Lords Chamber
10:15
Baroness O'Loan (Crossbench)
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Baroness O'Loan (Crossbench)
controlled, may cause a doctor to predict death. Noble Lords have articulated the concerns that exist about the inadequacy and danger of this primary definition. Illnesses which can be stabilised, halted or effectively managed by treatment must be excluded, ensuring that only genuinely terminal illnesses are included in the definition. And the second part of the test relates to the six month prognosis. We have heard at length about the difficulties of prognosis. Noble Lord Lord Stevens referred last week to the study of over 998,000 prognoses, which found that the accuracy of prognosis in the weeks months range dropped to 32%.
My Lords, that means that 68% of patients receive an incorrect prognosis in that range, and they may find themselves qualifying and choosing to die thinking that this is what's going to happen to them anyway, when they could have lived so much longer and their families and friends could have benefited from them continuing to live. Murray and Atkin, writing in the BMJ, said there are no valid tools, tests or clinical clinical examinations that can reliably and safely identify that a person is expected to die within six months.
And Paddy Stone, who's a former head of the Marie Curie Palliative Care Research Department at UCL, agreed. My research demonstrates there's no reliable way to identify patients with 6 to 12 months to live, at least no method that would be reliable enough to act as a safeguard for the proposed assisted dying legislation. And Professor Martin Vernon, of the British Geriatrics Society told the committee doctors and health professionals are very good at predicting when someone is going to die within 1 to 3 days.
They are also very good at predicting when someone's likely to survive beyond a year. In between those days, those times, it's almost impossible for a doctor to predict genuinely accurately. We have heard so often in the course of these proceedings that those who have disabilities are terrified that their lives will be seen as lesser value, and that they'll be identified as suitable for assisted death at some stage when they're suffering from pneumonia or unhealed pressure sore, for example, we know that there is a significant risk of unconscious bias against such patients.
Doctor Alex Hughes of King's College Hospital, noted in written evidence that doctors who choose to participate in assisted dying may be a self-selecting group, leading to a heightened risk of unconscious bias and therefore an increased risk of incorrect prognostication. Baroness Grey-Thompson the noble Baroness, in oral evidence to the Lords Select Committee, noted that the diagnosis of six months does not protect disabled people, arguing that the time limit could easily be eroded or doctors might intentionally overlook the six month criterion due to inherent discrimination against disabled people.
My Lords, there's also the risk of confirmation bias, particularly where a doctor decides to initiate a conversation about assisted dying with a patient. In so doing, the doctor has reached certain judgements about the patient. However, the doctor's assessment of the context in which the patient lives may be uninformed and when coming to a decision about whether the patient has more or fewer than six months to live, their initial judgement may be confirmed by them as a consequence of unrecognised confirmation bias.
If the doctor has made a decision that something may happen, but is unaware of factors which may impact on the patient's decision making, the doctor may well feel confirmed in his judgement after discussions with the patient. That is a significant risk given the extent to which patients generally believe that the information and advice given to doctors is to improve or enhance their situation, and also the extent to which patients have difficulty in comprehending what they're being told during these very sensitive discussions.
It's a very difficult issue, but the evidence is very sobering when one considers that an assisted death doesn't just deprive the patient of a future, but it also deprives those who love them of a future together, which may last years. It is for that reason that I seek the. I support these amendments which seek to clarify what the standard should be. A further question is, does this bill apply a proper test for access to assisted suicide? Autonomy is the all important other factor.
Once a person has a diagnosis and the requisite prognosis, this test is not widely used in other jurisdictions, and the consequence of using it is that under the Bill, no consideration of all the issues which have been discussed thus far during the Bill's progress through your Lordships House inability to access palliative care, pregnancy, disability, serious mental illness, poverty, bad or no housing, a sense of being a burden. The noble Lord, Lord Faulkner, told us that these considerations may properly contribute to a person reaching a clear, settled and informed wish to die.
However, it can well be argued that a person's problems due perhaps to poverty, isolation or a fear of being a burden could be addressed if they had a little more money or a decent place to live, they may well choose to live, not to die. In so many cases, it is the circumstances of their lives which lead so many people in other jurisdictions to seek assisted suicide and euthanasia, not illness. People talk of the right to choose to die, but they do not talk of the effect of being crushed by poverty and isolation, especially if it's accompanied, as it is in so many cases of terminal illness by disability.
And people think there's no way forward for them. The bill could lead to the rich and comfortable rejecting assisted dying and opting for palliative care in all its forms, and living contentedly and normally without suffering for much longer than the six month prognosis. While the poor and the marginalised die. This bill could lead to to those with serious mental health problems, choosing assisted dying at a moment of suicidal ideation. My Lords, the CQC report on the Mental Health Act, published last week, told us that black people are being detained at four times the rate of white people and that people living in deprived areas are 3.6 times more likely to be detained under the act than other people.
I do not think this is covered in the impact assessment. My Lords, the answer to these problems is not to be found in killing people. Rather, it is to be found in caring for them.
My Lords, that means that 68% of patients receive an incorrect prognosis in that range, and they may find themselves qualifying and choosing to die thinking that this is what's going to happen to them anyway, when they could have lived so much longer and their families and friends could have benefited from them continuing to live. Murray and Atkin, writing in the BMJ, said there are no valid tools, tests or clinical clinical examinations that can reliably and safely identify that a person is expected to die within six months.
And Paddy Stone, who's a former head of the Marie Curie Palliative Care Research Department at UCL, agreed. My research demonstrates there's no reliable way to identify patients with 6 to 12 months to live, at least no method that would be reliable enough to act as a safeguard for the proposed assisted dying legislation. And Professor Martin Vernon, of the British Geriatrics Society told the committee doctors and health professionals are very good at predicting when someone is going to die within 1 to 3 days.
They are also very good at predicting when someone's likely to survive beyond a year. In between those days, those times, it's almost impossible for a doctor to predict genuinely accurately. We have heard so often in the course of these proceedings that those who have disabilities are terrified that their lives will be seen as lesser value, and that they'll be identified as suitable for assisted death at some stage when they're suffering from pneumonia or unhealed pressure sore, for example, we know that there is a significant risk of unconscious bias against such patients.
Doctor Alex Hughes of King's College Hospital, noted in written evidence that doctors who choose to participate in assisted dying may be a self-selecting group, leading to a heightened risk of unconscious bias and therefore an increased risk of incorrect prognostication. Baroness Grey-Thompson the noble Baroness, in oral evidence to the Lords Select Committee, noted that the diagnosis of six months does not protect disabled people, arguing that the time limit could easily be eroded or doctors might intentionally overlook the six month criterion due to inherent discrimination against disabled people.
My Lords, there's also the risk of confirmation bias, particularly where a doctor decides to initiate a conversation about assisted dying with a patient. In so doing, the doctor has reached certain judgements about the patient. However, the doctor's assessment of the context in which the patient lives may be uninformed and when coming to a decision about whether the patient has more or fewer than six months to live, their initial judgement may be confirmed by them as a consequence of unrecognised confirmation bias.
If the doctor has made a decision that something may happen, but is unaware of factors which may impact on the patient's decision making, the doctor may well feel confirmed in his judgement after discussions with the patient. That is a significant risk given the extent to which patients generally believe that the information and advice given to doctors is to improve or enhance their situation, and also the extent to which patients have difficulty in comprehending what they're being told during these very sensitive discussions.
It's a very difficult issue, but the evidence is very sobering when one considers that an assisted death doesn't just deprive the patient of a future, but it also deprives those who love them of a future together, which may last years. It is for that reason that I seek the. I support these amendments which seek to clarify what the standard should be. A further question is, does this bill apply a proper test for access to assisted suicide? Autonomy is the all important other factor.
Once a person has a diagnosis and the requisite prognosis, this test is not widely used in other jurisdictions, and the consequence of using it is that under the Bill, no consideration of all the issues which have been discussed thus far during the Bill's progress through your Lordships House inability to access palliative care, pregnancy, disability, serious mental illness, poverty, bad or no housing, a sense of being a burden. The noble Lord, Lord Faulkner, told us that these considerations may properly contribute to a person reaching a clear, settled and informed wish to die.
However, it can well be argued that a person's problems due perhaps to poverty, isolation or a fear of being a burden could be addressed if they had a little more money or a decent place to live, they may well choose to live, not to die. In so many cases, it is the circumstances of their lives which lead so many people in other jurisdictions to seek assisted suicide and euthanasia, not illness. People talk of the right to choose to die, but they do not talk of the effect of being crushed by poverty and isolation, especially if it's accompanied, as it is in so many cases of terminal illness by disability.
And people think there's no way forward for them. The bill could lead to the rich and comfortable rejecting assisted dying and opting for palliative care in all its forms, and living contentedly and normally without suffering for much longer than the six month prognosis. While the poor and the marginalised die. This bill could lead to to those with serious mental health problems, choosing assisted dying at a moment of suicidal ideation. My Lords, the CQC report on the Mental Health Act, published last week, told us that black people are being detained at four times the rate of white people and that people living in deprived areas are 3.6 times more likely to be detained under the act than other people.
I do not think this is covered in the impact assessment. My Lords, the answer to these problems is not to be found in killing people. Rather, it is to be found in caring for them.
10:21
Lord Moylan (Conservative)
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Lord Moylan (Conservative)
Lords, I have four amendments in this group. Three of them are this group. Three of them are closely related. They are 85 894 and 896, the latter two being and 896, the latter two being consequential on 85. I also have amendment number 100, but I will come back to that towards the end. I'm grateful to the noble Baroness Lane-Fox Buckley and my noble friend Lord Hamilton of Epsom for giving their names, lending their names to number 85, and to the noble Lord, Lord Carlile of Berriew, for adding his name to 89.
For my Lords, one of the concerns about this Bill is the possibility that the condition that qualifies, it's one of the key qualifications to have a terminal illness that that the definition of that qualification becomes expanded over time. What I'm going to call creep, I'm not going to detain the House with examples from other jurisdictions, but there are examples from other jurisdictions where the scope for assisted dying has been made available to people with conditions that would hardly qualify as terminal illness and might not, might well not have qualified as appropriate in the minds of the legislators who first put the legislation together.
And I think it would give the public some confidence in the bill if they were to know that that capacity for creep was severely limited. My suggestion for limiting it is that there should be a list of what constitutes terminal illness. I'm not suggesting this list should be on the face of the bill. I believe the list should be issued by the Secretary of State by way of regulation, and it should be updated periodically in the light of medical advice.
I'm going to turn now to a couple of questions I've got for the noble and learned Lord, Lord Falconer. And then I will deal with some objections that might be raised. My first question concerns his own definition in clause two. In the first line of subsection one, where he in subsection one A, where he says the person has an inevitably progressive illness or disease, inevitably progressive illness or disease, which cannot be reversed by treatment. And my question to him is in the first places whether he regards inevitable and progressive as adding anything to the notion of depth of, of term, of being terminal.
In other words, is is each a subset of the other? Is the definition getting narrower with the addition of each of those words? Or are they in fact otiose? And if you left them out, the scope of the definition would be just the same. I'd be. I'd be interested to know his answer to that, although it doesn't affect directly what I'm now going to say. The question of the list was dealt with in the other place to some extent, and arguments were made which suggested that it would all be very difficult because people didn't always die from one illness.
Sometimes they had two terminal illnesses, or they had complications or comorbidities. And medically, I'm sure that is absolutely the case. But I don't think it's relevant to what I'm arguing for, because the bill is clear that you have to pass certain qualifications, certain thresholds, in order to be considered for assisted dying. And one of them is that you have an inevitably progressive illness or disease which cannot be reversed by treatment, but you only have to have one of them in order to qualify.
You could have two, but you would still qualify. It's irrelevant. You could. You could have one with several comorbidities and you would still qualify. So it doesn't matter in the case of an individual how they might die. In the end, what matters is their condition at a particular moment and whether they have a an inevitably progressive illness or disease at a particular time. So applying the list doesn't seem to me very difficult. The other objection that might be raised is that the list would be very difficult to put together, because there are many illnesses or diseases.
But actually, I think this is wrong. If one considers illnesses or diseases as a way of dying, and one excludes such things as falling off a roof or some adventitious accident of that character, if one considers the list of diseases or illnesses they are all known. We know medically what people die of. Very occasionally a new illness or disease of a terminal character arrives. Aids was an example in the 1980s and 90s. It completely shocked us.
It completely shocked us, partly because it is such a rare thing for a new terminal illness or disease to arrive. Of course, my amendment would allow if there were such an eventuality. Heaven forfend in the future, it allows for the Secretary of State to adjust the list. So we do know what it is, people, and we can put them together. And then the Secretary of State can make a list, and it will be subject to scrutiny, because all regulations made under this bill, I think the noble and learned Lord will confirm, have to be made by affirmative Statutory Instrument.
So it will be subject to scrutiny and people will be able to comment. And I think that would give them great assurance that creep was not going to be a feature of this. So I'd be grateful to her. The noble and learned Lords response to that proposal. I'm going to come now, briefly, if I may, to my final amendment in this group, which is quite different, which is amendment 100. This is genuinely probing because when I read the bill and I got to clause two, subsection four, I found a sentence which began nothing in this subsection results.
It was strange. Typographically because it's it isn't a new paragraph. There isn't a paragraph break, but nor does it run on directly as a sentence. It's obviously been botched in at some point, probably in the other place. Anyway, these things happen. So I read it, and then I read it again, and I read it over and over again, and at the end of it, I still could not work out what this sentence beginning in, in, in two for nothing in this subsection results what it actually means.
And even if I could construe it in such a way that it did mean something, I wouldn't know what it meant. In the context of clause two. So this is simply this is a genuine probing opportunity for clarity from the noble and learned Lord as to what import he thinks this sentence has in clause two. It would greatly, I think, certainly please me, and I think many other noble Lords, if we understood that, and if we understood whether in fact it should stand or be swept away.
My proposal to delete it is, as I say at this stage, entirely probing. In order to hear what the
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noble and learned Lord has to say. My Lords, I tabled amendment. 73.
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73. One of the issues about this is about whether an illness, a disease, about whether an illness, a disease, is terminal without treatment, and a simple example of that is type a simple example of that is type one diabetes. So the World Health
For my Lords, one of the concerns about this Bill is the possibility that the condition that qualifies, it's one of the key qualifications to have a terminal illness that that the definition of that qualification becomes expanded over time. What I'm going to call creep, I'm not going to detain the House with examples from other jurisdictions, but there are examples from other jurisdictions where the scope for assisted dying has been made available to people with conditions that would hardly qualify as terminal illness and might not, might well not have qualified as appropriate in the minds of the legislators who first put the legislation together.
And I think it would give the public some confidence in the bill if they were to know that that capacity for creep was severely limited. My suggestion for limiting it is that there should be a list of what constitutes terminal illness. I'm not suggesting this list should be on the face of the bill. I believe the list should be issued by the Secretary of State by way of regulation, and it should be updated periodically in the light of medical advice.
I'm going to turn now to a couple of questions I've got for the noble and learned Lord, Lord Falconer. And then I will deal with some objections that might be raised. My first question concerns his own definition in clause two. In the first line of subsection one, where he in subsection one A, where he says the person has an inevitably progressive illness or disease, inevitably progressive illness or disease, which cannot be reversed by treatment. And my question to him is in the first places whether he regards inevitable and progressive as adding anything to the notion of depth of, of term, of being terminal.
In other words, is is each a subset of the other? Is the definition getting narrower with the addition of each of those words? Or are they in fact otiose? And if you left them out, the scope of the definition would be just the same. I'd be. I'd be interested to know his answer to that, although it doesn't affect directly what I'm now going to say. The question of the list was dealt with in the other place to some extent, and arguments were made which suggested that it would all be very difficult because people didn't always die from one illness.
Sometimes they had two terminal illnesses, or they had complications or comorbidities. And medically, I'm sure that is absolutely the case. But I don't think it's relevant to what I'm arguing for, because the bill is clear that you have to pass certain qualifications, certain thresholds, in order to be considered for assisted dying. And one of them is that you have an inevitably progressive illness or disease which cannot be reversed by treatment, but you only have to have one of them in order to qualify.
You could have two, but you would still qualify. It's irrelevant. You could. You could have one with several comorbidities and you would still qualify. So it doesn't matter in the case of an individual how they might die. In the end, what matters is their condition at a particular moment and whether they have a an inevitably progressive illness or disease at a particular time. So applying the list doesn't seem to me very difficult. The other objection that might be raised is that the list would be very difficult to put together, because there are many illnesses or diseases.
But actually, I think this is wrong. If one considers illnesses or diseases as a way of dying, and one excludes such things as falling off a roof or some adventitious accident of that character, if one considers the list of diseases or illnesses they are all known. We know medically what people die of. Very occasionally a new illness or disease of a terminal character arrives. Aids was an example in the 1980s and 90s. It completely shocked us.
It completely shocked us, partly because it is such a rare thing for a new terminal illness or disease to arrive. Of course, my amendment would allow if there were such an eventuality. Heaven forfend in the future, it allows for the Secretary of State to adjust the list. So we do know what it is, people, and we can put them together. And then the Secretary of State can make a list, and it will be subject to scrutiny, because all regulations made under this bill, I think the noble and learned Lord will confirm, have to be made by affirmative Statutory Instrument.
So it will be subject to scrutiny and people will be able to comment. And I think that would give them great assurance that creep was not going to be a feature of this. So I'd be grateful to her. The noble and learned Lords response to that proposal. I'm going to come now, briefly, if I may, to my final amendment in this group, which is quite different, which is amendment 100. This is genuinely probing because when I read the bill and I got to clause two, subsection four, I found a sentence which began nothing in this subsection results.
It was strange. Typographically because it's it isn't a new paragraph. There isn't a paragraph break, but nor does it run on directly as a sentence. It's obviously been botched in at some point, probably in the other place. Anyway, these things happen. So I read it, and then I read it again, and I read it over and over again, and at the end of it, I still could not work out what this sentence beginning in, in, in two for nothing in this subsection results what it actually means.
And even if I could construe it in such a way that it did mean something, I wouldn't know what it meant. In the context of clause two. So this is simply this is a genuine probing opportunity for clarity from the noble and learned Lord as to what import he thinks this sentence has in clause two. It would greatly, I think, certainly please me, and I think many other noble Lords, if we understood that, and if we understood whether in fact it should stand or be swept away.
My proposal to delete it is, as I say at this stage, entirely probing. In order to hear what the
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noble and learned Lord has to say. My Lords, I tabled amendment. 73.
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73. One of the issues about this is about whether an illness, a disease, about whether an illness, a disease, is terminal without treatment, and a simple example of that is type a simple example of that is type one diabetes. So the World Health
10:30
Baroness Coffey (Conservative)
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Baroness Coffey (Conservative)
Organisation classifies diabetes as a disease. And under the bill as it stands and has been pointed out by witnesses in the I think, the Commons Select Committee, oral evidence, that means anybody who decided that they weren't going to take their insulin for whatever reason, would automatically have a reversible disease. And without taking insulin, they will die. So one of the things that I wanted to explore in this amendment is, is that what we're thinking about? Now? It's perfectly we know that people can withdraw from treatment on lots of things.
That's not what we're debating today. There are other examples where the extent has been sorry things have been extended in other countries. I appreciate we'll be getting on to issues about anorexia and similar in another group, so I won't dwell on those. But even conditions like arthritis, my noble friends just referred to Aids. Those all an HIV is also issues to do with hernias. I've been led to believe where these have been used as examples of in effect, where without treatment it's irreversible.
So I think we should consider carefully and hear and understand why we aren't putting some kind of condition on what the definition of terminal illness is. I think the other thing, and I can't remember which professor it was that spoke it in the Commons Select committee. As it stands, they suggested in general practice and in clinical practice, if somebody decided in, in hospital or, or the GP to suddenly say, I'm not going to take my insulin anymore, there would be pretty much an immediate trying to understand why.
Why is somebody trying to accelerate their death in this way now, in this bill? It's the standard 2005 Mental Capacity Act. That's the test that is simply are they in the right mind to make this decision? And of course, people might disagree with that decision, but there's no further trying to understand which would happen in a regular kind of clinical practice way. So that's why I think we need to try and get a sense of terminal illness. We know successfully so many people do get treated for cancer.
We know also it's one of the biggest killers and we the cancer plan I'm sure recognised that yesterday. But I think that we should also be thinking carefully about some. I think safeguards isn't exactly the right word I would use in this case, but to think about processes that we need to get into place to try and understand what can we do further or expect clinicians further in this bill to start to be able to ask those sorts of questions when we consider what technically, of course, is a terminal illness.
But as we know, people can live an exceptionally long time. People live with diabetes type one and have very fulfilling lives. So I think we should reconsider this in terms of aspects of definition.
That's not what we're debating today. There are other examples where the extent has been sorry things have been extended in other countries. I appreciate we'll be getting on to issues about anorexia and similar in another group, so I won't dwell on those. But even conditions like arthritis, my noble friends just referred to Aids. Those all an HIV is also issues to do with hernias. I've been led to believe where these have been used as examples of in effect, where without treatment it's irreversible.
So I think we should consider carefully and hear and understand why we aren't putting some kind of condition on what the definition of terminal illness is. I think the other thing, and I can't remember which professor it was that spoke it in the Commons Select committee. As it stands, they suggested in general practice and in clinical practice, if somebody decided in, in hospital or, or the GP to suddenly say, I'm not going to take my insulin anymore, there would be pretty much an immediate trying to understand why.
Why is somebody trying to accelerate their death in this way now, in this bill? It's the standard 2005 Mental Capacity Act. That's the test that is simply are they in the right mind to make this decision? And of course, people might disagree with that decision, but there's no further trying to understand which would happen in a regular kind of clinical practice way. So that's why I think we need to try and get a sense of terminal illness. We know successfully so many people do get treated for cancer.
We know also it's one of the biggest killers and we the cancer plan I'm sure recognised that yesterday. But I think that we should also be thinking carefully about some. I think safeguards isn't exactly the right word I would use in this case, but to think about processes that we need to get into place to try and understand what can we do further or expect clinicians further in this bill to start to be able to ask those sorts of questions when we consider what technically, of course, is a terminal illness.
But as we know, people can live an exceptionally long time. People live with diabetes type one and have very fulfilling lives. So I think we should reconsider this in terms of aspects of definition.
10:33
Lord Young of Norwood Green (Labour)
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Lord Young of Norwood Green (Labour)
Decided to speak. I haven't spoken in this debate before, but it was actually Lord Pannick contribution that made me want to contribution that made me want to speak in, in, in this debate. And he reminded us that nobody could he reminded us that nobody could say that a doctor can tell you that you would die within six months, but the bill does not. So provide its conditions require only 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.
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Is not down as being present. At week. When I was on the list, I
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When I was on the list, I checked. I checked before I. Went, not according to the one
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Went, not according to the one we are getting. To.
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And my name was on there. Yes. His name?
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Yeah. Sorry. Don't worry about it.
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Yeah. We don't. If it's the will of the house to hear him speak and find.
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find. Continue to write. Thank you. Well, I checked before I went. I'm puzzled. Right. So. It was. It was the. It was Lord So. It was. It was the. It was Lord Pannick comment that the person has an inevitably progressive illness or disease which cannot be reversed, and the person's death, in consequence, can reasonably be expected within six months. Now, we know from all the evidence that we've heard that trying to predict when someone will die is not a precise science.
But that isn't really the point of of this, of this particular bill. It's about ensuring that people have got a right to choose, and that they're doing so in circumstances where we can feel reasonably confident that the safeguards are there. And when I look at the when I look at the bill and the safeguards are there, there's there they are. This is a very cautious step forward. Initial request for assistance. First declaration witnessing first declaration. First doctor's assessment.
Second doctor's assessment. Doctor's assessments. Further provision. I mean, sometimes when I listen to some of the noble Lords speaking as though we've just got one doctor who may not be very mature or experienced, that is not the case within this bill. It's much more it's much more careful. It's much more. It's much more cautious. And I think it was it was Baroness Jay of Paddington last time. Who says who said who reminded us that one of the international facts that supports entirely the position that we're taking is that in the 33 jurisdictions where assisted dying is allowed, it is usually the case, and she cites 1 or 2 that following the suggestion by a doctor or prognosis, wherever you want to describe it, over a third of those who make the choice has described then do not use the the provision.
There's no question that they want to die. They're simply using it almost as an insurance policy. So I understand that there is a there is a real difference of opinion within within this House. There are those who feel that if we make this step forward, I listen carefully to what Baroness O'Loan was saying, that if we make this step, if we don't put more things on the face of the bill, that that it will be unsafe. I don't I don't take that point of view.
I take I take the point, point of view that we are giving people, as Lord Pannick said to us, we're giving people the right, the right to choose. That may not that may not accord with everybody's view in this House. There are others that wanted us to take into account degree of suffering. There was others wanted to take into account all sorts of of circumstances. But I don't accord with that, do I take I take the view that we are trying to in, in this House with some difficulty.
We're trying to ensure that we've got a bill that does give us give people the right to choose, that has got significant safeguards in there. Can it can it help people in, can it guarantee that we can tell people exactly when they're going to die? Of course we can't. We heard evidence previously. Wes Streeting, the Minister, announced recently that cancer treatment, we're going to make significant improvements on that. That will change people's lives fundamentally. So on those grounds, in my view, anyway, I hope that the House will continue to support this bill.
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Is not down as being present. At week. When I was on the list, I
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When I was on the list, I checked. I checked before I. Went, not according to the one
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Went, not according to the one we are getting. To.
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And my name was on there. Yes. His name?
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Yeah. Sorry. Don't worry about it.
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Yeah. We don't. If it's the will of the house to hear him speak and find.
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find. Continue to write. Thank you. Well, I checked before I went. I'm puzzled. Right. So. It was. It was the. It was Lord So. It was. It was the. It was Lord Pannick comment that the person has an inevitably progressive illness or disease which cannot be reversed, and the person's death, in consequence, can reasonably be expected within six months. Now, we know from all the evidence that we've heard that trying to predict when someone will die is not a precise science.
But that isn't really the point of of this, of this particular bill. It's about ensuring that people have got a right to choose, and that they're doing so in circumstances where we can feel reasonably confident that the safeguards are there. And when I look at the when I look at the bill and the safeguards are there, there's there they are. This is a very cautious step forward. Initial request for assistance. First declaration witnessing first declaration. First doctor's assessment.
Second doctor's assessment. Doctor's assessments. Further provision. I mean, sometimes when I listen to some of the noble Lords speaking as though we've just got one doctor who may not be very mature or experienced, that is not the case within this bill. It's much more it's much more careful. It's much more. It's much more cautious. And I think it was it was Baroness Jay of Paddington last time. Who says who said who reminded us that one of the international facts that supports entirely the position that we're taking is that in the 33 jurisdictions where assisted dying is allowed, it is usually the case, and she cites 1 or 2 that following the suggestion by a doctor or prognosis, wherever you want to describe it, over a third of those who make the choice has described then do not use the the provision.
There's no question that they want to die. They're simply using it almost as an insurance policy. So I understand that there is a there is a real difference of opinion within within this House. There are those who feel that if we make this step forward, I listen carefully to what Baroness O'Loan was saying, that if we make this step, if we don't put more things on the face of the bill, that that it will be unsafe. I don't I don't take that point of view.
I take I take the point, point of view that we are giving people, as Lord Pannick said to us, we're giving people the right, the right to choose. That may not that may not accord with everybody's view in this House. There are others that wanted us to take into account degree of suffering. There was others wanted to take into account all sorts of of circumstances. But I don't accord with that, do I take I take the view that we are trying to in, in this House with some difficulty.
We're trying to ensure that we've got a bill that does give us give people the right to choose, that has got significant safeguards in there. Can it can it help people in, can it guarantee that we can tell people exactly when they're going to die? Of course we can't. We heard evidence previously. Wes Streeting, the Minister, announced recently that cancer treatment, we're going to make significant improvements on that. That will change people's lives fundamentally. So on those grounds, in my view, anyway, I hope that the House will continue to support this bill.
10:38
Lord Shamash (Labour)
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Lord Shamash (Labour)
Yeah. My Lords, can I address the. On a personal note, my late the. On a personal note, my late brother in law suffered from muscular dystrophy. That is a horrendous progressive disease. horrendous progressive disease. Many of you may have come across it. The last years of his life were pushed around in a wheelchair. It was very difficult for the family
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and particularly difficult for my wife, his sister. The noble Lord isn't on the list,
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The noble Lord isn't on the list, so therefore wasn't there last week and shouldn't be taking part. me.
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We are. Yeah. Thank you. I apologise to to the
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Thank you. I apologise to to the members about that. The problem was in the later part of his life, his in the later part of his life, his lungs began to give way. And I remember him saying to me in the last 2 or 3 months of his life, I just wish somebody could help me here and so that I could end my life to watch somebody die like that. A member of your close family die from what is a horrendous disease, is something that I hope the House will take into account.
What I'm very concerned about is this clause 105, which I think is very, very tough indeed. And I sincerely hope that the House will actually reject this amendment
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it. Not. Agree the word model dies suffocating, suffocation? Yeah, can I apologise? The word is suffocating as his lungs began to to fade. Thank you.
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to fade. Thank you. If I could just rise and speak in support of Baroness Coffey amendment. And I'm going to talk about my sister, whom I did ask about my sister, whom I did ask before she died, whether I could bring her case before your Lordships. And she said, yes, and I
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and particularly difficult for my wife, his sister. The noble Lord isn't on the list,
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The noble Lord isn't on the list, so therefore wasn't there last week and shouldn't be taking part. me.
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We are. Yeah. Thank you. I apologise to to the
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Thank you. I apologise to to the members about that. The problem was in the later part of his life, his in the later part of his life, his lungs began to give way. And I remember him saying to me in the last 2 or 3 months of his life, I just wish somebody could help me here and so that I could end my life to watch somebody die like that. A member of your close family die from what is a horrendous disease, is something that I hope the House will take into account.
What I'm very concerned about is this clause 105, which I think is very, very tough indeed. And I sincerely hope that the House will actually reject this amendment
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it. Not. Agree the word model dies suffocating, suffocation? Yeah, can I apologise? The word is suffocating as his lungs began to to fade. Thank you.
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to fade. Thank you. If I could just rise and speak in support of Baroness Coffey amendment. And I'm going to talk about my sister, whom I did ask about my sister, whom I did ask before she died, whether I could bring her case before your Lordships. And she said, yes, and I
10:40
Lord Farmer (Conservative)
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Lord Farmer (Conservative)
have brought her case. She had a very unhappy life. She was badly abused when she was a child. She abused when she was a child. She tried to kill herself three times before she was 20. Now, thankfully before she was 20. Now, thankfully we she stayed alive until she was 75 and all the time she expressed a will, I don't want to live. When I came in here on the day I came in came in here on the day I came in here and was introduced, she was here and she said, I'm glad I'm alive, which I was very happy about.
However, thereafter she developed lung cancer. She had been a smoker and she was obviously dying. She refused treatment. OK, so she allowed the lung cancer to kill her. But at all times she had the option to allow her to have treatment for the lung cancer. And so the autonomy she had there was that she could actually take the positive route. She decided not to. She didn't have any assistance from anybody else. And she died actually fairly peacefully when she was 75.
And so I just want to bring that as a case to your Lordships House in support of what Baroness Coffey was saying. My Lord, I rise to 105.
However, thereafter she developed lung cancer. She had been a smoker and she was obviously dying. She refused treatment. OK, so she allowed the lung cancer to kill her. But at all times she had the option to allow her to have treatment for the lung cancer. And so the autonomy she had there was that she could actually take the positive route. She decided not to. She didn't have any assistance from anybody else. And she died actually fairly peacefully when she was 75.
And so I just want to bring that as a case to your Lordships House in support of what Baroness Coffey was saying. My Lord, I rise to 105.
10:42
Lord Shinkwin (Conservative)
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Lord Shinkwin (Conservative)
In the name of Lord Hunt of >> In the name of Lord Hunt of Kings Heath, to which I've added my Kings Heath, to which I've added my name, my Lords, I'm saddened by the prejudice we have heard expressed by members of your Lordships' House this morning. For those of us with a lifelong congenital condition, this amendment is personal. It is also crucial because people like me need protection from such blatant prejudice. Prejudice, which the pandemic says can inform so many clinical and even administrative decisions affecting disabled people's care and treatment decisions about life or death.
This amendment would give those of us with lifelong congenital conditions some protection. My Lords, I to imagine that some noble Lords might step at all as to how an NHS founded on the principle of equal access to treatments free at the point of delivery, to possibly also tolerate a culture of discrimination on grounds of disability? Surely that is the very antithesis of its founding charter. Perhaps it is. But human beings, being humans, we bring our prejudices and as the Lord Bowness Baroness O'Loan so ably reminded us, are unconscious bias to worked and healthcare staff are no exception.
This is especially the case when the very nature of a congenital lifelong disability can often mean a condition that, despite very expensive treatments, may never be cured. And I was reminded of such prejudice only recently when attending an appointment at a world renowned London hospital. The clinical staff could not have been nicer or more professional. In contrast, the young receptionist could barely conceal his hostility. When I spoke to him. I have no idea why, but he was laughing and joking with another patient soon afterwards.
All I know is that I experienced an immediately recognised discrimination, as if somehow I chose to look or sound like this. I most definitely did not. Yet I'm discriminated against it, against because of it. Well, I'll never forget that. When I was beginning my slow and painful recovery following neurosurgery 30 years ago, it wasn't the intense pain or the absolute exhaustion which nearly killed me, but rather the shocking and brutal awareness that some of the nursing and medical staff's expectations for my recovery and life chances were so unbelievably low.
Here is I, a young man who, only 24 hours earlier, had taken a toll from a Minister, confirming that a charity campaign I've led on had secured £50 million, suddenly reduced to being unable to speak, to swallow, to breathe independently. Trust by the cultural presumption that, as a disabled person I should have minimal expectations for the rest of my life. My Lords, I share this lived experience which left me with a diagnosis of PTSD at the age of 25, and which I would much rather have consigned to the deepest recesses of my mind, because it is directly relevant to this amendment.
Sadly, there are so few of us in your Lordships' House who can draw on such lived experience and insights. Which brings me to another essential point. It's this the noble and learned Lord Falconer of Thoroton has raised the issue of legitimacy. My Lords, specifically in relation to amendment 105. Given that your Lordships' House is so desperately unrepresentative, not just of disabled people, but particularly on people with lifelong congenital conditions, perhaps a noble and learned Lord Willetts explain in his closing remarks as to why on earth any non-disabled member of this House would presume that it is a law making body.
It has either the authority or the credibility, or indeed the legitimacy to reject this amendment. My Lords, it has none. And I remind your Lordships House that not one, not one organisation of or for disabled people supports this Bill. My Lords, I have another question. I was given a six month terminal diagnosis as a last resort. I was operated on for 12 hours and it all into one of the surgeons who took great pleasure in telling me afterwards.
It was pretty aggressive surgery, but hey, I was going to die anyway. But some miracle. Having spent three years learning to talk again, I'm still here. Yet my overall condition is inevitably progressive and cannot be reversed by treatment. So I wonder if I would qualify for assisted dying. Perhaps I would in time, but I'd be far less likely to fall victim to scope creep if this amendment was passed. I mentioned scope creep.
I fear that this bill implicitly puts a price on my head, and people with lifelong congenital conditions, because it effectively facilitates a pathway whereby withholding expensive treatments risks making people like me eligible for assisted dying. My Lord, let us remember that some people are determined that this bill, as has been the case in other jurisdictions, is only the beginning already. My death. My decision had criticised the bill as inadequate.
Now I have huge respect for lawyers, particularly those in your Lordships' House. But that doesn't mean I'm comfortable about the likelihood that some of them may pose to extend the law, perhaps using the. My Lords, this bill poses a very real and present danger for people with lifelong congenital conditions. This amendment is crucial to mitigating that threat. So I close with this appeal to the noble and learned Lords. Please will he accept this amendment until I asked him to confirm that he agrees with me that after consideration of this crucial amendment, should neither be filibustering?
This amendment would give those of us with lifelong congenital conditions some protection. My Lords, I to imagine that some noble Lords might step at all as to how an NHS founded on the principle of equal access to treatments free at the point of delivery, to possibly also tolerate a culture of discrimination on grounds of disability? Surely that is the very antithesis of its founding charter. Perhaps it is. But human beings, being humans, we bring our prejudices and as the Lord Bowness Baroness O'Loan so ably reminded us, are unconscious bias to worked and healthcare staff are no exception.
This is especially the case when the very nature of a congenital lifelong disability can often mean a condition that, despite very expensive treatments, may never be cured. And I was reminded of such prejudice only recently when attending an appointment at a world renowned London hospital. The clinical staff could not have been nicer or more professional. In contrast, the young receptionist could barely conceal his hostility. When I spoke to him. I have no idea why, but he was laughing and joking with another patient soon afterwards.
All I know is that I experienced an immediately recognised discrimination, as if somehow I chose to look or sound like this. I most definitely did not. Yet I'm discriminated against it, against because of it. Well, I'll never forget that. When I was beginning my slow and painful recovery following neurosurgery 30 years ago, it wasn't the intense pain or the absolute exhaustion which nearly killed me, but rather the shocking and brutal awareness that some of the nursing and medical staff's expectations for my recovery and life chances were so unbelievably low.
Here is I, a young man who, only 24 hours earlier, had taken a toll from a Minister, confirming that a charity campaign I've led on had secured £50 million, suddenly reduced to being unable to speak, to swallow, to breathe independently. Trust by the cultural presumption that, as a disabled person I should have minimal expectations for the rest of my life. My Lords, I share this lived experience which left me with a diagnosis of PTSD at the age of 25, and which I would much rather have consigned to the deepest recesses of my mind, because it is directly relevant to this amendment.
Sadly, there are so few of us in your Lordships' House who can draw on such lived experience and insights. Which brings me to another essential point. It's this the noble and learned Lord Falconer of Thoroton has raised the issue of legitimacy. My Lords, specifically in relation to amendment 105. Given that your Lordships' House is so desperately unrepresentative, not just of disabled people, but particularly on people with lifelong congenital conditions, perhaps a noble and learned Lord Willetts explain in his closing remarks as to why on earth any non-disabled member of this House would presume that it is a law making body.
It has either the authority or the credibility, or indeed the legitimacy to reject this amendment. My Lords, it has none. And I remind your Lordships House that not one, not one organisation of or for disabled people supports this Bill. My Lords, I have another question. I was given a six month terminal diagnosis as a last resort. I was operated on for 12 hours and it all into one of the surgeons who took great pleasure in telling me afterwards.
It was pretty aggressive surgery, but hey, I was going to die anyway. But some miracle. Having spent three years learning to talk again, I'm still here. Yet my overall condition is inevitably progressive and cannot be reversed by treatment. So I wonder if I would qualify for assisted dying. Perhaps I would in time, but I'd be far less likely to fall victim to scope creep if this amendment was passed. I mentioned scope creep.
I fear that this bill implicitly puts a price on my head, and people with lifelong congenital conditions, because it effectively facilitates a pathway whereby withholding expensive treatments risks making people like me eligible for assisted dying. My Lord, let us remember that some people are determined that this bill, as has been the case in other jurisdictions, is only the beginning already. My death. My decision had criticised the bill as inadequate.
Now I have huge respect for lawyers, particularly those in your Lordships' House. But that doesn't mean I'm comfortable about the likelihood that some of them may pose to extend the law, perhaps using the. My Lords, this bill poses a very real and present danger for people with lifelong congenital conditions. This amendment is crucial to mitigating that threat. So I close with this appeal to the noble and learned Lords. Please will he accept this amendment until I asked him to confirm that he agrees with me that after consideration of this crucial amendment, should neither be filibustering?
10:51
Lord Evans of Rainow (Conservative)
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Lord Evans of Rainow (Conservative)
Yes. Sir, Lord Shamash mentioned a very moving story from his family a very moving story from his family regarding Duchenne muscular dystrophy, and I've got a very similar story, but from a slightly similar story, but from a slightly different angle. My cousin Stephen was diagnosed with Duchenne muscular dystrophy in 1960s, and in the 1960s this was a terminal illness without any real idea of prognosis other than they would die as very, very young people. But my family were determined to try and make Stephen's life as comfortable as possible and as long as as possible.
And they campaigned with their local MP, who just so happened to be Alf Morris, Baron Morris of Manchester, an outstanding Member of Parliament and a service to this House. And they worked with him to come up with the Disability and Chronically Sick and Disabled Persons Act 1970. They went on to then develop therapies for Duchenne muscular dystrophy, including making wheelchair provision compulsory on the NHS, and my cousin lived five years longer than the average of Duchenne muscular dystrophy patients.
So the point I'm making to the Lordships house if if you use this assisted dying bill to that extent, if we'd given up when he was a very, very young man, that never happened. He had a full life in his so far as he could, and he lived till he was 21, 21 years of age, when he was an average age of 14 or 15. So it just goes to say, if you give up at a very early stage, you don't know how far you can push this disease.
And in the 21st century, through medication, Duchenne muscular dystrophy sufferers do have an extended lifespan. So having an offering assisted dying to people with chronic diseases. You don't know the miracles of science and medication can extend these people's lives.
And they campaigned with their local MP, who just so happened to be Alf Morris, Baron Morris of Manchester, an outstanding Member of Parliament and a service to this House. And they worked with him to come up with the Disability and Chronically Sick and Disabled Persons Act 1970. They went on to then develop therapies for Duchenne muscular dystrophy, including making wheelchair provision compulsory on the NHS, and my cousin lived five years longer than the average of Duchenne muscular dystrophy patients.
So the point I'm making to the Lordships house if if you use this assisted dying bill to that extent, if we'd given up when he was a very, very young man, that never happened. He had a full life in his so far as he could, and he lived till he was 21, 21 years of age, when he was an average age of 14 or 15. So it just goes to say, if you give up at a very early stage, you don't know how far you can push this disease.
And in the 21st century, through medication, Duchenne muscular dystrophy sufferers do have an extended lifespan. So having an offering assisted dying to people with chronic diseases. You don't know the miracles of science and medication can extend these people's lives.
10:53
Lord Blencathra (Conservative)
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Lord Blencathra (Conservative)
The Lord. >> There's another peer who sat here for many hours last Friday, desperately keen to speak on on desperately keen to speak on on this group of amendments. And then towards the end, nearly about 5:30, I heard the magnificent speech from the noble Lord, the Lord Rook, who's not currently in his place. And it really was quite an incredibly good speech. And I suppose the only benefit of being a sort of carry over tail end, Charlie, was that I was able to read his speech in Hansard once again, and I commend it as being superb.
And then, my Lords, I concluded there was nothing I could usefully add to what the noble Lord had said. So I've decided not to try to add anything more to it, and I conclude my remarks.
And then, my Lords, I concluded there was nothing I could usefully add to what the noble Lord had said. So I've decided not to try to add anything more to it, and I conclude my remarks.
10:54
Lord Harper (Conservative)
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Lord Harper (Conservative)
My Lords, I'm going to speak very briefly. I just wanted to put one useful piece of information on one useful piece of information on the record, because it's been very relevant to the debates that we've had. And somebody previously referenced the the government's, the welcome cancer plan that the government published, and I thought it just worth sharing with the House. There was a very important, relevant piece of information in the cancer plan that your Lordships might wish to be aware of on previous occasions.
And I think the noble Lord Lord Stevens of Birmingham set this out. He referred to the government's plan for palliative care. And when we spoke about it, I think just last week, the expectation was that that plan was going to be published this autumn, and I hope the Minister can confirm that I've I've got this right when she speaks in the cancer plan. It's now been made clear that and I quote next, next year we will publish a modern service framework on palliative and end of life care to address these challenges.
So without being explicit about it, the the palliative care plan has now slipped into 2027. No indication of when in 2027. And given my experience of these things, it could easily be the end of 2027. So we're being asked again to consider this bill when the government's isn't even going to publish its plan on palliative care until sometime next year. And it's already now slipped twice in a few months. And I think I draw two lessons from that.
One is if you don't have high quality, universally available palliative care, then you're not giving people a genuine choice. And as my noble friend Lord Shinkwin said, there are expectations in society which will push people inevitably towards assisted suicide. Whether they really want that to be the case or not. The second thing it says to me is that palliative care isn't really a priority for the government. If you can't even produce the plan, which was originally going to be this year, if you can't even produce the plan for improving palliative care until some time next year, with no specific date attached to it, heaven knows what your priority is going to be actually delivering the services that people require.
My sense is if the plan is not coming out till next year, we're not even going to see improved services in this Parliament, in which case there's no meaningful choice. And on that basis, we shouldn't proceed
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with this bill. I speak to.
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I speak to. Amendments 82 and 83 A, which I've added my name to that of Lord I've added my name to that of Lord Polak. And I do note that amendment 83 has been withdrawn, which was 83 has been withdrawn, which was tabled by my noble friend Baroness Murphy and the noble Lady, Lady Nokes, which would have extended Nokes, which would have extended the period of eligibility from 6 to 12 months for neurological conditions. I add my name to these
And I think the noble Lord Lord Stevens of Birmingham set this out. He referred to the government's plan for palliative care. And when we spoke about it, I think just last week, the expectation was that that plan was going to be published this autumn, and I hope the Minister can confirm that I've I've got this right when she speaks in the cancer plan. It's now been made clear that and I quote next, next year we will publish a modern service framework on palliative and end of life care to address these challenges.
So without being explicit about it, the the palliative care plan has now slipped into 2027. No indication of when in 2027. And given my experience of these things, it could easily be the end of 2027. So we're being asked again to consider this bill when the government's isn't even going to publish its plan on palliative care until sometime next year. And it's already now slipped twice in a few months. And I think I draw two lessons from that.
One is if you don't have high quality, universally available palliative care, then you're not giving people a genuine choice. And as my noble friend Lord Shinkwin said, there are expectations in society which will push people inevitably towards assisted suicide. Whether they really want that to be the case or not. The second thing it says to me is that palliative care isn't really a priority for the government. If you can't even produce the plan, which was originally going to be this year, if you can't even produce the plan for improving palliative care until some time next year, with no specific date attached to it, heaven knows what your priority is going to be actually delivering the services that people require.
My sense is if the plan is not coming out till next year, we're not even going to see improved services in this Parliament, in which case there's no meaningful choice. And on that basis, we shouldn't proceed
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with this bill. I speak to.
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I speak to. Amendments 82 and 83 A, which I've added my name to that of Lord I've added my name to that of Lord Polak. And I do note that amendment 83 has been withdrawn, which was 83 has been withdrawn, which was tabled by my noble friend Baroness Murphy and the noble Lady, Lady Nokes, which would have extended Nokes, which would have extended the period of eligibility from 6 to 12 months for neurological conditions. I add my name to these
10:57
Baroness Grey-Thompson (Crossbench)
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Baroness Grey-Thompson (Crossbench)
two amendments because I think it's important to have real clarity on important to have real clarity on what we mean by six month diagnosis, and also have specialist certification by an independent consultant. And the reason I added my name to these two amendments, because Professor Paddy Stone, because Professor Paddy Stone, who's the former head of Marie Curie Palliative Care Research Department at UCL, said there's no Department at UCL, said there's no real reliable way to identify patients with a 6 to 12 month diagnosis and at least no method which would provide an adequate safeguard.
And we have to remember, there is no Royal College that supports this bill or thinks the safeguards in this bill are good enough. Amendments 97 and 98 are really tidying up amendments of the language of this bill. It's quite minor, but person with a disability doesn't exist in law. It's used interchangeably in this bill and society, but with the disability suggests that my impairment is something I can pick up or put down at will, which I can't. And I think to show some understanding of what disabled people experience, then it should be the language of both the DDA and the Equality Act, and recognising that the social model of disability exists.
Now, I don't know if the drafting was a refutation of the social model or perhaps a drafting mistake, but it does show a lack of connection to disabled people and deaf and disabled peoples organisations. We're told that language changes all the time and it really doesn't. There may be different language used around the world, but this is British law and we should use the the words that are in acts that already exist. Last week, the noble Lord Harper raised things that we think we need fixing and never get around to.
And I thought of an example at the time, the DDA, which I sat on, sorry, I sat on the National Disability Council with the noble Lord Lord Shinkwin said 31 years ago that taxis in this country should be wheelchair accessible. 31 years later, we still haven't sorted it. I have an amendment in the English devolution bill next week to fix that, but it's these examples. If we've got to wait 31 years for taxis to be accessible for disabled people, can noble Lords not understand why disabled people fear this bill? Amendment 106 in the name of Lord Hunt of Kings Heath, my noble friend Baroness O'Loan again is looking about clarity of that six month diagnosis.
Now we're constantly told there's nothing to worry about, but it's easy soundbites. This bill is caught between two competing policies trying to ensure safety versus personal choice, and the state has a duty to ensure those choices are sufficiently informed and based on accurate medical assessment. So by building in an independent prognosis, this recognises that in a life ending law, the margin for error must be minimal and oversight must be robust. It sends a clear signal that assisted dying is exceptional, and that those who seek it must face rigorous, medically sound scrutiny that reinforces both public trust and protection for vulnerable individuals.
Other amendments in this group are about recognising whether condition is stable or not, and is there to protect disabled people whose impact of impairment might mirror a terminal condition. Now the noble Lord Lord Shinkwin talked about his impairment. I looked myself, I found out two years ago I only have one and a half kidneys. I would have thought that medical professionals would have told me that slightly earlier, but if I chose to stop catheterising, I would very quickly experience urinary tract infections. I would have backfilled my kidneys and I would get almost immediate kidney damage.
So would someone like me be included in this bill? We've had lots of letters from people with MND, lots of other conditions, who assume that if this bill passes, they would be part of it. And I think many of those conditions would not be included. So I find it interesting. The noble Lord, Lord Moylan, suggested about having a list. I think we have to think about this really clearly, because we might be giving false hope to people right now who think they're being included, when actually they wouldn't.
And I'd like to ask the noble Lord, the Minister, sorry, lady Minister, about what the government is doing about frailty, and we discuss frailty. Last week, 10% of people over 65 are frail. That goes up to nearly 50% for those over 85, 34, 30 to 40% of people over 65 are admitted to acute wards living with frailty. These things would all impact whether somebody would choose assisted suicide. And I recognise that this does cross into some of the groups that we're going to be talking about later, about whether someone may refuse treatment.
I'd like to thank the noble and learned Lord for meeting yesterday. We probably agree to disagree on whether he's answering questions in the chamber, so I would like to know whether the noble and learned Lord has read the paper by the Complex Life and Death Decisions group at King's College London, which perfectly captures some of the issues that we're trying to grapple with. Now. One of the examples in that paper was someone with diabetes who took insulin, who managed their condition but becomes depressed, decides to stop taking the insulin knowing that they will die.
So they might be able to request assisted suicide. Would this person be eligible for this bill? And I am worried about the pressures that doctors would be under when they make judgements about quality of life. We've got to be really careful that any safeguard doesn't slip to 7 or 8 months, or expansion comes via the back door. My Lords, I also want to raise the issue of my noble friend Baroness Campbell of Surbiton having to contribute remotely. So any disabled peer who is allowed to speak remotely has to speak first in the debate.
After the mover of the amendment, they have no opportunity to raise questions or intervene. I recognise the technology is not easy, but they are not able to contribute in this debate on an equal basis. And I've said before, it would be sad if the only place that we're talking about equal access for disabled people in this country would be through this bill. But, my Lords, this is Parliament. If we can't give equal access to disabled people here, what are we actually doing? The noble my noble friend Lord Pannick spoke last week and very passionately about the word reasonable.
My Lords, the word reasonable is a very difficult word for disabled people. We were promised reasonable adjustment in both the DDA and the Equality Act, and actually reasonable sounded reasonable at the time. But actually it's a word that is used to stifle and actually stop inclusion of disabled people. So last week's debates made me even more convinced that we have to provide really good information to people who are requesting assisted suicide, so they absolutely understand the pros and cons of what they're entering into.
So, my Lords, I think this clarity is really, really important. I don't think we can necessarily have a list, but at the moment I think it's way too vague. And many of us have talked about the equality impact assessment. We don't think it's good enough. We've been told the government's not going to revisit it, but actually I don't believe the numbers in that equality impact assessment. I believe they're going to be much higher than we think they are. My final point is I also want to raise the issue of the palliative care framework.
And when that report is going to come out. When I met with the noble and learned Lord yesterday, we talked about reassurance whether we could actually get this debate into it started off as tenant groups. I think the noble and learned Lord is now saying whether we could agree to 20 groups. Well, my Lord, I said yesterday to noble Lord, Lord, I'm not able to even think about what that grouping might look like until we've got the answers to some of these questions.
And actually, I do think it's really important that we have there's some urgency around the palliative care framework and that report being launched, because we're not going to have reassurance about what the world is going to look like until we see that data. So I'd be very grateful for the noble Lady, the Minister, to answer that. And I'm very much looking forward to the noble and learned Lords answers to the questions I've raised today.
And we have to remember, there is no Royal College that supports this bill or thinks the safeguards in this bill are good enough. Amendments 97 and 98 are really tidying up amendments of the language of this bill. It's quite minor, but person with a disability doesn't exist in law. It's used interchangeably in this bill and society, but with the disability suggests that my impairment is something I can pick up or put down at will, which I can't. And I think to show some understanding of what disabled people experience, then it should be the language of both the DDA and the Equality Act, and recognising that the social model of disability exists.
Now, I don't know if the drafting was a refutation of the social model or perhaps a drafting mistake, but it does show a lack of connection to disabled people and deaf and disabled peoples organisations. We're told that language changes all the time and it really doesn't. There may be different language used around the world, but this is British law and we should use the the words that are in acts that already exist. Last week, the noble Lord Harper raised things that we think we need fixing and never get around to.
And I thought of an example at the time, the DDA, which I sat on, sorry, I sat on the National Disability Council with the noble Lord Lord Shinkwin said 31 years ago that taxis in this country should be wheelchair accessible. 31 years later, we still haven't sorted it. I have an amendment in the English devolution bill next week to fix that, but it's these examples. If we've got to wait 31 years for taxis to be accessible for disabled people, can noble Lords not understand why disabled people fear this bill? Amendment 106 in the name of Lord Hunt of Kings Heath, my noble friend Baroness O'Loan again is looking about clarity of that six month diagnosis.
Now we're constantly told there's nothing to worry about, but it's easy soundbites. This bill is caught between two competing policies trying to ensure safety versus personal choice, and the state has a duty to ensure those choices are sufficiently informed and based on accurate medical assessment. So by building in an independent prognosis, this recognises that in a life ending law, the margin for error must be minimal and oversight must be robust. It sends a clear signal that assisted dying is exceptional, and that those who seek it must face rigorous, medically sound scrutiny that reinforces both public trust and protection for vulnerable individuals.
Other amendments in this group are about recognising whether condition is stable or not, and is there to protect disabled people whose impact of impairment might mirror a terminal condition. Now the noble Lord Lord Shinkwin talked about his impairment. I looked myself, I found out two years ago I only have one and a half kidneys. I would have thought that medical professionals would have told me that slightly earlier, but if I chose to stop catheterising, I would very quickly experience urinary tract infections. I would have backfilled my kidneys and I would get almost immediate kidney damage.
So would someone like me be included in this bill? We've had lots of letters from people with MND, lots of other conditions, who assume that if this bill passes, they would be part of it. And I think many of those conditions would not be included. So I find it interesting. The noble Lord, Lord Moylan, suggested about having a list. I think we have to think about this really clearly, because we might be giving false hope to people right now who think they're being included, when actually they wouldn't.
And I'd like to ask the noble Lord, the Minister, sorry, lady Minister, about what the government is doing about frailty, and we discuss frailty. Last week, 10% of people over 65 are frail. That goes up to nearly 50% for those over 85, 34, 30 to 40% of people over 65 are admitted to acute wards living with frailty. These things would all impact whether somebody would choose assisted suicide. And I recognise that this does cross into some of the groups that we're going to be talking about later, about whether someone may refuse treatment.
I'd like to thank the noble and learned Lord for meeting yesterday. We probably agree to disagree on whether he's answering questions in the chamber, so I would like to know whether the noble and learned Lord has read the paper by the Complex Life and Death Decisions group at King's College London, which perfectly captures some of the issues that we're trying to grapple with. Now. One of the examples in that paper was someone with diabetes who took insulin, who managed their condition but becomes depressed, decides to stop taking the insulin knowing that they will die.
So they might be able to request assisted suicide. Would this person be eligible for this bill? And I am worried about the pressures that doctors would be under when they make judgements about quality of life. We've got to be really careful that any safeguard doesn't slip to 7 or 8 months, or expansion comes via the back door. My Lords, I also want to raise the issue of my noble friend Baroness Campbell of Surbiton having to contribute remotely. So any disabled peer who is allowed to speak remotely has to speak first in the debate.
After the mover of the amendment, they have no opportunity to raise questions or intervene. I recognise the technology is not easy, but they are not able to contribute in this debate on an equal basis. And I've said before, it would be sad if the only place that we're talking about equal access for disabled people in this country would be through this bill. But, my Lords, this is Parliament. If we can't give equal access to disabled people here, what are we actually doing? The noble my noble friend Lord Pannick spoke last week and very passionately about the word reasonable.
My Lords, the word reasonable is a very difficult word for disabled people. We were promised reasonable adjustment in both the DDA and the Equality Act, and actually reasonable sounded reasonable at the time. But actually it's a word that is used to stifle and actually stop inclusion of disabled people. So last week's debates made me even more convinced that we have to provide really good information to people who are requesting assisted suicide, so they absolutely understand the pros and cons of what they're entering into.
So, my Lords, I think this clarity is really, really important. I don't think we can necessarily have a list, but at the moment I think it's way too vague. And many of us have talked about the equality impact assessment. We don't think it's good enough. We've been told the government's not going to revisit it, but actually I don't believe the numbers in that equality impact assessment. I believe they're going to be much higher than we think they are. My final point is I also want to raise the issue of the palliative care framework.
And when that report is going to come out. When I met with the noble and learned Lord yesterday, we talked about reassurance whether we could actually get this debate into it started off as tenant groups. I think the noble and learned Lord is now saying whether we could agree to 20 groups. Well, my Lord, I said yesterday to noble Lord, Lord, I'm not able to even think about what that grouping might look like until we've got the answers to some of these questions.
And actually, I do think it's really important that we have there's some urgency around the palliative care framework and that report being launched, because we're not going to have reassurance about what the world is going to look like until we see that data. So I'd be very grateful for the noble Lady, the Minister, to answer that. And I'm very much looking forward to the noble and learned Lords answers to the questions I've raised today.
11:06
Lord Markham (Conservative)
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Lord Markham (Conservative)
As I think probably building on from that. I think that is correct. from that. I think that is correct. There are two different approaches here. There are those people amongst us who believe that choice should come first. And within that choice, obviously there should be protections and safeguards, and there are those people who equally have very firm beliefs that the restrictions should, should, should be in place as as protections first. And if I summarise these group of amendments, that's what a lot of them are about, saying that there are certain illnesses that should be excluded from it all.
Certain groups, such as disabled groups, that you should only be allowed to have this if you've got some kind of unbearable pain or or suffering, or there's no chance of treatments to extend it. And where I would come against this, I would like to bring two points in really. Firstly, that of public opinion, and that is overwhelmingly in favour of choice 70%. All the different opinion polls and I include disabled groups in that again show that disabled people are 70% in favour of that.
And then I'd say the personal experiences of those people who are terminally ill, and that is that firstly, they don't want to die. They'd be delighted if there's treatments that are going to extend their lives beyond six months on much longer. They'd be delighted for that. But for them, getting the opportunity to have a desk of their choosing is a great comfort in insurance. It doesn't mean that they're going to rush out and take it as soon as they have it.
In a lot of cases, about 30% in other countries, they won't use it at all. But the fact is they want it to be there like an insurance policy, so that if towards the end of their life, they really do have unbearable suffering. And that's how they define unbearable suffering, that might be pain, that might be a loss of dignity, that might be a feeling that they really don't want to go on. Whatever their choice is, it is their choice and their reason for that and wanting to do that.
And for me, that's the important thing that we're trying to make sure we can have it. Yes, with the protections. But at the end of the day, giving the people the ability and the autonomy that they can have, the comfort and the choice of being able to die in the way that they wish to as being the most fundamental right of all.
Certain groups, such as disabled groups, that you should only be allowed to have this if you've got some kind of unbearable pain or or suffering, or there's no chance of treatments to extend it. And where I would come against this, I would like to bring two points in really. Firstly, that of public opinion, and that is overwhelmingly in favour of choice 70%. All the different opinion polls and I include disabled groups in that again show that disabled people are 70% in favour of that.
And then I'd say the personal experiences of those people who are terminally ill, and that is that firstly, they don't want to die. They'd be delighted if there's treatments that are going to extend their lives beyond six months on much longer. They'd be delighted for that. But for them, getting the opportunity to have a desk of their choosing is a great comfort in insurance. It doesn't mean that they're going to rush out and take it as soon as they have it.
In a lot of cases, about 30% in other countries, they won't use it at all. But the fact is they want it to be there like an insurance policy, so that if towards the end of their life, they really do have unbearable suffering. And that's how they define unbearable suffering, that might be pain, that might be a loss of dignity, that might be a feeling that they really don't want to go on. Whatever their choice is, it is their choice and their reason for that and wanting to do that.
And for me, that's the important thing that we're trying to make sure we can have it. Yes, with the protections. But at the end of the day, giving the people the ability and the autonomy that they can have, the comfort and the choice of being able to die in the way that they wish to as being the most fundamental right of all.
11:09
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)
My Lords, I'm grateful for the >> My Lords, I'm grateful for the contributions today on eligibility and definition of terminal illness. Once again, I'll keep detailed comments limited to amendments on which the government has major legal, technical or operational workability concerns. But if I could first give a reassurance to your Lordships House, responding to the observations of the noble Lord, Lord Harper and the noble Lady Baroness Grey-Thompson regarding the modern service framework on palliative care and end of life care, we do acknowledge there has been a drafting error which the noble Lord and the noble Lady have picked up, and the drafting error is indeed in the National Cancer Plan.
But my reassurance to your Lordships House is, as has been previously stated, the interim update will be published this spring and the full modern service framework will follow in the autumn. So it's purely down to drafting error. So if I can turn now to the amendments, amendments 71, 77 and 79 tabled by the noble Lady Baroness Finlay and amendments 83, a 104 and 105 tabled by the noble Lords Lord Pollock and Lord hunt, of of Kings Heath and the noble Lady Baroness Grey Thompson.
Noble Lords may wish to note the government's workability concern with this set of amendments. Key terms and concepts within these amendments are undefined, which may introduce uncertainty when determining who is eligible under the bill, and in particular under amendment 71, 77, 79. What it means to slow a disease. There is a risk that unclear eligibility criteria could result in ambiguity. Ambiguity for those applying the legislation, which may give rise to legal challenges to decisions made under it.
Amendment 105 could also give rise to legal challenge on the basis that excluding people with particular conditions from assisted dying may not be justified under article two or article eight of the EC, and may amount to unjustified discrimination under article 14. Any differential treatment would need to be objectively and reasonably justified in order to comply with each regulation obligations. Amendments 74 and 94, tabled by the noble Lord Lord Taylor of Holbeach, would exclude from the definition of terminal illness any individual whose condition can be meaningfully halted or controlled by available treatment.
Clinically, it may be difficult to determine whether an illness or disease can be meaningfully halted or controlled by treatment, and it is possible that an illness or disease could have a short halt before deterioration starts again. This will make it difficult for clinicians to decide whether a person is terminally ill and eligible for assisted dying, and is likely to lead to challenges to decisions. These amendments may result in a person becoming ineligible, irrespective of whether they choose to take the available treatment.
Turning to amendment 75, also tabled by the noble Lady Baroness Finlay, that would amend the definition of terminally ill by removing the test of death being reasonably expected in six months, and replacing it with a requirement that the rate of progress of the disease with treatment in line with Nice guidelines, indicates that death can be expected within six months. Introducing the concept of treatment in accordance with Nice guidelines may create difficulties, as the amendment would require clinicians to assess the patient's prognosis as if they were treated in accordance with Nice guidelines.
This may result in a person becoming ineligible, irrespective of whether they choose to have treatment. In accordance with Nice guidelines. This amendment therefore, requires clinicians to make a judgement on a potentially hypothetical basis. Amendment 80, tabled by the noble Lady Baroness Lawlor, would provide that a person is terminally ill, where their death has an 80% likelihood of occurring within six months, according to the written opinion of two specialist consultant level hospital doctors. These doctors must be knowledgeable about and have experience of treating patients with the progressive illness in question.
This amendment would create significant operational workability concerns. It would require the clinician making a determination about the person's progress prognosis to meet a high threshold of certainty. The criteria could be especially difficult to meet for a person who has a rare progressive illness or disease, about which there may not be widespread clinical knowledge or experience. Amendment 82, tabled by the noble Lord Lord Polak, would require two consultants to provide a view on an individual's life expectancy and for them to determine that their death can be highly probable within six months, rather than the current drafting of can be reasonably expected.
Several terms are not defined in the amendment and are likely to leave lead to ambiguity, including operational issues around which doctors are to assess life expectancy and to what standard. Amendment 44 for a, tabled by the noble Lady Baroness Finlay, seeks to change the bill's eligibility criteria from six months to three months at a later stage in the process, by requiring the panel to be satisfied, a person's death can be expected within three months before granting a certificate of eligibility.
This amendment would create significant workability concerns. Firstly, this amendment is in direct conflict with the eligibility criteria set out in clause one and clause two, which require that a person's death is to be reasonably expected within six months. Secondly, this amendment, by not including a test of reasonable expectation, would require a higher degree of confidence around the prognosis. It is likely to be challenging for a panel to assess this, given its reliance on evidence from the coordinating and independent doctors who will have applied a different six month test.
In addition, given the lack of clinical evidence and guaranteed information on which to base the panel's decision, there would be an increased risk of legal challenge. I now turn to amendments 85, 89 four and 89 six, tabled by the noble Lord, Lord Moylan, amendments 85 and 896 would require the Secretary of State to specify a complete list of illnesses or diseases that fall within the scope of what is terminally ill in regulations. As drafted, these amendments are likely to be unworkable, as it is often a combination of illnesses interacting as opposed to a single one that leads to a terminal diagnosis.
This means it would be extremely difficult, if not impossible, to accurately list all possible combinations of conditions that would lead to a prognosis of less than six months. This amendment leaves it to the Secretary of State to decide what counts as a terminal illness or disease, and the basis on which they are to do so is ambiguous. Amendment 894 would alter the commencement provisions, meaning that the voluntary Assisted Dying Commissioner would need to have substantive functions as well as to have been appointed within 12 months of Royal Assent.
If the bill, once enacted, would not otherwise fully operational within 12 months. This would mean that the Commissioner was being asked to exercise functions with respect to a service that did not yet exist. Finally, amendment 106, in the name of my noble friend Lord Hunt of Kings Heath, would affect those applying for an assisted death where the terminal illness has arisen from medical negligence, malpractice or omission by a healthcare professional institution. The process of obtaining an assisted death would be halted until all investigations, compensation and support had concluded.
This could delay assisted death to otherwise eligible people. As a person's medical history for their illness or disease would need to be assessed for negligence, malpractice, omission, or error before they would be eligible. My Lords, I make no other comment. No comment on the other amendments in this group. However, as noble Lords are aware, the amendments have not had technical drafting support from officials. Therefore, further revision and corresponding amendments may be needed to provide consistent and coherent terminology throughout the bill.
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Lady sits down. May I pursue the point she made about my amendment point she made about my amendment 85? My understanding of the bill as 85? My understanding of the bill as drafted is that one has to have an inevitably progressive illness or inevitably progressive illness or disease. Not that one has to have a disease. Not that one has to have a diagnosis, a six month diagnosis of your prognosis, of your death. Now, the two might be quite separate.
One might have, as the noble Lady said, a combination of circumstances which mean you're likely to die within six months without having a specific disease, identifiable disease. And the noble Baroness seems to be saying that the government's interpretation of this clause is that one doesn't need to have a specific, identifiable terminal illness. One simply needs to have a set of circumstances which together might result in a prognosis of death within six months. Now, if that is the case, and that is the government's view of the meaning of that clause, then as the noble Lady, the Minister seems to imply, that widens to an astonishing extent.
The conditions that might qualify for for this bill. And I would just like to hear the noble Lady, the Minister say, and possibly the noble and learned Lord, Lord Falconer, when he speaks, may want to comment on this, if that really is their interpretation, that it could be any set of circumstances that lead to a six month diagnosis
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illness. Perhaps if I could just briefly refer to look at the actual amendment, as I said in my response, that the workability concerns are about the specification of a list of illnesses or diseases, and I've of illnesses or diseases, and I've already outlined why they would be unworkable because of the fact that it's often that combination of illnesses as well as, I might add, complications of illnesses and that are interacting rather than that single one.
And I referred earlier to why it would be extremely difficult. So I have been looking at the very specifics of the amendment, but to do what it says would create more ambiguity than is amendment. But in reality, my response. Order, order my response is covering our concerns where I don't make a comment. As I say, there are no workability concerns.
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The Minister sits. Before the. Minister sits down as she will
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Minister sits down as she will know the. I have made it clear that know the. I have made it clear that I'm concerned about suffering in the last days of life, and one of the last days of life, and one of the key elements of that is palliative care. And when one talks palliative care. And when one talks about treatment, one of the incentives for death is suffering. Has the Minister got anything to say to the House about the status of palliative care within the National Health Service? And are there any plans afoot, and when are the plans going to be, and when will this particular course of treatment be available to people? Otherwise, many people faced with terminal illness will be very tempted to seek assisted suicide.
And I think that's should be discouraged.
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If I could gently say we are discussing a group of amendments discussing a group of amendments about the definition of terminal illness, to the point on palliative care that I have already placed a care that I have already placed a letter in the library of the house outlining all of the work in respect of palliative care, and I have also made reference to the modern service framework well.
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modern service framework well. Before the Minister sits down, I have to confess to having listened to my noble friend Lord Moylan in response to what the Minister said. To be a little confused, the Minister seemed to be saying in her comments about some of the amendments in this group that the problem with them, by having a list of conditions, was that you could quite often have a terminal diagnosis as a result of a group of conditions or circumstances or illnesses.
Now, my reading is that that isn't what the bill says. The bill seems to say for the purposes of the act, a person is terminally ill. If a they have an an inevitably progressive illness or disease. Not not lots of them. One which cannot be reversed by treatment and the person's death in consequence of that illness or disease can reasonably be expected within six months. Now I read the amendment very carefully, which was talking about having a specified list of conditions which, incidentally, coming back to the point Lord Markham made is what the public, or twice as many people support that approach than a terminal illness.
The minister's answer in response to my noble friend Lord Moylan exchange, seemed to be disagreeing with what's actually in the bill. So I have to say, I'm now more confused than I
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was before she got to her feet. Can she clear that up? I'm. I'm sorry. The noble Lord
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I'm. I'm sorry. The noble Lord is confused, and I know that my noble friend, Lord Faulkner will be noble friend, Lord Faulkner will be pleased to assist him with that. Any confusion that there is in the
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Any confusion that there is in the case of this amendment. I suggested. The lady, the Minister, that the
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The lady, the Minister, that the answer to Lord Harper is very simple. A person, an unfortunate person, may have more than one inevitably progressive illness or disease, each of which will lead to their death within six months. And it's a standard principle of statutory interpretation that the
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singular includes the plural. Yeah. May I comment before the noble Lady sits down? I'd hesitate to Lady sits down? I'd hesitate to intervene on the noble Lord Lord Pannick, because that would be quite correctly stopped by the quite correctly stopped by the whips. But what the noble Lord is saying isn't to the point. Of course, one can have. If one has one fatal illness that is going to kill one in some time, in some time kill one in some time, in some time in the future, say a certain form of cancer.
1st May of course have another fatal illness, another illness, say heart disease. I'm not a medical person, which could equally see one off in at some point in the future. And that, of course, would be included in the scope entirely. Understand that that isn't quite what the noble Lady is saying. She is saying that one might have a combination of circumstances, each of which might be non-fatal in itself, but in combination might result in a terminal diagnosis within six months, so that one might, if one is a frail person, have.
And again, I'm not a medical person. Pneumonia combined with certain other conditions such that that combination could be very threatening and might lead to death within six months. But none of those instances would be fatal in themselves. Now that seems to be what the noble Lady the Minister is saying, but that is not, I suggest, what the bill is saying. There has to be an identifiable term.
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I'm not entirely clear what this is. An intervention or or or a is. An intervention or or or a speech, but if it's well, if you let me finish, if it's an intervention, it should be clearer and briefer than that and actually
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and briefer than that and actually have a question. So please come to a point. This is I'm sorry, this is exposed, something that has never exposed, something that has never been mentioned in relation to this bill before. And, and in the whole of our debate on terminal illness, of our debate on terminal illness, it's a matter of crucial importance. And I know the noble noble Lady, the Minister wants to dodge it, but it seems that the government's interpretation of of that, of of that I can't refer to it now.
Clause two one is very different from what it appears to say in its plain language.
But my reassurance to your Lordships House is, as has been previously stated, the interim update will be published this spring and the full modern service framework will follow in the autumn. So it's purely down to drafting error. So if I can turn now to the amendments, amendments 71, 77 and 79 tabled by the noble Lady Baroness Finlay and amendments 83, a 104 and 105 tabled by the noble Lords Lord Pollock and Lord hunt, of of Kings Heath and the noble Lady Baroness Grey Thompson.
Noble Lords may wish to note the government's workability concern with this set of amendments. Key terms and concepts within these amendments are undefined, which may introduce uncertainty when determining who is eligible under the bill, and in particular under amendment 71, 77, 79. What it means to slow a disease. There is a risk that unclear eligibility criteria could result in ambiguity. Ambiguity for those applying the legislation, which may give rise to legal challenges to decisions made under it.
Amendment 105 could also give rise to legal challenge on the basis that excluding people with particular conditions from assisted dying may not be justified under article two or article eight of the EC, and may amount to unjustified discrimination under article 14. Any differential treatment would need to be objectively and reasonably justified in order to comply with each regulation obligations. Amendments 74 and 94, tabled by the noble Lord Lord Taylor of Holbeach, would exclude from the definition of terminal illness any individual whose condition can be meaningfully halted or controlled by available treatment.
Clinically, it may be difficult to determine whether an illness or disease can be meaningfully halted or controlled by treatment, and it is possible that an illness or disease could have a short halt before deterioration starts again. This will make it difficult for clinicians to decide whether a person is terminally ill and eligible for assisted dying, and is likely to lead to challenges to decisions. These amendments may result in a person becoming ineligible, irrespective of whether they choose to take the available treatment.
Turning to amendment 75, also tabled by the noble Lady Baroness Finlay, that would amend the definition of terminally ill by removing the test of death being reasonably expected in six months, and replacing it with a requirement that the rate of progress of the disease with treatment in line with Nice guidelines, indicates that death can be expected within six months. Introducing the concept of treatment in accordance with Nice guidelines may create difficulties, as the amendment would require clinicians to assess the patient's prognosis as if they were treated in accordance with Nice guidelines.
This may result in a person becoming ineligible, irrespective of whether they choose to have treatment. In accordance with Nice guidelines. This amendment therefore, requires clinicians to make a judgement on a potentially hypothetical basis. Amendment 80, tabled by the noble Lady Baroness Lawlor, would provide that a person is terminally ill, where their death has an 80% likelihood of occurring within six months, according to the written opinion of two specialist consultant level hospital doctors. These doctors must be knowledgeable about and have experience of treating patients with the progressive illness in question.
This amendment would create significant operational workability concerns. It would require the clinician making a determination about the person's progress prognosis to meet a high threshold of certainty. The criteria could be especially difficult to meet for a person who has a rare progressive illness or disease, about which there may not be widespread clinical knowledge or experience. Amendment 82, tabled by the noble Lord Lord Polak, would require two consultants to provide a view on an individual's life expectancy and for them to determine that their death can be highly probable within six months, rather than the current drafting of can be reasonably expected.
Several terms are not defined in the amendment and are likely to leave lead to ambiguity, including operational issues around which doctors are to assess life expectancy and to what standard. Amendment 44 for a, tabled by the noble Lady Baroness Finlay, seeks to change the bill's eligibility criteria from six months to three months at a later stage in the process, by requiring the panel to be satisfied, a person's death can be expected within three months before granting a certificate of eligibility.
This amendment would create significant workability concerns. Firstly, this amendment is in direct conflict with the eligibility criteria set out in clause one and clause two, which require that a person's death is to be reasonably expected within six months. Secondly, this amendment, by not including a test of reasonable expectation, would require a higher degree of confidence around the prognosis. It is likely to be challenging for a panel to assess this, given its reliance on evidence from the coordinating and independent doctors who will have applied a different six month test.
In addition, given the lack of clinical evidence and guaranteed information on which to base the panel's decision, there would be an increased risk of legal challenge. I now turn to amendments 85, 89 four and 89 six, tabled by the noble Lord, Lord Moylan, amendments 85 and 896 would require the Secretary of State to specify a complete list of illnesses or diseases that fall within the scope of what is terminally ill in regulations. As drafted, these amendments are likely to be unworkable, as it is often a combination of illnesses interacting as opposed to a single one that leads to a terminal diagnosis.
This means it would be extremely difficult, if not impossible, to accurately list all possible combinations of conditions that would lead to a prognosis of less than six months. This amendment leaves it to the Secretary of State to decide what counts as a terminal illness or disease, and the basis on which they are to do so is ambiguous. Amendment 894 would alter the commencement provisions, meaning that the voluntary Assisted Dying Commissioner would need to have substantive functions as well as to have been appointed within 12 months of Royal Assent.
If the bill, once enacted, would not otherwise fully operational within 12 months. This would mean that the Commissioner was being asked to exercise functions with respect to a service that did not yet exist. Finally, amendment 106, in the name of my noble friend Lord Hunt of Kings Heath, would affect those applying for an assisted death where the terminal illness has arisen from medical negligence, malpractice or omission by a healthcare professional institution. The process of obtaining an assisted death would be halted until all investigations, compensation and support had concluded.
This could delay assisted death to otherwise eligible people. As a person's medical history for their illness or disease would need to be assessed for negligence, malpractice, omission, or error before they would be eligible. My Lords, I make no other comment. No comment on the other amendments in this group. However, as noble Lords are aware, the amendments have not had technical drafting support from officials. Therefore, further revision and corresponding amendments may be needed to provide consistent and coherent terminology throughout the bill.
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Lady sits down. May I pursue the point she made about my amendment point she made about my amendment 85? My understanding of the bill as 85? My understanding of the bill as drafted is that one has to have an inevitably progressive illness or inevitably progressive illness or disease. Not that one has to have a disease. Not that one has to have a diagnosis, a six month diagnosis of your prognosis, of your death. Now, the two might be quite separate.
One might have, as the noble Lady said, a combination of circumstances which mean you're likely to die within six months without having a specific disease, identifiable disease. And the noble Baroness seems to be saying that the government's interpretation of this clause is that one doesn't need to have a specific, identifiable terminal illness. One simply needs to have a set of circumstances which together might result in a prognosis of death within six months. Now, if that is the case, and that is the government's view of the meaning of that clause, then as the noble Lady, the Minister seems to imply, that widens to an astonishing extent.
The conditions that might qualify for for this bill. And I would just like to hear the noble Lady, the Minister say, and possibly the noble and learned Lord, Lord Falconer, when he speaks, may want to comment on this, if that really is their interpretation, that it could be any set of circumstances that lead to a six month diagnosis
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illness. Perhaps if I could just briefly refer to look at the actual amendment, as I said in my response, that the workability concerns are about the specification of a list of illnesses or diseases, and I've of illnesses or diseases, and I've already outlined why they would be unworkable because of the fact that it's often that combination of illnesses as well as, I might add, complications of illnesses and that are interacting rather than that single one.
And I referred earlier to why it would be extremely difficult. So I have been looking at the very specifics of the amendment, but to do what it says would create more ambiguity than is amendment. But in reality, my response. Order, order my response is covering our concerns where I don't make a comment. As I say, there are no workability concerns.
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The Minister sits. Before the. Minister sits down as she will
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Minister sits down as she will know the. I have made it clear that know the. I have made it clear that I'm concerned about suffering in the last days of life, and one of the last days of life, and one of the key elements of that is palliative care. And when one talks palliative care. And when one talks about treatment, one of the incentives for death is suffering. Has the Minister got anything to say to the House about the status of palliative care within the National Health Service? And are there any plans afoot, and when are the plans going to be, and when will this particular course of treatment be available to people? Otherwise, many people faced with terminal illness will be very tempted to seek assisted suicide.
And I think that's should be discouraged.
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If I could gently say we are discussing a group of amendments discussing a group of amendments about the definition of terminal illness, to the point on palliative care that I have already placed a care that I have already placed a letter in the library of the house outlining all of the work in respect of palliative care, and I have also made reference to the modern service framework well.
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modern service framework well. Before the Minister sits down, I have to confess to having listened to my noble friend Lord Moylan in response to what the Minister said. To be a little confused, the Minister seemed to be saying in her comments about some of the amendments in this group that the problem with them, by having a list of conditions, was that you could quite often have a terminal diagnosis as a result of a group of conditions or circumstances or illnesses.
Now, my reading is that that isn't what the bill says. The bill seems to say for the purposes of the act, a person is terminally ill. If a they have an an inevitably progressive illness or disease. Not not lots of them. One which cannot be reversed by treatment and the person's death in consequence of that illness or disease can reasonably be expected within six months. Now I read the amendment very carefully, which was talking about having a specified list of conditions which, incidentally, coming back to the point Lord Markham made is what the public, or twice as many people support that approach than a terminal illness.
The minister's answer in response to my noble friend Lord Moylan exchange, seemed to be disagreeing with what's actually in the bill. So I have to say, I'm now more confused than I
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was before she got to her feet. Can she clear that up? I'm. I'm sorry. The noble Lord
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I'm. I'm sorry. The noble Lord is confused, and I know that my noble friend, Lord Faulkner will be noble friend, Lord Faulkner will be pleased to assist him with that. Any confusion that there is in the
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Any confusion that there is in the case of this amendment. I suggested. The lady, the Minister, that the
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The lady, the Minister, that the answer to Lord Harper is very simple. A person, an unfortunate person, may have more than one inevitably progressive illness or disease, each of which will lead to their death within six months. And it's a standard principle of statutory interpretation that the
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singular includes the plural. Yeah. May I comment before the noble Lady sits down? I'd hesitate to Lady sits down? I'd hesitate to intervene on the noble Lord Lord Pannick, because that would be quite correctly stopped by the quite correctly stopped by the whips. But what the noble Lord is saying isn't to the point. Of course, one can have. If one has one fatal illness that is going to kill one in some time, in some time kill one in some time, in some time in the future, say a certain form of cancer.
1st May of course have another fatal illness, another illness, say heart disease. I'm not a medical person, which could equally see one off in at some point in the future. And that, of course, would be included in the scope entirely. Understand that that isn't quite what the noble Lady is saying. She is saying that one might have a combination of circumstances, each of which might be non-fatal in itself, but in combination might result in a terminal diagnosis within six months, so that one might, if one is a frail person, have.
And again, I'm not a medical person. Pneumonia combined with certain other conditions such that that combination could be very threatening and might lead to death within six months. But none of those instances would be fatal in themselves. Now that seems to be what the noble Lady the Minister is saying, but that is not, I suggest, what the bill is saying. There has to be an identifiable term.
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I'm not entirely clear what this is. An intervention or or or a is. An intervention or or or a speech, but if it's well, if you let me finish, if it's an intervention, it should be clearer and briefer than that and actually
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and briefer than that and actually have a question. So please come to a point. This is I'm sorry, this is exposed, something that has never exposed, something that has never been mentioned in relation to this bill before. And, and in the whole of our debate on terminal illness, of our debate on terminal illness, it's a matter of crucial importance. And I know the noble noble Lady, the Minister wants to dodge it, but it seems that the government's interpretation of of that, of of that I can't refer to it now.
Clause two one is very different from what it appears to say in its plain language.
11:28
Lord Faulkner of Worcester (Labour)
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Lord Faulkner of Worcester (Labour)
Yeah. >> Your job. >> Sorry. Could I first of all pay
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Sorry. Could I first of all pay tribute to the speeches of the noble Lord Lord Farmer, Lord Shinkwin and Lord Shamash, all of Shinkwin and Lord Shamash, all of which referred to distressing personal circumstances? And I think the House is grateful for people being willing to talk about these issues in this very difficult debate. This group of amendments concerns the definition of terminal illness, as people have just identified the definition of a person being terminally ill to satisfy the requirements of the bill is that the person has an inevitably progressive illness or disease, which cannot be reversed by treatment and the person's death in consequence of that illness or disease, can reasonably be expected within six months.
May I just pick up four points that came out of the debate? First of all, the words inevitably and progressive plainly limit the words illness or disease. So the illness or disease has to be both inevitable and progressive to deal with the point raised by the noble Lord Lord Moylan. Secondly, to deal with the very important point raised by the Baroness Finlay of Llandaff on the last occasion, frailty is plainly not within that definition. So frailty or old age or something similar would not satisfy the requirements of an inevitably progressive illness or disease.
That specific point was addressed in the Commons, where the initial draft of the bill had the words inevitably progressive illness, disease or condition, and the word condition was removed to deal with that specific point. Secondly, the word the progressive illness or disease which cannot be reversed by treatment, that is, to deal with the sort of example given by the noble Baroness Baroness Coffey and by other noble Lords. There will be conditions, illnesses or diseases such as type one diabetes or HIV Aids, where there is a traditional and accepted treatment which will effectively reverse the effect of the condition, it won't get rid of it completely.
You still may have HIV, you still may be a type one diabetic, but the effect of the condition is reversed and the intention of putting in the word reversed was to deal with those. Thirdly, there will be difficult choices that people have to make when they are ill. For example, if you have a brain tumour which is going to kill you, should you have a very difficult operation? If you have cancer, should you go on taking a palliative chemotherapy, which may be very distressing in a number of respects.
The way it is drafted is this should not be available for people with the type one diabetes situation, but it should not be compelling people to take very, very difficult and distressing decisions about health. I strongly support that approach. Secondly, the requirement is that you have that in consequence of that illness or disease, you can reasonably be expected to live within, expected to die within six months. In terms of the point that the noble Lord Lord Moylan began to career off with a few moments ago, the progressive illness or disease has to be what brings your life to an end.
The point that the noble Baroness Baroness Merron was making seems to me to be clear. Suppose I have cancer. Suppose I am being treated with chemotherapy. Suppose that it is inevitable that I will succumb to a infection within a week, two weeks, six weeks. That is a situation where there is a combination. But my death will be in consequence of the cancer. As far as the period of six months is concerned, could I adopt the approach of Sir Christopher Witty, who gave evidence in the Commons on the public Bill committee? The central view? And that means what's the what's the the central likelihood of a particular person? Survival is usually reasonable, reasonably accurate, that someone is now in a pathway from which there is not going to be a return.
If you are going to choose a period, then six months is reasonable. It is generally very predictable that someone is going to die in the foreseeable future, but predicting whether that will be in five months or seven months is a lot harder. And there would be some caution. Again, I agree with the accuracy of that and I agree with the realism of it. There has to be a period taken. I believe you can't have a bill that just says terminally ill.
There's got to be a period. What is the right period? The right period that gives people enough of a chance to think about what to do. And it will be different for different people to talk about it with those that they love, to reach a conclusion, a firm and settled conclusion on it. One has got to choose a period. And for the reasons that Sir Christopher gives, I think six months is a reasonable one. But there's nobody in this chamber who doesn't recognise that the closer you are to the end, the more accurate it is going to be.
The statistics that are being produced saying very many of these predictions are inaccurate is obviously right. If one's thinking it's five months or seven months. But what Sir Christopher is saying is broadly, they are often accurate. Could I in the light of that approach, and I think it is a sensible and well thought out approach in the Bill, may I deal with the particular groups of amendments? First of all, the groups, which is amendment 71, 72, 73, 74 and 94 and 204, all of which suggest that you've got to take into account any treatment which might slow or halt or ameliorate the condition.
I understand these amendments to be based on the proposition in considering whether you've got six months or more to live, you should have regard to treatments that could be taken rather than those that have been taken, because plainly there's got to be six months or less to live before you become eligible. For the reasons I gave in my initial remarks, I am not in favour of any of these amendments because they require the dying person to make difficult decisions about what care to take, so I am unfortunately not in favour of those.
The next group of amendments is to try to reduce the six month period, or have a higher standard of proof for the six month period. So, for example, the Baroness Lawler's proposal that it. Can I just finish this, the Baroness Lawlor proposal of 80% and two people expert in the area. The requirement of the bill is that there should be a reasonable expectation that the person's death will come within six months. That has got to be approved by two separate doctors and a panel where there is any doubt about the prognosis.
Then each or both of the doctors have got to seek the advice of somebody specialist in the area. That seems to me to be a appropriate degree of safeguarding. I apologise.
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I just wanted to clarify what the noble and learned Lord said, he said. As I understand it, he didn't support these amendments because it would mean that a dying person would have to make difficult decisions. Well, isn't requesting an assisted suicide a difficult
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an assisted suicide a difficult decision that they're already taking? Of course. Of course it's a difficult
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Of course it's a difficult decision, but that's the decision that the person has got to be clear and firm and settled about. I do and firm and settled about. I do not see a parity between the decision that the individual has got to make and making sure that there are appropriately qualified people ensuring that the person has the the disease. They just seem to me to be two different, important but different requirements. The next group of amendments, primarily advanced by the noble Lord, Lord Frost, was the question of whether or not suffering should be an element in the eligibility that terminal illness itself was not sufficient.
We have had this debate on a number of occasions, in particular at the Second Reading, and we've had it in a number of those circumstances where, where a where a terminal illness should be excluded, for all the reasons I have given in the past, I am not in favour of suffering being the requirement. What is suffering will vary from person to person. In some cases it will be the indignity. In some cases it will be the appalling thought of the change in relationship with those they love.
For others, it will be the pain that they are going through. It is not, in my respectful view, an appropriate or easily applied condition. So for all the reasons that I've given on a number of occasions before, I'm against putting in the question of suffering. The next group of amendments were those advanced this morning, which should which says that if you are the victim of medical negligence, Baroness O'Loan if you are the victim of medical negligence, you should not be entitled to an assisted death.
So if, for example, your doctor failed to diagnose your condition early enough for you to get treatment and as a result you are likely to die earlier, even though you have the condition. For example, prostate cancer is the position that because of the negligence of your doctor, you are truly to be denied the right to an assisted death. I unfortunately can't see the logic of that.
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Sorry Lord Beith, I didn't say with respect that you should be denied an assisted death. I said that assisted death should not be
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that assisted death should not be available until all compensation, etc. matters have been sorted out. I think I've dealt with the
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I think I've dealt with the point. Could I, could I? I've dealt with inevitably progressive? Could I deal with the noble Lord Lord I deal with the noble Lord Lord Moylan list of illnesses? I think again, I do not think that is either practical or sensible. The state would have to identify all the list of illnesses they might miss. Some new illnesses come. Surely it is much better that one has a definition of what the policy aim is, and the policy aim is an inevitably progressive illness or disease, which cannot be reversed by treatment.
Can I indicate by an example why the noble Lord Lord Moylan is wrong? If you think about HIV Aids, how many people would have died without this option? If this option is to be made available before, the state would have been willing to recognise that that was a fatal condition. And I do think it would be jolly unfair to people that you have to wait for the state to make that decision. Could I go on the the the noble Lord Lord Moylan also asked for a sorry.
Yeah.
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I deliberately didn't intervene on the Minister earlier, but on the noble and learned Lord earlier noble and learned Lord earlier because he, you know, dealt with the point and I thought we'd spent enough time on it. He's now just enough time on it. He's now just made it even more confusing, he seems to be saying, and I just want to make sure I've got this right. The Minister appeared to be saying The Minister appeared to be saying that you could have a set of conditions, none of which were fatal, but the combination of them fatal, but the combination of them was terminal and that would trigger the circumstance.
I said that wasn't what the bill said. The noble Lord Pannick pointed out that if you had a range of conditions, all of which were fatal, that would count. I don't dispute that at all. What the noble and learned Lord seems to be saying is, if someone has a condition which isn't currently recognised as being terminal, you would qualify under this bill. Is that is that did I just hear him correctly or have I
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got that wrong? What I was saying, for example, is it would be the medical is it would be the medical profession could easily recognise, for example, that HIV Aids is fatal for example, that HIV Aids is fatal and they would have recognised that at a particular time and that would be a medical diagnosis. The effect be a medical diagnosis. The effect of the noble Lord Lord Moylan amendment is you can't rely on HIV Aids as a basis for saying that you are you have an inevitably progressive illness or disease which cannot be reversed by treatment, which was the position for a long time, unless the state has put that into a list of regulations.
And what I am saying is that it should be the doctor's determination of whether or not the illness or disease is inevitably progressive, not whether or not there is a Statutory Instrument that says it's one of the list. So I think that is my clear position in relation to that. Could I go on with the questions that have been raised that the, the, the noble Lord Lord Moylan asked, what does the paragraph under two four in fact mean? What it means is the fact that you have a disability or a mental disorder which cannot justify a terminal illness doesn't mean that you can't nevertheless qualify because you do have a terminal illness which satisfies the requirement of section two one.
Could I deal with the question of congenital disorder and amendment 105? If the position is that you are suffering from a. A progressive illness or disease which is likely to end your life within six months, then I think you should be entitled to an assisted death in the form. And my noble friend Lord Shamash referred to such a condition in relation to his cousin. I'm not in favour of of of of excluding a
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Sorry. Could I first of all pay tribute to the speeches of the noble Lord Lord Farmer, Lord Shinkwin and Lord Shamash, all of Shinkwin and Lord Shamash, all of which referred to distressing personal circumstances? And I think the House is grateful for people being willing to talk about these issues in this very difficult debate. This group of amendments concerns the definition of terminal illness, as people have just identified the definition of a person being terminally ill to satisfy the requirements of the bill is that the person has an inevitably progressive illness or disease, which cannot be reversed by treatment and the person's death in consequence of that illness or disease, can reasonably be expected within six months.
May I just pick up four points that came out of the debate? First of all, the words inevitably and progressive plainly limit the words illness or disease. So the illness or disease has to be both inevitable and progressive to deal with the point raised by the noble Lord Lord Moylan. Secondly, to deal with the very important point raised by the Baroness Finlay of Llandaff on the last occasion, frailty is plainly not within that definition. So frailty or old age or something similar would not satisfy the requirements of an inevitably progressive illness or disease.
That specific point was addressed in the Commons, where the initial draft of the bill had the words inevitably progressive illness, disease or condition, and the word condition was removed to deal with that specific point. Secondly, the word the progressive illness or disease which cannot be reversed by treatment, that is, to deal with the sort of example given by the noble Baroness Baroness Coffey and by other noble Lords. There will be conditions, illnesses or diseases such as type one diabetes or HIV Aids, where there is a traditional and accepted treatment which will effectively reverse the effect of the condition, it won't get rid of it completely.
You still may have HIV, you still may be a type one diabetic, but the effect of the condition is reversed and the intention of putting in the word reversed was to deal with those. Thirdly, there will be difficult choices that people have to make when they are ill. For example, if you have a brain tumour which is going to kill you, should you have a very difficult operation? If you have cancer, should you go on taking a palliative chemotherapy, which may be very distressing in a number of respects.
The way it is drafted is this should not be available for people with the type one diabetes situation, but it should not be compelling people to take very, very difficult and distressing decisions about health. I strongly support that approach. Secondly, the requirement is that you have that in consequence of that illness or disease, you can reasonably be expected to live within, expected to die within six months. In terms of the point that the noble Lord Lord Moylan began to career off with a few moments ago, the progressive illness or disease has to be what brings your life to an end.
The point that the noble Baroness Baroness Merron was making seems to me to be clear. Suppose I have cancer. Suppose I am being treated with chemotherapy. Suppose that it is inevitable that I will succumb to a infection within a week, two weeks, six weeks. That is a situation where there is a combination. But my death will be in consequence of the cancer. As far as the period of six months is concerned, could I adopt the approach of Sir Christopher Witty, who gave evidence in the Commons on the public Bill committee? The central view? And that means what's the what's the the central likelihood of a particular person? Survival is usually reasonable, reasonably accurate, that someone is now in a pathway from which there is not going to be a return.
If you are going to choose a period, then six months is reasonable. It is generally very predictable that someone is going to die in the foreseeable future, but predicting whether that will be in five months or seven months is a lot harder. And there would be some caution. Again, I agree with the accuracy of that and I agree with the realism of it. There has to be a period taken. I believe you can't have a bill that just says terminally ill.
There's got to be a period. What is the right period? The right period that gives people enough of a chance to think about what to do. And it will be different for different people to talk about it with those that they love, to reach a conclusion, a firm and settled conclusion on it. One has got to choose a period. And for the reasons that Sir Christopher gives, I think six months is a reasonable one. But there's nobody in this chamber who doesn't recognise that the closer you are to the end, the more accurate it is going to be.
The statistics that are being produced saying very many of these predictions are inaccurate is obviously right. If one's thinking it's five months or seven months. But what Sir Christopher is saying is broadly, they are often accurate. Could I in the light of that approach, and I think it is a sensible and well thought out approach in the Bill, may I deal with the particular groups of amendments? First of all, the groups, which is amendment 71, 72, 73, 74 and 94 and 204, all of which suggest that you've got to take into account any treatment which might slow or halt or ameliorate the condition.
I understand these amendments to be based on the proposition in considering whether you've got six months or more to live, you should have regard to treatments that could be taken rather than those that have been taken, because plainly there's got to be six months or less to live before you become eligible. For the reasons I gave in my initial remarks, I am not in favour of any of these amendments because they require the dying person to make difficult decisions about what care to take, so I am unfortunately not in favour of those.
The next group of amendments is to try to reduce the six month period, or have a higher standard of proof for the six month period. So, for example, the Baroness Lawler's proposal that it. Can I just finish this, the Baroness Lawlor proposal of 80% and two people expert in the area. The requirement of the bill is that there should be a reasonable expectation that the person's death will come within six months. That has got to be approved by two separate doctors and a panel where there is any doubt about the prognosis.
Then each or both of the doctors have got to seek the advice of somebody specialist in the area. That seems to me to be a appropriate degree of safeguarding. I apologise.
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I just wanted to clarify what the noble and learned Lord said, he said. As I understand it, he didn't support these amendments because it would mean that a dying person would have to make difficult decisions. Well, isn't requesting an assisted suicide a difficult
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an assisted suicide a difficult decision that they're already taking? Of course. Of course it's a difficult
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Of course it's a difficult decision, but that's the decision that the person has got to be clear and firm and settled about. I do and firm and settled about. I do not see a parity between the decision that the individual has got to make and making sure that there are appropriately qualified people ensuring that the person has the the disease. They just seem to me to be two different, important but different requirements. The next group of amendments, primarily advanced by the noble Lord, Lord Frost, was the question of whether or not suffering should be an element in the eligibility that terminal illness itself was not sufficient.
We have had this debate on a number of occasions, in particular at the Second Reading, and we've had it in a number of those circumstances where, where a where a terminal illness should be excluded, for all the reasons I have given in the past, I am not in favour of suffering being the requirement. What is suffering will vary from person to person. In some cases it will be the indignity. In some cases it will be the appalling thought of the change in relationship with those they love.
For others, it will be the pain that they are going through. It is not, in my respectful view, an appropriate or easily applied condition. So for all the reasons that I've given on a number of occasions before, I'm against putting in the question of suffering. The next group of amendments were those advanced this morning, which should which says that if you are the victim of medical negligence, Baroness O'Loan if you are the victim of medical negligence, you should not be entitled to an assisted death.
So if, for example, your doctor failed to diagnose your condition early enough for you to get treatment and as a result you are likely to die earlier, even though you have the condition. For example, prostate cancer is the position that because of the negligence of your doctor, you are truly to be denied the right to an assisted death. I unfortunately can't see the logic of that.
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Sorry Lord Beith, I didn't say with respect that you should be denied an assisted death. I said that assisted death should not be
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that assisted death should not be available until all compensation, etc. matters have been sorted out. I think I've dealt with the
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I think I've dealt with the point. Could I, could I? I've dealt with inevitably progressive? Could I deal with the noble Lord Lord I deal with the noble Lord Lord Moylan list of illnesses? I think again, I do not think that is either practical or sensible. The state would have to identify all the list of illnesses they might miss. Some new illnesses come. Surely it is much better that one has a definition of what the policy aim is, and the policy aim is an inevitably progressive illness or disease, which cannot be reversed by treatment.
Can I indicate by an example why the noble Lord Lord Moylan is wrong? If you think about HIV Aids, how many people would have died without this option? If this option is to be made available before, the state would have been willing to recognise that that was a fatal condition. And I do think it would be jolly unfair to people that you have to wait for the state to make that decision. Could I go on the the the noble Lord Lord Moylan also asked for a sorry.
Yeah.
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I deliberately didn't intervene on the Minister earlier, but on the noble and learned Lord earlier noble and learned Lord earlier because he, you know, dealt with the point and I thought we'd spent enough time on it. He's now just enough time on it. He's now just made it even more confusing, he seems to be saying, and I just want to make sure I've got this right. The Minister appeared to be saying The Minister appeared to be saying that you could have a set of conditions, none of which were fatal, but the combination of them fatal, but the combination of them was terminal and that would trigger the circumstance.
I said that wasn't what the bill said. The noble Lord Pannick pointed out that if you had a range of conditions, all of which were fatal, that would count. I don't dispute that at all. What the noble and learned Lord seems to be saying is, if someone has a condition which isn't currently recognised as being terminal, you would qualify under this bill. Is that is that did I just hear him correctly or have I
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got that wrong? What I was saying, for example, is it would be the medical is it would be the medical profession could easily recognise, for example, that HIV Aids is fatal for example, that HIV Aids is fatal and they would have recognised that at a particular time and that would be a medical diagnosis. The effect be a medical diagnosis. The effect of the noble Lord Lord Moylan amendment is you can't rely on HIV Aids as a basis for saying that you are you have an inevitably progressive illness or disease which cannot be reversed by treatment, which was the position for a long time, unless the state has put that into a list of regulations.
And what I am saying is that it should be the doctor's determination of whether or not the illness or disease is inevitably progressive, not whether or not there is a Statutory Instrument that says it's one of the list. So I think that is my clear position in relation to that. Could I go on with the questions that have been raised that the, the, the noble Lord Lord Moylan asked, what does the paragraph under two four in fact mean? What it means is the fact that you have a disability or a mental disorder which cannot justify a terminal illness doesn't mean that you can't nevertheless qualify because you do have a terminal illness which satisfies the requirement of section two one.
Could I deal with the question of congenital disorder and amendment 105? If the position is that you are suffering from a. A progressive illness or disease which is likely to end your life within six months, then I think you should be entitled to an assisted death in the form. And my noble friend Lord Shamash referred to such a condition in relation to his cousin. I'm not in favour of of of of excluding a