do not want them writing up how I will die in future.
15:11
Lord Polak (Conservative)
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Lord Polak (Conservative)
Oh. >> Oh, sorry, I apologise. >> If I may, I'd like to apologise to the house I have waited now it's the eighth week, I think, to. I the eighth week, I think, to. I have three amendments coming up in have three amendments coming up in the next book. One group. I have to be in synagogue at 4:30 this afternoon, so I apologise. I won't be able to speak sadly, and I had short speeches to my amendments, but I just thought as a courtesy to
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the House, I won't be here to do it. Thank you. And the noble Lord
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Thank you. And the noble Lord had had notified me of that before, and I greatly thank him for his courtesy. Could I very briefly courtesy. Could I very briefly refer to the contents of the debate, first of all, devolution, which the noble Baroness raised? I've got noble Baroness raised? I've got nothing to add in relation to devolution, but it felt more like it was aiming at the government rather than me. I'm very supportive
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the House, I won't be here to do it. Thank you. And the noble Lord
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Thank you. And the noble Lord had had notified me of that before, and I greatly thank him for his courtesy. Could I very briefly courtesy. Could I very briefly refer to the contents of the debate, first of all, devolution, which the noble Baroness raised? I've got noble Baroness raised? I've got nothing to add in relation to devolution, but it felt more like it was aiming at the government rather than me. I'm very supportive
15:12
Lord Falconer of Thoroton (Labour)
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Lord Falconer of Thoroton (Labour)
rather than me. I'm very supportive of the government in this respect, but I've got to say in relation to that, could I primarily focus on what my noble friend Lord Rooker said? And I do not say this without thinking about it. The noble Lord Lord Rooker, I think, is somebody who I have the greatest respect for having been in government, not as long as him, because I was sacked three years before he was sacked, and he was only sacked because the electorate replaced the Labour government with a conservative government.
He survived throughout the whole thing. He is in broad outline, right when he says section one contains the spine of the trunk of the bill. This moment does represent, I very much believe, an opportunity for us as a House to try to see if there is a way to get through this in time to send the bill back. And I, I completely accept what the noble Lord Lord Rooker is saying. My responsibility for trying to bring forward as quickly and as well as possible, the areas where he was kind enough to say, I've been clear about what my amendments were, so I welcome the door that the noble Lord, Lord Rooker, has opened.
I am more than willing to sit down in relation to each of the areas where I have identified that I'm willing to move and try to agree as much as possible what those movements should be. I'm absolutely sure that we won't agree on everything, but those things that we don't agree on, we can determine at Report stage. And so I, I very enthusiastically welcome what the noble Lord, Lord Rooker said about the way forward in relation. Can I just briefly say what deal with what the noble Baroness Shah Baroness Falkner said? Obviously I'm not responsible either for the impact assessment or the quality impact assessment.
I have to say that having read the points made by the Commissioner of the. I think the government are right. It does not justify a new either impact assessment or a quality assessment. The government has been absolutely clear as to why they think in principle, the bill doesn't doesn't offend against the convention or the Human Rights Act. They've also been incredibly helpful through Ministers in saying where they think amendments might give rise to problems. And it's perfectly legitimate for the government to say we're worried about amendments, but not to introduce a whole new assessment in
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relation to it. What the noble Lord, the
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What the noble Lord, the Minister, agree that when courts in the United Kingdom rule, that the public sector equality duty cannot public sector equality duty cannot be an afterthought and has to be complied with throughout, and that the Parliament needs to be aware of changes in circumstances or new issues that come up that that is the ruling of that court is one that needs to be abided with. I'm sorry, I've given my notes away. So I got blunt. I can't remember the the title of the court case I referenced, but I'm sure the noble Lord will will be able to find it in Hansard.
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I'm not aware of the court case. It does not. It does not justify a
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It does not. It does not justify a new impact. Equality and equality assessment. In this case. I was. Talking about the public sector
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Talking about the public sector equality duty and the applicability of the public sector equality duty.
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I do not think that justifies the the new. I mean, the thing the the new. I mean, the thing about equality assessments, lawyers can constantly right point and say, you haven't considered this, you haven't considered that. But having read in detail the equality
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assessment, it deals properly and adequately with the issues. I think it will be possible to
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I think it will be possible to
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get to the next list of amendments. My Lords question is clause one stand part of the bill as amended? That opinion will say content contrary, not content. The contents have it. Amendment 69 Lord Carlile already debated, not moved. We now move to clause two, amendment 70. Lord Harper.
He survived throughout the whole thing. He is in broad outline, right when he says section one contains the spine of the trunk of the bill. This moment does represent, I very much believe, an opportunity for us as a House to try to see if there is a way to get through this in time to send the bill back. And I, I completely accept what the noble Lord Lord Rooker is saying. My responsibility for trying to bring forward as quickly and as well as possible, the areas where he was kind enough to say, I've been clear about what my amendments were, so I welcome the door that the noble Lord, Lord Rooker, has opened.
I am more than willing to sit down in relation to each of the areas where I have identified that I'm willing to move and try to agree as much as possible what those movements should be. I'm absolutely sure that we won't agree on everything, but those things that we don't agree on, we can determine at Report stage. And so I, I very enthusiastically welcome what the noble Lord, Lord Rooker said about the way forward in relation. Can I just briefly say what deal with what the noble Baroness Shah Baroness Falkner said? Obviously I'm not responsible either for the impact assessment or the quality impact assessment.
I have to say that having read the points made by the Commissioner of the. I think the government are right. It does not justify a new either impact assessment or a quality assessment. The government has been absolutely clear as to why they think in principle, the bill doesn't doesn't offend against the convention or the Human Rights Act. They've also been incredibly helpful through Ministers in saying where they think amendments might give rise to problems. And it's perfectly legitimate for the government to say we're worried about amendments, but not to introduce a whole new assessment in
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relation to it. What the noble Lord, the
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What the noble Lord, the Minister, agree that when courts in the United Kingdom rule, that the public sector equality duty cannot public sector equality duty cannot be an afterthought and has to be complied with throughout, and that the Parliament needs to be aware of changes in circumstances or new issues that come up that that is the ruling of that court is one that needs to be abided with. I'm sorry, I've given my notes away. So I got blunt. I can't remember the the title of the court case I referenced, but I'm sure the noble Lord will will be able to find it in Hansard.
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I'm not aware of the court case. It does not. It does not justify a
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It does not. It does not justify a new impact. Equality and equality assessment. In this case. I was. Talking about the public sector
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Talking about the public sector equality duty and the applicability of the public sector equality duty.
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I do not think that justifies the the new. I mean, the thing the the new. I mean, the thing about equality assessments, lawyers can constantly right point and say, you haven't considered this, you haven't considered that. But having read in detail the equality
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assessment, it deals properly and adequately with the issues. I think it will be possible to
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I think it will be possible to
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get to the next list of amendments. My Lords question is clause one stand part of the bill as amended? That opinion will say content contrary, not content. The contents have it. Amendment 69 Lord Carlile already debated, not moved. We now move to clause two, amendment 70. Lord Harper.
15:16
Lord Harper (Conservative)
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Lord Harper (Conservative)
My Lords, I rise to move. Amendment 70 together with Amendment 70 together with amendment 78, which I will speak to. And there's also amendment 829, And there's also amendment 829, which my noble friend Lord Sandhurst has put into this group. These amendments were originally tabled in the name of Lord Hendy, who was wasn't able to be here last week, but we didn't get to them last week and I have taken them over in my name. Just so noble Lords are aware why they're there.
They are responding to concerns raised by David Green, a barrister specialising in industrial disease cases, and Michael Rawlinson KC, who wrote to a number of peers alerting us that the current drafting of this bill can negatively affect victims of some victims of occupational diseases. And I'm going to set out what that concern is. And then I hope the noble and learned Lord Liddle Falconer can respond to it in a more detailed way than he has in the letter that he circulated to peers in the last day or so.
And I'm also going to raise a couple of other related issues, which we will come to later in our debates, but which I think are similar. They raise similar issues. So the issue at hand is that if victims of. So the reference in the amendments is to to reference injuries or or diseases that people get during their working life. The reason for doing that is to raise this issue is that if victims of occupational diseases opt for assisted suicide, their dependants under my reading of it will probably lose their right to sue whoever calls their disease.
Under the Fatal Accidents Act 1976. Unless this bill specifically provided otherwise, which it doesn't currently. Now, just to give noble Lords an idea of the size of the issue in 2023, 2218 people in Britain died of mesothelioma, which is the prime fatal occupational disease which is a fatal cancer caused exclusively by asbestos. And that's just by way of comparison. That's considerably more than the 1624 people who were caused by road deaths. And we know how seriously the government takes that.
It's just published an entire road safety strategy to reduce that number. Many more died of lung cancer, with asbestos as a causative factor or of respiratory failure secondary to asbestosis or pleural thickening or other occupational diseases. Now, since virtually all instances of mesothelioma are caused by asbestos exposure and most asbestos exposure was occupational, most victims can sue a former employer, in reality usually represented by an insurer, and the damages recovered are an important way of paying for medical and nursing care and importantly, of providing for surviving dependents.
And claims arising from these occupational diseases can be pursued, pursued during the lifetime of the victim or by their families after their death. Under the Fatal Accidents Act 1976 and the Law Reform Miscellaneous Provisions Act 1934, and a good deal of claims are presumed after death in this way for the benefit of families, and partly that's because, following the diagnosis of mesothelioma, sadly, the prognosis following diagnosis is relatively short, and so that's why so many families have to seek the damages rather than the the victim being able to do so.
Now, the key point is this the dependence of a deceased person can sue if and only if the death is caused by any wrongful act, neglect or default, which is such as would if death had not ensued, had entitled the person injured to maintain an action and recover damages. That's in section one, one of the Fatal Accidents Act. The requirement is that the breach of duty is caused the death. But the law that's developed on section one of that act requires an unbroken chain of causation between the defendant's breach of duty and the death.
If the dependents of the deceased are to recover damages, and in general, an individual's decision to end their life by suicide breaks the chain of causation between a defendant's earlier breach of duty and the death. In other words, the law considers that the deaths have been caused by the choice of the victim and not by the negligence of the defendant. Now, there are narrow exceptions to this rule, for example, where the defendant's breach was of a duty to prevent suicide as it was in the Reeves case, or where the defendant causes a psychiatric injury which itself causes the suicide.
But where an individual has full capacity and that we know they must have if they're going to have used this bill. But if it becomes an act, because we've debated that at length. But if they have capacity in the defendant's duty is decades in the past, the common law would regard a freely made choice to end their life as a novus actus interveniens. And forgive me if I mispronounced that not being. As I've said on many occasions, lawyer, it's a new and different cause, breaking the chain of causation.
So what that would mean is that the person that died of fatal mesothelioma would have their cause of death recorded by the coroner as an industrial disease. But clause 38 of the bill, as drafted, makes provision for the cause of death in these cases to be recorded for coronial and certification purposes as an assisted death, and excludes this cause from the category of unnatural deaths, meaning that there's no inquest, so that means the assisted deaths will necessarily not be certificated as being caused by industrial disease, even if that was the cause of the terminal illness which led the deceased to be eligible for an assisted death.
So that means that at common law and under the Fatal Accidents Act, it would break the chain of causation between the former employers negligence and the victims ultimate death. And that means that a victim of an occupational cancer with limited life expectancy, who would meet the criteria in the bill and who actually would probably face a painful and unpleasant death, even though that's not a criteria for the bill, as we've debated, has a dilemma. They've got a choice between prolonging their suffering but preserving their family's right to damages or ending their suffering, but losing a right potentially worth hundreds of thousands of pounds to the people they leave behind.
And at the moment, that is not dealt with anywhere in the bill. So I've got a specific question about that, and I will refer in a minute to what the Noble and learned law said in his letter. But I also want to just ask whether there are other areas where there are similar issues which haven't been thought about. The two that that come to mind for myself is is the first one is around members of the armed forces. And I've tabled an amendment which will come up later in the bill because, again, the compensation schemes in the armed forces again wouldn't, under my understanding, would not pay out if somebody had a an occupational disease, which they'd got because of their military service, if they were to seek an assisted suicide, that would preclude them and their dependents from receiving compensation under that scheme.
And I think that is a and that's even more particularly a failure, given the duty of care the state owes to those who put their lives at risk on its behalf. And I'd also be interested in understanding the interaction between this and the government's statutory diffuse mRNA payment scheme. That, of course, would pay out. So in cases where there is no employer still in existence or no insurer still in existence, or they can't be identified, there's a statutory scheme which I know a bit about.
I took the regulations through Parliament when I was a Minister in the Department for Work and Pensions that pays out on diagnosis. So that means potentially somebody whose employer was still around and on the hook, who sought an assisted suicide, would do themselves or their dependents out of compensation, whereas somebody whose employer or insurer was not around or not traceable and who qualified under the statutory scheme which is paid out on diagnosis, would actually not do themselves, I think, out of the compensation.
And that seems to me an invidious position based on complete chance. And I don't know whether whether that's been thought about by the sponsors of the bill. And I'd be interested to know the specific answers to those questions, but also whether there are other areas like those which haven't been considered. And and that, of course, is one of the areas. Why, if this had been a government bill as part of the process, other government departments would have looked at it and would have would have thought about these issues and would have made sure they were dealt with.
My final point is that the noble and learned Lord dealt with this a bit in the letter that he circulated. He referenced this. He thanked my noble friend Lord Sandhurst and Lord Hendy, whose name, as I said, was originally on these amendments. For their conversations. He said he had tabled amendments to clause 47 in the reporting section of this bill, which would require an early report about the impact. I will come that, but I don't think that goes far enough, because if this bill goes onto the statute book, there are going to be people who I think legal position is going to be put at risk and damaged by the by what's in the bill.
And that's not going to be remedied by a report. If the report comes out and says, yes, there is a problem, it will require further primary legislation to fix it. And I think it would be better if we understood what the issue was. Now, if there is an issue now, we should make sure there's an amendment table for report, which would deal with it both for the Fatal Accidents Act, but also for those members of the armed forces and in this area.
I think it would be helpful if and I don't think this this breaches the government's neutral position on the bill. But if if it was identified, if there were any other similar areas where we could deal with it. Amendment at report, I think that would be welcome. So that was the purpose of myself tabling these two amendments. I think it's a very important area, and I look forward in due course to the answers from the noble and learned Lord, Lord Falconer.
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Thank you, my Lord. Yes.
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Yes. Amendment proposed clause two, page two. Line three. After the word disease, insert the words or injuries.
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injuries. My Lord. If I can follow my noble friend and I hope the reasonably concise and I hope the reasonably concise my amendment. 829 I ask to be moved into this group because it covers into this group because it covers the same substantive ground. It was hopeful that about a fortnight ago, with Lord Hendy, I met the noble
They are responding to concerns raised by David Green, a barrister specialising in industrial disease cases, and Michael Rawlinson KC, who wrote to a number of peers alerting us that the current drafting of this bill can negatively affect victims of some victims of occupational diseases. And I'm going to set out what that concern is. And then I hope the noble and learned Lord Liddle Falconer can respond to it in a more detailed way than he has in the letter that he circulated to peers in the last day or so.
And I'm also going to raise a couple of other related issues, which we will come to later in our debates, but which I think are similar. They raise similar issues. So the issue at hand is that if victims of. So the reference in the amendments is to to reference injuries or or diseases that people get during their working life. The reason for doing that is to raise this issue is that if victims of occupational diseases opt for assisted suicide, their dependants under my reading of it will probably lose their right to sue whoever calls their disease.
Under the Fatal Accidents Act 1976. Unless this bill specifically provided otherwise, which it doesn't currently. Now, just to give noble Lords an idea of the size of the issue in 2023, 2218 people in Britain died of mesothelioma, which is the prime fatal occupational disease which is a fatal cancer caused exclusively by asbestos. And that's just by way of comparison. That's considerably more than the 1624 people who were caused by road deaths. And we know how seriously the government takes that.
It's just published an entire road safety strategy to reduce that number. Many more died of lung cancer, with asbestos as a causative factor or of respiratory failure secondary to asbestosis or pleural thickening or other occupational diseases. Now, since virtually all instances of mesothelioma are caused by asbestos exposure and most asbestos exposure was occupational, most victims can sue a former employer, in reality usually represented by an insurer, and the damages recovered are an important way of paying for medical and nursing care and importantly, of providing for surviving dependents.
And claims arising from these occupational diseases can be pursued, pursued during the lifetime of the victim or by their families after their death. Under the Fatal Accidents Act 1976 and the Law Reform Miscellaneous Provisions Act 1934, and a good deal of claims are presumed after death in this way for the benefit of families, and partly that's because, following the diagnosis of mesothelioma, sadly, the prognosis following diagnosis is relatively short, and so that's why so many families have to seek the damages rather than the the victim being able to do so.
Now, the key point is this the dependence of a deceased person can sue if and only if the death is caused by any wrongful act, neglect or default, which is such as would if death had not ensued, had entitled the person injured to maintain an action and recover damages. That's in section one, one of the Fatal Accidents Act. The requirement is that the breach of duty is caused the death. But the law that's developed on section one of that act requires an unbroken chain of causation between the defendant's breach of duty and the death.
If the dependents of the deceased are to recover damages, and in general, an individual's decision to end their life by suicide breaks the chain of causation between a defendant's earlier breach of duty and the death. In other words, the law considers that the deaths have been caused by the choice of the victim and not by the negligence of the defendant. Now, there are narrow exceptions to this rule, for example, where the defendant's breach was of a duty to prevent suicide as it was in the Reeves case, or where the defendant causes a psychiatric injury which itself causes the suicide.
But where an individual has full capacity and that we know they must have if they're going to have used this bill. But if it becomes an act, because we've debated that at length. But if they have capacity in the defendant's duty is decades in the past, the common law would regard a freely made choice to end their life as a novus actus interveniens. And forgive me if I mispronounced that not being. As I've said on many occasions, lawyer, it's a new and different cause, breaking the chain of causation.
So what that would mean is that the person that died of fatal mesothelioma would have their cause of death recorded by the coroner as an industrial disease. But clause 38 of the bill, as drafted, makes provision for the cause of death in these cases to be recorded for coronial and certification purposes as an assisted death, and excludes this cause from the category of unnatural deaths, meaning that there's no inquest, so that means the assisted deaths will necessarily not be certificated as being caused by industrial disease, even if that was the cause of the terminal illness which led the deceased to be eligible for an assisted death.
So that means that at common law and under the Fatal Accidents Act, it would break the chain of causation between the former employers negligence and the victims ultimate death. And that means that a victim of an occupational cancer with limited life expectancy, who would meet the criteria in the bill and who actually would probably face a painful and unpleasant death, even though that's not a criteria for the bill, as we've debated, has a dilemma. They've got a choice between prolonging their suffering but preserving their family's right to damages or ending their suffering, but losing a right potentially worth hundreds of thousands of pounds to the people they leave behind.
And at the moment, that is not dealt with anywhere in the bill. So I've got a specific question about that, and I will refer in a minute to what the Noble and learned law said in his letter. But I also want to just ask whether there are other areas where there are similar issues which haven't been thought about. The two that that come to mind for myself is is the first one is around members of the armed forces. And I've tabled an amendment which will come up later in the bill because, again, the compensation schemes in the armed forces again wouldn't, under my understanding, would not pay out if somebody had a an occupational disease, which they'd got because of their military service, if they were to seek an assisted suicide, that would preclude them and their dependents from receiving compensation under that scheme.
And I think that is a and that's even more particularly a failure, given the duty of care the state owes to those who put their lives at risk on its behalf. And I'd also be interested in understanding the interaction between this and the government's statutory diffuse mRNA payment scheme. That, of course, would pay out. So in cases where there is no employer still in existence or no insurer still in existence, or they can't be identified, there's a statutory scheme which I know a bit about.
I took the regulations through Parliament when I was a Minister in the Department for Work and Pensions that pays out on diagnosis. So that means potentially somebody whose employer was still around and on the hook, who sought an assisted suicide, would do themselves or their dependents out of compensation, whereas somebody whose employer or insurer was not around or not traceable and who qualified under the statutory scheme which is paid out on diagnosis, would actually not do themselves, I think, out of the compensation.
And that seems to me an invidious position based on complete chance. And I don't know whether whether that's been thought about by the sponsors of the bill. And I'd be interested to know the specific answers to those questions, but also whether there are other areas like those which haven't been considered. And and that, of course, is one of the areas. Why, if this had been a government bill as part of the process, other government departments would have looked at it and would have would have thought about these issues and would have made sure they were dealt with.
My final point is that the noble and learned Lord dealt with this a bit in the letter that he circulated. He referenced this. He thanked my noble friend Lord Sandhurst and Lord Hendy, whose name, as I said, was originally on these amendments. For their conversations. He said he had tabled amendments to clause 47 in the reporting section of this bill, which would require an early report about the impact. I will come that, but I don't think that goes far enough, because if this bill goes onto the statute book, there are going to be people who I think legal position is going to be put at risk and damaged by the by what's in the bill.
And that's not going to be remedied by a report. If the report comes out and says, yes, there is a problem, it will require further primary legislation to fix it. And I think it would be better if we understood what the issue was. Now, if there is an issue now, we should make sure there's an amendment table for report, which would deal with it both for the Fatal Accidents Act, but also for those members of the armed forces and in this area.
I think it would be helpful if and I don't think this this breaches the government's neutral position on the bill. But if if it was identified, if there were any other similar areas where we could deal with it. Amendment at report, I think that would be welcome. So that was the purpose of myself tabling these two amendments. I think it's a very important area, and I look forward in due course to the answers from the noble and learned Lord, Lord Falconer.
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Thank you, my Lord. Yes.
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Yes. Amendment proposed clause two, page two. Line three. After the word disease, insert the words or injuries.
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injuries. My Lord. If I can follow my noble friend and I hope the reasonably concise and I hope the reasonably concise my amendment. 829 I ask to be moved into this group because it covers into this group because it covers the same substantive ground. It was hopeful that about a fortnight ago, with Lord Hendy, I met the noble
15:28
Lord Sandhurst (Conservative)
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Lord Sandhurst (Conservative)
and learned Lord, and we discussed this situation. Broadly speaking, this situation. Broadly speaking, there was acceptance and as I understand it, the proposed understand it, the proposed proposer of this bill will be bringing forward an amendment which bringing forward an amendment which will tidy up various loose ends. He'll the word review will be He'll the word review will be changed to assessment. And the reference to victims of occupational diseases and 1 or 2 other tidying up matters. My Lord, as has been explained.
And I can do this shortly. But it is important, as currently drafted, it is probable. I would say it's highly probable that a victim of an occupational disease such as, for example, asbestosis, caused by the negligence of some tort Pfizer will, if they go down the assisted dying route at that point, lose the right to recover damages for the injury, which is put them in the position where they wish to die. And this will also mean that their As and successors, their family will lose that right to the Fatal Accidents Act claim, so that it would be quite wrong that someone who suffers a horrible illness and decides they cannot bear it any longer, and to terminate their life just a few months before the end.
That their family, who deserve the money to cover themselves for the whole of the life which that person would have enjoyed. But for the injury which has created the asbestosis that those dependants should lose, that entitlement to compensation if the victim goes down the route of assisted dying. And but on the law as it currently stands and it's been to the Supreme Court, obviously not, or the House of Lords, not in this context exactly, but in other contexts.
It's quite clear that this would be a break in the chain of causation or say, it seems to me, and I think to others who are interested in this field and therefore, at the very least, either there should be an express amendment to the bill, which would be a matter for the proposer, which actually addresses this directly, or at the very least, there should be the review, which I ask for in amendment 8 to 9, which will look at what has actually been happening in the first year after the bill becomes an act and comes into effect, and how it is operating.
But it is really important that really quite large numbers of people each year who stand to be in the class of people who might be affected, are not disadvantageously affected by this bill. It would be an unintended consequence and a most undesirable one. And it's on that basis that I put this amendment before the House.
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Thank you Lord. It's a it's a pleasure to follow
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It's a it's a pleasure to follow the noble Lord Lord Sandhurst. And I'm particularly grateful to the noble Lord, Lord Harper, for noble Lord, Lord Harper, for advancing amendment 70 and 78, which I drafted. But unfortunately, which I drafted. But unfortunately, it was unable to be here last week when I thought they'd be debated. when I thought they'd be debated. Can I say about amendment 70 and 78? The purpose of these, I should say
And I can do this shortly. But it is important, as currently drafted, it is probable. I would say it's highly probable that a victim of an occupational disease such as, for example, asbestosis, caused by the negligence of some tort Pfizer will, if they go down the assisted dying route at that point, lose the right to recover damages for the injury, which is put them in the position where they wish to die. And this will also mean that their As and successors, their family will lose that right to the Fatal Accidents Act claim, so that it would be quite wrong that someone who suffers a horrible illness and decides they cannot bear it any longer, and to terminate their life just a few months before the end.
That their family, who deserve the money to cover themselves for the whole of the life which that person would have enjoyed. But for the injury which has created the asbestosis that those dependants should lose, that entitlement to compensation if the victim goes down the route of assisted dying. And but on the law as it currently stands and it's been to the Supreme Court, obviously not, or the House of Lords, not in this context exactly, but in other contexts.
It's quite clear that this would be a break in the chain of causation or say, it seems to me, and I think to others who are interested in this field and therefore, at the very least, either there should be an express amendment to the bill, which would be a matter for the proposer, which actually addresses this directly, or at the very least, there should be the review, which I ask for in amendment 8 to 9, which will look at what has actually been happening in the first year after the bill becomes an act and comes into effect, and how it is operating.
But it is really important that really quite large numbers of people each year who stand to be in the class of people who might be affected, are not disadvantageously affected by this bill. It would be an unintended consequence and a most undesirable one. And it's on that basis that I put this amendment before the House.
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Thank you Lord. It's a it's a pleasure to follow
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It's a it's a pleasure to follow the noble Lord Lord Sandhurst. And I'm particularly grateful to the noble Lord, Lord Harper, for noble Lord, Lord Harper, for advancing amendment 70 and 78, which I drafted. But unfortunately, which I drafted. But unfortunately, it was unable to be here last week when I thought they'd be debated. when I thought they'd be debated. Can I say about amendment 70 and 78? The purpose of these, I should say
15:32
Lord Hendy (Labour)
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Lord Hendy (Labour)
I there's nothing I disagree with in what Lord Harper or Lord Sandhurst has said, but just in Sandhurst has said, but just in relation to 70 and 78, the purpose relation to 70 and 78, the purpose of these of these amendments was to broaden the definition of disease broaden the definition of disease to include injuries. It seemed to me completely illogical that somebody who is in exactly the same position, facing death within six months because of some untoward event, like contracting an illness or being hit by a car or suffering some injury at work, should not be in the same position.
And if one thinks about, in particular injuries at work in inhalation of asbestos fibre or silica or cotton results in byssinosis or silicosis or asbestosis or mesothelioma, and they would be covered by the legislation as currently proposed. But inhalation of a poisonous gas at work causing injury, which is likely to result in death within six months, would not be covered. It didn't seem to me that there was a logical distinction to be made there. I should also say that the law doesn't regard there as being a distinction.
The law of common law of negligence requires that you don't harm someone else. Whether the harm is by an injury, or whether it's by causing that person to contract an illness. And that's particularly evident in the field which Lord Harper developed, namely injury at work, the Health and Safety at Work Act, the Workplace Health, Safety and Welfare Regulations 1992, and the common law of of workplace negligence all require that the employer keeps the workplace safe and makes no distinction between whether the danger arises as a risk of injury.
Getting a arm mangled in a machine, or the risk of disease by the inhalation of some noxious particles that cause a lung disease. So it to me, there is no logical distinction. And it would be right that the bill should extend the scope of disease, illness and disease. Of course not defined in the bill as presently drafted. Extend it to cover illness as well. Well, turning to the main point, which both Lord Harper and Lord Lord Sandhurst noble Lords developed, it's the the risk as.
Lord. The noble Lord Lord Sandhurst and noble Lord, Lord Carlile put in their explanatory statement, which both of which Lord Sandhurst has developed this morning, that the defendants will probably lose their right under the Fatal Accidents Act to sue the alleged tortfeasor said to have caused the disease, unless the bill specifically provides otherwise, which currently it doesn't. I agree with Lord Sandhurst legal analysis. It is likely that insurers will say no. The cause of death here was not the underlying underlying mesothelioma.
It was the fact that this person opted for an assisted death. Noble Lord Lord Sandhurst has developed the consequences for the family. But I just wanted to add what about the consequences for the injured person? Are they going to think to themselves, well, if I opt for an assisted death, I'm going to deprive my family of extensive damages that they wouldn't enjoy if, if, if, if I, if I go for an assisted death, of course, there's going to be considerable pressure on that person to say, I'm going to put up with the suffering as long as I can until I die, to make sure that my family get the money.
Now, I don't want to be rude to insurance companies, but they have to do what they can to safeguard their assets and and avoid paying out what they don't need to pay out. They will fight these cases. And therefore it seems to me that it would. It's important that the bill to quote those words specifically provides otherwise, and which it doesn't, does not currently. I'm very grateful for the interview that I had with my noble and learned friend Lord Faulkner with Lord Sandhurst discussing these matters.
A week or so ago, I had mistakenly thought that the power of my oratory was such that he was convinced by my argument, but he wasn't, and is quite clear from his amendment that he's put down to today. Amendment 718. See that he doesn't accept that the bill should provide a measure that would protect the victim in the circumstances that we're discussing. The noble Baroness Finlay of Llandaff. And I put down an amendment 717, which is obviously not before the House today, which sought to redress this by requiring that the coroner recorded that the cause of death was the underlying disease, whilst noting that the death was won by assisted dying.
Now, whether that goes far enough to protect these victims from the insurers who claim that the death was not caused by the underlying disease, I don't know. But it goes a bit further than the amendment, which is currently proposed by the noble Lords Sandhurst and Carlisle. And in my view, it's essential that the Bill protects against the
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danger which I've outlined. I'm very concerned by the
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I'm very concerned by the amendment by my noble friend Lord Harper, to extend the bill's definition of terminal illness to definition of terminal illness to include simply the one word injuries. I agree absolutely, entirely with my noble friend Lord entirely with my noble friend Lord Sanders. And what the noble Lord, Lord, Lord Faulkner, may propose to ensure that those who have suffered an industrial injury are not deprived of their rightful compensation. And I support
And if one thinks about, in particular injuries at work in inhalation of asbestos fibre or silica or cotton results in byssinosis or silicosis or asbestosis or mesothelioma, and they would be covered by the legislation as currently proposed. But inhalation of a poisonous gas at work causing injury, which is likely to result in death within six months, would not be covered. It didn't seem to me that there was a logical distinction to be made there. I should also say that the law doesn't regard there as being a distinction.
The law of common law of negligence requires that you don't harm someone else. Whether the harm is by an injury, or whether it's by causing that person to contract an illness. And that's particularly evident in the field which Lord Harper developed, namely injury at work, the Health and Safety at Work Act, the Workplace Health, Safety and Welfare Regulations 1992, and the common law of of workplace negligence all require that the employer keeps the workplace safe and makes no distinction between whether the danger arises as a risk of injury.
Getting a arm mangled in a machine, or the risk of disease by the inhalation of some noxious particles that cause a lung disease. So it to me, there is no logical distinction. And it would be right that the bill should extend the scope of disease, illness and disease. Of course not defined in the bill as presently drafted. Extend it to cover illness as well. Well, turning to the main point, which both Lord Harper and Lord Lord Sandhurst noble Lords developed, it's the the risk as.
Lord. The noble Lord Lord Sandhurst and noble Lord, Lord Carlile put in their explanatory statement, which both of which Lord Sandhurst has developed this morning, that the defendants will probably lose their right under the Fatal Accidents Act to sue the alleged tortfeasor said to have caused the disease, unless the bill specifically provides otherwise, which currently it doesn't. I agree with Lord Sandhurst legal analysis. It is likely that insurers will say no. The cause of death here was not the underlying underlying mesothelioma.
It was the fact that this person opted for an assisted death. Noble Lord Lord Sandhurst has developed the consequences for the family. But I just wanted to add what about the consequences for the injured person? Are they going to think to themselves, well, if I opt for an assisted death, I'm going to deprive my family of extensive damages that they wouldn't enjoy if, if, if, if I, if I go for an assisted death, of course, there's going to be considerable pressure on that person to say, I'm going to put up with the suffering as long as I can until I die, to make sure that my family get the money.
Now, I don't want to be rude to insurance companies, but they have to do what they can to safeguard their assets and and avoid paying out what they don't need to pay out. They will fight these cases. And therefore it seems to me that it would. It's important that the bill to quote those words specifically provides otherwise, and which it doesn't, does not currently. I'm very grateful for the interview that I had with my noble and learned friend Lord Faulkner with Lord Sandhurst discussing these matters.
A week or so ago, I had mistakenly thought that the power of my oratory was such that he was convinced by my argument, but he wasn't, and is quite clear from his amendment that he's put down to today. Amendment 718. See that he doesn't accept that the bill should provide a measure that would protect the victim in the circumstances that we're discussing. The noble Baroness Finlay of Llandaff. And I put down an amendment 717, which is obviously not before the House today, which sought to redress this by requiring that the coroner recorded that the cause of death was the underlying disease, whilst noting that the death was won by assisted dying.
Now, whether that goes far enough to protect these victims from the insurers who claim that the death was not caused by the underlying disease, I don't know. But it goes a bit further than the amendment, which is currently proposed by the noble Lords Sandhurst and Carlisle. And in my view, it's essential that the Bill protects against the
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danger which I've outlined. I'm very concerned by the
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I'm very concerned by the amendment by my noble friend Lord Harper, to extend the bill's definition of terminal illness to definition of terminal illness to include simply the one word injuries. I agree absolutely, entirely with my noble friend Lord entirely with my noble friend Lord Sanders. And what the noble Lord, Lord, Lord Faulkner, may propose to ensure that those who have suffered an industrial injury are not deprived of their rightful compensation. And I support
15:39
Lord Blencathra (Conservative)
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Lord Blencathra (Conservative)
entirely with an oval or Lord Hendy said on that. But I did disagree with his general thesis that the bill should be extended to include bill should be extended to include all other injuries, because I think that could take us in a rather dangerous direction. My Lords, we dangerous direction. My Lords, we all know that some injuries are awfully catastrophic, relentlessly painful, and leave no prospect of painful, and leave no prospect of meaningful recovery. And for those individuals, the desire to offer control over the terminal and over control over the terminal and over the timing and manner of their death is understandable and deeply felt.
If the law permits assisted death for terminal illness, it is emotionally incoherent in some ways to ask why a grievous, irreversible injury that will inevitably lead to death should be treated differently. And I think my noble friend's amendment is born of a. And the noble Lord Hendy suggestion is born of a humane impulse to extend compassion to a group whose suffering can be as severe as that of the terminally ill. But, my Lords, compassion must be married to clarity and caution.
When Parliament contemplates measures that permit an irreversible outcome. Extending the definition to injuries raises serious legal, clinical and ethical problems. And, if I may set them out briefly, the principal flaws and risks which I see from the proposed change. First, the term injury is legally and clinically vague. What counts as an injury? Does the word encompass acute trauma, chronic sequelae, surgical complications, other serious harm, or the long term consequences of an earlier wound? Without precise limits, the category could sweep far beyond the narrow cohort.
The amendments proposals are proposals. Proponents intended vagueness of this threshold invites inconsistent application and litigation. Second, the proposed threshold that the injury be reasonably expected to result in death, I also suggest with problematic prognosis over severe injury is often uncertain, as it is with terminal illness and and can change with treatment, rehabilitation and time. Modern trauma care, reconstructive surgery, and rehabilitation can alter trajectories in ways that are difficult to predict at the bedside, using reasonably expected to result in death without a clear evidential standard.
Hence, clinicians wide discretion and risk premature decisions made on the basis of an evolving clinical picture. And third, my Lords, there is a real danger of premature decisions in acute settings. Many catastrophic injuries occur in emergency contacts where where prognosis is evolving and where immediate stabilisation, surgery or intensive rehabilitation may change outcomes, allowing assisted death on the basis of an early prognosis. Risks. Decisions taken before full treatment options have been explored, and before the patient has had the opportunity to adapt to new circumstances or benefit from specialist rehabilitation.
My, I will not I will not talk about the civil law and compensation matters because that's been already expertly covered by my noble friends and the noble Lord Lord Hendy. And also my noble friend mentioned the coronial investigatory consequences which arise. Again, I will not elaborate on those. My Lords, there's the slippery slope argument here once injuries are included, just the simple one word injuries are included. Then pressure may grow to widen eligibility further to chronic disability, psychiatric consequences, or non-combat trauma.
Experience from other jurisdictions shows how initial expansions can lead to broader reinterpretation over time. Parliament must be wary of opening a door that cannot easily be closed. And, my Lords, the clinical complexity of catastrophe, of catastrophic injury demands multidisciplinary expertise. This is not one GP giving an opinion here. Assessing such cases properly would require a trauma. Surgeons, rehabilitation specialists, pain teams, psychiatrists and a whole range of different medical specialities. The bill's processes must ensure that such expertise is mandatory before any irreversible step is taken.
Otherwise, we risk decisions being made without the full range of clinical knowledge that these cases demand. My Lords, I conclude by saying if Parliament is to consider injuries within scope, it must do so with surgical precision, so to speak. It needs narrow definitions, it needs higher evidential standards, and it needs mandatory specialist review and explicit protections for families and compensation rights. Only then can we balance mercy with the safeguards that such irreversible decisions demand. I urge the House to reflect very carefully on the human impulse behind this amendment, and on the legal and clinical realities that make its adoption.
Adding one word injuries, as my noble friends propose, I believe it. As currently drafted. It would be deeply problematic to add this to the bill.
If the law permits assisted death for terminal illness, it is emotionally incoherent in some ways to ask why a grievous, irreversible injury that will inevitably lead to death should be treated differently. And I think my noble friend's amendment is born of a. And the noble Lord Hendy suggestion is born of a humane impulse to extend compassion to a group whose suffering can be as severe as that of the terminally ill. But, my Lords, compassion must be married to clarity and caution.
When Parliament contemplates measures that permit an irreversible outcome. Extending the definition to injuries raises serious legal, clinical and ethical problems. And, if I may set them out briefly, the principal flaws and risks which I see from the proposed change. First, the term injury is legally and clinically vague. What counts as an injury? Does the word encompass acute trauma, chronic sequelae, surgical complications, other serious harm, or the long term consequences of an earlier wound? Without precise limits, the category could sweep far beyond the narrow cohort.
The amendments proposals are proposals. Proponents intended vagueness of this threshold invites inconsistent application and litigation. Second, the proposed threshold that the injury be reasonably expected to result in death, I also suggest with problematic prognosis over severe injury is often uncertain, as it is with terminal illness and and can change with treatment, rehabilitation and time. Modern trauma care, reconstructive surgery, and rehabilitation can alter trajectories in ways that are difficult to predict at the bedside, using reasonably expected to result in death without a clear evidential standard.
Hence, clinicians wide discretion and risk premature decisions made on the basis of an evolving clinical picture. And third, my Lords, there is a real danger of premature decisions in acute settings. Many catastrophic injuries occur in emergency contacts where where prognosis is evolving and where immediate stabilisation, surgery or intensive rehabilitation may change outcomes, allowing assisted death on the basis of an early prognosis. Risks. Decisions taken before full treatment options have been explored, and before the patient has had the opportunity to adapt to new circumstances or benefit from specialist rehabilitation.
My, I will not I will not talk about the civil law and compensation matters because that's been already expertly covered by my noble friends and the noble Lord Lord Hendy. And also my noble friend mentioned the coronial investigatory consequences which arise. Again, I will not elaborate on those. My Lords, there's the slippery slope argument here once injuries are included, just the simple one word injuries are included. Then pressure may grow to widen eligibility further to chronic disability, psychiatric consequences, or non-combat trauma.
Experience from other jurisdictions shows how initial expansions can lead to broader reinterpretation over time. Parliament must be wary of opening a door that cannot easily be closed. And, my Lords, the clinical complexity of catastrophe, of catastrophic injury demands multidisciplinary expertise. This is not one GP giving an opinion here. Assessing such cases properly would require a trauma. Surgeons, rehabilitation specialists, pain teams, psychiatrists and a whole range of different medical specialities. The bill's processes must ensure that such expertise is mandatory before any irreversible step is taken.
Otherwise, we risk decisions being made without the full range of clinical knowledge that these cases demand. My Lords, I conclude by saying if Parliament is to consider injuries within scope, it must do so with surgical precision, so to speak. It needs narrow definitions, it needs higher evidential standards, and it needs mandatory specialist review and explicit protections for families and compensation rights. Only then can we balance mercy with the safeguards that such irreversible decisions demand. I urge the House to reflect very carefully on the human impulse behind this amendment, and on the legal and clinical realities that make its adoption.
Adding one word injuries, as my noble friends propose, I believe it. As currently drafted. It would be deeply problematic to add this to the bill.
15:44
Lord Carlile of Berriew (Crossbench)
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Lord Carlile of Berriew (Crossbench)
To amendment 8 to 9, to which I put my name and which was moved by the noble Lord Lord Sandhurst. And I added my name because I share experience with Lord Hendy and with Lord Sandhurst. We've all seen cases in which a potentially huge claim under the Fatal Accidents Act arises, which will provide a family with a payment for their dependency on the deceased for many years to come. So these are very substantial claims, and probably all three of us have done cases for both claimants and trade unions on the one side and insurance companies on the other side.
Insurance companies are very business like. They're very accurate, but they're not social services organisations. And one of the questions they asked their council, particularly their leading counsel, their KC in such cases is are we liable to pay. Is there a point we can take that it does not arise because the death was caused by some other means, and there have been many cases in which what what Lord Harper referred to earlier, novus actus interveniens, has been cited as a reason for not paying.
So there is, at the very least an ambiguity. And at the at a greater level, a grave injustice available if the noble and learned Lord does not agree to clarify what I think is a point he would probably agree with in principle. And so that is why I support what has been said earlier.
Insurance companies are very business like. They're very accurate, but they're not social services organisations. And one of the questions they asked their council, particularly their leading counsel, their KC in such cases is are we liable to pay. Is there a point we can take that it does not arise because the death was caused by some other means, and there have been many cases in which what what Lord Harper referred to earlier, novus actus interveniens, has been cited as a reason for not paying.
So there is, at the very least an ambiguity. And at the at a greater level, a grave injustice available if the noble and learned Lord does not agree to clarify what I think is a point he would probably agree with in principle. And so that is why I support what has been said earlier.
15:45
Lord Empey (Ulster Unionist Party)
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Lord Empey (Ulster Unionist Party)
My Lords, I think this has been >> My Lords, I think this has been a very interesting debate. Maybe members perhaps don't appreciate members perhaps don't appreciate the extent of the potential and the length of time that this potential could be open. When I was a Minister for Enterprise in Belfast and represented East Belfast as an elected member, that particular area had vast numbers of people suffering from asbestosis, mesothelioma, pleural plaques and so on because it was an industrial area, we were shipbuilding, we had aircraft building, electrical work and asbestos was involved in wiring.
It was involved. The workforce used to play snowballs with. That's the extent of it. Now what emerged, and this is the point that I think is important. I'm sure the noble Lord, Lord will understand this. What emerged was that, first of all, a lot of the companies like Turner and Newell, which was very famous company, a lot of those companies have gone out of business, and their insurers, in some cases have gone with them because of the extent of claims.
But what people I think need to understand is that in some cases, and the reason why the Northern Ireland government got involved, because the state at one point owned the company. So the state was the employer. Therefore, there was a direct liability between the company, the client, the company and ultimately the state. Now the state owns a number of businesses on and off over the years, all over the UK. And it's not confined to asbestosis or diseases related thereto.
As the noble Lord Lord Harper mentioned, there's the whole question of the armed forces and all such things like that. But just to give you some extent of the spread of all of this, it emerged that over the years, sometimes it can take up to 30 years before something like asbestosis becomes obvious. And there's virtually for at least and for, for many of these diseases, there's no cure. It's very brutal. And it can be very quick. But what was emerging was that when workers was emerging was that when workers came home, their clothing past the asbestos onto their spouses and their children.
And I remember many years ago setting money aside to 20, 50 to cover potential claims that were going to arise from the state having owned some parts, some companies over the years, and therefore the absence of any insurer, the absence of employer, the state ended up in that position. So I put money aside to 2050. So I do think these amendments have opened up a new a whole new frontier that we have to get sorted out, because the risk, obviously, is that those dependants will therefore not have absolutely no recompense whatsoever.
Not only will their relatives have died a pretty brutal death, as Lord Hendy will know from his experience, but they'll be left destitute. So I do think this is something that needs sorting out.
It was involved. The workforce used to play snowballs with. That's the extent of it. Now what emerged, and this is the point that I think is important. I'm sure the noble Lord, Lord will understand this. What emerged was that, first of all, a lot of the companies like Turner and Newell, which was very famous company, a lot of those companies have gone out of business, and their insurers, in some cases have gone with them because of the extent of claims.
But what people I think need to understand is that in some cases, and the reason why the Northern Ireland government got involved, because the state at one point owned the company. So the state was the employer. Therefore, there was a direct liability between the company, the client, the company and ultimately the state. Now the state owns a number of businesses on and off over the years, all over the UK. And it's not confined to asbestosis or diseases related thereto.
As the noble Lord Lord Harper mentioned, there's the whole question of the armed forces and all such things like that. But just to give you some extent of the spread of all of this, it emerged that over the years, sometimes it can take up to 30 years before something like asbestosis becomes obvious. And there's virtually for at least and for, for many of these diseases, there's no cure. It's very brutal. And it can be very quick. But what was emerging was that when workers was emerging was that when workers came home, their clothing past the asbestos onto their spouses and their children.
And I remember many years ago setting money aside to 20, 50 to cover potential claims that were going to arise from the state having owned some parts, some companies over the years, and therefore the absence of any insurer, the absence of employer, the state ended up in that position. So I put money aside to 2050. So I do think these amendments have opened up a new a whole new frontier that we have to get sorted out, because the risk, obviously, is that those dependants will therefore not have absolutely no recompense whatsoever.
Not only will their relatives have died a pretty brutal death, as Lord Hendy will know from his experience, but they'll be left destitute. So I do think this is something that needs sorting out.
15:49
Baroness Finlay of Llandaff (Crossbench)
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Baroness Finlay of Llandaff (Crossbench)
And I'm. Lord Hendy, with whom I had conversations going back to last September. And my concern has been because I've looked after these because I've looked after these patients, many of them dying of mesothelioma. And it certainly did seem to be a loophole. If the chain of causation was not completely intact. We had advice in several calls from extremely wise sources. I won't list them all, and I learnt a great deal about the legal side and the Fatal Accident Act.
But I just have some questions. Now to the noble and learned Lord, who I met with yesterday, and he assured me he would be bringing forward amendments. But unfortunately I didn't see them at the time and it was only much, much later that they've appeared in my inbox and I haven't been able to go through in detail exactly that, the precise wording. But the concerns are that unless this is absolutely watertight, these companies will essentially wriggle out of any type of compensation.
And I therefore wonder what the position is of coronial oversight in these cases, where perhaps even the diagnosis might be questioned by a company and it could be difficult for a family to to provide some of the evidence that they might be demanding. One doesn't know. And I also want to ask, what's the position of the life insurance policy of the individual in the event that they have an industrial disease where there is a chain of causation, they might be eligible.
One hopes they are eligible for compensation that needs to be followed through. But then again, somebody could claim some way that
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the chain of causation had been broken. My Lord, I would like to express
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My Lord, I would like to express my appreciation to the noble Lord Lord Hendy and Lord Lord Harper for bringing these matters to our bringing these matters to our attention. I had prepared a speech describing the awful situation that describing the awful situation that is mesothelioma, etc. I won't talk about that. I'll just say a very
But I just have some questions. Now to the noble and learned Lord, who I met with yesterday, and he assured me he would be bringing forward amendments. But unfortunately I didn't see them at the time and it was only much, much later that they've appeared in my inbox and I haven't been able to go through in detail exactly that, the precise wording. But the concerns are that unless this is absolutely watertight, these companies will essentially wriggle out of any type of compensation.
And I therefore wonder what the position is of coronial oversight in these cases, where perhaps even the diagnosis might be questioned by a company and it could be difficult for a family to to provide some of the evidence that they might be demanding. One doesn't know. And I also want to ask, what's the position of the life insurance policy of the individual in the event that they have an industrial disease where there is a chain of causation, they might be eligible.
One hopes they are eligible for compensation that needs to be followed through. But then again, somebody could claim some way that
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the chain of causation had been broken. My Lord, I would like to express
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My Lord, I would like to express my appreciation to the noble Lord Lord Hendy and Lord Lord Harper for bringing these matters to our bringing these matters to our attention. I had prepared a speech describing the awful situation that describing the awful situation that is mesothelioma, etc. I won't talk about that. I'll just say a very
15:52
Baroness O'Loan (Crossbench)
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Baroness O'Loan (Crossbench)
about that. I'll just say a very couple of things very briefly. This has so clearly identified a huge gap in provision in this legislation, and a situation in which a bill is being passed which may have consequences, which are not provided for in any way in the bill. And I'm thinking particularly of the Fatal Accidents Act situation, the people who are dying of these industrial diseases and military victims. I had no idea that military victims would would lose compensation in that situation.
So I'm very grateful to them for, for for identifying such a significant gap. I think it's it's very important for members of the armed forces, because I think that many of them suffer from, from mental illnesses as a consequence of their service, in addition to any other condition from which they suffer. And that always makes life harder for people in trying to negotiate their way through and make decisions of this very profound kind. The noble Baroness Brown mentioned the problem of insurance policies and suicides.
Now, I know, I think, anyway, that most insurance companies will pay out after a suicide, provided that the the minimum time has elapsed since the taking out of the policy. But it appears now that if if someone has an assisted suicide and we don't quite know how that will will affect their insurance policy. But if the underlying cause of death, the terminal illness which has led to the granting of the assisted suicide, is something like cancer, that may send the insurer straight back to find out what underlying causes or underlying habits were disclosed, such as the fact that the person was a smoker.
It all becomes enormously complicated for the person suffering from a terminal illness, who is seeking to make a decision about whether they seek assisted death or not. There is no no provision in this act for the consequences for their families in situations like this.
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I think this is a really interesting. Group of amendments, and I think it's raised more questions for me it's raised more questions for me than it's probably answered. In terms of when we talk about injury, I immediately think about people I immediately think about people who've had a spinal cord injury, who become a quadriplegic or who become a quadriplegic or paraplegic by the very nature of my former career, I know a lot of wheelchair users who've been
So I'm very grateful to them for, for for identifying such a significant gap. I think it's it's very important for members of the armed forces, because I think that many of them suffer from, from mental illnesses as a consequence of their service, in addition to any other condition from which they suffer. And that always makes life harder for people in trying to negotiate their way through and make decisions of this very profound kind. The noble Baroness Brown mentioned the problem of insurance policies and suicides.
Now, I know, I think, anyway, that most insurance companies will pay out after a suicide, provided that the the minimum time has elapsed since the taking out of the policy. But it appears now that if if someone has an assisted suicide and we don't quite know how that will will affect their insurance policy. But if the underlying cause of death, the terminal illness which has led to the granting of the assisted suicide, is something like cancer, that may send the insurer straight back to find out what underlying causes or underlying habits were disclosed, such as the fact that the person was a smoker.
It all becomes enormously complicated for the person suffering from a terminal illness, who is seeking to make a decision about whether they seek assisted death or not. There is no no provision in this act for the consequences for their families in situations like this.
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I think this is a really interesting. Group of amendments, and I think it's raised more questions for me it's raised more questions for me than it's probably answered. In terms of when we talk about injury, I immediately think about people I immediately think about people who've had a spinal cord injury, who become a quadriplegic or who become a quadriplegic or paraplegic by the very nature of my former career, I know a lot of wheelchair users who've been
15:54
Baroness Grey-Thompson (Crossbench)
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Baroness Grey-Thompson (Crossbench)
wheelchair users who've been through various compensation cases. Luckily, these days, the survival rate for someone paraplegia or tetraplegia is is very high. But I think we also have to take that into account. Thinking I hadn't thought before about the impact on anyone that's been in the military. And again, I know quite a few people who are injured through the military. And I think, you know, generally the public are very supportive of of the military and what they've gone through, and we wouldn't want any unintended consequences for them.
But when I was looking at things like asbestosis and other conditions that have been debated in this group, it became very clear that the conditions present, in many cases quite late, when treatment is then very difficult and many die before the compensation claim has gone through. And I know we've talked before about coercion, and I know Miss Leadbeater's said in in various debates and comments that she's concerned about people being coerced not to end their life.
And this is actually a situation where I could see this happening, because if you go online just just a few minutes, you you Google asbestosis compensation or spinal cord injury compensation, there's a plethora of websites that come up straight away with calculators that you can have an indication of how much you could possibly gain. And I had a look and it goes from a couple of thousand pounds for back injury, which obviously wouldn't account for this up to £493,000 for someone with quadriplegia.
But in terms of asbestosis, the figures given as a range were £50,000 to £1 million and that is a life changing amount of money for many, many families in this country. And it will colour the decisions they make. And this is slightly strange. You know, we talk about someone being a burden and but but actually people will make a different decision because they're thinking of their children and their grandchildren and protecting them for the rest of their lives.
So I do think a lot of clarity is needed in this space in terms of making sure that coercion doesn't go either way. And I'd be very interested in understanding from the noble and learned Lord, what intends to do to actually offer greater clarification for
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this group of amendments? My Lords, as we've heard from my noble friend Lord Harper. His amendments 70.
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His amendments 70. And 78 seek to expand the definition of terminal illness beyond illness or disease to beyond illness or disease to include terminal injuries. If this amendment were accepted, it would enable those who have suffered enable those who have suffered terminal injuries through military service, for example, or industrial injuries, to access assistance
But when I was looking at things like asbestosis and other conditions that have been debated in this group, it became very clear that the conditions present, in many cases quite late, when treatment is then very difficult and many die before the compensation claim has gone through. And I know we've talked before about coercion, and I know Miss Leadbeater's said in in various debates and comments that she's concerned about people being coerced not to end their life.
And this is actually a situation where I could see this happening, because if you go online just just a few minutes, you you Google asbestosis compensation or spinal cord injury compensation, there's a plethora of websites that come up straight away with calculators that you can have an indication of how much you could possibly gain. And I had a look and it goes from a couple of thousand pounds for back injury, which obviously wouldn't account for this up to £493,000 for someone with quadriplegia.
But in terms of asbestosis, the figures given as a range were £50,000 to £1 million and that is a life changing amount of money for many, many families in this country. And it will colour the decisions they make. And this is slightly strange. You know, we talk about someone being a burden and but but actually people will make a different decision because they're thinking of their children and their grandchildren and protecting them for the rest of their lives.
So I do think a lot of clarity is needed in this space in terms of making sure that coercion doesn't go either way. And I'd be very interested in understanding from the noble and learned Lord, what intends to do to actually offer greater clarification for
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this group of amendments? My Lords, as we've heard from my noble friend Lord Harper. His amendments 70.
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His amendments 70. And 78 seek to expand the definition of terminal illness beyond illness or disease to beyond illness or disease to include terminal injuries. If this amendment were accepted, it would enable those who have suffered enable those who have suffered terminal injuries through military service, for example, or industrial injuries, to access assistance
15:57
Earl Howe (Conservative)
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Earl Howe (Conservative)
injuries, to access assistance under this bill. My Lords, it seems to me that these amendments are helpful in at least two ways. First of all, they raise the question of how we should define a terminal illness or disease. If a person has been injured and has a prognosis of
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six months, should that. Be described? Should that person be described as terminally ill? For be described as terminally ill? For the purposes of the bill, I suggest that this is not just a question that this is not just a question for the noble and learned Lord. It's also one of relevance to Ministers since we've, as we've Ministers since we've, as we've said on previous occasions, it will be state run services that deliver be state run services that deliver assistance.
And on that account, Ministers will need to be clear on what constitutes terminal illness. Put another way, if, as Lord Hendy rightly said, an injury is legally distinct from an illness, why should people with six months to live for reasons other than an illness or disease be excluded from the scope of the bill? My noble friend Lord Blencathra argued that adding injury to illness would be a slippery slope. I think I need to reflect on that because I wasn't wholly convinced by by what he what he said, because there is a moral case, I would suggest, around an injured, terminally ill person, which we need to resolve.
By the same token, if the question remains open, are we happy that it will be left to the courts to expand the definition of illness? If that is what the court decides, and one could envisage that that that happening, the second way in which the amendments are helpful is the issue raised by my noble friend Lord Sandhurst amendment 829, which seeks to address a specific problem caused by the interaction between this bill and the Fatal Accidents Act, 1976.
Having listened to my noble friend, both my noble friends, I share their concern. And as amendment 829 rightly implies, it
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six months, should that. Be described? Should that person be described as terminally ill? For be described as terminally ill? For the purposes of the bill, I suggest that this is not just a question that this is not just a question for the noble and learned Lord. It's also one of relevance to Ministers since we've, as we've Ministers since we've, as we've said on previous occasions, it will be state run services that deliver be state run services that deliver assistance.
And on that account, Ministers will need to be clear on what constitutes terminal illness. Put another way, if, as Lord Hendy rightly said, an injury is legally distinct from an illness, why should people with six months to live for reasons other than an illness or disease be excluded from the scope of the bill? My noble friend Lord Blencathra argued that adding injury to illness would be a slippery slope. I think I need to reflect on that because I wasn't wholly convinced by by what he what he said, because there is a moral case, I would suggest, around an injured, terminally ill person, which we need to resolve.
By the same token, if the question remains open, are we happy that it will be left to the courts to expand the definition of illness? If that is what the court decides, and one could envisage that that that happening, the second way in which the amendments are helpful is the issue raised by my noble friend Lord Sandhurst amendment 829, which seeks to address a specific problem caused by the interaction between this bill and the Fatal Accidents Act, 1976.
Having listened to my noble friend, both my noble friends, I share their concern. And as amendment 829 rightly implies, it
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Baroness Finlay of Llandaff (Crossbench)
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Baroness Finlay of Llandaff (Crossbench)
Predictions Predictions are Predictions are highly Predictions are highly unreliable and is largely guesswork. Some national celebrities have clamoured for eligibility live for years, while others campaigning for this bill for themselves are clearly ineligible. Do doctors need to be 95% confident or 50% confident to rule that the patient will die within six months to be eligible? No validated clinical tools or tests exist to make such determinations with sufficient reliability.
For life ending decisions, this lack of reliable knowledge leaves clinicians to face pressure to make prognoses they cannot substantiate with concurrent legal risks and ethical dilemmas. Medical science recognises broad trajectories of decline. Those dying of cancer often experience a relatively long, stable period, followed by rapid deterioration over weeks or months. People with advanced organ failure, such as heart or lung disease, tend to decline in an unpredictable, fluctuating pattern marked by crises and partial recoveries. Others, particularly those with multiple conditions, neurological illness, or frailty, experience a slow, progressive dwindling over years, with an average of 20 or more months from identification of early palliative care needs to death, and during that time quite marked fluctuations.
Whilst these patterns help clinicians anticipate needs for care, they do not forecast how long an individual has left to live. A six month prognosis is not a clinical truth. Medical prognostication for terminal illnesses is based on averages. However, in the individual, marked variables influence survival, including treatment response, infections, and physiological resilience. A time based legal threshold would turn population level averages into high stakes individual errors approving some who are not within six months and denying others who are and assisted.
Death is irreversible, amplifying the consequences of prognostic errors and litigation. A systematic review of 42 studies on clinicians predictions in terminal cancer patients found very low accuracy rates, ranging from 23% upwards, in a multicentre study of over 2000 parts of care, patients with advanced cancer. Physicians clinical predictions were accurate in only 35% of cases. Tools like the surprise question would you be surprised if this patient's alive in a certain number of months or weeks have been tried as a way to predict those likely to die? It performs poorly at 6 to 12 month predictions, and especially for people who have multiple conditions.
The six month rule is unsafe and unworkable. Assisted dying legislation requires criteria that are objective, transparent, and as evidence based as possible. The definition must exclude conditions that can be meaningfully stabilised or controlled for years, as in amendment 104. In the name of my noble friend, Lady Baroness Grey-Thompson. Manageable conditions must not be treated as terminal. If somebody during an episode of depression or other life trauma, such as bereavement or in a relationship, Break-Up decides to stop whatever treatment they have when they're feeling suicidal, such as the diabetic who decides they stop their insulin, knowing that if they do, they will die within weeks.
My Lords, the arbitrary time of six months is unverifiable. You have a less than 50%, 50, 50% chance of being right. And the index of suspicion as written on the bill is far too low. A review paper by Scott Murray and Simon Atkin in the British Medical Journal in March described how inaccurate prognostic tools are and the importance of illness trajectories, which can provide broad timeframes and patterns of likely decline to help understand disease progress. Patients with frailty have been described as being on a tightrope.
Some will stay on for years, but others may suddenly be blown off by infection or by a fall and die rapidly. And this bill says nothing about pain or suffering or potential suffering. The only disease related issue is prognosis. Yet accuracy at six months below 50% is a pure guess that someone has six months to live. To tackle these problems. Amendment 71 and 77 and 90 are options to try to look at the progress of disease, to increase the chance of being a little more accurate at six months, which is at the point at which you could trigger the process of applying for an assisted death.
Amendment 79 would help clarify whether the disease is progressing, because some potential disease modifying treatments have been ignored, or the patient perhaps doesn't even know about them. The progress of the illness will give a far better indication of whether your rapidly deteriorating or whether you are, in fact, remarkably stable. Amendment 444 A would allow you to be monitored whilst you have other support. Having triggered a request for an assisted death, and that would allow specialist palliative care to be available to you if you wish to try out various suggestions.
Then as the disease is progressing more obviously towards death and there is a greater sense of predictability, the person would then be eligible for sign off by the panel and given the lethal drugs. The best evidence towards predictability would be the point that the prognostic index score indicates the person has a more than 50% chance of dying within six weeks. However, my amendment 444 A is a compromise because I am sure that many will feel that the six weeks is too short a time frame.
It's to suggest that the patient cannot have lethal drugs until they really are seen to be terminally ill, and the clinicians are more confident to predict that death will be likely to occur within three months. The patient, rapidly declining, would not need to wait from first assessment to having an assisted death, because they would be seen to be declining rapidly. But the patient who is completely stable would then not risk having the lethal drugs until there was evidence that they were actually in the last phase of their terminal illness, and some wrongful deaths could be avoided.
Some jurisdictions include frailty in a definition of terminal illness. Others don't. Evidence was sent to the Committee stage in the other place about this. It was a paper in Age and Ageing in 2025, entitled Why we need to consider frailty in the Assisted Dying Debate. With this extensive uncertainty around frailty and other multimorbid conditions, does the noble and learned Lord Moore include frailty in his definition of terminal illness, or does he not? And does he accept that disease progress is critically important to avoid wrongful deaths? I beg to move.
Amendment proposed clause two. Page
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two. Line four. After reversed. Insert or slowed. My Lords, Baroness Campbell of My Lords, Baroness Campbell of Surbiton is taking part remotely. I invite Baroness Campbell of
For life ending decisions, this lack of reliable knowledge leaves clinicians to face pressure to make prognoses they cannot substantiate with concurrent legal risks and ethical dilemmas. Medical science recognises broad trajectories of decline. Those dying of cancer often experience a relatively long, stable period, followed by rapid deterioration over weeks or months. People with advanced organ failure, such as heart or lung disease, tend to decline in an unpredictable, fluctuating pattern marked by crises and partial recoveries. Others, particularly those with multiple conditions, neurological illness, or frailty, experience a slow, progressive dwindling over years, with an average of 20 or more months from identification of early palliative care needs to death, and during that time quite marked fluctuations.
Whilst these patterns help clinicians anticipate needs for care, they do not forecast how long an individual has left to live. A six month prognosis is not a clinical truth. Medical prognostication for terminal illnesses is based on averages. However, in the individual, marked variables influence survival, including treatment response, infections, and physiological resilience. A time based legal threshold would turn population level averages into high stakes individual errors approving some who are not within six months and denying others who are and assisted.
Death is irreversible, amplifying the consequences of prognostic errors and litigation. A systematic review of 42 studies on clinicians predictions in terminal cancer patients found very low accuracy rates, ranging from 23% upwards, in a multicentre study of over 2000 parts of care, patients with advanced cancer. Physicians clinical predictions were accurate in only 35% of cases. Tools like the surprise question would you be surprised if this patient's alive in a certain number of months or weeks have been tried as a way to predict those likely to die? It performs poorly at 6 to 12 month predictions, and especially for people who have multiple conditions.
The six month rule is unsafe and unworkable. Assisted dying legislation requires criteria that are objective, transparent, and as evidence based as possible. The definition must exclude conditions that can be meaningfully stabilised or controlled for years, as in amendment 104. In the name of my noble friend, Lady Baroness Grey-Thompson. Manageable conditions must not be treated as terminal. If somebody during an episode of depression or other life trauma, such as bereavement or in a relationship, Break-Up decides to stop whatever treatment they have when they're feeling suicidal, such as the diabetic who decides they stop their insulin, knowing that if they do, they will die within weeks.
My Lords, the arbitrary time of six months is unverifiable. You have a less than 50%, 50, 50% chance of being right. And the index of suspicion as written on the bill is far too low. A review paper by Scott Murray and Simon Atkin in the British Medical Journal in March described how inaccurate prognostic tools are and the importance of illness trajectories, which can provide broad timeframes and patterns of likely decline to help understand disease progress. Patients with frailty have been described as being on a tightrope.
Some will stay on for years, but others may suddenly be blown off by infection or by a fall and die rapidly. And this bill says nothing about pain or suffering or potential suffering. The only disease related issue is prognosis. Yet accuracy at six months below 50% is a pure guess that someone has six months to live. To tackle these problems. Amendment 71 and 77 and 90 are options to try to look at the progress of disease, to increase the chance of being a little more accurate at six months, which is at the point at which you could trigger the process of applying for an assisted death.
Amendment 79 would help clarify whether the disease is progressing, because some potential disease modifying treatments have been ignored, or the patient perhaps doesn't even know about them. The progress of the illness will give a far better indication of whether your rapidly deteriorating or whether you are, in fact, remarkably stable. Amendment 444 A would allow you to be monitored whilst you have other support. Having triggered a request for an assisted death, and that would allow specialist palliative care to be available to you if you wish to try out various suggestions.
Then as the disease is progressing more obviously towards death and there is a greater sense of predictability, the person would then be eligible for sign off by the panel and given the lethal drugs. The best evidence towards predictability would be the point that the prognostic index score indicates the person has a more than 50% chance of dying within six weeks. However, my amendment 444 A is a compromise because I am sure that many will feel that the six weeks is too short a time frame.
It's to suggest that the patient cannot have lethal drugs until they really are seen to be terminally ill, and the clinicians are more confident to predict that death will be likely to occur within three months. The patient, rapidly declining, would not need to wait from first assessment to having an assisted death, because they would be seen to be declining rapidly. But the patient who is completely stable would then not risk having the lethal drugs until there was evidence that they were actually in the last phase of their terminal illness, and some wrongful deaths could be avoided.
Some jurisdictions include frailty in a definition of terminal illness. Others don't. Evidence was sent to the Committee stage in the other place about this. It was a paper in Age and Ageing in 2025, entitled Why we need to consider frailty in the Assisted Dying Debate. With this extensive uncertainty around frailty and other multimorbid conditions, does the noble and learned Lord Moore include frailty in his definition of terminal illness, or does he not? And does he accept that disease progress is critically important to avoid wrongful deaths? I beg to move.
Amendment proposed clause two. Page
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two. Line four. After reversed. Insert or slowed. My Lords, Baroness Campbell of My Lords, Baroness Campbell of Surbiton is taking part remotely. I invite Baroness Campbell of
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Baroness Campbell of Surbiton (Crossbench)
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Baroness Campbell of Surbiton (Crossbench)
Surbiton to speak. >> My Lords, before I speak to
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My Lords, before I speak to amendments in this group, I would like to say that I've also not like to say that I've also not received the letter sent from the noble and learned Lord Lord Faulks regarding amendments to proposals to return with. So I am somewhat in the dark today, since the content relate to remarks I am about to make now. So please check the distribution list and such information is crucial to our deliberations, especially when one relies so heavily on remote participation for inclusion as I do.
My Lords, I have added my name to amendments 71, 79 and 90. In the name of my noble friend Baroness Finlay of Lord Balfe, and my voice is weak. Today my words will be spoken by my voice facilitator.
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Amendment 71. Amendment 71 is
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Amendment 71. Amendment 71 is important because treatments which reverse or slow the effects of a terminal illness are being developed all the time. Patients developed all the time. Patients who would once have feared choking due to swallow deterioration can now receive nutrition through a now receive nutrition through a simple device, yet still taste food and even drink wine safely. Ventilators like mine are now commonplace and easily transportable. They offset debilitating shortness of breath and improve ability.
Improve ability to talk. There is much to be celebrated by medical developments and treatments, which give real choices to people challenged with life limiting and terminal health conditions. Those seeking an assisted death need to know about them. For example, why would anyone be aware of improvements in, say, ventilation unless they, a family member or friend receive that benefit? Indeed, medical professionals in other specialities are also unlikely to know about them. But knowledge is power.
It eases anxiety and it offers hope. To paraphrase Donald Rumsfeld, you don't know what you don't know. Amendment 71 seeks to add an essential safeguard ensuring someone does not elect for an assisted death due to an unknown, unknown. People with terminal illnesses will often be unaware of the latest developments, both in medical and social care. Their immediate circle, and the doctors and allied professionals they turn to may also not be familiar with them. We know that fear of the future, potential pain and loss of autonomy are key factors in wanting a change in the law.
But if these fears are based on lack of knowledge, that is not a good reason for an assisted death. Lack of knowledge equals lack of choice. Turning to amendment 79, I wish to thank the noble and learned Lord, Lord Falconer, for meeting with me and to distinguished consultants from Saint Thomas's Hospital this week, namely Professor Nicholas Hart and Doctor Robin Howard. Both are experts in treating patients with complex and progressive illnesses. They explained why diagnosis and prognosis alone cannot be reliable indicators of how and when a person can be reasonably expected to die.
They also illustrated the very wide range of medical, technical, pharmaceutical, social and environmental modifying treatments that can slow down progression and alleviate systems of symptoms. They gave powerful examples of terminally ill patients living far beyond their prognosis and thriving at home and in the community due to good quality health and social care interventions, there is hardly anything more important in this bill than determination of prognosis. Naturally, prognosis will be highly dependent upon the treatment received.
Disease modifying treatments will be highly significant. Prognosis will vary greatly depending on whether the person received no treatment, poor or inadequate treatment, or indeed best practice. Take my own condition spinal muscular atrophy. I have been given different prognoses over the years depending upon the hospital and attending doctors. Indeed, when I was admitted to my local hospital with a chest infection, the senior consultant in intestine in intensive care informed my husband it would not be in my best interest or even fair to treat me as I was at the end of life.
That was over ten years ago and here I am. I am not alone. I can give your Lordships many examples of inappropriate prognostication, prognostication of people with progressive health conditions, especially those with a neuromuscular diagnosis. I thank my lucky stars. I have a consultant who has advocated life saving operations and treatments over the years. Friends of mine have not been so lucky. My Lords, we have a responsibility to ensure anyone seeking an assisted death has experience of the best possible care and support available to them.
An assisted death should never be seen as a better alternative than suboptimal treatment, not by members of this House, the individual, their family, friends or the wider society. My Lords, when you're at your lowest help from medicine, technology and good care and support can mean the difference between hope or despair, life or death. That is why I support these amendments. Lastly, turning to amendment 90. This addresses an especially important consideration for those who may not voluntarily stop eating and drinking.
There is nothing voluntary about eating disorders, and people with eating disorders do not typically cease intake of fluids. People with such conditions talk of being controlled by anorexia. The mental illness is such. They feel they have no choice but to do anorexia's bidding. Despite this, they present as articulate, knowledgeable and with mental capacity. American born Chelsea Roth was diagnosed with anorexia and given a few months to live. Thankfully, she got the right help, information and medical support before medical aid in dying was legalised in her country.
She now lives in London, where she leads the eat, Breathe, Thrive Foundation for eating Disorders to support and advocate for people in this this situation. She tells me she is deeply concerned for her community, knowing that she and others like her could have ended their lives were it legal to do so. Miss Roth has drawn my attention to amendment 14, accepted with a without a vote in the other place tabled by Naz Shah MP. This provides that someone cannot be considered terminally ill only because they have voluntarily chosen to stop eating and drinking.
Clause two two is necessary to prevent individuals from effectively manufacturing a terminal illness through self-starvation or dehydration, in order to qualify for an assisted death, something that has already occurred in the state of Oregon. It does not, however, on its own, provide adequate protection, a protection for people with eating disorders. As Miss Shaw herself has said, a loophole remains.
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Lord Oates people with anorexia do not stop eating voluntarily, and do not stop eating voluntarily, and many eating disorders, including many eating disorders, including including body, can be life threatening without involving cessation of food and fluids. Amendment 90 will address this gap
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My Lords, before I speak to amendments in this group, I would like to say that I've also not like to say that I've also not received the letter sent from the noble and learned Lord Lord Faulks regarding amendments to proposals to return with. So I am somewhat in the dark today, since the content relate to remarks I am about to make now. So please check the distribution list and such information is crucial to our deliberations, especially when one relies so heavily on remote participation for inclusion as I do.
My Lords, I have added my name to amendments 71, 79 and 90. In the name of my noble friend Baroness Finlay of Lord Balfe, and my voice is weak. Today my words will be spoken by my voice facilitator.
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Amendment 71. Amendment 71 is
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Amendment 71. Amendment 71 is important because treatments which reverse or slow the effects of a terminal illness are being developed all the time. Patients developed all the time. Patients who would once have feared choking due to swallow deterioration can now receive nutrition through a now receive nutrition through a simple device, yet still taste food and even drink wine safely. Ventilators like mine are now commonplace and easily transportable. They offset debilitating shortness of breath and improve ability.
Improve ability to talk. There is much to be celebrated by medical developments and treatments, which give real choices to people challenged with life limiting and terminal health conditions. Those seeking an assisted death need to know about them. For example, why would anyone be aware of improvements in, say, ventilation unless they, a family member or friend receive that benefit? Indeed, medical professionals in other specialities are also unlikely to know about them. But knowledge is power.
It eases anxiety and it offers hope. To paraphrase Donald Rumsfeld, you don't know what you don't know. Amendment 71 seeks to add an essential safeguard ensuring someone does not elect for an assisted death due to an unknown, unknown. People with terminal illnesses will often be unaware of the latest developments, both in medical and social care. Their immediate circle, and the doctors and allied professionals they turn to may also not be familiar with them. We know that fear of the future, potential pain and loss of autonomy are key factors in wanting a change in the law.
But if these fears are based on lack of knowledge, that is not a good reason for an assisted death. Lack of knowledge equals lack of choice. Turning to amendment 79, I wish to thank the noble and learned Lord, Lord Falconer, for meeting with me and to distinguished consultants from Saint Thomas's Hospital this week, namely Professor Nicholas Hart and Doctor Robin Howard. Both are experts in treating patients with complex and progressive illnesses. They explained why diagnosis and prognosis alone cannot be reliable indicators of how and when a person can be reasonably expected to die.
They also illustrated the very wide range of medical, technical, pharmaceutical, social and environmental modifying treatments that can slow down progression and alleviate systems of symptoms. They gave powerful examples of terminally ill patients living far beyond their prognosis and thriving at home and in the community due to good quality health and social care interventions, there is hardly anything more important in this bill than determination of prognosis. Naturally, prognosis will be highly dependent upon the treatment received.
Disease modifying treatments will be highly significant. Prognosis will vary greatly depending on whether the person received no treatment, poor or inadequate treatment, or indeed best practice. Take my own condition spinal muscular atrophy. I have been given different prognoses over the years depending upon the hospital and attending doctors. Indeed, when I was admitted to my local hospital with a chest infection, the senior consultant in intestine in intensive care informed my husband it would not be in my best interest or even fair to treat me as I was at the end of life.
That was over ten years ago and here I am. I am not alone. I can give your Lordships many examples of inappropriate prognostication, prognostication of people with progressive health conditions, especially those with a neuromuscular diagnosis. I thank my lucky stars. I have a consultant who has advocated life saving operations and treatments over the years. Friends of mine have not been so lucky. My Lords, we have a responsibility to ensure anyone seeking an assisted death has experience of the best possible care and support available to them.
An assisted death should never be seen as a better alternative than suboptimal treatment, not by members of this House, the individual, their family, friends or the wider society. My Lords, when you're at your lowest help from medicine, technology and good care and support can mean the difference between hope or despair, life or death. That is why I support these amendments. Lastly, turning to amendment 90. This addresses an especially important consideration for those who may not voluntarily stop eating and drinking.
There is nothing voluntary about eating disorders, and people with eating disorders do not typically cease intake of fluids. People with such conditions talk of being controlled by anorexia. The mental illness is such. They feel they have no choice but to do anorexia's bidding. Despite this, they present as articulate, knowledgeable and with mental capacity. American born Chelsea Roth was diagnosed with anorexia and given a few months to live. Thankfully, she got the right help, information and medical support before medical aid in dying was legalised in her country.
She now lives in London, where she leads the eat, Breathe, Thrive Foundation for eating Disorders to support and advocate for people in this this situation. She tells me she is deeply concerned for her community, knowing that she and others like her could have ended their lives were it legal to do so. Miss Roth has drawn my attention to amendment 14, accepted with a without a vote in the other place tabled by Naz Shah MP. This provides that someone cannot be considered terminally ill only because they have voluntarily chosen to stop eating and drinking.
Clause two two is necessary to prevent individuals from effectively manufacturing a terminal illness through self-starvation or dehydration, in order to qualify for an assisted death, something that has already occurred in the state of Oregon. It does not, however, on its own, provide adequate protection, a protection for people with eating disorders. As Miss Shaw herself has said, a loophole remains.
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Lord Oates people with anorexia do not stop eating voluntarily, and do not stop eating voluntarily, and many eating disorders, including many eating disorders, including including body, can be life threatening without involving cessation of food and fluids. Amendment 90 will address this gap
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Lord Pannick (Crossbench)
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Lord Pannick (Crossbench)
and further protect people with anorexia. Thank you. >> Say what a great pleasure it is to follow Baroness Campbell of Surbiton, and also to add how pleased I am. I'm sure all noble Lords are that she is very much still with us, and I hope you'll be with us for many years to come. This is an important group and it's an important group because, as has been emphasised, scientific precision is of course not possible in this area.
Nobody could say that. A doctor can tell you that you will die within six months, but the bill does not. So provide the bill's conditions only require that the doctor and the panel in due course are satisfied that the person has an inevitably progressive illness or disease, which cannot be reversed by treatment and the person's death in consequence, can reasonably be expected within six months and reasonably be expected. Recognises the absence of scientific certainty of absolute knowledge in this very difficult area.
Now why, in my opinion, does the Bill so provide the noble and learned Lord will give his views? You, of course. But why, in my view, is the bill right to so provide? Because and we're down to the fundamentals of this legislation. Because if I'm told by my doctor that I sadly have an inevitable progressive illness or disease, and my death can reasonably, reasonably be expected within six months, I should have the choice of saying I wish to end my life by taking advantage of the provisions of this bill, and each of these amendments seeks fundamentally to undermine the core of this bill and the philosophy which guides this bill.
I entirely accept that opponents of the bill disagree. But this is the core of the bill, and this is why the bill, rightly so, provides, and it is no answer to these provisions and to this philosophy that happily, having been given that prognosis, I may well, should I choose not to exercise the provisions. The powers under this bill live for seven months or 12 months, or two years, or however long. It would be wonderful if my doctors were incorrect.
But it is my choice, having been given that prognosis. That is what this bill is about. It is right and proper that we ensure, and we've taken days debating it. It's right and proper that that decision is made on a voluntary basis, that there's no coercion. But once those conditions are satisfied, if I'm told by my doctor that is my prognosis, then it
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should be my choice whether to use the provisions in this bill. Whether he agrees.
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Whether he agrees. With me that one of the international facts, which supports international facts, which supports entirely the position he's now taking, is that in the 33 now taking, is that in the 33 now jurisdictions where this where assisted dying is now allowed, it assisted dying is now allowed, it is usually the case and I cite 1 or 2 where over a third of those who in fact make the choice which he's described following that suggestion by their doctor or prognosis or whatever you want to describe it, then do not use the the provision which is provided simply because which is provided simply because there's no question that they want to die, but simply that they are using it almost as an insurance policy.
Nobody could say that. A doctor can tell you that you will die within six months, but the bill does not. So provide the bill's conditions only require that the doctor and the panel in due course are satisfied that the person has an inevitably progressive illness or disease, which cannot be reversed by treatment and the person's death in consequence, can reasonably be expected within six months and reasonably be expected. Recognises the absence of scientific certainty of absolute knowledge in this very difficult area.
Now why, in my opinion, does the Bill so provide the noble and learned Lord will give his views? You, of course. But why, in my view, is the bill right to so provide? Because and we're down to the fundamentals of this legislation. Because if I'm told by my doctor that I sadly have an inevitable progressive illness or disease, and my death can reasonably, reasonably be expected within six months, I should have the choice of saying I wish to end my life by taking advantage of the provisions of this bill, and each of these amendments seeks fundamentally to undermine the core of this bill and the philosophy which guides this bill.
I entirely accept that opponents of the bill disagree. But this is the core of the bill, and this is why the bill, rightly so, provides, and it is no answer to these provisions and to this philosophy that happily, having been given that prognosis, I may well, should I choose not to exercise the provisions. The powers under this bill live for seven months or 12 months, or two years, or however long. It would be wonderful if my doctors were incorrect.
But it is my choice, having been given that prognosis. That is what this bill is about. It is right and proper that we ensure, and we've taken days debating it. It's right and proper that that decision is made on a voluntary basis, that there's no coercion. But once those conditions are satisfied, if I'm told by my doctor that is my prognosis, then it
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should be my choice whether to use the provisions in this bill. Whether he agrees.
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Whether he agrees. With me that one of the international facts, which supports international facts, which supports entirely the position he's now taking, is that in the 33 now taking, is that in the 33 now jurisdictions where this where assisted dying is now allowed, it assisted dying is now allowed, it is usually the case and I cite 1 or 2 where over a third of those who in fact make the choice which he's described following that suggestion by their doctor or prognosis or whatever you want to describe it, then do not use the the provision which is provided simply because which is provided simply because there's no question that they want to die, but simply that they are using it almost as an insurance policy.
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Baroness Jay of Paddington (Labour)
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Baroness Jay of Paddington (Labour)
Is a very important point, because this bill is concerned about providing choice. There is no mandatory obligation. Of course not. But if you're given this information, you should have the right. It's your life to decide whether you wish to take advantage of these provisions. I would argue strongly in many cases if it were me, if it were my family, that there are other options, other things should be done, of course. But but it is a choice and people should have that choice.
That is the philosophy. That is what has guided so many jurisdictions around the world. Many noble Lords don't agree with that and that is their right. But that's what this bill is all about.
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Lord sits. Down. He emphasises, rightly.
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He emphasises, rightly. Emphasises, that choice is an essential element of this. But in essential element of this. But in so emphasising he appears to cast so emphasising he appears to cast this word choice in a very black and white manner, as if choice can suggest not perhaps 100%, but 99% certainty one way or another. And I'm sure the noble Lord is very grateful that he's never been in the situation of the patient sitting in that chair having a conversation with a doctor, as I have, unfortunately, and I can tell him that it's not a conversation with one doctor.
It's a conversation across a multiple range of people because doctors want you to have second opinions and speak to others and see if others might be better able to to help, to think of how you might ameliorate your, your, your illness, particularly as in the case of cancer. And what they tend to do is not to give you that choice of you are likely to reasonably going to be dead in six months. Well, they're more likely to say, let's see if X or Y or Z treatment or drug will perhaps help you.
We need to try that for a little while. And then when you do that, then you see what the results are. And that's how that is the reason I would say with great respect to, to noble Lady, lady, lady J. That in the impact assessment, we're told the 66% of people in the two jurisdictions referenced were cancer patients. And she's quite right to say that 40% of those cancer patients with didn't exercise their right. Well, potentially one of the reasons I said this in second readings, I'm not going to repeat it, but potentially one of the reasons it didn't exercise that choice, because that certainty of choice changed.
The situation changed as they went along. And perhaps that's why they didn't exercise. So, so, so much emphasis on choice. Perhaps is is unwise in this uncertain world.
That is the philosophy. That is what has guided so many jurisdictions around the world. Many noble Lords don't agree with that and that is their right. But that's what this bill is all about.
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Lord sits. Down. He emphasises, rightly.
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He emphasises, rightly. Emphasises, that choice is an essential element of this. But in essential element of this. But in so emphasising he appears to cast so emphasising he appears to cast this word choice in a very black and white manner, as if choice can suggest not perhaps 100%, but 99% certainty one way or another. And I'm sure the noble Lord is very grateful that he's never been in the situation of the patient sitting in that chair having a conversation with a doctor, as I have, unfortunately, and I can tell him that it's not a conversation with one doctor.
It's a conversation across a multiple range of people because doctors want you to have second opinions and speak to others and see if others might be better able to to help, to think of how you might ameliorate your, your, your illness, particularly as in the case of cancer. And what they tend to do is not to give you that choice of you are likely to reasonably going to be dead in six months. Well, they're more likely to say, let's see if X or Y or Z treatment or drug will perhaps help you.
We need to try that for a little while. And then when you do that, then you see what the results are. And that's how that is the reason I would say with great respect to, to noble Lady, lady, lady J. That in the impact assessment, we're told the 66% of people in the two jurisdictions referenced were cancer patients. And she's quite right to say that 40% of those cancer patients with didn't exercise their right. Well, potentially one of the reasons I said this in second readings, I'm not going to repeat it, but potentially one of the reasons it didn't exercise that choice, because that certainty of choice changed.
The situation changed as they went along. And perhaps that's why they didn't exercise. So, so, so much emphasis on choice. Perhaps is is unwise in this uncertain world.
16:46
Lord Pannick (Crossbench)
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Lord Pannick (Crossbench)
Began by asking you about my experiences. I don't really want to experiences. I don't really want to talk about my personal experiences, except to say that those I have except to say that those I have loved have faced terminal diagnosis. So I'm very familiar with all of this on a personal basis, as I'm this on a personal basis, as I'm sure is everyone or almost everyone in this committee. And our experiences, of course, guide our view as to the merits or otherwise
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of this bill. Lord. A question and this is not a trick question. I sincerely want to trick question. I sincerely want to know what his opinion of it is. From a legal point of view. The bill refers, and he has said that bill refers, and he has said that the bill refers to a reasonable expectation of death within six expectation of death within six months normally, and this was a point made by the noble Baroness, point made by the noble Baroness, Lady Findlay of Clonduff, just now.
And I have some amendments later which address this specifically. Normally a prognosis given by a doctor in a particular case would be a medium that an average, an average of the sort we call a medium. That is, it says that 50% of people in your position will die within six months, but 50% will live longer than six months. Now, which one are you? And I just want to know, would that 50% constitute for him a reasonable expectation, or would he expect a higher threshold to apply in a case like this? I hope I've made that.
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The noble Lord, that I don't think any doctor, any panel, any think any doctor, any panel, any court would adopt that type of approach to a complicated issue of approach to a complicated issue of this sort. They would rely upon the judgement of the doctor, who no doubt would be well aware or should doubt would be well aware or should be well aware of the provisions of this bill. If enacted, the doctor this bill. If enacted, the doctor will exercise his or her judgement and will be able to tell the patient whether there is a reasonable expectation of death within six months.
And the doctor? The doctor will give that that judgement. And and whether you're eligible under the bill depends upon that judgement. It's as simple as that.
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of this bill. Lord. A question and this is not a trick question. I sincerely want to trick question. I sincerely want to know what his opinion of it is. From a legal point of view. The bill refers, and he has said that bill refers, and he has said that the bill refers to a reasonable expectation of death within six expectation of death within six months normally, and this was a point made by the noble Baroness, point made by the noble Baroness, Lady Findlay of Clonduff, just now.
And I have some amendments later which address this specifically. Normally a prognosis given by a doctor in a particular case would be a medium that an average, an average of the sort we call a medium. That is, it says that 50% of people in your position will die within six months, but 50% will live longer than six months. Now, which one are you? And I just want to know, would that 50% constitute for him a reasonable expectation, or would he expect a higher threshold to apply in a case like this? I hope I've made that.
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The noble Lord, that I don't think any doctor, any panel, any think any doctor, any panel, any court would adopt that type of approach to a complicated issue of approach to a complicated issue of this sort. They would rely upon the judgement of the doctor, who no doubt would be well aware or should doubt would be well aware or should be well aware of the provisions of this bill. If enacted, the doctor this bill. If enacted, the doctor will exercise his or her judgement and will be able to tell the patient whether there is a reasonable expectation of death within six months.
And the doctor? The doctor will give that that judgement. And and whether you're eligible under the bill depends upon that judgement. It's as simple as that.
16:49
Lord Farmer (Conservative)
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Lord Farmer (Conservative)
Lord, simply. Well, my Lords. >> The noble Lord Pannick is quite right that autonomy is the basic right that autonomy is the basic principle under this bill. And in fact, the noble Lord, Lord Faulkner, told the Select Committee. The essence of the bill before us is autonomy, which which makes it an outlier. But terminal illness plus an autonomous decision should not be the model that allows this bill to be engaged. That terminal illness must also be causing suffering. And this is why I support my noble friend Lord Frost amendment 84.
Rather than this being a cruel and heartless precondition, there are many public policy reasons for this that others have mentioned. I'm sure first, it would prevent social and economic circumstances in fear of being a burden from driving applications for assisted suicide. Second, if suffering were included, doctors could probably discuss palliative care and pain management, and lack of care could never be the motivation. Finally, there's a democratic imperative the publicly presented raison d'etre for this bill is always the relief of suffering, yet without a suffering requirement, assisted suicide can be for any reason.
If there's a terminal illness judged to lead to death within six months. Others have said why this six month rule is is unsafe and unworkable. Baroness Finlay of Llandaff I mean, we're glad Esther Rantzen is still with us three months. Three years after she was diagnosed with stage four lung cancer and we all sympathise greatly and genuinely with the loss of control she's facing. None of us look forward to that. And like Dame Esther, I'm also in my ninth decade.
It's not at all theoretical that I, or indeed anybody else in this chamber, might be in a similar position fairly soon. None of us can be casual or flippant about the loss of autonomy. However, neither can we be reckless about this further move into what is in fact, extreme bodily autonomy. I am particularly taken by the late Rabbi Jonathan Sacks treatment of autonomy and the noble Lord, Lord Falconer, assured the nation on the today programme yesterday that he respects people of faith throughout morality.
The last book sacks published whilst alive, he stressed that human dignity does not come from autonomy alone, but from being in relationship with others and, dare I say it with God. The thread running through is that we are moral beings because we are not alone. Autonomy is, he said, a significant moral principle. But there are other values, equally significant that limit or limits autonomy when it comes to life and death. Society must decide whether life is something we own or something over which we are stewards.
For sacks, redefining life as private property is inherently dangerous. If life becomes seen as disposable at will, society risks weakening its shared responsibility to protect and care for the vulnerable. When autonomy is allowed to trump all other values, the moral fabric of care and duty becomes to unravel, allowing assisted suicide to enable unfettered choice shifts dignity away from intrinsic worth towards functionality or self-sufficiency, a dangerous precedent once the boundary between caring for life and ending life is blurred, society risks losing reverence for the vulnerable.
Sacks treats the enthroning of personal autonomy as symptomatic of our cultural shift away from shared moral responsibility, a we orientation to hyper individualism. The fixation on me, which you could also say is selfishness, assisted suicide, further skews this imbalance by treating life purely as an individual possession rather than a shared trust, it's not surprising the bill's sponsors have gone down the same autonomy rather than suffering route as the US has done, because international metrics bracket US with the US in terms of how individualistic we are as a nation.
Yet Australia has an even higher individualism score than the UK states and territories within IT and other high scoring countries such as Netherlands, Canada, New Zealand have all resisted the siren song of extreme bodily autonomy in this area. And so should we. I
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mentioned shrouded attributes. This is a pretty high quality speech. It has pretty little to do speech. It has pretty little to do with the six months. It's got to do with the whole principle of the bill. I'm just wondering whether or bill. I'm just wondering whether or not it's going to connect back into the six months.
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the six months. I'm supporting noble Lord David Frosts inclusion of suffering, Frosts inclusion of suffering, which is increasing the choice from autonomy to to increase suffering. And that's how it joins here. As people have said before, many Lords have said it's a very important area for us to discuss, and it's the underlying principle that that the noble Lord has said is is supporting this bill. I mentioned shrouded attributes of Second Reading, long term unintended consequences of a course of action that might be politically attractive in the short term.
Others have warned of the inevitable widening of this bill through judicial review and future legislation. But I want to point out where else extreme bodily autonomy might take us. It's currently illegal to sell body materials. No money can change hands apart from fixed compensation for expenses incurred donating eggs, sperm and live organs like kidneys, all people can get for donating blood and plasma is like refreshments, asserting autonomy and ownership over body parts would mean people could sell one of their kidneys, perhaps to get out of debt.
I mean, do we really want that? There's also the rare condition of body integrity dysphoria or Bid. They feel that they have a specific, healthy part of their body that does not belong to them, that their body might only feel right if it were removed or disabled? Until this happens, and sadly, sometimes after amputation, they experience intense, persistent distress, which usually starts in childhood or early adolescence and is life long again. Do we really want what would be illegal for doctors to perform now in this area, to become legal and socially acceptable? It's our duty and role in the UK legislative system to bottom out these shrouded attributes, these long term culture shifting consequences.
Bodily autonomy can never be treated as an absolute right. It must also always be balanced against our status as moral social beings. Its primacy in this bill is not a virtue, but a fatal flaw.
Rather than this being a cruel and heartless precondition, there are many public policy reasons for this that others have mentioned. I'm sure first, it would prevent social and economic circumstances in fear of being a burden from driving applications for assisted suicide. Second, if suffering were included, doctors could probably discuss palliative care and pain management, and lack of care could never be the motivation. Finally, there's a democratic imperative the publicly presented raison d'etre for this bill is always the relief of suffering, yet without a suffering requirement, assisted suicide can be for any reason.
If there's a terminal illness judged to lead to death within six months. Others have said why this six month rule is is unsafe and unworkable. Baroness Finlay of Llandaff I mean, we're glad Esther Rantzen is still with us three months. Three years after she was diagnosed with stage four lung cancer and we all sympathise greatly and genuinely with the loss of control she's facing. None of us look forward to that. And like Dame Esther, I'm also in my ninth decade.
It's not at all theoretical that I, or indeed anybody else in this chamber, might be in a similar position fairly soon. None of us can be casual or flippant about the loss of autonomy. However, neither can we be reckless about this further move into what is in fact, extreme bodily autonomy. I am particularly taken by the late Rabbi Jonathan Sacks treatment of autonomy and the noble Lord, Lord Falconer, assured the nation on the today programme yesterday that he respects people of faith throughout morality.
The last book sacks published whilst alive, he stressed that human dignity does not come from autonomy alone, but from being in relationship with others and, dare I say it with God. The thread running through is that we are moral beings because we are not alone. Autonomy is, he said, a significant moral principle. But there are other values, equally significant that limit or limits autonomy when it comes to life and death. Society must decide whether life is something we own or something over which we are stewards.
For sacks, redefining life as private property is inherently dangerous. If life becomes seen as disposable at will, society risks weakening its shared responsibility to protect and care for the vulnerable. When autonomy is allowed to trump all other values, the moral fabric of care and duty becomes to unravel, allowing assisted suicide to enable unfettered choice shifts dignity away from intrinsic worth towards functionality or self-sufficiency, a dangerous precedent once the boundary between caring for life and ending life is blurred, society risks losing reverence for the vulnerable.
Sacks treats the enthroning of personal autonomy as symptomatic of our cultural shift away from shared moral responsibility, a we orientation to hyper individualism. The fixation on me, which you could also say is selfishness, assisted suicide, further skews this imbalance by treating life purely as an individual possession rather than a shared trust, it's not surprising the bill's sponsors have gone down the same autonomy rather than suffering route as the US has done, because international metrics bracket US with the US in terms of how individualistic we are as a nation.
Yet Australia has an even higher individualism score than the UK states and territories within IT and other high scoring countries such as Netherlands, Canada, New Zealand have all resisted the siren song of extreme bodily autonomy in this area. And so should we. I
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mentioned shrouded attributes. This is a pretty high quality speech. It has pretty little to do speech. It has pretty little to do with the six months. It's got to do with the whole principle of the bill. I'm just wondering whether or bill. I'm just wondering whether or not it's going to connect back into the six months.
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the six months. I'm supporting noble Lord David Frosts inclusion of suffering, Frosts inclusion of suffering, which is increasing the choice from autonomy to to increase suffering. And that's how it joins here. As people have said before, many Lords have said it's a very important area for us to discuss, and it's the underlying principle that that the noble Lord has said is is supporting this bill. I mentioned shrouded attributes of Second Reading, long term unintended consequences of a course of action that might be politically attractive in the short term.
Others have warned of the inevitable widening of this bill through judicial review and future legislation. But I want to point out where else extreme bodily autonomy might take us. It's currently illegal to sell body materials. No money can change hands apart from fixed compensation for expenses incurred donating eggs, sperm and live organs like kidneys, all people can get for donating blood and plasma is like refreshments, asserting autonomy and ownership over body parts would mean people could sell one of their kidneys, perhaps to get out of debt.
I mean, do we really want that? There's also the rare condition of body integrity dysphoria or Bid. They feel that they have a specific, healthy part of their body that does not belong to them, that their body might only feel right if it were removed or disabled? Until this happens, and sadly, sometimes after amputation, they experience intense, persistent distress, which usually starts in childhood or early adolescence and is life long again. Do we really want what would be illegal for doctors to perform now in this area, to become legal and socially acceptable? It's our duty and role in the UK legislative system to bottom out these shrouded attributes, these long term culture shifting consequences.
Bodily autonomy can never be treated as an absolute right. It must also always be balanced against our status as moral social beings. Its primacy in this bill is not a virtue, but a fatal flaw.
16:56
Lord Moore of Etchingham (Non-affiliated)
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Lord Moore of Etchingham (Non-affiliated)
High Court. said that this was at the heart of the bill, in the sense that I think he's right about that. And I think it illustrates one of the great it illustrates one of the great problems of the bill. You see, it's emerged very much from this debate. And the noble Lady Finlay made that clear that really this is very uncertain in any medical terms. And yet doctors are being asked to provide it. So why is that happening? Well, because it's the gateway.
It's a necessary gateway. And therefore it seems to me to set up very perverse incentives in the mind of the doctor. Professional problem. Most doctors who will wish to give such a prognosis will be in favour of assisted dying. That will seem the natural likelihood about all of this. And if they therefore want to give the patient or the applicant what he wants, they will be less likely to want to inquire about all the and help with other possible better treatments that might solve the problem, because actually, the patient may be in a situation when they want to, they want to die and they don't want to solve the problem.
So it seems to be a rather a big burden is being put on the doctors by this. And it's not really a professional. It's not right professionally. So why is this burden being put on them? Well, that of course, is by the result of the views of the progenitors of the bill. And I think the reason I'm guessing here why they concentrated on six months is they could see how difficult they're desperate to get it through in some way, and they could see how difficult it would be if you started to argue about unbearable pain, for example, what's the definition of unbearable? How does that how does that have a sort of scientific or objective? Sorry.
Sorry. I thought that the noble Lord was, was was intervening upon me. So? So it seems to me that what will happen once, if it were passed and and six months was the only sort of medical criterion, was that it would very quickly become obvious that it was not adequate as a reason for doing it. But of course, by then the progenitors of the bill would have scored their main hit, because they would have got it in law that autonomy triumphs and there is assisted dying.
And then later on they would say, and they'd be right, that if we have assisted dying, this is a silly criterion or inadequate criterion. And so we need other ones and we need more. So I'm sorry to use the the tired phrase, but it does seem to me to be a slippery slope.
It's a necessary gateway. And therefore it seems to me to set up very perverse incentives in the mind of the doctor. Professional problem. Most doctors who will wish to give such a prognosis will be in favour of assisted dying. That will seem the natural likelihood about all of this. And if they therefore want to give the patient or the applicant what he wants, they will be less likely to want to inquire about all the and help with other possible better treatments that might solve the problem, because actually, the patient may be in a situation when they want to, they want to die and they don't want to solve the problem.
So it seems to be a rather a big burden is being put on the doctors by this. And it's not really a professional. It's not right professionally. So why is this burden being put on them? Well, that of course, is by the result of the views of the progenitors of the bill. And I think the reason I'm guessing here why they concentrated on six months is they could see how difficult they're desperate to get it through in some way, and they could see how difficult it would be if you started to argue about unbearable pain, for example, what's the definition of unbearable? How does that how does that have a sort of scientific or objective? Sorry.
Sorry. I thought that the noble Lord was, was was intervening upon me. So? So it seems to me that what will happen once, if it were passed and and six months was the only sort of medical criterion, was that it would very quickly become obvious that it was not adequate as a reason for doing it. But of course, by then the progenitors of the bill would have scored their main hit, because they would have got it in law that autonomy triumphs and there is assisted dying.
And then later on they would say, and they'd be right, that if we have assisted dying, this is a silly criterion or inadequate criterion. And so we need other ones and we need more. So I'm sorry to use the the tired phrase, but it does seem to me to be a slippery slope.
16:59
Baroness Freeman of Steventon (Crossbench)
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Baroness Freeman of Steventon (Crossbench)
Can I make a very quick point? I wasn't expecting to speak on this, wasn't expecting to speak on this, so apologies for not being prepared, but when I was at Cambridge I worked on many risk communication worked on many risk communication tools that were used by doctors to help calculate somebody's prognosis, help calculate somebody's prognosis, particularly of cancer, and to communicate it to patients. And a very standard way of communicating that prognosis was to say, out of 100 patients with characteristics like yours, we would expect X number to be alive in one year or five years or whatever.
So I don't think it's unreasonable for us to be asking what reasonable means in terms of that number that would survive out of 100 at, say, six months. My Lords, I would like to speak to amendment 75, which I've
So I don't think it's unreasonable for us to be asking what reasonable means in terms of that number that would survive out of 100 at, say, six months. My Lords, I would like to speak to amendment 75, which I've
17:00
Baroness Hollins (Crossbench)
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Baroness Hollins (Crossbench)
added my name to, and I think it addresses probably the most addresses probably the most decisive yet hardest to confirm clinical issue and is central to clinical issue and is central to the bill. Prognosis is not determined by diagnosis alone. Throughout my career as a doctor, I've seen many patients whose disease sounded on paper as though disease sounded on paper as though disease was imminent, yet their course was significantly altered by evidence based treatment and high quality palliative care.
In evidence to the select committee, the Royal College of General Practitioners stated it is possible to make reasonably accurate prognosis of death within minutes, hours or a few days. When this stretches to months, then the scope for error can extend into days. And I agree with my noble friend that a 50% likelihood of a six month prognosis is not reasonable. Amendment 75 ensures that when we speak of an expected prognosis of six months, we do so in the context of treatment offered to them, in line with national Nice guidelines and tied to clinical reality.
Without this safeguard, there's a risk that people who choose to participate in assisted suicide could start the process even where treatment is delayed, unavailable, or not even offered, and where symptoms or fear of the future are instead driving a perception of hopelessness. A three month prognosis, as in amendment four for for a. My noble friend Lady Finlay, would be much more accurate, as there is an evidence based assessment tool available through the Continuing Healthcare Fast Track process.
Noble Lords may be unaware that fast track funding is available for those who have a rapidly deteriorating condition, where they are approaching the terminal stage and approaching the end of their life, and this funding is used to provide much needed nursing care, hospice involvement and support for families, and can be put in place usually within 48 hours. Now, NHS guidance notes that the Fast Track funding tool is used when urgent care is required at the end of life. The most robust data currently available comes from a 2023 observational study published in British medical journal Open Quality.
It examined 439 patients referred for NHS continuing Healthcare fast track funding, the median survival for patients whose fast track funding was approved was only 18 days, and a minority of patients were still alive at 90 days after referral, showing a much more accurate prognosis. The short survival time found in the study suggests that many referrals occur very late, sometimes limiting the ability to arrange preferred care settings. And I think ignorance within primary care of this funding pathway and its usefulness in supporting people to stay at home during their last days and weeks, contributes to its low take up, and perhaps the rather unnecessarily large number of people who spend their last days in in hospital.
Approval for fast track funding helps clinicians by grounding prognosis and already incredibly difficult task to predict in nationally agreed standards rather than variable local practice. There must be absolute clarity that no one becomes eligible for assisted suicide because the system has failed them, especially regarding geographical variability in treatment options or lack of awareness of these treatment options.
In evidence to the select committee, the Royal College of General Practitioners stated it is possible to make reasonably accurate prognosis of death within minutes, hours or a few days. When this stretches to months, then the scope for error can extend into days. And I agree with my noble friend that a 50% likelihood of a six month prognosis is not reasonable. Amendment 75 ensures that when we speak of an expected prognosis of six months, we do so in the context of treatment offered to them, in line with national Nice guidelines and tied to clinical reality.
Without this safeguard, there's a risk that people who choose to participate in assisted suicide could start the process even where treatment is delayed, unavailable, or not even offered, and where symptoms or fear of the future are instead driving a perception of hopelessness. A three month prognosis, as in amendment four for for a. My noble friend Lady Finlay, would be much more accurate, as there is an evidence based assessment tool available through the Continuing Healthcare Fast Track process.
Noble Lords may be unaware that fast track funding is available for those who have a rapidly deteriorating condition, where they are approaching the terminal stage and approaching the end of their life, and this funding is used to provide much needed nursing care, hospice involvement and support for families, and can be put in place usually within 48 hours. Now, NHS guidance notes that the Fast Track funding tool is used when urgent care is required at the end of life. The most robust data currently available comes from a 2023 observational study published in British medical journal Open Quality.
It examined 439 patients referred for NHS continuing Healthcare fast track funding, the median survival for patients whose fast track funding was approved was only 18 days, and a minority of patients were still alive at 90 days after referral, showing a much more accurate prognosis. The short survival time found in the study suggests that many referrals occur very late, sometimes limiting the ability to arrange preferred care settings. And I think ignorance within primary care of this funding pathway and its usefulness in supporting people to stay at home during their last days and weeks, contributes to its low take up, and perhaps the rather unnecessarily large number of people who spend their last days in in hospital.
Approval for fast track funding helps clinicians by grounding prognosis and already incredibly difficult task to predict in nationally agreed standards rather than variable local practice. There must be absolute clarity that no one becomes eligible for assisted suicide because the system has failed them, especially regarding geographical variability in treatment options or lack of awareness of these treatment options.
17:03
Baroness Lawlor (Conservative)
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Baroness Lawlor (Conservative)
Your indulgence. >> Tabled amendment. >> 72. >> An amendment 80. I won't say
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An amendment 80. I won't say anything about it other than to mention to the noble Lord Lord Pannick that it is a philosophical Pannick that it is a philosophical concept, but academic philosophy is very divided on whether how worthwhile it is as a concept which was drafted in in recent centuries. So I begin, if you, if I may, with my amendment 80, which is which substitutes some detail for the very vague requirement that death within six months can reasonably be expected.
We have already heard in the committee from everybody, not only today, but other days, that certain diagnoses of is a very inexact science or diagnosis is diagnosing someone has six months is very inexact. And we've heard from Baroness Finlay opening that conditions can differ, patterns differ, patients differ. We've heard as well. And from the noble Lady Baroness Hollins. And each patient must be assessed on an individual basis. Against this, my amendment proposes requires that the difficult job.
This is amendment 80. My Lords, the difficult job of assessment is done by two consultants specialising in the relevant area, and it pins down that the the expectation should be instead an 80% probability. And if the sponsors are in earnest, that those eligible really should be those who are within six months of death, they should be pleased to accept an amendment that tries to overcome the inexactness of such judgements by requiring confirmation of by the two most highly qualified experts in the area, or two of the most well, and they should accept that an 80% likelihood is what, in this context, can reasonably be expected.
Now I'll move on briefly to 72. The bill already refuses eligibility for assisted suicide when a condition that in itself is diagnosed to lead to death within six months cannot, can be, cannot be reversed. My amendment takes the next logical step by limiting eligibility to cases where the condition not only cannot be reversed, but also cannot be relieved, controlled, or ameliorated. So I'm adding to what has already been proposed in this group. The amendment aims to substitute a constructive, optimistic approach to treating illness, rather than one that writes off the patient and points them on the path to suicide.
The requirement that when steps cannot, can be taken to relieve, control, or ameliorate is a disease. The patient can no longer be considered for. Assisted suicide will remove many otherwise difficult cases from this murky area, and allow that the mechanisms that have been set up to operate as best they can. For those whom the bill on its face intends them. People whose deterioration is inevitable. And there is an even more pressing reason to take this amendment than these two, unless we positively exclude from eligibility patients whose condition could be relieved, controlled or ameliorated, we set up the conditions in which relief, control and amelioration of terminal illness will become increasingly rare.
We've heard some remarkable instances today, not least from Baroness Campbell, a Baroness Campbell of Surbiton whom I'm delighted to see back. But why will an overburdened health service try to give some extra months of life, a higher degree of relief, of pain or amelioration, or arresting the progression of the disease when it is so much easier to direct the patient by expectation or implicitly towards assisted suicide? What about relatives, even no more than ordinarily unscrupulous or greedy ones, or merely selfish ones, for whom the speedy death of their loved one is likely to seem desirable? Or, we may reasonably fear, an overzealous state service committed to the task of accelerating the pathway of such an unfortunate cases to their end.
My amendment guards against these consequences, some of the worst of a bill so rich and varied in its capacity for harm.
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An amendment 80. I won't say anything about it other than to mention to the noble Lord Lord Pannick that it is a philosophical Pannick that it is a philosophical concept, but academic philosophy is very divided on whether how worthwhile it is as a concept which was drafted in in recent centuries. So I begin, if you, if I may, with my amendment 80, which is which substitutes some detail for the very vague requirement that death within six months can reasonably be expected.
We have already heard in the committee from everybody, not only today, but other days, that certain diagnoses of is a very inexact science or diagnosis is diagnosing someone has six months is very inexact. And we've heard from Baroness Finlay opening that conditions can differ, patterns differ, patients differ. We've heard as well. And from the noble Lady Baroness Hollins. And each patient must be assessed on an individual basis. Against this, my amendment proposes requires that the difficult job.
This is amendment 80. My Lords, the difficult job of assessment is done by two consultants specialising in the relevant area, and it pins down that the the expectation should be instead an 80% probability. And if the sponsors are in earnest, that those eligible really should be those who are within six months of death, they should be pleased to accept an amendment that tries to overcome the inexactness of such judgements by requiring confirmation of by the two most highly qualified experts in the area, or two of the most well, and they should accept that an 80% likelihood is what, in this context, can reasonably be expected.
Now I'll move on briefly to 72. The bill already refuses eligibility for assisted suicide when a condition that in itself is diagnosed to lead to death within six months cannot, can be, cannot be reversed. My amendment takes the next logical step by limiting eligibility to cases where the condition not only cannot be reversed, but also cannot be relieved, controlled, or ameliorated. So I'm adding to what has already been proposed in this group. The amendment aims to substitute a constructive, optimistic approach to treating illness, rather than one that writes off the patient and points them on the path to suicide.
The requirement that when steps cannot, can be taken to relieve, control, or ameliorate is a disease. The patient can no longer be considered for. Assisted suicide will remove many otherwise difficult cases from this murky area, and allow that the mechanisms that have been set up to operate as best they can. For those whom the bill on its face intends them. People whose deterioration is inevitable. And there is an even more pressing reason to take this amendment than these two, unless we positively exclude from eligibility patients whose condition could be relieved, controlled or ameliorated, we set up the conditions in which relief, control and amelioration of terminal illness will become increasingly rare.
We've heard some remarkable instances today, not least from Baroness Campbell, a Baroness Campbell of Surbiton whom I'm delighted to see back. But why will an overburdened health service try to give some extra months of life, a higher degree of relief, of pain or amelioration, or arresting the progression of the disease when it is so much easier to direct the patient by expectation or implicitly towards assisted suicide? What about relatives, even no more than ordinarily unscrupulous or greedy ones, or merely selfish ones, for whom the speedy death of their loved one is likely to seem desirable? Or, we may reasonably fear, an overzealous state service committed to the task of accelerating the pathway of such an unfortunate cases to their end.
My amendment guards against these consequences, some of the worst of a bill so rich and varied in its capacity for harm.
17:09
Lord Frost (Non-affiliated)
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Lord Frost (Non-affiliated)
My Lords, I rise to introduce >> My Lords, I rise to introduce amendment 84, which has already been touched on by the noble Lord, Lord Lord Farmer. And I'm grateful, Lord Lord Farmer. And I'm grateful, and I thank Lord Carter of Haslemere for his support. Now, Haslemere for his support. Now, this group, as we've heard, is primarily about the definition of terminal illness. And my amendment in this group does touch on a somewhat different but related and important point, which is whether the terminal illness criterion, the existence of terminal illness is in itself sufficient as a criterion.
I'm I'm doubtful that it is. And that's why I've proposed this amendment. Now, Lords, as we know, there are two different models around the world for the law the kind of law that we are considering. Both models require or include a terminal illness criterion. One type says there also has to be suffering. There has to be a suffering criterion. And that's the model. As has been said in Australia, New Zealand and elsewhere. The second type does not, and it rests entirely on the concept of autonomy.
The, the, the belief that if you know you're going to die soon or you've been told you're going to die soon, you have the right to ask the state to allow you access to assisted suicide. Now, I'll say more about this autonomy point in a moment. But to state the obvious, this bill is, of course, based on the second of those two models. And one of the problems is that much of the campaign for this bill is based on the first model, the assumption of a suffering criterion.
So hence my amendment, which would introduce a concept of unbearable suffering which cannot be relieved by treatment. And the amendment is, I guess, a probing one. And it aims to test the reasoning behind the bill's supporters preference for that. That type. So my amendment does four things, and some of what I'm about to say has already been touched on. So I will be brief. First, it aligns the legal test of the bill with the public justification for the bill.
It is clear that the campaign around the bill bases much of its work on the need to deal with suffering, and if suffering is the moral foundation offered to the public, then it should be in any eventual statute. It's clear, actually, from all the discussion around the bill, that many voters believe it already is in the bill, and it should be second. It stops drift and the slippery slope. And the problem here is if the if the real justification for access to assisted suicide is autonomy, what is the justification for what is the justification for the robustness of the six month limit? We've heard of the vulnerability of provisions in this bill to court rulings, to judicial review, to the existence of the.
Though of course, there is a way of resolving that particular problem. Other broader principles, other specific legislation like the Equality Act, now, a suffering led criterion, helps Parliament draw and defend a clear and principled line. Third is relatively not totally, but relatively easy to identify unbearable suffering. As has been noted, it's usually obvious from demeanour and body language when there's frequent and unbearable pain, and this fact helps distinguish between qualifying and non-qualifying reasons for access to assisted dying.
The social pressures vital given that we've already heard from the sponsor how widely drawn some of those criteria might, in the end be. And fourth, it has to be noted that, with some exceptions, a small number of exceptions, most other jurisdictions that use these laws have a suffering criterion. Australia. The proposed legislation in France now happily stalled for the time being. Netherlands, Belgium, Luxembourg, Spain, Portugal, the rejected legislation in Slovenia, New Zealand, Colombia and so on all have a suffering criterion, and I think they do so for a good reason.
So I hope the noble and learned Lord Hall Faulkner could, when he responds to the debate on this group, perhaps explain he's touched on it before, but I think explain in greater depth why he's so insistent on autonomy. Only Bill, whether he recognises any limits on autonomy and whether he's whether and why he's content to rest on autonomy as a justification, while allowing campaigners to make the case based on suffering. Now I want to, as I said, say a few words, particularly on this autonomy point, because it is so crucial, I think the justification for it and the bill's sponsors have been clear on the importance they attached to it.
And the noble and learned Lord, Lord Faulkner, it's been quoted before, but needs saying again, said the essence of the Bill is autonomy. You have a choice. Once you satisfy the requirement, and obviously the safeguards have to be complied with. That is the essence of the bill, he said. It is autonomy. We heard from the noble and learned Lord Lord Pannick, who's not in his place of the importance of choice in this area, which is really another way of expressing the same issue.
Now, proponents of the bill have at times been perhaps a little dismissive of those of us who have religious convictions and suggest that we shouldn't bring them to this debate. But I suggest that the belief in autonomy is also an a priori conviction, with no more right, no less right to be heard unchallenged. It is surprising, perhaps, to find Ayn Rand like views of the importance of individual autonomy emanating from the Labour benches. It is a view that one can have, but I suggest that very few people do, in fact have such views in practice now.
My Lords, autonomy, I think, is unsafe as a principle and must be coupled with other criteria, as my amendment does for one important reason autonomy is not, in fact unlimited, and it never will be in any society. We all have our own moral views, but we don't have unlimited power to bring them into society. We all have to operate within a framework of laws which are themselves ultimately based on a set of moral judgements. We do not have an overriding right to choose the most obvious level.
We do not allow murder. Even if you believe murder to be justified. At a more prosaic level, we are not allowed to define for ourselves what the content and obligations of marriage are that are defined in law on the basis of an understanding of the purpose of marriage. And if you have a different view, that's interesting, but it doesn't affect the constraints that you're working in. And there are many other areas and practices in which a view of the absolute importance of autonomy might lead us to tolerate them, but in practice we do not.
As Professor John Keogh, the expert lawyer, academic and bioethicist work, wrote in his magisterial work on this whole question and I quote, is there a right to choose to have a healthy limb amputated, to undergo FGM, to take hard drugs, to engage in duelling, or to sell oneself into slavery? End quote. Those are things that many of us in this House would, I assume, baulk at. But the autonomy principle might nevertheless justify. So why is it so unreasonable to think that autonomy might not be insufficient as a principle in the area covered by this bill, either? Now, if the sponsors of this bill think autonomy, freedom of choice, is some sort of completely unqualified principle, then logically they must have some sort of niche and superman view of the ability to make up moral principles as you go along.
Now, if they don't think that, and I don't think they really do think that, then there must accept there are constraints on individual autonomy. And once you have conceded that, you've conceded that autonomy is not an overriding principle. It must be seen in a context in which one in which we choose to think that certain moral rules, societal presumptions, laws, whatever, override personal judgement. Now, so far, suicide, the desire undesirability of dying by it, the illegality of assisting it has so far been one of those moral presumptions.
Yet the bill's proponents think it's obvious, not debateable, but obvious, that this particular rule can simply be cast aside. I don't agree. And Professor Keown, again I quote. This idea is too often advanced as if it was an obvious conclusion rather than a controversial proposition. So to conclude, my Lords, this is why autonomy is not enough as the basis for this Bill. Indeed, under the guise of autonomy sort of sneaked into the bill is a subversion of the general taboo on suicide, the general societal efforts to prevent it, the legal prohibition on assisting it.
And this bill proposes to change the translation of that moral framework into legal provisions. And it's why we must be so cautious that we know what we're doing if we proceed with this bill. Now, as we've heard many complaints about the speed of discussion in this House. And the truth is, this bill, as it stands, is unsafe at
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any speed. But it is somewhat safer. You're over the ten minute limit.
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You're over the ten minute limit. Could you please wind up? Thank you. Conclusion. It is somewhat safer
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Conclusion. It is somewhat safer with the two criteria of autonomy plus life expectancy and of plus life expectancy and of unbearable and irremediable suffering. It limits the scope of suffering. It limits the scope of the moral and legal change. Or as I would see it, regression that were undertaking here. And that's why I have tabled amendment 84 and why I think it is so essential.
I'm I'm doubtful that it is. And that's why I've proposed this amendment. Now, Lords, as we know, there are two different models around the world for the law the kind of law that we are considering. Both models require or include a terminal illness criterion. One type says there also has to be suffering. There has to be a suffering criterion. And that's the model. As has been said in Australia, New Zealand and elsewhere. The second type does not, and it rests entirely on the concept of autonomy.
The, the, the belief that if you know you're going to die soon or you've been told you're going to die soon, you have the right to ask the state to allow you access to assisted suicide. Now, I'll say more about this autonomy point in a moment. But to state the obvious, this bill is, of course, based on the second of those two models. And one of the problems is that much of the campaign for this bill is based on the first model, the assumption of a suffering criterion.
So hence my amendment, which would introduce a concept of unbearable suffering which cannot be relieved by treatment. And the amendment is, I guess, a probing one. And it aims to test the reasoning behind the bill's supporters preference for that. That type. So my amendment does four things, and some of what I'm about to say has already been touched on. So I will be brief. First, it aligns the legal test of the bill with the public justification for the bill.
It is clear that the campaign around the bill bases much of its work on the need to deal with suffering, and if suffering is the moral foundation offered to the public, then it should be in any eventual statute. It's clear, actually, from all the discussion around the bill, that many voters believe it already is in the bill, and it should be second. It stops drift and the slippery slope. And the problem here is if the if the real justification for access to assisted suicide is autonomy, what is the justification for what is the justification for the robustness of the six month limit? We've heard of the vulnerability of provisions in this bill to court rulings, to judicial review, to the existence of the.
Though of course, there is a way of resolving that particular problem. Other broader principles, other specific legislation like the Equality Act, now, a suffering led criterion, helps Parliament draw and defend a clear and principled line. Third is relatively not totally, but relatively easy to identify unbearable suffering. As has been noted, it's usually obvious from demeanour and body language when there's frequent and unbearable pain, and this fact helps distinguish between qualifying and non-qualifying reasons for access to assisted dying.
The social pressures vital given that we've already heard from the sponsor how widely drawn some of those criteria might, in the end be. And fourth, it has to be noted that, with some exceptions, a small number of exceptions, most other jurisdictions that use these laws have a suffering criterion. Australia. The proposed legislation in France now happily stalled for the time being. Netherlands, Belgium, Luxembourg, Spain, Portugal, the rejected legislation in Slovenia, New Zealand, Colombia and so on all have a suffering criterion, and I think they do so for a good reason.
So I hope the noble and learned Lord Hall Faulkner could, when he responds to the debate on this group, perhaps explain he's touched on it before, but I think explain in greater depth why he's so insistent on autonomy. Only Bill, whether he recognises any limits on autonomy and whether he's whether and why he's content to rest on autonomy as a justification, while allowing campaigners to make the case based on suffering. Now I want to, as I said, say a few words, particularly on this autonomy point, because it is so crucial, I think the justification for it and the bill's sponsors have been clear on the importance they attached to it.
And the noble and learned Lord, Lord Faulkner, it's been quoted before, but needs saying again, said the essence of the Bill is autonomy. You have a choice. Once you satisfy the requirement, and obviously the safeguards have to be complied with. That is the essence of the bill, he said. It is autonomy. We heard from the noble and learned Lord Lord Pannick, who's not in his place of the importance of choice in this area, which is really another way of expressing the same issue.
Now, proponents of the bill have at times been perhaps a little dismissive of those of us who have religious convictions and suggest that we shouldn't bring them to this debate. But I suggest that the belief in autonomy is also an a priori conviction, with no more right, no less right to be heard unchallenged. It is surprising, perhaps, to find Ayn Rand like views of the importance of individual autonomy emanating from the Labour benches. It is a view that one can have, but I suggest that very few people do, in fact have such views in practice now.
My Lords, autonomy, I think, is unsafe as a principle and must be coupled with other criteria, as my amendment does for one important reason autonomy is not, in fact unlimited, and it never will be in any society. We all have our own moral views, but we don't have unlimited power to bring them into society. We all have to operate within a framework of laws which are themselves ultimately based on a set of moral judgements. We do not have an overriding right to choose the most obvious level.
We do not allow murder. Even if you believe murder to be justified. At a more prosaic level, we are not allowed to define for ourselves what the content and obligations of marriage are that are defined in law on the basis of an understanding of the purpose of marriage. And if you have a different view, that's interesting, but it doesn't affect the constraints that you're working in. And there are many other areas and practices in which a view of the absolute importance of autonomy might lead us to tolerate them, but in practice we do not.
As Professor John Keogh, the expert lawyer, academic and bioethicist work, wrote in his magisterial work on this whole question and I quote, is there a right to choose to have a healthy limb amputated, to undergo FGM, to take hard drugs, to engage in duelling, or to sell oneself into slavery? End quote. Those are things that many of us in this House would, I assume, baulk at. But the autonomy principle might nevertheless justify. So why is it so unreasonable to think that autonomy might not be insufficient as a principle in the area covered by this bill, either? Now, if the sponsors of this bill think autonomy, freedom of choice, is some sort of completely unqualified principle, then logically they must have some sort of niche and superman view of the ability to make up moral principles as you go along.
Now, if they don't think that, and I don't think they really do think that, then there must accept there are constraints on individual autonomy. And once you have conceded that, you've conceded that autonomy is not an overriding principle. It must be seen in a context in which one in which we choose to think that certain moral rules, societal presumptions, laws, whatever, override personal judgement. Now, so far, suicide, the desire undesirability of dying by it, the illegality of assisting it has so far been one of those moral presumptions.
Yet the bill's proponents think it's obvious, not debateable, but obvious, that this particular rule can simply be cast aside. I don't agree. And Professor Keown, again I quote. This idea is too often advanced as if it was an obvious conclusion rather than a controversial proposition. So to conclude, my Lords, this is why autonomy is not enough as the basis for this Bill. Indeed, under the guise of autonomy sort of sneaked into the bill is a subversion of the general taboo on suicide, the general societal efforts to prevent it, the legal prohibition on assisting it.
And this bill proposes to change the translation of that moral framework into legal provisions. And it's why we must be so cautious that we know what we're doing if we proceed with this bill. Now, as we've heard many complaints about the speed of discussion in this House. And the truth is, this bill, as it stands, is unsafe at
**** Possible New Speaker ****
any speed. But it is somewhat safer. You're over the ten minute limit.
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You're over the ten minute limit. Could you please wind up? Thank you. Conclusion. It is somewhat safer
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Conclusion. It is somewhat safer with the two criteria of autonomy plus life expectancy and of plus life expectancy and of unbearable and irremediable suffering. It limits the scope of suffering. It limits the scope of the moral and legal change. Or as I would see it, regression that were undertaking here. And that's why I have tabled amendment 84 and why I think it is so essential.
17:20
Lord Carter of Haslemere (Crossbench)
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Lord Carter of Haslemere (Crossbench)
I have added my name to this amendment 84, since I think the noble Lord Lord Frost has struck gold with this amendment in requiring, I quote, unbearable suffering which cannot be relieved by treatment, it raises four critical issues at the epicentre of this bill. First, his amendment exposes the total unreliability of a six months prognosis of a terminal illness. As we've heard from numerous Lords trying to predict, life expectancy is a hopeless exercise, especially when medical advances are improving at such a phenomenal rate.
As the noble Lord, the sponsor has said. In relation to a prediction of six months to live, we are not dealing with certainty. I am with him on that. Let me give you an illustration from a real case. I know of somebody who has given a 5% chance of living for ten years because he was suffering from an advanced, aggressive cancer. It's not exact, but a 5% chance of living for ten years approximates broadly to a reasonable expectation of dying within six months.
That was 21 years ago, and as far as I know, I am still here. Noble Lords will correct me if I've got that wrong. Yeah, it does sometimes feel slightly otherworldly listening to these debates. Secondly, amendment 84 requirement for unbearable suffering, which cannot be relieved by treatment, would have the obvious merit of bringing the effectiveness of palliative care into play, which is not currently the case. As the bill stands, as we know, the experts say palliative care relieves pain in most cases and can help people who want to die, to want to live.
This is why a full assessment by a palliative care specialist is so important, as earlier amendments sensibly proposed. But the noble Lord, the sponsor, has said he is, quote, incredibly opposed to unbearable suffering as the root of this bill. His view is unsurprising since the effectiveness of palliative care would then significantly reduce the bill's impact. And so the noble Lord falls back on the personal autonomy argument, telling the select committee the essence of the bill is autonomy. You have a choice.
It is autonomy. So the bill would give people the option of an assisted death if they have simply had enough of life. This is the third issue which would be resolved by amendment 84. But should the National Health Health Service really be assisting a person to kill themselves if they simply had enough of life, whether or not they are in pain and whether or not their feelings relate to their terminal illness? Is that what a health service should be doing? That starts to look very much like assisted suicide? Fourthly, I respectfully suggest the noble Lord the sponsor, gets on the Clapham omnibus and asks anyone who supports assisted dying the reasons why they do so.
Overwhelmingly, they will say that people should not have to suffer unbearable suffering. Yet astonishingly, you will not find the words pain or suffering anywhere in the bill. I read it word for word last night at great length to check that point. I couldn't find those words without any reference to unbearable suffering. There will be a massive disconnect between the public expectation and the bill's contents. Let's be clear the vast majority of the public are not on the edge of their seats watching our deliberations, not the vast majority.
Very few indeed will have read the bill. They will therefore have a view of the bill based on the common sense assumption that people seeking an assisted death will be suffering unbearable pain. The noble Lord Lord Frost compelling amendment injects that common sense into the bill by providing for that, and I heartily support him. And amendment 84.
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To involve myself in this debate. I see this whole legislative I see this whole legislative process as being about practicalities. In the end, it's practicalities. In the end, it's very good that we've had exposition of the articulation of motivation of the articulation of motivation for the bill, motivation for people seeking success for this bill. But seeking success for this bill. But I am very concerned, as a citizen that the competition we've saved beautifully into this, because I think this is about palliative care.
I think this is about relief from suffering. I think this bill should should have been about these very matters. But in actual fact, of course it's not. It's about all the incentives from government to public authorities, all those people that legislation actually motivates is about promoting the idea that assisting dying is assisted dying is available or assisted suicide is available, whereas in actual fact, what the medical profession prefers and the colleges are clearly of that view and what are all the medical colleges have said is that they want to see proper palliative care, and we don't want a competition for the funding of one for the against the other.
And I can see both in individual lives and in family lives and in the social life that we have together, governed by a government, that the pressures are all going to be on, not relief of suffering through palliative care, but for assisted suicide. And I don't agree with it. And that's why I've opposing this bill, I will.
As the noble Lord, the sponsor has said. In relation to a prediction of six months to live, we are not dealing with certainty. I am with him on that. Let me give you an illustration from a real case. I know of somebody who has given a 5% chance of living for ten years because he was suffering from an advanced, aggressive cancer. It's not exact, but a 5% chance of living for ten years approximates broadly to a reasonable expectation of dying within six months.
That was 21 years ago, and as far as I know, I am still here. Noble Lords will correct me if I've got that wrong. Yeah, it does sometimes feel slightly otherworldly listening to these debates. Secondly, amendment 84 requirement for unbearable suffering, which cannot be relieved by treatment, would have the obvious merit of bringing the effectiveness of palliative care into play, which is not currently the case. As the bill stands, as we know, the experts say palliative care relieves pain in most cases and can help people who want to die, to want to live.
This is why a full assessment by a palliative care specialist is so important, as earlier amendments sensibly proposed. But the noble Lord, the sponsor, has said he is, quote, incredibly opposed to unbearable suffering as the root of this bill. His view is unsurprising since the effectiveness of palliative care would then significantly reduce the bill's impact. And so the noble Lord falls back on the personal autonomy argument, telling the select committee the essence of the bill is autonomy. You have a choice.
It is autonomy. So the bill would give people the option of an assisted death if they have simply had enough of life. This is the third issue which would be resolved by amendment 84. But should the National Health Health Service really be assisting a person to kill themselves if they simply had enough of life, whether or not they are in pain and whether or not their feelings relate to their terminal illness? Is that what a health service should be doing? That starts to look very much like assisted suicide? Fourthly, I respectfully suggest the noble Lord the sponsor, gets on the Clapham omnibus and asks anyone who supports assisted dying the reasons why they do so.
Overwhelmingly, they will say that people should not have to suffer unbearable suffering. Yet astonishingly, you will not find the words pain or suffering anywhere in the bill. I read it word for word last night at great length to check that point. I couldn't find those words without any reference to unbearable suffering. There will be a massive disconnect between the public expectation and the bill's contents. Let's be clear the vast majority of the public are not on the edge of their seats watching our deliberations, not the vast majority.
Very few indeed will have read the bill. They will therefore have a view of the bill based on the common sense assumption that people seeking an assisted death will be suffering unbearable pain. The noble Lord Lord Frost compelling amendment injects that common sense into the bill by providing for that, and I heartily support him. And amendment 84.
**** Possible New Speaker ****
To involve myself in this debate. I see this whole legislative I see this whole legislative process as being about practicalities. In the end, it's practicalities. In the end, it's very good that we've had exposition of the articulation of motivation of the articulation of motivation for the bill, motivation for people seeking success for this bill. But seeking success for this bill. But I am very concerned, as a citizen that the competition we've saved beautifully into this, because I think this is about palliative care.
I think this is about relief from suffering. I think this bill should should have been about these very matters. But in actual fact, of course it's not. It's about all the incentives from government to public authorities, all those people that legislation actually motivates is about promoting the idea that assisting dying is assisted dying is available or assisted suicide is available, whereas in actual fact, what the medical profession prefers and the colleges are clearly of that view and what are all the medical colleges have said is that they want to see proper palliative care, and we don't want a competition for the funding of one for the against the other.
And I can see both in individual lives and in family lives and in the social life that we have together, governed by a government, that the pressures are all going to be on, not relief of suffering through palliative care, but for assisted suicide. And I don't agree with it. And that's why I've opposing this bill, I will.
17:26
Lord Wolfson of Tredegar (Conservative)
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Lord Wolfson of Tredegar (Conservative)
Seek the indulgence of the committee. Could I say a word to my amendment? And I am not speaking, amendment? And I am not speaking, so to speak, if I may, with my frontbench hat on, because I understand that this group is going to carry on next Friday, and I'm in the middle of a trial and I can't attend, I'm afraid next Friday. So can I just speak to my amendment in this group now, but not summarise on the front bench? I hope the committee would allow me to do just just that I am very I'm very grateful, but I will limit my comments to my amendment and the points which arise from that.
My amendment is an amendment 83 B and it's to add the words, despite any treatment that the person may be receiving. And the reason for that, and it ties in, of course, also to a point made by Lord Pannick, which I'll come to in a moment because it's all tied together. The reason for that is this the trigger is in clause two. One for the purposes of this act, a person is terminally ill. If and there are two conditions, both of which have to be satisfied.
First of all, the person has an inevitably progressive illness or disease which cannot be reversed by treatment. So pausing there, let's say, God forbid one has, I don't know, pancreatic cancer and it cannot be reversed by treatment. So that's what you've got. The second B is that the person's death in consequence of that illness or disease, can reasonably be expected within six months. Now there are two points which arise out of that. First of all, there's the point which directly comes from my amendment.
And my amendment would add the words. Despite any treatment the person may be receiving, because otherwise it seems to me that it is unclear whether the six months is with treatment or without treatment. In other words, you've got pancreatic cancer, you're having treatment now. You've got pancreatic, pancreatic cancer. It cannot be reversed by treatment. A tick B in consequence of that illness or disease. Now, does it mean that illness or disease, so to speak, itself untreated or does it mean notwithstanding the treatment you have been given? I suspect it's the latter.
The noble and learned Lord Wood intends, but it does seem to me it's far from clear. And one actually it actually reads more like the former, although I suspect it is the latter. So that's why I put my amendment forward, and I would respectfully invite the noble and learned Lord to consider it. And as I say, apologies to him and to the Minister and to everybody, if I'm not here next week to hear the fulsome response there to the other point which arises in the can reasonably be expected, is the question whether that is the 50% point or not.
Let me just say literally 30s on that. It does seem to me as a matter of law, and I'm sorry, the noble Lord Lord Pannick is not here, but as a matter of law, legitimate expectation. If I have a legitimate expectation in public law, I do not need to have a more than 50% expectation of it happening. And there was authority at the highest level in the House of Lords. That legitimate expectation means reasonable expectation. I see I am comforted by nods from the noble and learned Baroness Brady butler-sloss always comforting.
That does seem to me, therefore, that as a matter of law, I can have a reasonable expectation of X, even if I do not think X is more likely than not. And I do think that's an important point, which perhaps the committee will consider going forward. I think people are reading that as a 5050 mean or median, but it seems to me that I can have a reasonable expectation, for example, if it raining tomorrow, if I think there's only a 30%, that's a reasonable expectation.
It's not more likely than not. I don't want to stray too far from my own amendments. I will now sit down, but I'm grateful to the Committee
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for its indulgence. I would never stand in the way of a colleague who has a trial, and of a colleague who has a trial, and I hope it's an important trial, and one which will improve general knowledge.
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knowledge. I'm defending the interests of a
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Labour supporting newspaper. Well, there we are. We know the noble Lord adheres to the cab rank rule. My Lords, we've heard three
My amendment is an amendment 83 B and it's to add the words, despite any treatment that the person may be receiving. And the reason for that, and it ties in, of course, also to a point made by Lord Pannick, which I'll come to in a moment because it's all tied together. The reason for that is this the trigger is in clause two. One for the purposes of this act, a person is terminally ill. If and there are two conditions, both of which have to be satisfied.
First of all, the person has an inevitably progressive illness or disease which cannot be reversed by treatment. So pausing there, let's say, God forbid one has, I don't know, pancreatic cancer and it cannot be reversed by treatment. So that's what you've got. The second B is that the person's death in consequence of that illness or disease, can reasonably be expected within six months. Now there are two points which arise out of that. First of all, there's the point which directly comes from my amendment.
And my amendment would add the words. Despite any treatment the person may be receiving, because otherwise it seems to me that it is unclear whether the six months is with treatment or without treatment. In other words, you've got pancreatic cancer, you're having treatment now. You've got pancreatic, pancreatic cancer. It cannot be reversed by treatment. A tick B in consequence of that illness or disease. Now, does it mean that illness or disease, so to speak, itself untreated or does it mean notwithstanding the treatment you have been given? I suspect it's the latter.
The noble and learned Lord Wood intends, but it does seem to me it's far from clear. And one actually it actually reads more like the former, although I suspect it is the latter. So that's why I put my amendment forward, and I would respectfully invite the noble and learned Lord to consider it. And as I say, apologies to him and to the Minister and to everybody, if I'm not here next week to hear the fulsome response there to the other point which arises in the can reasonably be expected, is the question whether that is the 50% point or not.
Let me just say literally 30s on that. It does seem to me as a matter of law, and I'm sorry, the noble Lord Lord Pannick is not here, but as a matter of law, legitimate expectation. If I have a legitimate expectation in public law, I do not need to have a more than 50% expectation of it happening. And there was authority at the highest level in the House of Lords. That legitimate expectation means reasonable expectation. I see I am comforted by nods from the noble and learned Baroness Brady butler-sloss always comforting.
That does seem to me, therefore, that as a matter of law, I can have a reasonable expectation of X, even if I do not think X is more likely than not. And I do think that's an important point, which perhaps the committee will consider going forward. I think people are reading that as a 5050 mean or median, but it seems to me that I can have a reasonable expectation, for example, if it raining tomorrow, if I think there's only a 30%, that's a reasonable expectation.
It's not more likely than not. I don't want to stray too far from my own amendments. I will now sit down, but I'm grateful to the Committee
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for its indulgence. I would never stand in the way of a colleague who has a trial, and of a colleague who has a trial, and I hope it's an important trial, and one which will improve general knowledge.
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knowledge. I'm defending the interests of a
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Labour supporting newspaper. Well, there we are. We know the noble Lord adheres to the cab rank rule. My Lords, we've heard three
17:31
Lord Carlile of Berriew (Crossbench)
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Lord Carlile of Berriew (Crossbench)
very cogent speeches from the noble Lord Lord Frost, the noble Lord, Lord Carter and the noble Lord, Lord Taylor, about the suffering point. And if we look at the point. And if we look at the discussion that we've had this afternoon, we have now, we now have a very clear and stark difference between assisted suicide based on between assisted suicide based on suffering and assisted suicide based on choice. The public and I agree entirely with the noble Lord Lord Frost in what he said.
And I think Lord Taylor said the same to the public, expect this bill to be dealing with suffering. The public understand this bill to be dealing with great suffering. They understand that the choice to have one's life ended is based on great suffering, though it doesn't say so in the bill. And that, I would suggest, is something that has to be clarified by the sponsor. On the other side of the argument, we heard from my noble friend Lord Pannick in a very eloquent speech, and I have a lot of sympathy with the noble Lord in the sense that I know, though I don't think it's generally known that, as he said, he has very personal experience of the issues that are arising in this bill.
But the form of choice that he is suggesting, in my view, comes very close to be a choice for anyone who is seriously ill, not just somebody who is seriously ill with an expectation of death within a certain limited period, whatever that happens to be. And what I would like to suggest to you, Lordships, is that what we are trying to achieve here, those of us who like the noble and learned Lord, the sponsor, are actually trying to reach the end of our process in the House of Lords on the basis that there will be a bill.
So it has to be the best possible bill that can be. I fear that we are not focusing on what choice really means, and in my view, I would submit to your Lordships, we're talking about informed choice. We're talking about accurate choice if we can achieve it. And I bear in mind very much what my noble friend Baroness Finlay said. We're talking about a protective choice, by which I mean that is the duty of the state to protect the citizen, even when they are making a choice.
We do not, as citizens, have unlimited free choices in what we do. So the protection is important. It has to be a morally sound choice, because that is part of our polity, that we do things that are morally sound, and that the government protects us from those which may not be. It has to be a choice founded on medical and scientific and integrity. And there's the rub, my Lords, back to the points which my noble friend Baroness Finlay made about the uncertainty of the scientific and medical integrity of what is proposed.
And so for those reasons, I support the amendments which are focussed on choice. And I'm just going to mention some other amendments, three other amendments which I also support. The first is amendment number 76, which is not in my name. It's in the name of the noble and learned Lord Lord Garnier. But he wasn't able to be here for the latter part of today's proceedings, and I agreed to mention it at his request. It does something very simple in clause 21B it adds one word direct.
So a person is terminally ill. If B the person's death in direct consequence of that illness or disease can reasonably be expected within six months. Now, it may not be the perfect word, but it's about it's about facts and it's about consequences of those facts. And what I agree with Lord Garnier about very strongly is that if there is to be a death of someone through the assistance of a third party, which is what this bill is fundamentally about, then it doesn't have to be.
It cannot be just a consequence of the illness. It cannot be one of the many consequences of the illness. It has to be the, or at least a major consequence of the illness. And that's the purpose of that amendment. There has to be a bond, as it were, between the illness or disease and the death which ensues. The next amendment I want to deal with is number 93, which suggests leaving out clause two, sub clause three altogether.
It lacks clarity as to when an assisted death would be permitted treatment which only relieves the symptoms of an inevitable of an inevitably progressive illness or disease temporarily, is not to be regarded as treatment which can reverse that illness. So what, my Lords, if the relief that's provided for an inevitably progressive illness not only provides relief from the symptoms, but provides extra time to the person who's suffering from the illness or disease, I would argue that if it allows extra time, the individual concerned is having a new experience.
They are seeing what can happen if their symptoms are relieved, they need to discuss with their medical advisers whether they can have that relief of their symptoms again, will it prolong their life if they have that relief again? And so the relief may cause a fundamental change of heart by the individual. And therefore I don't believe that should be any there should be any possibility of the six months period being elongated in any way by that relief. Indeed, I believe that the period should start again if such relief is given, so that the person concerned can have an informed choice.
And the Third Amendment I want to mention is, is amendment 96, which suggests that clause subclause four should be left out. For the avoidance of doubt, a person is not to be considered to be terminally ill only because they're a person with a disability or mental disorder, or both, followed by an important further sentence, which I won't read out because of time. But what this subclause fails to deal with is the proportionality between the disease which leads, which is the terminal illness, and the disability or mental disorder, or both, from which that person also suffers.
It's a complex little conundrum, but it's a very important one. And I believe that that proportionality needs to be clarified in order that this bill can be the best possible bill we can have. So, my Lords, I think we have much still to learn about the issues that have been under discussion. And I would invite the noble and learned Lord to consider these carefully and present some draft amendments to us before we meet again in a week's time.
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My Lords, I rise to speak to.
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I wish to seek a cast iron assurance from the government whip that those of us whose speeches will be delayed till next Friday are recorded by the government and will be allowed to speak. That's all I wanted to say at this stage. We want an assurance that we'll be
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We want an assurance that we'll be allowed to speak next Friday if we delay our speeches from today. I will shortly make an
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I will shortly make an announcement to that effect. Very good. My Lords. I rise.
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To speak to amendments 99, 102 and 105. In the name of my noble friend Lord Hunt of Kings Heath, friend Lord Hunt of Kings Heath, who is unable to be in his place today for reasons that will become apparent, I've also added my name apparent, I've also added my name to these amendments and declare an interest, as I am the carer for a family member with long term family member with long term dementia. Taken together, these amendments address a single fundamental problem in the bill, fundamental problem in the bill, namely the current definition of terminal illness.
It is too broad, too vague and therefore too vulnerable to expansion by interpretation, by pressure and ultimately by the courts. These amendments do not seek to frustrate the bill's stated purpose. They seek to clarify it. They seek to ensure that eligibility rests on being already dying, not on age, disability, long standing conditions or cognitive decline. That clarity matters not only for patients, but for clinicians, families and the credibility of the law itself. Amendment 99 makes clear that being elderly is not of itself a qualifying condition.
This should be uncontroversial. Yet the current drafting seeks risks, conflating age, frailty and terminal illness. Evidence to the Lords Select committee repeatedly warned that older patients commonly present with multimorbidity multiple long term conditions, interacting in ways that make prognosis deeply uncertain. Professor Martin Vernon told the Select committee in your Lordships House that in such cases, prognostication is extraordinarily difficult, particularly where frailty blurs the line between disability and terminal illness. If we do not exclude age explicitly, we risk encoding ageism into statute.
Amendment 102 provides similar clarity in relation to dementia, confirming that dementia is to be treated as a disability, not a terminal illness in itself. This reflects both clinical reality and ethical responsibility. Dementia has an unpredictable course, and many people live for years with meaningful relationships and quality of life. In 2008, my father was diagnosed with mild cognitive impairment, a form of dementia. In 2010, he was diagnosed with Alzheimer's. As a family, we expected these diagnoses would dramatically shorten and limit his life.
Although his condition has declined in the 16 years that follow, he requires now considerable support from family members and from a heroic team of carers. Despite this, he continues to live with a good degree of independence and a real quality of his life, while his dad jokes continue to get worse. Definitely, they should be subject to a terminal diagnosis. He continues to be someone of good humour, and if you told me a decade ago that we would be sitting tomorrow at the cherry Red Records Stadium hoping and praying for AFC Wimbledon's first home win since September, I simply would not have believed you in line with my father's experience, your Lordship Select Committee on this bill heard compelling evidence that the six month prognosis safeguard is particularly unreliable, particularly when it comes to cognitive conditions.
To treat dementia as terminal by default would place profoundly vulnerable people at risk, especially given the well-documented, documented difficulty of assessing capacity. When cognition fluctuates, we will obviously come to capacity in later amendments. Finally, amendment 105 addresses congenital, genetic and lifelong conditions conditions present from birth and compatible with long term survival. This is a necessary safeguard. Evidence of the Commons Bill Committee made clear that the bill's current language phrases such as inevitably progressive and cannot be reversed by treatment, is worryingly elastic.
Clinicians warn that without clarity, even manageable conditions could fall within scope, particularly if treatment is refused or unavailable. We have seen this in Oregon, where qualifying conditions under a similarly broad definition have come to include arthritis and complications from a fall. This is not a path that this house should leave open. Underlying all four of these. All three of these amendments is a shared concern about scope creep. The Equality and Human Rights Commission, as we've heard already today, warned at Second Reading that clause two lacks sufficient clarity to be applied consistently by medical professionals and human rights experts told the Lords Select Committee that the six month criterion could itself become the basis for article 14 challenges, precisely because it is arbitrary and weakly justified.
Once Parliament establishes an autonomy based model with clear boundaries, pressure for expansion is not hypothetical. It is inevitable. We should also listen carefully to disabled people, Disability rights UK told the Commons committee that assistant. The House Select Committee that assistance to die should not be easier to access than assistance to live, as the noble Baron Baroness Grey-Thompson has repeatedly, repeatedly warned disabled people could fall within scope through secondary complications. If we are not careful. These are not marginal cases.
They are not coincidences, they are warning signs. My Lords, the House is being asked to authorise a profound change in the relationship between the state medicine and death. To my mind, this is the most consequential legislation as to the view of the state upon human life that this House has considered for some time. If Parliament is so to do, it must legislate with precision. These amendments do not impose a moral view. They set guardrails, and I would encourage my noble and learned friend Lord Falconer of Thoroton to consider these amendments, and if not, to at least assure the House how we can make sure that this legislation protects against ageism, ableism, and against a quiet drift from terminal illness to judging certain lives as less worth living.
In that sense, these amendments are not hostile to the bill's supporters. They are an invitation to make the bill honest about its scope, defensible in law and safer in practice. I therefore strongly support amendments 99, 102 and 105, and I urge the House to do likewise.
**** Possible New Speaker ****
Yeah. I speak to amendments 82 and 83,
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I speak to amendments 82 and 83, a in particular, which were advanced by Lord Polak who cannot advanced by Lord Polak who cannot be here after 4:00 today. And I have said that I will speak in have said that I will speak in support of them. I should say also
And I think Lord Taylor said the same to the public, expect this bill to be dealing with suffering. The public understand this bill to be dealing with great suffering. They understand that the choice to have one's life ended is based on great suffering, though it doesn't say so in the bill. And that, I would suggest, is something that has to be clarified by the sponsor. On the other side of the argument, we heard from my noble friend Lord Pannick in a very eloquent speech, and I have a lot of sympathy with the noble Lord in the sense that I know, though I don't think it's generally known that, as he said, he has very personal experience of the issues that are arising in this bill.
But the form of choice that he is suggesting, in my view, comes very close to be a choice for anyone who is seriously ill, not just somebody who is seriously ill with an expectation of death within a certain limited period, whatever that happens to be. And what I would like to suggest to you, Lordships, is that what we are trying to achieve here, those of us who like the noble and learned Lord, the sponsor, are actually trying to reach the end of our process in the House of Lords on the basis that there will be a bill.
So it has to be the best possible bill that can be. I fear that we are not focusing on what choice really means, and in my view, I would submit to your Lordships, we're talking about informed choice. We're talking about accurate choice if we can achieve it. And I bear in mind very much what my noble friend Baroness Finlay said. We're talking about a protective choice, by which I mean that is the duty of the state to protect the citizen, even when they are making a choice.
We do not, as citizens, have unlimited free choices in what we do. So the protection is important. It has to be a morally sound choice, because that is part of our polity, that we do things that are morally sound, and that the government protects us from those which may not be. It has to be a choice founded on medical and scientific and integrity. And there's the rub, my Lords, back to the points which my noble friend Baroness Finlay made about the uncertainty of the scientific and medical integrity of what is proposed.
And so for those reasons, I support the amendments which are focussed on choice. And I'm just going to mention some other amendments, three other amendments which I also support. The first is amendment number 76, which is not in my name. It's in the name of the noble and learned Lord Lord Garnier. But he wasn't able to be here for the latter part of today's proceedings, and I agreed to mention it at his request. It does something very simple in clause 21B it adds one word direct.
So a person is terminally ill. If B the person's death in direct consequence of that illness or disease can reasonably be expected within six months. Now, it may not be the perfect word, but it's about it's about facts and it's about consequences of those facts. And what I agree with Lord Garnier about very strongly is that if there is to be a death of someone through the assistance of a third party, which is what this bill is fundamentally about, then it doesn't have to be.
It cannot be just a consequence of the illness. It cannot be one of the many consequences of the illness. It has to be the, or at least a major consequence of the illness. And that's the purpose of that amendment. There has to be a bond, as it were, between the illness or disease and the death which ensues. The next amendment I want to deal with is number 93, which suggests leaving out clause two, sub clause three altogether.
It lacks clarity as to when an assisted death would be permitted treatment which only relieves the symptoms of an inevitable of an inevitably progressive illness or disease temporarily, is not to be regarded as treatment which can reverse that illness. So what, my Lords, if the relief that's provided for an inevitably progressive illness not only provides relief from the symptoms, but provides extra time to the person who's suffering from the illness or disease, I would argue that if it allows extra time, the individual concerned is having a new experience.
They are seeing what can happen if their symptoms are relieved, they need to discuss with their medical advisers whether they can have that relief of their symptoms again, will it prolong their life if they have that relief again? And so the relief may cause a fundamental change of heart by the individual. And therefore I don't believe that should be any there should be any possibility of the six months period being elongated in any way by that relief. Indeed, I believe that the period should start again if such relief is given, so that the person concerned can have an informed choice.
And the Third Amendment I want to mention is, is amendment 96, which suggests that clause subclause four should be left out. For the avoidance of doubt, a person is not to be considered to be terminally ill only because they're a person with a disability or mental disorder, or both, followed by an important further sentence, which I won't read out because of time. But what this subclause fails to deal with is the proportionality between the disease which leads, which is the terminal illness, and the disability or mental disorder, or both, from which that person also suffers.
It's a complex little conundrum, but it's a very important one. And I believe that that proportionality needs to be clarified in order that this bill can be the best possible bill we can have. So, my Lords, I think we have much still to learn about the issues that have been under discussion. And I would invite the noble and learned Lord to consider these carefully and present some draft amendments to us before we meet again in a week's time.
**** Possible New Speaker ****
My Lords, I rise to speak to.
**** Possible New Speaker ****
I wish to seek a cast iron assurance from the government whip that those of us whose speeches will be delayed till next Friday are recorded by the government and will be allowed to speak. That's all I wanted to say at this stage. We want an assurance that we'll be
**** Possible New Speaker ****
We want an assurance that we'll be allowed to speak next Friday if we delay our speeches from today. I will shortly make an
**** Possible New Speaker ****
I will shortly make an announcement to that effect. Very good. My Lords. I rise.
**** Possible New Speaker ****
To speak to amendments 99, 102 and 105. In the name of my noble friend Lord Hunt of Kings Heath, friend Lord Hunt of Kings Heath, who is unable to be in his place today for reasons that will become apparent, I've also added my name apparent, I've also added my name to these amendments and declare an interest, as I am the carer for a family member with long term family member with long term dementia. Taken together, these amendments address a single fundamental problem in the bill, fundamental problem in the bill, namely the current definition of terminal illness.
It is too broad, too vague and therefore too vulnerable to expansion by interpretation, by pressure and ultimately by the courts. These amendments do not seek to frustrate the bill's stated purpose. They seek to clarify it. They seek to ensure that eligibility rests on being already dying, not on age, disability, long standing conditions or cognitive decline. That clarity matters not only for patients, but for clinicians, families and the credibility of the law itself. Amendment 99 makes clear that being elderly is not of itself a qualifying condition.
This should be uncontroversial. Yet the current drafting seeks risks, conflating age, frailty and terminal illness. Evidence to the Lords Select committee repeatedly warned that older patients commonly present with multimorbidity multiple long term conditions, interacting in ways that make prognosis deeply uncertain. Professor Martin Vernon told the Select committee in your Lordships House that in such cases, prognostication is extraordinarily difficult, particularly where frailty blurs the line between disability and terminal illness. If we do not exclude age explicitly, we risk encoding ageism into statute.
Amendment 102 provides similar clarity in relation to dementia, confirming that dementia is to be treated as a disability, not a terminal illness in itself. This reflects both clinical reality and ethical responsibility. Dementia has an unpredictable course, and many people live for years with meaningful relationships and quality of life. In 2008, my father was diagnosed with mild cognitive impairment, a form of dementia. In 2010, he was diagnosed with Alzheimer's. As a family, we expected these diagnoses would dramatically shorten and limit his life.
Although his condition has declined in the 16 years that follow, he requires now considerable support from family members and from a heroic team of carers. Despite this, he continues to live with a good degree of independence and a real quality of his life, while his dad jokes continue to get worse. Definitely, they should be subject to a terminal diagnosis. He continues to be someone of good humour, and if you told me a decade ago that we would be sitting tomorrow at the cherry Red Records Stadium hoping and praying for AFC Wimbledon's first home win since September, I simply would not have believed you in line with my father's experience, your Lordship Select Committee on this bill heard compelling evidence that the six month prognosis safeguard is particularly unreliable, particularly when it comes to cognitive conditions.
To treat dementia as terminal by default would place profoundly vulnerable people at risk, especially given the well-documented, documented difficulty of assessing capacity. When cognition fluctuates, we will obviously come to capacity in later amendments. Finally, amendment 105 addresses congenital, genetic and lifelong conditions conditions present from birth and compatible with long term survival. This is a necessary safeguard. Evidence of the Commons Bill Committee made clear that the bill's current language phrases such as inevitably progressive and cannot be reversed by treatment, is worryingly elastic.
Clinicians warn that without clarity, even manageable conditions could fall within scope, particularly if treatment is refused or unavailable. We have seen this in Oregon, where qualifying conditions under a similarly broad definition have come to include arthritis and complications from a fall. This is not a path that this house should leave open. Underlying all four of these. All three of these amendments is a shared concern about scope creep. The Equality and Human Rights Commission, as we've heard already today, warned at Second Reading that clause two lacks sufficient clarity to be applied consistently by medical professionals and human rights experts told the Lords Select Committee that the six month criterion could itself become the basis for article 14 challenges, precisely because it is arbitrary and weakly justified.
Once Parliament establishes an autonomy based model with clear boundaries, pressure for expansion is not hypothetical. It is inevitable. We should also listen carefully to disabled people, Disability rights UK told the Commons committee that assistant. The House Select Committee that assistance to die should not be easier to access than assistance to live, as the noble Baron Baroness Grey-Thompson has repeatedly, repeatedly warned disabled people could fall within scope through secondary complications. If we are not careful. These are not marginal cases.
They are not coincidences, they are warning signs. My Lords, the House is being asked to authorise a profound change in the relationship between the state medicine and death. To my mind, this is the most consequential legislation as to the view of the state upon human life that this House has considered for some time. If Parliament is so to do, it must legislate with precision. These amendments do not impose a moral view. They set guardrails, and I would encourage my noble and learned friend Lord Falconer of Thoroton to consider these amendments, and if not, to at least assure the House how we can make sure that this legislation protects against ageism, ableism, and against a quiet drift from terminal illness to judging certain lives as less worth living.
In that sense, these amendments are not hostile to the bill's supporters. They are an invitation to make the bill honest about its scope, defensible in law and safer in practice. I therefore strongly support amendments 99, 102 and 105, and I urge the House to do likewise.
**** Possible New Speaker ****
Yeah. I speak to amendments 82 and 83,
**** Possible New Speaker ****
I speak to amendments 82 and 83, a in particular, which were advanced by Lord Polak who cannot advanced by Lord Polak who cannot be here after 4:00 today. And I have said that I will speak in have said that I will speak in support of them. I should say also
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Lord Sandhurst (Conservative)
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Lord Sandhurst (Conservative)
say. Admirable speeches. Every word. say. Admirable speeches. Every word. Right. Amendment 82 and I can take this shortly. I'm very conscious of the time. Addresses the phrase the time. Addresses the phrase reasonably expected in defining who reasonably expected in defining who is terminally, terminally ill and in SERPs in its place, asked for those words to be removed and insert in its place, be highly probable, and require dual specialist certification by independent consultants. In other words, it's to do with the vagueness which would otherwise occur and which would be subjective and dangerously elastic.
As life goes forward 5 or 10 years down the road. And this bill is applied, and I'm assuming that this bill goes into force so the threshold is too low. The condition is too uncertain. Inserting the words will require two independent specialists, consultants with expertise in the relevant field. And when we look at vagueness and uncertainty and the risk of people who aren't really experts in the field, giving this sort of advice to an individual, I was particularly moved by the powerful speech of Baroness Campbell.
We've had others as well who've had similar experiences, not least Lord Polak, who cannot be here and who would have been speaking to this amendment. And I know that it is that which has motivated him to bring this amendment. So this amendment 82 would. Sorry, I have to get the right number. Yes, it is 82. Two would introduce a higher test. It would be a safeguard that is both practical and ethical. It's about introducing something which is much closer to the sort of certainty and confidence is perhaps the word one wants confidence, not just vague possibilities.
Amendment 83 does not touch on the six month time not touch on the six month time frame. What it does is to ensure that eligibility for assisted dying rests on rigorous and established clinical standards, not on a broad prognostic guess. It is to be determined by clinical judgement in accordance with peer reviewed palliative care standards. It may be someone can come up with a better way of putting that, but that is a shot at saying this is something which doctors in this position will understand.
Lord Polak, as I reminded the House, is living proof that such predictions can be very wrong. So amendment 83 is a step towards a proper principle. It retains the six month frame time frame, but insists that the judgement is grounded in peer reviewed palliative care standards, not vague estimates. So I would urge that these small amendments strengthen the bill and they safeguard our humanity. If we decide to go down the route of
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adopting this bill. My Lords, this would seem to be a convenient time to pause a convenient time to pause proceedings for the day. I therefore beg to move that debate on this amendment. Be adjourned. If on this amendment. Be adjourned. If agreed, can colleagues in attendance please make sure at the end of the proceedings their name end of the proceedings their name is registered at the table for the continuation of the debate on 6th February.
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February. The noble Lady would allow me just to intervene quickly. Noble Lords will know that I sat for the whole day waiting for amendments, and I have not intervened. But I want to just put on record that I won't be able to be here next Friday, and therefore I would invite the House to consider particularly what Baroness Campbell of Surbiton said in relation to amendment 87. And I'd like, if I may, to put on record my thanks to my noble friend, the noble and learned Lord, in relation to his willingness to look at the issues in relation to anorexia and bulimia.
And I regret that I will not be able to be here. Imminently. My Lords, the question is that a debate on this amendment be adjourned, as many of that opinion
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shall say, content contrary, not content to the contents have it. My Lords, I beg to move that the
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House be resumed. Question is that the House be resumed, as many are of that opinion, shall say, content opinion, shall say, content contrary, not content. The contents have it.
**** Possible New Speaker ****
My Lords, I beg to move the House. Do now adjourn.
As life goes forward 5 or 10 years down the road. And this bill is applied, and I'm assuming that this bill goes into force so the threshold is too low. The condition is too uncertain. Inserting the words will require two independent specialists, consultants with expertise in the relevant field. And when we look at vagueness and uncertainty and the risk of people who aren't really experts in the field, giving this sort of advice to an individual, I was particularly moved by the powerful speech of Baroness Campbell.
We've had others as well who've had similar experiences, not least Lord Polak, who cannot be here and who would have been speaking to this amendment. And I know that it is that which has motivated him to bring this amendment. So this amendment 82 would. Sorry, I have to get the right number. Yes, it is 82. Two would introduce a higher test. It would be a safeguard that is both practical and ethical. It's about introducing something which is much closer to the sort of certainty and confidence is perhaps the word one wants confidence, not just vague possibilities.
Amendment 83 does not touch on the six month time not touch on the six month time frame. What it does is to ensure that eligibility for assisted dying rests on rigorous and established clinical standards, not on a broad prognostic guess. It is to be determined by clinical judgement in accordance with peer reviewed palliative care standards. It may be someone can come up with a better way of putting that, but that is a shot at saying this is something which doctors in this position will understand.
Lord Polak, as I reminded the House, is living proof that such predictions can be very wrong. So amendment 83 is a step towards a proper principle. It retains the six month frame time frame, but insists that the judgement is grounded in peer reviewed palliative care standards, not vague estimates. So I would urge that these small amendments strengthen the bill and they safeguard our humanity. If we decide to go down the route of
**** Possible New Speaker ****
adopting this bill. My Lords, this would seem to be a convenient time to pause a convenient time to pause proceedings for the day. I therefore beg to move that debate on this amendment. Be adjourned. If on this amendment. Be adjourned. If agreed, can colleagues in attendance please make sure at the end of the proceedings their name end of the proceedings their name is registered at the table for the continuation of the debate on 6th February.
**** Possible New Speaker ****
February. The noble Lady would allow me just to intervene quickly. Noble Lords will know that I sat for the whole day waiting for amendments, and I have not intervened. But I want to just put on record that I won't be able to be here next Friday, and therefore I would invite the House to consider particularly what Baroness Campbell of Surbiton said in relation to amendment 87. And I'd like, if I may, to put on record my thanks to my noble friend, the noble and learned Lord, in relation to his willingness to look at the issues in relation to anorexia and bulimia.
And I regret that I will not be able to be here. Imminently. My Lords, the question is that a debate on this amendment be adjourned, as many of that opinion
**** Possible New Speaker ****
shall say, content contrary, not content to the contents have it. My Lords, I beg to move that the
**** Possible New Speaker ****
House be resumed. Question is that the House be resumed, as many are of that opinion, shall say, content opinion, shall say, content contrary, not content. The contents have it.
**** Possible New Speaker ****
My Lords, I beg to move the House. Do now adjourn.