Lords Chamber

Friday 27th February 2026

(began 3 weeks ago)

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10:06
10:07
None Portrait Legislation: Rare Cancers Bill – third reading
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10:07
10:07
None Portrait Legislation: Rare Cancers Bill – third reading
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My Lords, I beg to move that

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this bill be. Now read a third time. Question is that. The question
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None Portrait Bill do now pass. Baroness Elliott of Whitburn Bay (Labour)
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this bill do now pass. I would just like to say a few words about the genuine cross-party cooperation in getting this bill to this point. It has been this House at its best and the other place at its best. And I would like to say a few thanks. Firstly to Doctor Scott Arthur MP, who introduced the bill in the other place, supported very, very forcefully I think is the word by our dear friend Dame Siobhan McDonagh MP, who was so personally affected by the issues in this bill.

But I also want to say that the 55% of people who die of a rare cancer from the implementation of what is in this bill will make a difference to those people moving forward. And I met a young man the other day who had lost both parents to glioblastoma, and he was overjoyed that we were doing this. And I think that is something, as public servants, that we need to remember when we debate issues in this House, that the impact of what we do and what we say really does have an impact on people out there whose lives are affected by the laws we make.

I, I finally want to say that on a very positive note, we should remember dear friends who have passed today of this place, Baroness Margaret McDonagh and Baroness Tessa Jowell, who lost their lives to one of these rare cancers, both very formidable women, struck down in the prime of their time. And we shouldn't forget that. And also to thank all of those noble Lords who made very personal speeches in the Second Reading, telling their own stories about themselves, their families, their friends.

And I want to say personally, thank you to that. And thank you so much to everyone for their support in getting this bill to this point.
10:10
Lord Blencathra Portrait Lord Blencathra (Conservative)
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Thank you. Question is that this bill do now pass. >> My Lords, I spoke to this excellent little bill at Second Reading and said that I wanted to table an amendment to put the Royal Marsden Hospital front and centre Marsden Hospital front and centre in clause two, three B, which states ensure that a person to be known as a National Speciality Lead for rare cancers is appointed with a job description that includes promoting and facilitating research into rare cancers by providing advice in relation to the design and planning of research, and facilitating collaboration between interested persons.

My Lords, I did not table an amendment because the Bill would not then clear our parliamentary timetable. However, I want to press the noble Lady, the Minister on the essential need, in my opinion, to have the Royal Marsden involved in that section, either as a National Speciality Lead or the job description of that person must involve the master. The Royal Marsden is the greatest rare cancer specialist hospital in Europe and in the top four in the whole world. Since Second Reading on the 16th January, the Royal Marsden announced on the 10th of February a new £1 billion expansion of its world leading cancer hub, together with the Institute of Cancer Research, and this will be the largest cancer treatment and research facility anywhere in the world.

My Lords, it's just three miles away from this place, and if we want this bill to succeed, please, please, Minister, put the world's best people in charge.
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Baroness Merron Portrait Baroness Merron, The Parliamentary Under-Secretary for Health and Social Care (Labour)
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My Lords, I am delighted to reaffirm government support for this important Bill. It will make a real difference for rare cancer patients. And as my noble friend Baroness Elliot said, it stands as a real tribute and amount of change to the memory of those we have lost, including our noble friends Baroness McDonagh and the noble Lady Baroness Joel. I have been touched to hear that charities have referred to this as a bill of hope, and I hope myself that is what it will be.

It aligns with our ambition to strengthen the UK's research landscape and improve outcomes for all those affected by a rare cancer, and it also complements the recently published National Cancer Plan, which will drive improvements in prevention, diagnosis, treatment and research across the country. To the noble Lord, Lord Blencathra, I'm pleased to confirm that the new Brain Tumour Research Consortium will be led by the Royal Marsden Hospitals, as well as working with hospitals all across the country, and certainly it is expected they will be consulted when we are looking for the person who will be the speciality lead.

So, my Lords, I am most grateful to all those who contributed throughout the passage of this Bill and in particular to my noble friend Baroness Elliot, for her committed leadership and sensitivity in this matter, in bringing this important legislation forward. Many noble Lords engage so constructively at Second Reading, and I wish to thank all, all of those as well as those advocates in the other place, including Doctor Scott Arthur, who led this bill. This government is determined to go further for everyone diagnosed with a rare cancer.

So I'm delighted that this government supports this bill and that it has been so strongly supported from across the House, both in the other place and in your Lordships House.
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None Portrait Deputy Lord Speaker Lord Gardiner of Kimble (Non-affiliated)
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that have been will say, content,
10:16
None Portrait Legislation: Terminally Ill Adults (End of Life) Bill - committee stage (day 10)
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not content. The contents have it.
10:16
Lord Kennedy of Southwark Portrait Lord Kennedy of Southwark (Labour)
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My Lord, before we begin the Committee stage, I've got a few brief remarks to make. Firstly, my Lords, I reiterate my thanks on Lords, I reiterate my thanks on behalf of the whole House to all staff across the House for the work facilitating this city. A huge amount of work takes place during the day and the days before this sitting to consider this important business. On today's Committee stage, I will not repeat my previous statements, but I should remind noble Lords that in line with the resolution of the House to ask for more time on the bill, I will look to adjourn proceedings around 6 p.m.

But noble Lords and noble Lords can seek to bring proceedings to an end at any time by moving the motion that the House be now resumed. I hope we can conclude the group we are on when we adjourn, but if necessary, I will adjourn the House in the middle of a group. The clerks. The table will have compiled a list of all noble Lords in attendance at the beginning of that adjourned group, noble Lords will be able to check with the table to ensure their name is registered on the list.

If the group is adjourned. It will remain the case that only those present at the start of the debate can participate. Even on a subsequent day, to help with those participating throughout the day, the whips have facilitated a 40 minute lunch break. At around 1 p.m. My noble friend Lord Falconer has set a target for today's debate. I hope the usual discipline and courtesies of the House will make for some more progress. Courtesy, kindness and respect for noble Lords whom have a different opinion to yourself.

Remembering that everybody holds views just as sincerely as you hold. Yours should be the cornerstone of our debates today and always. For general guidance on how noble Lords should conduct themselves, I highly recommend the companion in particular paragraph 4.29 on page 60 and paragraphs 8.81 and 8.82 on page 143, which are particularly useful for today's proceedings. Noble Lord should not be having conversations with others during the debate. If you want to have conversations, please leave the chamber to do that. With that, I think we should be able to business on pause.
10:18
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Lord Falconer of Thoroton Portrait Lord Falconer of Thoroton (Labour)
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I am the person who has been complaining about filibustering on complaining about filibustering on the radio I made. I moved a motion on the 8th of January in which I on the 8th of January in which I set out in detail my position about the delays that have been made. I have complied completely and continue to comply completely with the courtesies of the House during the course of the debate, but that does not mean that I do not think the position is that we are taking an undue length of time in relation to it.

May I give the House the statistics? We have spent 53 hours debating this bill at Committee stage. If we include the additional scrutiny by a select committee and the two full days of debate at Second Reading, we have had more than 80 hours of deliberations on this bill since it was passed to us in June, more than eight months ago, 1253 amendments have been tabled in total, of which we have debated 354. So far we have had over eight. We have over 850 amendments left to be debated, which would suggest we need another 22 days of Committee stage if we continue at this glacial pace.

After nine days of debate, we have completed consideration of just three clauses. We have debated 20 seats groups and have another 60 still to go. I completely endorse what my noble friend, the Chief Whip has said, that we have got to be kind and we have got to be courteous. I would earnestly ask the House to consider whether or not we could agree informally how we could make progress and complete the Committee stage by the end of the next day, because otherwise we failed to do what we are so good at, which is scrutiny and improvement.

The way it is going at the moment, we will reach no conclusions whatsoever. We will appear to be an irrelevant talking shop.
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Lord Sharpe of Epsom Portrait Lord Sharpe of Epsom (Conservative)
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First of all, can I thank the Chief Whip for the remarks he made earlier and the response that he made in writing to me following the remarks I made at the end of the last session, where we've adjourned mid group, and he's committed to make that list that the clerks will compile of those that were present at the beginning of the group, available to the various whips, offices and the crossbenchers, so that they can be circulated. And everyone is then clear about who was here, which will hopefully then avoid the confusion that we had at the beginning of a session a few weeks ago where it wasn't entirely clear who was present.

And I think we then ended up having some extra speeches from people that perhaps were not necessarily here at the beginning. So I thank him very much for that helpful advice. Just on the other points that have been made, very briefly, there hasn't been any filibustering. The average length of a speech, well, I hear noble Lords groaning. The average length of a speech in our committee stages so far has been less than

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five. For what it's worth to the chamber is that the noble Lord chamber is that the noble Lord Harper is just beginning his first filibuster. Now.

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filibuster. Now. With respect. Well, I think perhaps the noble Lady should listen to what the government chief whip said about treating people whip said about treating people with kindness, courtesy and respect I was making. I, I started by thanking the government Chief Whip for his helpful observation to avoid confusion when we adjourn mid group, and I was only responding to the points that had been made earlier, including by the noble and learned Lord Lord Falconer of Thoroton, who spoke at some considerable length in his remarks.

And I would have already concluded my remark by now if the noble Lady hadn't intervened on me. So let me just let me just finish what I was going to say, which is the average length of a speech has been less than five minutes, which is half of the length of the time that's set out in the companion. And of course, people moving amendments have up to 15 minutes. So I think that demonstrates that noble Lords are indeed doing what the noble Lady opposite suggested, and making sure they focus on new points and focus on keeping their speeches short.

On a number of occasions I've not said things I'd planned on saying because they've been well ventilated and I felt the remarks had been made. The final point I would would the final point I would make. And again, the grounds do not suggest that people are listening with courtesy and respect. I've I've actually been in this chamber for every single minute of the debate on this bill, and I've listened to every contribution, even those that I fundamentally don't agree with. With courtesy and respect.

And I think it's good. It's good that we all do that on a bill of such importance, which is being viewed by people actually outside this chamber. The final
10:27
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10:30
None Portrait Amendment:122 Baroness Cass (Crossbench)
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monitoring of its implementation will be absolutely crucial. And there are several aspects of there are several aspects of implementation that will need to follow closely. Firstly, any evidence of the concerns that have evidence of the concerns that have been widely expressed in this House of coercion, and particularly to take account of differentials in take account of differentials in the socio economic circumstances of those seeking assisted deaths. Secondly, we need to be aware of postcode lotteries and implementation and particular challenges in staffing and delivery in certain localities.

And thirdly, we need to be aware of creep as has occurred in other jurisdictions. Now, in a later amendment, I've proposed that voluntary assisted dying services should be commissioned by the specialised commissioning team currently located in NHS England. This team commissions highly specialist small volume services and the assisted dying services would fall within this. Within this definition, and the advantage of this approach is that there's a national Service spec, nationally defined workforce requirements and quality standards and monitoring of the contract by the national team.

In late January, Lord Fuller did notify us of his planned amendments to ensure that the service will be regulated by NHS or CQC or both. However, it's not yet clear how that might work in practice, so this leaves us with the currently proposed arrangements in clause four, in which the Voluntary Assisted Dying Commissioner has a dual role, he or she is required to take on much of the operational delivery of the process and at the same time monitor the operation of the act and report on it to national authorities.

I would submit that it's not appropriate for the Commissioner to be both poacher turned gamekeeper and to mark his or her own homework, because he'll be mixing his roles. Then, as shamelessly as I just mixed my metaphors. So my amendments, therefore, seek to separate the role of the Commissioner to be much like the Children's Commissioner, who is fully independent from the agencies that she has oversight of, and a director to undertake the delivery aspects of the work. Now, these may or may not be the finally agreed terms or or mechanisms, but I think the intent is clear and I leave it open to both the noble and Lord learned Lord, the sponsor and other noble Lords to discuss, discuss other ways in which this separation of roles might be achieved.

My only other point is to draw attention to my amendment 131, which makes clear that although the commissioner is supposed to be an individual who has held high judicial office, neither the commissioner nor the director is discharging a judicial function in undertaking their responsibilities under this act. And on this point, I really am just a warm up for Lord Weir of Ballyholme builds out the
10:33
None Portrait Deputy Chair of Committees. Lord Gardiner of Kimble (Non-affiliated)
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speak further to his amendment 129. On this aspect, my Lords, I beg to move.
10:33
Lord Beith Portrait Lord Beith (Liberal Democrat)
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Amendment proposed clause four, page two, line 24 at end insert and page two, line 24 at end insert and speak.

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Very briefly to. You in the chair of the committee very shortly, if I may committee very shortly, if I may speak very briefly to my amendment in this group, simply to say that to broaden the debate which no Baroness Bi Baroness Cass has introduced, clearly there is a need to establish that this post can have confidence and a degree of consensus around it. And I'm not sure that's been achieved by what's been proposed so far. So my amendment simply brings in the procedure which is used in the other place in the Commons for most regulatory posts that are the subject of some sort of hearing process by the relevant select committee, that system has been developed in years.

While I was in the Commons and as chairman of the Justice Committee, I operated it several times. It works reasonably well in some. In rare cases. The Treasury Committee, for example, has a veto on the appointment. That's as this amendment itself does, but it's a means of trying to ensure that the right questions are asked at the right time when appointments are made. Surely, after recent weeks, we've learned the lesson that if you don't have a proper scrutiny of appointments and you don't have a system in which the right questions are asked, things can go very badly wrong.

And we certainly don't want them to go badly wrong in this area. And that is sufficient to explain what my amendment is about.
10:35
Lord Garnier Portrait Lord Garnier (Conservative)
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My Lords are very grateful that the noble Lord was able to introduce his remarks before he has to go and perform his functions as chairman of committee. I've only got a few things to say, and it's a very my my amendment is is discreet in the sense that it doesn't really affect much of the rest of the, the, the bill, and it really can be taken quite briefly. And I do hope that the noble and learned Lord, Lord Faulkner will be able to agree it, not least because it bolsters the job that he once held.

That said, I, I, with respect, disagree with only one point that the noble Lady, Lady Cass mentioned in her remarks, and that is that the the function of the commissioner is not simply administrative. There is a judicial element to, to the work of the Commission, and that's to be found in clause four Subclause four Subclause d one of the principal functions of the Commissioner is the determining of applications for reconsideration of panel decisions under section 18. That said, I fully accept that it's a it's a mixed function job, it's partly administrative and it's partly judicial, but then so are quite a lot of senior judicial jobs.

The Lord Chief Justice, the master of the rolls all have very heavy administrative burdens, as well as having to perform a judicial function. And no one would suggest I would venture to put before the committee that those people should be appointed directly by the Prime Minister. I think it is more appropriate for someone in this particular position. I think it is constitutionally more appropriate constitutionally more appropriate for someone who is to be the, the, the voluntary assisted dying commissioner to be appointed as so many other judicial and quasi judicial posts are by the sovereign, on the recommendation of the Lord Chancellor.

Now, I appreciate the office of the Lord Chancellor has changed a lot since the 2005 act. More's the pity, in my view. But there we are. That's a long time ago when I become Prime Minister. Of course I shall have it changed. But. I do think that there is a nice distinction to be drawn between the appointments made in the way that I suggest, and if my amendment is accepted by the committee or by the the House as a whole, it will obviously have a knock on effect on the appointment of the.

The Deputy Commissioner under paragraph 31 of schedule one of of the bill. But don't let's delay ourselves in relation to that. All I'm saying is that I think it is more appropriate for this particular function to be appointed by the sovereign on the advice of the Lord Chancellor, as so many other similar posts are. It was said, I think in the other place by a Minister responding to the government that the Investigatory Powers Commissioner is appointed by the Prime Minister, and he, like the assisted dying Commissioner, has to be a sitting or retired member of the senior judiciary.

Well, the I think that's a false point. The distinction between this job and the Investigatory Powers Commissioner is that the Investigatory Powers Commissioner is dealing with matters of national security, and that is essentially a matter for the Prime Minister. Whereas this assisted dying commissioner is not dealing with matters of national security, foreign policy or anything of that nature, he is dealing simply with the the workings of the of of this Bill or this act as it as it may yet become.

So it's a very short point. It's a very simple point, and I'm sure it's one that the, the noble and learned Lord can easily agree with, because it doesn't damage the bill. It's simply a technical adjustment of the route to appointment, and I urge the committee to support it. Thank you.
10:39
Lord Weir of Ballyholme Portrait Lord Weir of Ballyholme (Democratic Unionist Party)
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I rise to move three amendments in this group, two standing in my name and the third, on behalf of Baroness Foster, which I have co-signed. I'll just touch on that briefly. At 128128 is essentially largely probing in nature the bill. And I think we wouldn't take any particular exceptions to this deals lists the principal functions of the commissioner but doesn't outline. I think it's a bit of a gap here. Outline the specific duties of the commissioner.

And so it was to probe whether those, as suggested, the duties are correct. And also, I think to see where we can have a A level. The commissioner has a particular role in terms of, of having ensuring effective oversight. So that is the purpose of 1 to 8. But I look forward directly on 1 to 8 to hearing the response of the bill's sponsor in relation to that, because we feel that there is a bit of a gap at present, moving on to 1 to 9 to follow on from the remarks of of Baroness Cass.

I'd not anticipated whenever I arrived today being Baroness Cass effectively being my the warm up act for me in relation to that. And I thank her for her remarks. But 1 to 9 is essentially dealing with the issue of whether the Commissioner is required to be, or should be required to be, either a senior judge or retired judge. In part, it is also got a slightly probing quality to it. And again, I would seek from that to listen to the remarks of the bill's sponsor.

But also, I think given where the passage of the bill has gone so far and we're in a slightly fluid situation, is where this lands. If things remain unchanged at present. And I appreciate, for instance, there have been a number of formulas. For example, I think Lord Carlile has made some suggestions of how we could inject back some level of judicial introduction to the panels themselves. It is something I think, that would probably be keen to press at Report stage.

If that issue isn't resolved and we're left with the current situation. The reason being that this bill, whenever it was introduced in the Commons, initially had as one of its absolutely core elements, the judicial function and indeed a judge within it, within the panels themselves. This was supposedly one of the great selling points of the supposed safest bill in the world, I have to say, slightly self proclaimed safest bill in the world. But we've seen that that that position, albeit I'm sure that the bill sponsors will give reasons for that.

That position has been resiled from and we've moved away from that, that core element. So if we're not having a core element within of a judge within the Parliament itself, do we leave a situation in which the Commissioner having to be either a, a, a, a senior serving judge or retired judge, does that create a veneer of judicial impact when actually the core element has been has been taken out? And that is more all the more appropriate? Whenever we look at the functions that have been listed for it.

And there are five functions that being listed briefly, A and B are receiving documents and compiling a list of eligible panel members. It's hard to say where that would require a particular level of judicial impact that is essentially administrative in nature. Similarly, at C, where it is making relations, sorry, making arrangements in relation to the panel, that again, is a function which largely lies within administrative competence rather than any element of judicial quality. The one area which does touch upon it, as was highlighted, is a D when it talks about reconsideration of cases, but the cases are not to be considered reconsidered on their own merits, and the sponsor of the bill in the other place, Kim Leadbeater said the commissioner's quote, not to be acting as a judge.

So even within that, there is a query over the level of judicial impact that is going to be there a D and finally, at at A, we see the that there will be a sort of a monitoring role. And particularly as regards the medical statistics and the question mark in relation to that, if we are looking for somebody who's going to produce that particular role, as probably initially suggested, is that that was initially, I think, put within the remit of the Chief Medical Officer.

And it seems to be that a medical professional is much better suited to that particular role within that. So there are queries over the applicability and whether we are simply creating a facade of judicial involvement by having a the requirement currently within the bill. Moving on, then finally to the position of my other amendment, which is at four nine, six C, this would actually create the the opportunity to afford the person, if they if they desire an opportunity for a hearing in front of the Commissioner, rather than simply being decided by a paper hearing.

And it would cover aspects where someone is registered disabled under the act, whether there where there are particular issues over communication availability, cognitive impairment, mental distress, for instance, and where it's in the interests of justice. Now, we would take on board very much. I think the remarks, I think of Lord Faulkner and others who have indicated that we're dealing with people who may be in a very latter stage of of illnesses and as such, their physical movements in terms of appearance may be very limited, which is why, very specifically, the amendment enables that, that there is the opportunity for this simply to be done remotely.

So it would not be a question of someone having to go into particular position. But particularly and we know that there is a lot of concern that is out there amongst disabled groups. And I think this is one aspect which I think is of concern to them. We know that that if there is the opportunity for an applicant to be seen and heard, there can be great advantages within that. We know that, for example, that enables the commission to test out issues around whether there's been any level of miscommunication.

Well, there's been any level of misunderstanding to detect whether the person has a level of motivation, of feeling that they are a burden, or indeed, that where there has been a level of coercion which has gone unnoticed up to that point. And I think that is the advantage of giving that opportunity of a level of hearing. This has been something which has been highlighted by the UN. Human rights experts Report on disabilities, which has talked about that there can be barriers in terms of communication and accessibility for disabled people, and that a failure to adapt procedures to deal with those issues can lead to a form of de facto discrimination.

That is a point which I think has also been highlighted when similar legislation, but the Scottish Human Rights Commission have talked about the need for accessible communication and decision making support to ensure that any request is genuine and that paper based procedures can disadvantage people in with cognitive, sensory or communication impairments in unless they're adapted. So this is to seek a level of reassurance and a level of adaptation. And by giving that opportunity for the applicant does preserve the idea of autonomy.

So I look forward to the bill's sponsor answering the queries. I am sure he will do that in a very kind, in a very elegant and eloquent manner. And I'm sure possibly with without perhaps a great deal of hope of him necessarily adopting these amendments. But I look forward nevertheless to hear his conclusions on the remarks that I've made.
10:48
Baroness Freeman of Steventon Portrait Baroness Freeman of Steventon (Crossbench)
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My Lords, I. >> My Lords, I. >> My Lords, I rise to introduce amendment one for for a in my name, which is related to my other which is related to my other amendments two, seven, 268 and 728A, which a group much later, and which I don't expect to speak to. I draw attention to my register of interests. When I was at the Winton Centre in Cambridge, I led a team that produced information for patients within the NHS, and I'm still involved with that.

And it's this experience which underscores this amendment, which has the support of the BMA. Amendment 144A makes the assisted Dying Commissioner responsible for the provision of the personalised and balanced information required for patients making their end of life decisions under this act. This is because I know how much is involved in producing this information, how carefully it needs to be done, how controversial it can be and therefore that it needs to be properly resourced, and the lines of responsibility for it to be clear.

Now, I know we've already had discussion around informed consent, and I think we all agree that people during this process outlined in the bill need to go through the process of consent, but they also need to go through the process of shared decision making, which is different for both shared decision making and consent, though eligible people need to be given the risks and benefits of different options open to them, including of doing nothing. And that information has to be personalised as much to each patient as possible, and it has to be presented in a way that's understandable to them.

And it's rightly the responsibility of the doctors to give that information to patients and to check their understanding of it through talking with them. But where do the doctors get that information from? Increasingly, healthcare professionals are provided with tools to help them. Online risk calculators help personalise information on prognoses or the chances of an event for a patient like the one they're talking to at that moment. Decision aids bring together all the current known evidence on side effects and represented in easily understood ways, and patients can take these away and refer back to them whilst considering their decision.

And I just want to give an example for benign enlarged prostate. There are two main classes of medicines and eight at least eight different types of surgery available to patients. And I don't think a single individual doctor would know the actual numbers for the average effectiveness, and for each of the major side effects for every one of those ten options, each specialist would know the figures for 2 or 3 of the options that they offered or were familiar with, enough to consent their patients for their favoured option, but not enough to help the patient make an informed choice from all of the options available.

To do that, they need a decision support tool which has all of that information, but also more than that. And that's why these sorts of decision aids are needed. And I want to give the House a sense of what's involved in making them, because it's important to understanding this amendment. When we make them, we work hand in hand with patients and members of the public, with people with visual and learning disabilities and neurodiversity, and conduct academic research into how people interpret numbers and graphics representing them.

And I mentioned that the need for informed consent and for shared decision making are different. And what we find when we work with people is that when making a decision, people weigh up a much broader range of pros and cons than simply risk and benefit numbers. The information they want is not just a percentage risk. That would tend to be what doctors would be able to tell them when doing informed consent, but also information about how to access different options, including those available outside the NHS.

They want to know what would or might happen, like what a certain test actually involves and why it's done. They want to know where things would happen. They need to know what their rights are and their options are about things like their right to say no to something or to have someone else with them. They want prompts for questions that they might want to ask or consider asking, and spaces to write notes for themselves to be passed on if they didn't have, so they don't have to repeat themselves at every appointment.

All of these things in one place help people who are not feeling at their best, navigate an unfamiliar medical world, and have more confidence that the decisions that they're making are the best ones for them. And we know that from working with patients and getting their feedback that this is the sort of information that terminally ill people will need in order to support them making decisions around their end of life. I describe all of this to illustrate that this information needs to be very carefully put together, and I know that it takes time.

It takes about a year or so to do all the background research design test with a range of real patients and relatives, and possibly longer in this case because it'll need to be quite personalised and kept up to date because of the geographical variations in provisions of different options provided by different providers, like those who find in palliative care. And of course, that time and that team doing that work will need to be funded and the final versions will need to be approved and then kept constantly up to date.

And that's why I proposed amendment 144 A to ensure that this very important job is overseen by the Assisted Dying Commissioner. With their legal background and the current job description in the in the bill, they should have the means to request the right amount of resourcing from the government to make sure that this information is produced to the right, standard and well maintained. Now, I don't think anyone in this chamber or outside would disagree that balanced, personalised information about options in a suitable format for everybody, whatever their disabilities, is critical to this bill, and I don't think that anyone will, having heard what that takes, underestimate the amount of work that this will entail.

There will be a lot of people who might want to persuade patients rather than inform them around this decision, and that makes it particularly important that official information is produced, carefully overseen, kept up to date. And currently in this bill, it's not entirely clear whose responsibility this commissioning of information provision would be. When we make them, we commission to make these by a team within NHS England. But it doesn't just spontaneously happen even within the NHS. It's unclear to me whose responsibility it will be when NHS England disbands, for example, and an assisted dying service may be outside the NHS.

And that's why I think it's important that this bill specifically assigns this critical responsibility. And the best person, the only person with the specific ability to ensure funds appears to be the proposed assisted dying Commissioner.
10:55
Lord Moylan Portrait Lord Moylan (Conservative)
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So sorry, my Lords. >> I rise to speak briefly to my. >> Amendment 134, which is a probing amendment. The noble Lord, probing amendment. The noble Lord, Lord Weir, drew our attention to clause four Subclause four, which set out what he referred to as the principal functions as the functions of the assisted dying Commissioner. In fact, the text says the principal functions, and my amendment suggests replacing the word principal with sole. Those functions are very extensive.

They're elaborated in, amongst other places. Schedule one. Schedule two. Section 16. Section 18. Section 49. They are, as I say, very, very extensive. They include in schedule one a general power to do anything which may be necessary or appropriate for the for the Commissioner to do in order to be able to carry out his functions. He is not short of responsibilities, and he is not short of powers in order to be able to carry them out. Yet in the on the face of the bill, these are described as his principal functions.

So my first question to the noble and learned Lord is are there any other functions? Would is anything lost by changing the word principal to sole? Does he consider that there are secondary functions that the assisted dying commissioner has? Now, I ask that I say this briefly, because many of us are concerned that the voluntary assisted dying Commissioner could easily become an advocate for change to the to the to the framework that we are establishing in this bill.

In particular, it may be found that some of the requirements that are set out in the bill are irksome and difficult and take time. Well, of course, that is quite deliberate. The noble and learned Lord has set up a structure which is not meant to be easy to navigate quite deliberately. This is not an easy structure to navigate, and it may well be that that that the assisted dying commissioner comes out with his annual report. He has to produce annual accounts.

I'm sure it will contain things over and above purely financial figures. He will come out with his annual report suggesting changes and relaxations and so forth. He can't make those changes and relaxations mostly on his own. But we do not want, if we establish this bill, which many of us are strongly opposed to, we do not want an officially paid, highly regarded advocate for the relaxation of the of of the safeguards that we have built in to be operating out there.

So I come back to the question very simply. First of all, does the noble and learned Lord want to say whether he considers there are other functions over and above those set out in the bill and taking account of the general power I've already mentioned, and secondly, that he will give us some assurance that he does not see this role as being one which is an advocate for relaxation or change.
10:58
Lord Frost Portrait Lord Frost (Non-affiliated)
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My Lord. four three, six in my name. These two amendments relate to one of the specific functions just just elaborated by the noble Lord. Lord Moylan 135 creates in clause for a specific duty on the Commissioner of ensuring the paperwork relating to individual cases is, in order of the right quality, so that the process can proceed as the amendment would sit, and I quote, the paperwork should be present, complete and of a sufficient standard.

Amendment 436 creates in clause 16 an elaboration of what that duty means in practice, that is, to request further and improve paperwork if it's not in order, and in particular, if any doubt exists over whether eligibility criteria are met. Now, why is these are these amendments necessary? It's a very specific issue, clearly, but the commissioner has a function, inter alia, to receive documents, refer cases and so on. And that is obviously crucial to the working of this process.

Now, as described, that function implicitly of course, includes ensuring the documentation is in order. But it does not make it is not made explicit anywhere in the bill. And the purpose of these amendments is to make that requirement explicit and to create a clear legal duty on the Commissioner to ensure the paperwork is of a sufficient standard. Now, is this just a paperwork requirement, a process requirement? No it isn't. And why is it not? Well, first, the commissioner has a mandatory duty to pass paperwork to the Assisted Dying Review panel.

The existing duty exists requires only that the paperwork exists, not that it be of the right quality. And that is self-evidently a weakness. Second, the panel itself has to be satisfied that the various eligibility and other requirements are in fact met, and the basis on which they do that is the documentation. And how can it be confident it is taking a good decision if there is no process to ensure that the documentation itself is of the right quality? Thirdly, there's obviously a particular issue with all of this.

If, as seems at least possible from earlier discussions, face to face elements of this process are weakened or eliminated. In that case, you are entirely relying on the quality of the documentation, and it is even more vital that the paperwork be of good quality. Fourth, the paperwork duty, a good paperwork duty increases the chances of any systemic problems in the process becoming visible to the commissioner. For example, if certain doctors, certain medical practitioners consistently produce poor quality paperwork, the specific duty makes it much more likely that this is going to be picked up.

Fifth, suppose there is a criminal investigation following any of these cases. In that case, obviously the the the patient, the person receiving assistance. However we wish to describe it, the patient will not be around to give evidence and the paperwork will be the only basis on which an investigation can proceed. Again, it must be of high quality. And finally, my Lords, there's there's plenty of evidence in real in the real world of why the paperwork, getting the paperwork right is so important.

We in the UK, in our normal bureaucratic existence and dealing with the state constantly, I think, find errors in our paperwork. I certainly find it in relation to to me. How much more so will it be for people who have had psychological treatment for a range of different providers, different hospitals, different medical practitioners, perhaps in different parts of the country? It's very easy to see how errors can creep in to this process, and all the more necessary to have a clear duty overseas.

In other jurisdictions, there's a there's a very long list of problems with the paperwork in in the Netherlands, a recent government evaluation showed that up to 15% of assisted deaths were not even recorded in the official systems because of some paperwork error. 1 or 2% of cases in the Netherlands were described as, quote, not careful. In Belgium, a range of investigations have showed specifically reporting problems with poor documentation, incomplete assessments, missing information, and in Canada there have been many investigations into the paperwork, most recently last year, an investigation based on FOI requests uncovered significant systemic problems with the British Columbia made oversight system.

It found 208 2833 reporting issues and completion errors for just 2767 deaths. That is more than one error per case. There's an eligibility error rate of nearly 5%, and despite all these issues, only a handful of referrals were made to regulatory bodies and to the police. And in passing, it's perhaps worth noting that the internal documents released under this FOI reveal that one of the officials in the system recommended that the Canadian Oversight Unit should not be, quote, overly strict in enforcing the paperwork protocols because this quote may discourage providers from offering assisted dying.

My Lords, I hope I've said enough to to illustrate why it is so crucial that there is a specific legal duty to get this paperwork right. I don't think my two amendments raise huge issues of principle. They simply will make sure that a process which perhaps we will one day have legislated for, though perhaps not, that this process is done properly and risks that we have repeatedly discussed over our ten days of discussion are reduced to the minimum. And I hope that the Noble and learned law might look at these amendments on that basis and consider their helpful.



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My Lords. If I may speak to my amendment

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If I may speak to my amendment 144, which is related to my noble friend Lord Frost, who has made many of the points I was about to many of the points I was about to make. And if I just may add to what Lord Frost has just said, he's used the word paperwork all the all the way through what he's just saying and the importance of paperwork. Well, I would make over and above what the noble Lord has just said, what the noble Lord has just said, that the NHS has a notorious reputation with paperwork.

How many times have you heard about the loss of patients medical records? And indeed, as my noble friend Lord Frost said, that the medical records are inaccurate and many, many hours have been spent in this house. And when I was a health Minister, talk about the digitisation, digitisation of the NHS in terms of paperwork, my Lords, this is this bill is an excellent opportunity to say to the NHS or whoever takes responsible for this, when we go for the consultations, when people go for consultations, they are done digitally.

What I mean by that is you do not use a pen and paper. Doctors handwriting is notoriously difficult to read and that has to be then transcribed and digitised by a second party. And mistakes and errors happen, which is one of the reasons why there are so many areas in medical records. So I would just like to
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11:07
Baroness Finlay of Llandaff Portrait Baroness Finlay of Llandaff (Crossbench)
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In this group, amendment 139 simply requires the Commissioner to report to Parliament. But in amendment 913, I've tried to ensure independence and freedom from bias of the commissioner and staff, the Voluntary Assisted Dying Commissioner, as a public figurehead of an assisted death regime, must be free of any whiff of conflict of interest or any perceived bias. Conflicts of interest can be direct, such as the Commissioner had shares in a provider of assisted deaths when increased deaths are profitable, but as the standards of Business Conduct Policy for NHS England points out, perceived conflicts of interest can also present problems.

All interests must be declared. NHS England's policy also states officers must be mindful of any situation where relationships may give rise to a perception that a loyalty, credit or responsibility is owed to another person or body, and it goes on to state it includes the fact that previous employment, directly or indirectly providing a service or product, could be seen to actually be an influential factor. So my noble friend Lord Weir has addressed the functions of the Commissioner.

I will not repeat those, but I just add a few points to them. Appointments to panels must not be biased to those sympathetic to assisted deaths, while also avoiding those who had publicly expressed some scepticism. The Commissioner is to review appeals. Bias can creep in here. Failure to follow statutory safeguards could be viewed leniently, and we've already heard examples of that from the noble Lord Lord Frost and highlighting failures in panels would actually reflect badly on the commissioner who had appointed them.

In reviewing and reporting on the operation, the whole regime could skew reporting because it's not clear which stakeholder groups will be consulted and which data will be collected and what will be omitted. And that, again, could leave room for bias. The amendment simply embodies the principles set out in the Cabinet Office's Governance Code on Public appointments. And I quote, there should be no conflicts of interest that would call into question their ability to perform the role. So can the noble Lady, the Minister confirm that these standards would be adhered to in any appointment? The governance code, my Lord, states that many conflicts of interest could be satisfactorily resolved and mitigated, given the Prime Minister much discretion.

Could a mitigation allow an assisted suicide organisations patron to serve as the Commissioner? This isn't purely hypothetical. In Belgium, the joint head of the Federal Commission for the Control and Evaluation of Euthanasia was one of the leading proponents of the 2002 law there, and since then has euthanised more than 100 patients and has become somewhat of a celebrity. That reputation has caused controversy. We've already heard about under-reporting.

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Thank you for giving way isn't a critical difference when you're talking about conflicts of interest talking about conflicts of interest is in this case, this will be law. So this has been something that has been passed by Parliament. And so I been passed by Parliament. And so I don't believe in any public appointments where someone is supportive of a law of the land

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that is deemed to be a conflict of interest. The point that I was trying to

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The point that I was trying to make, and I'm sorry that the noble Lord perhaps hasn't or I haven't expressed it properly, is that there is a huge amount of discretion here, and the Commissioner will be the person who appoints the panels. So in a way, by assessing the work of the panels, the Commission will be marking his or her own homework. And that doesn't provide the independence that one would require. If I may go on. We heard about problems, too, that have occurred in New Zealand, where there have been difficulties.

That was in our select committee hearing that the noble Lord was present at. And I think these need to be taken just as a warning that we ensure there is independent transparency and lack of bias of the Commission through statutory safeguards to avoid the failures that have occurred in other countries. In the case of Mortier versus Belgium, the European Court. I apologise for interrupting the noble Lady, but I a little bit confused. It seems to me that there is considerable principled difference between expertise and conflict of interest, and that people who have been involved in assisted dying have expertise.

They don't necessarily have a conflict of interest. You can be a professional, as I'm sure the noble Lady will understand and be independent. So why? Why is expertise ruled out? I'm grateful to the noble Lady for that intervention because expertise is not ruled out. It is the way that the Commission functions that is important that that does not allow skewing and silencing. What I was going to go on to point out is that the Belgian commission, one of the commissioners, resigned because that person felt that whenever they were raising issues about problems in reporting, that they were being silenced and were unable to continue to provide ethically high standards, and that their own expertise was not being respected.

I would be grateful if I could just continue for a moment, because I am not trying to filibuster, and I would like to make that absolutely clear. Following the extremely unpleasant, vicious comments that have been made about me, both in the media and in very aggressive emails that have been sent to me. So if I may continue, I would be most grateful. So I'm simply asking whether a commissioner with a financial interest in an assisted death business, whatever that is, however that is commissioned, is actually truly independent and there seems to be no requirement for the appointment to be scrutinised by a Committee of Parliament or for a register of interest to be published.

But I'm sure that that would happen because that is a normal course of action in this country. But the equality impact assessment seemed to be silence on this. The noble Lord, Lord Garnier, has referred to the Constitutional Reform Act of 2005, in relation to appointments. So I will not repeat that either. But this Commissioner's post appears as written to be in the gift of the Prime Minister, and there doesn't appear to be verified impartiality in terms of the exercise of the functions.

Given the great importance of this role, and the problem that if this role does not work well, public confidence in the system would be lost.
11:15
Baroness Fox of Buckley Portrait Baroness Fox of Buckley (Non-affiliated)
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My Lord. >> My Lord. >> My my remarks follow on actually very usefully from those of the noble Lady Baroness Finlay of Llandaff. And she's made some points I was going to make, so I won't make them. But I want to make some of this. I do think that we should consider the inter action between the rather murky world of politics and the role of the commissioner, and I wouldn't raise that issue if this role wasn't entirely, as I understand it, a political gift of the Prime Minister, effectively a patronage office.

And we all surely know the problems that that can create. I mean, it's been rather vividly illustrated in recent months. So I just want to probe what happens if this goes wrong, or rather, how can we stop it going wrong in the first place? Because I do think that there is genuine concerns about a lack of accountability and transparency around the appointment process of the commissioner. And so for that reason, I added my name to the to amendment 126, in the name of the noble Lord Lord Udny-Lister, who is unable to be here today.

But I think he's spot on to suggest, or one of his suggestions is that the appointment is accompanied by a public statement by the Prime Minister. Whoever the Prime Minister is attesting to the suitability, the independence and the neutrality of the candidate, the Prime Minister is ultimately held to account for this appointment and it's clear why they've made it, and so on and so on. The commissioner is a crucial role. Commissioner will have the power to both run and monitor this service.

Yet the bill seems to leave the commissioner's role open to self-definition, appointed by a Prime Minister. And that's it. We're all meant to trust it. And I don't want to be cynical, but I do think the question of independence and neutrality is important because this is a controversial and polarising issue. And if we didn't think it was, we only have to look at the rather testy atmosphere every Friday in this house, let alone on the airwaves in between. So I think we owe it to the public that they feel that they can trust the process.

If this bill is made law. And I think that we have to ask what happens if a partisan figure is chosen? How can that be addressed democratically? What is the process? If there's a problem with the conduct of this commissioner, who is accountable for that? And that's one of the reasons I've added my name to amendment 913A in the name of the noble Lord, Lord Wolfson, which seeks ways that anyone with concerns about the conduct of the Commissioner can make representations both to the Prime Minister and the amendment seeks to probe the process by which the Commissioner can be held accountable for their conduct.

And that takes me back to neutrality and independence. So let's consider if we leave this appointment, as the bill seems to, to the Prime Minister, and they're given complete discretion about who to appoint, how will we protect the role from political controversy, from being seen as possibly partisan? The noble and learned Lord, Lord Faulkner, won't want to compromise the role in that way, I'm sure. But therefore, maybe some of these amendments, I think, will be helpful in insulating it from any accusation of bias.



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Is she not concerned, as I am, that we are conflating expertise that we are conflating expertise with bias? People think that because somebody is expert, they're independent. It doesn't necessarily independent. It doesn't necessarily follow. There could be people who are expert, but at the same time they're very biased in terms of

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they're very biased in terms of their approach to any subject. And I think that is absolutely, self-evidently true. And in the real world. Let me just put it that way. And I so I want I wanted to just note that the present Prime Minister is himself not personally neutral. Personally, I don't mean personally. And indeed he promised, as we now well know, Esther Rantzen, that assisted dying would be made legal. Although, by the way, that was not a promise made to the British electorate, and it was not in the manifesto, but it was certainly made in public with much, you know, singing and dancing.

Would the Prime Minister's personal views influence who he chose as a commissioner? Now, you might think that's far too cynical. I'm being grubby, right? That's fair enough, right? But I want to know, is there anything in the bill that guards against such grubby behaviour? Because if anyone thinks there's no grubby behaviour in politics, they need to get out more. The commissioner, if the commissioner is perceived. Oh, sorry.

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If I may again, this is something. This is a post which will only happen if there's the law will only happen if there's the law has been passed by the Parliament, and I'm not aware that perhaps a noble Lady can help me. If there's noble Lady can help me. If there's any other public appointment process which says that someone process which says that someone cannot be in favour of the law, that they will be in charge of implementing, is is is the noble implementing, is is is the noble Lady aware of any others where that is the case? Or is the noble Lady saying that this should be the only example where someone can't be in favour of the law of the land and

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the job that they've been appointed to do? I maybe want to clarify. Sorry, let me just get back on that one let me just get back on that one point. I just want to clarify. I don't anticipate that those people who have reservations about who have reservations about assisted dying will be queuing up to be the commissioner, as it happens. So I'm not arguing at all that the commissioner could not be an enthusiast. But what happens if they become an activist and an they become an activist and an advocate for it? And and mission creep follows? That's very different.

I am fine, you know somebody who says, I voted for it, somebody in this House might well be that person and they might have disagreed with me. I'm not impugning their. But what happens? How do you stop someone if they say, great, I'm the commission, I'm now in charge of monitoring this and so on. We've had good examples, so I don't want to repeat them. The noble Lord Lord Moylan wants to interrupt or not. No no, no, it's past right. OK, alright. I'm. I'm trying to finish.

I'm trying to finish.

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I. I wonder whether I might whether

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I wonder whether I might whether the noble Lady might agree with me in response to Lord Markham's question that senior and significant public appointments significant public appointments always involve an independent panel assessment panel making a assessment panel making a recommendation. But moreover, they also involve select committees of this House or and or including the House of Commons to take evidence. And there are recent examples. Only a few months ago, in July, in fact, last year where my successor was questioned interminably, I would have thought if I if I can exaggerate a little bit here by the Women and Equalities Committee over a small donation made years earlier to a campaign group and and did not win approval from the committee, presumably on that basis.

So parliamentary scrutiny and or the independent panel are profoundly important. But the noble Lady agree

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prerequisites. I actually think that was a very

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I actually think that was a very helpful intervention, and I think helpful intervention, and I think that we can therefore see that the process of appointing the commissioner should not just simply commissioner should not just simply be in the gift of the Prime Minister, and that there are processes and I think we've processes and I think we've illustrated that and then the the difficulties in relation to accusations of neutrality or partial partiality and so on in that process will come up.

But at the moment, there's nothing in this bill that would allow any of that to have come up before the appointment. And then just I'm now will will finish. I'm suggesting that there are a range of amendments in this group that the noble and learned Lord might want to look at carefully and accept some of, so that the role can be insulated from party politics or accusations of of of advocacy and all of those kind of speculative what if this goes wrong? What if that goes wrong? Maybe nothing would go wrong.

But if something does go wrong with the conduct of the commissioner, or there seem to be actually acting as an advocate activist, there is nothing in the bill that would mean that Parliament could do anything about it. We would just be stuck with it. And so can I ask the noble and learned Lord, what checks does he see for impartiality and guardrails against activism in the Commissioner's choice and role? What process will the Commissioner will there be to ensure a Commissioner's impartiality in their role, even if not in their personal their views? How can we make that guaranteed and what will happen? How can we hold conduct to the highest account? At the moment, it seems to me there is no mechanism in the bill to do so.

And without that formal oversight, I would say that it's unsafe. The way the bill has set out appointing a commissioner, and it just should be relooked at.
11:25
Lord Deben Portrait Lord Deben (Conservative)
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I have tried in the. >> Contributions I've made, which have been few, although I have in fact been present almost every moment of this bill. But I have moment of this bill. But I have tried to point out to the noble Lord those occasions when his actions can make a great deal of difference. And it does seem to me that this is one of those I have been pressed by the media to speak about this bill. I have refused every opportunity because I believe that this bill should be debated in this House, and there should be no attempt outside to make it difficult for us to say what we need to say in our proper carrying through of our business.

If I had appeared on the radio, I would have said that the problem that we are faced with is that there is so much in this bill that is uncertain, unexplained, leaving to Ministers, leaving to particular appointees that we do not know how this bill would work in practice. This is not a question of whether you're on the side of the bill or against it. It is we have a duty to make this bill work.

I don't like the bill, and I don't agree with the principle of it, but I'm not speaking here from either of those points of view. I'm speaking here to try to get this bill, a suitable bill to do the job, which the promoters want to do. And I much resent the way in which people attack that, as if one is behaving improperly. So can I take these? And the disgraceful behaviour attacking one of the most distinguished members of this House, who is knowledgeable and able, and has a history of fighting for the rights and the the kind of behaviour we should have for the terminally ill and the ill that needs palliative care is really a disgrace to this, and I hope that the sponsors of the Bill will apologise publicly for what has been said to the noble Lady, because it is unacceptable in.

So may I just say why this is the most important group perhaps, that we've had. There is very genuinely held concern outside about the mechanisms which will make this bill the safest bill there is. And the person who does this job is clearly not going to be somebody who is against the whole principle. Lord Markham is perfectly right. If this becomes the law, the law will be carried through. The question is, is the person who is going to do this job? A person who will command the respect and support of the nation as a whole, and the amendments which are before us are simply an attempt to find ways of making sure that that happens.

They are not suggesting that it should be somebody who's opposed to the principle. First of all, I can't imagine anybody applying for it. If you don't believe in the principle, I certainly am not going to apply for it myself. But the fact of the matter, the fact of the matter is it's going to be somebody who supports the bill and who's prepared to carry it through, but that person must have the respect of the public as a whole. And the appointment therefore becomes very important.

Now, I don't want to tread on very sad circumstances, but we haven't got a terribly good history about appointments in recent years on both sides of the House. So this is not a party political comment, so it makes it very important at this point to get this right. And there is no question of filibustering to say to the noble Lord that this is the heart of the problem. This is a bill which is supported in principle by many who are in the organisations who are going to carry it through, but it is opposed, in particular by all of them, because the bill hasn't met concerns they've got.

And if, if. Well, I'm sorry, the noble Lady may may grimace at this and I'm sorry she may grimace at it. But the fact is they have given a list of things that they would like to see put right. None of those so far have been properly addressed by the proponents of this bill, and that is a fundamental issue. And this is not about things that don't matter. These are the people that are going to be asked to carry this through.

And therefore, it's not unreasonable for those of us who want a good deal to say, please, can you meet each one of those demands, concerns so that we feel that the professions concerned are able properly to join in the carrying through of this bill? And

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I do give having referred, I'm sorry to pointed out the latest. I know I'm out of order, in fact,

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I know I'm out of order, in fact, because I was not here at the beginning of this amendment. But I feel it is important to say to the feel it is important to say to the noble Lord that I was not grimacing at the point he was making. I'm going to continue with this point, going to continue with this point, because it is a general point that there was no there has been very there was no there has been very limited discussion on the amendment since I've come into the House.
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Lord Deben Portrait Lord Deben (Conservative)
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I think it perfectly right for the noble Lady to have intervened because I referred to her in my apology. I therefore want the noble Lord, who is proposing this bill, to face the three issues which are centred around these amendments, and I am dealing with these amendments. And I say to the whip, these amendments are trying to meet the genuine concerns of people who are not necessarily opposed to the bill. They want to make sure that this key person knows what his or her job is, is appointed in a way which the public can have confidence in and is in fact, not the harbinger of what has been called mission creep.

Now, those are three very simple things to ask for. And the thing that really worries me, and I say this directly to the noble Lord, Lord Falconer, is I cannot understand why at the beginning of this bill he didn't get up and say, we know there's a problem about the fact that it used to be thought that this bill had a judicial element in it, and it doesn't now, and I am prepared to look at seeing how to change that. Secondly, we know that the professional bodies have got real concerns, and I'm going to present my answers to those.

And thirdly, I do know that there's much in this bill that isn't specific enough, which is why the select committees have said that this bill is inappropriate and unacceptable in its present form. And I'll put those things right. Had he said those three things, we would have been a long way forward in this bill. And therefore, this bill is not being held up by filibustering. It's being held up by the fact that the people who are putting forward this bill are so determined that this bill will pass that they are not willing, it seems to me, to listen to the reasonable comments, even from people who have restrained themselves from entering into the beer garden, which they've outside.
11:34
Lord Sandhurst Portrait Lord Sandhurst (Conservative)
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Yeah. >> Yeah. >> Yeah, yeah, absolutely. >> I'm going.

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I'm going. To speak to two amendments which I have put down in this group. They I have put down in this group. They go to the practice in operation 430 and 434. May I introduce them? However, by making this point, I was one of the seven people fortunate enough to be identified in the observer a couple of weeks ago as having put down a lot of amendments, contrary to what the observer suggested, and indeed quite numerous hostile messages I received either by letter or email, these amendments, together with all the others I've put down, except for two which relate to the victims of industrial disease.

All my amendments were put forward by the Law Society of England and Wales, and by the clad group clad at King's College London, the latter, for those who weren't here the other week, are a group of distinguished psychiatrist, psychologist, social scientist and lawyer with particular interest in this and related issues. And they want to see them and the Law Society, they are neutral on the principle of the bill, but they want to see a safe and effective bill.

And my two amendments are, together with others I put down, are aimed at that 430. Some will be pleased to see, others will not actually is for a streamlined non panel basis. Can I just explain it? It requires the insertion of a new clause. This section applies where the commissioner receives the first declaration and then a report about the first assessment, which contains a statement that the coordinating professional is satisfied as to all the matters, and then a report about the second assessment of the person, which contains a statement indicating that the independent professional is satisfied as to all the matters, and then the Commissioner must, it says, as soon as reasonably practicable, consider the person's eligibility to provide you with assistance, and he may then or she consider the person's eligibility personally refer the person's case to a person qualified to sit on the Assisted Dying review panel, or refer the person's case to a multidisciplinary panel.

And what multidisciplinary panel. And what this means in practice is that the. I'm trying to take it quickly. It will be a modified procedure where there is agreement between the coordinating and independent professionals. The Commissioner could then consider the application alone or refer it to the panel. So it would not necessarily have to go to the panel. A full panel would only be mandated if the independent professional is not in agreement with the coordinating professional, that the criteria are met, or if it becomes clear during the modified procedure that further evidence is needed.

So some of those who are not in favour of this Bill may be concerned that this amendment could potentially weaken the process. And I remind the House that Dame Caroline Swift, latterly a High Court judge but formerly lead counsel in the Shipman Inquiry, has said that she is afraid that safeguards on assisted dying are likely to be eroded. And so we do have to be very careful because Dame Caroline Smith was right at the sharp end of looking at this, and that is important.

She has seen what happens with a rogue doctor. And she said those safeguards may seem adequate now, but they are likely to be eroded over time. As leading counsel to the Shipman Inquiry, I saw how this had happened with the safeguards for the issuing of cremation certificates over the years, the Second Doctor's role became diluted. They were seldom independent of the first, rarely examined the body and the signing of the second form became little more than a tick box exercise.

So, my Lords, my First Amendment for 30 might be at risk later on of leading to dilution, but I hope it is an indication that there might, in clear cases where everyone's agreed early on the a way of moving it on swiftly to the advantage of someone who is really anxious to go down this course and has capacity and all the other requirements. So I hope that will be seen as a positive move and not a reckless move.

And I'm surprised that no one has come to me ever since this was put down and said, that's a good idea, we'll stick it in the bill. Four, three, four is clause 16 an amendment there? It is simply intended to make it clear beyond doubt that referral to the panel is mandatory. Wherever the independent professional is not satisfied that all the requirements are met. The Law Society believes, and I agree, that as it stands at the moment, it is not necessarily mandatory and it should be.

And so I ask rhetorically, why not? And isn't this aren't these both jolly good amendments?
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Baroness O'Loan Portrait Baroness O'Loan (Crossbench)
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By my Lords, I would like to

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speak to them as 145 and four three. Rise to speak. I thank the noble

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Rise to speak. I thank the noble Lady for giving way. My Lords, I rise to speak to amendment 146, rise to speak to amendment 146, which is tabled in the name of Baroness Carr Baroness Eaton, and in my name. Before I do so, in the interest of brevity, I would like to say that I support all that has been said in the context of the appointment of the Commissioner. This cannot be a personal prime ministerial appointment. It cannot be a matter of patronage.

The role must be insulated from day to day politics, especially given the risk of damage to trust in nurses, doctors, the judiciary and in this new process by which the state enables the taking of life. I agreed to with the amendments to which seek to introduce some process to the actual appointment of the Commissioner, and I agree to the amendments in relation to conflicts of interest and registers of interests. But, my Lords, by amendment 132, the noble Baroness Baroness Cass seeks to establish conclusively that the commissioners principal functions are monitoring and reporting on the assisted dying process.

And she has introduced by amendment one, two, two a new role, that of director, who will put the assisted dying regime into action, selecting and overseeing panels, receiving applications, deciding on appeals and the other duties. In clause four four, both the British Association of Social Workers and the Law Society gave evidence that an independent regulator for VSED was essential. Now Baroness Foster, noble Baroness Barran foster is not able to be with us today by amendment one, two, eight identifies necessary duties which will provide additional safeguards if enacted.

Ensuring compliance, identifying risk and identifying the circumstances in which things may go wrong with possible tragic consequences. The. I want to speak, though, to amendment 146 Baroness Eaton is unable to be with us today, and this is about the very specific risk to people in care and nursing homes, the majority of whom are vulnerable for one reason or another. The situation of care homes is a matter which the noble Baroness and I have raised repeatedly during the course of this bill.

This amendment develops an obligation which would be imposed by the noble Baroness. Amendment 128, requiring identification and mitigation of risk. It imposes a duty on the Commissioner to monitor and identify emerging risk in the operation of assisted dying, in registered care or nursing homes, and to take reasonable and proportionate steps to prevent or mitigate that risk. Where such risk appears systemic, the Commissioner must notify the Secretary of State for Health and Social Care so that appropriate remedial action can be taken.

My Lords, the issues of vulnerability and capacity, the risk of coercion, the risk of abuse are all particularly relevant to care and nursing homes. Can the noble Lord noble and learned Lord, Lord Faulkner, assure your Lordships House that these matters really have been properly considered and provided for? I do have some difficulty because the scope of the issue is massive. As of 2023, which is the latest official figures, nearly 400,000 people lived in some 15,000 care and nursing homes in England and Wales, 85.7% of the total beds in care homes were occupied.

At the time of the survey, 70% of all care home residents have dementia or severe memory problems. The average period of residence in a care home is about two and a half years, and most of them die in the homes, and those figures will have increased in the three years since they became available. Now, some 120,000 people a year over 75 are diagnosed with cancer each year, and there will therefore be a significant number, possibly the largest cohort in England and Wales, who have a terminal illness.

However you define it and will have a prognosis of six months or less to live, and who live in care homes. On the basis of these figures, it is possible to extrapolate that tens of thousands of people living in care homes will be eligible for assisted dying. And my Lords, there is an extent to which many of these people are forgotten. Isolated group who have very little control over their lives. Many of them just can't leave their nursing care homes, and they're very much susceptible to pressure and to coercion, both organisational coercion and personal coercion.

We know, my Lords, that there have been terrible cases of abuse of elderly in care homes. Age UK lists the possible forms of abuse. It's very long, but perhaps for this purpose financial, economic, physical, psychological and organisational abuse are particularly relevant, as are neglect and acts of omission and domestic abuse. Age UK point out that a person can be subject to multiple forms of abuse simultaneously. Financial abuse may include an element of physical abuse, or neglect may be a feature of coercive control, perpetrators of abuse or neglect are often people who are trusted and relied on by the person, the older person, such as family members or care staff.

In these circumstances, there is a risk of vulnerable care home residents being coerced expressly or implicitly into assisted dying or just giving up because their situation, which might be capable of immediate improvement, has become intolerable. My Lords, the bill does not address concerns about care homes. Care England have said that care providers are dangerously unprepared for what lies ahead. 84% of providers of care homes said that they have not been consulted on the bill or its implications. 24% of providers said staffing would become very difficult, as many staff would conscientiously object, with a further 16% expressing similar concerns.

Only 14% one 4% reported staff being willing to participate in the whole procedure, 34% reported their staff not being willing to participate at all, and only 13% said they could manage assisted dying in their homes. Only 13% could manage assisted dying in their homes. The potential impact of this bill on care homes does not seem to have been addressed. It is very difficult to recruit and keep staff in care homes, and part of the reason, of course, is that the wages are very low in many cases and it is difficult and demanding work.

But many care homes do wonderful work, my Lords, but there are undoubtedly those which are understaffed and which struggle to satisfy CQC requirements. The funding of care is an ongoing risk factor for abuse, and experience overseas has shown that people can be coerced, whether directly or indirectly, into a decision that they should die because of financial issues. My Lord, it is essential that every possible control is included in this bill to avoid the the problem of what we might call arranging death by proxy.

You know, coercing someone into into suicide so that you don't have to take any further action to, to ensure that they are no longer using up resources which a family wish to inherit, for example. So a change in the law may erode the trust placed in medical professionals by our residents. That's what the care homes have said. The change may erode trust in medical professionals, they said. Many of our residents, this is sorry, this is Saint John of God.

Many of our Saint John's care homes. Sorry, excuse me. Many of our residents, sadly, already see themselves as a burden. This can be financial or just because they are now reliant on those who once relied on them. It makes them vulnerable to deciding for the wrong reason as a result of exploitation. Older people in social care as a whole are already viewed as a problem without a solution. The DNR scandal is a clear demonstration that an existing broken system places a lower value upon the lives of other older people than of others.

My Lords, I urge the noble and learned Lord, Lord Faulkner, to accept these amendments to provide some security and safeguards for those who will live and die in our care and nursing homes, if he is reluctant to do so, I have to ask him what controls will he introduce to protect the old, the isolated, the lonely and the vulnerable? And my Lords, I'm afraid it won't be enough to answer me by saying that's the job of the CQC. What will the noble Lord Mann noble and learned? Sorry, what will the noble Baroness, the Minister, do to address the problems and the risk which will exist in our care and nursing homes?
11:50
Lord Morrow Portrait Lord Morrow (Democratic Unionist Party)
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Go for it, go.

**** Possible New Speaker ****

I rise to support of amendment 146A in my name, which requires the 146A in my name, which requires the Voluntary Assisted Dying Commissioner to have particular regard to the right to life under regard to the right to life under article two of the European Convention on Human Rights. When carrying out their functions under carrying out their functions under this Bill, of course, enabling this amendment, I recognise that under amendment, I recognise that under section six of the Human Rights Act 1998, public bodies are required to act in a way that is incompatible with each of the convention rights.

So I cannot can appreciate somebody attempting to argue that this amendment is unnecessary. But as noble Lords will understand, section six of the Human Rights Act sets out a minimum floor for public bodies. They must act compatibly with the convention, but it does not provide a method for decision making. It does not tell them how much weight to give a specific right in a particular statutory context, without any further guidance. The balancing exercise between rights is left in the hands of the public body, with the courts subsequently determining the legitimacy of the decision by a judicial review after the act.

But my Lords, in this life and death matter, we cannot wait until after the act, until the people have lost their lives. Nor should we leave the question of balance solely to the courts. Parliament must take ownership, and Parliament must give a steer and signal to which issues matter most. My Lords, historically we have done this through particular regards clauses to provide just one example under section 22 of the Online Safety Act, we require Ofcom to have particular regard to the importance of protecting users right to freedom of expression within the law, given the concerns that freedom of expression often loses out to risk aversion of administrative convenience, we made clear that any justification to restrict content must consciously and explicitly address article ten rights.

In effect, the clause has Parliament taken, but has Parliament take the policy choice demanded under the EC, rather than leaving it to unforeseeable Ofcom decisions. Turning then to the context of the Bill before us and the reason why I have tabled this amendment, I am troubled, my Lords, that concerns around the article two right to life have too often been squeezed out of this debate. Instead, attention has been fixed on the question of whether the safeguards which many of us consider essential to protect the lives of those vulnerable to comorbidades or potential coercion, would restrict access to assisted suicide and so impinge upon the article eight right to family life and privacy.

My Lords, I am far from alone in having this concern. Last November, after providing evidence to the Select Committee that considered this bill, the Equality and Human Rights Commissioner commissions, Alastair Henderson wrote to the chair of that committee to reiterate the exact issue I have raised, he said, and I quote, the government's equality impact assessment does not strike the right balance, as it mainly focuses on the access issues. It provides more limited information on the potential risks, such as those around safeguarding and coercion, which might affect people with different protected characteristics.

The same marginalisation of article two is present in the government's Human Rights Memorandum of the Bill. Several key concerns around article two raised by experts in the field are simply ignored. Let me provide two brief examples to illustrate my point. Firstly, the memorandum defends the lack of statutory appeal for family members who might raise new evidence of coercion or other factors influencing the decision, on the grounds that it is necessary and proportionate to ensure the process is not frustrated.

Through lengthy legal challenges and protect the article eight right of a person to choose the time and matter of their death. But shockingly, the memorandum makes no reference to the article two right to life that may be impinged should the panel overlook an important influencing factor. And secondly, and I raise this point at Second Reading, the memorandum fails to engage with the concern raised by Tom cross KC and the that the bill unjustifiably discriminates against those persons whose disabilities manifest in the expression of suicidal suicidal ideation insofar as it lacks a mechanism, manifests in the expression of suicidal ideation insofar as it lacks of mechanism to clearly distinguish whether their wish to die is a manifestation of their disability, or whether it is a genuine decision unrelated to their disability.

Consequently, in their opinion, as it stands, the bill could well breach article 14 together with article two of the ECHR. Again, the government seemed to have ignored this concern. The noble Baroness, Lady Mirren, said in a written reply on the 14th of July that the government was aware of Tom Croft's cases advice when updating the memorandum, but chose to not reference it. I find that significant, and she assured the House that the government has set out the articles of the ECHR, which it considers are likely to be engaged by the Bill, including article 14, together with the article.

So for the sake of time, my Lord, I want to ask directly the Minister today, and while I am putting this to the Minister, she will remember quite clearly that a few weeks ago the noble Lady Baroness Falkner, a former chair of the Equality and Human Rights Commission, called on the government to update its equality impact assessment in line with the request of nearly 60 members of this House. As her question was raised during the clause one stand part debate, the Minister did not have the opportunity to respond.

I wonder if she will do so now, and explain why the government does not seem to be following the usual guidance set out in the Cabinet Office's guide to making legislation. In failing to update its impact assessment. Returning to my argument, my Lord, I think that the government addressing these concerns around article two would help correct the unhelpful impression that these are not things to be concerned about because I am worried, as I suspect others are, by the impression given at the Dispatch Box each week, that safeguards are basically perceived as a barrier to equal access, rather than a justifiable and proportionate measure to life.

Protect life as the state is obliged to do. I believe we are in danger of the article two right against being intentionally deprived of life by the state, which is absolute, not article eight. This is a dangerous place to be. The government may indeed be neutral on the matter, as they claim, and they are just setting out that it is possible, with the margin of appreciation afforded by the Strasbourg court. But as amendments one, two, six and 913 remind us, the voluntary assisted dying Commissioner may well not be neutral already mentioned.

Indeed they could be. An advocate has already been said of assisted dying. Who wants to see the expansion of the regime and the erosion of safeguards? My fear is that if the government send the message that article two does not really matter. Strasbourg has ruled that the legislation assisted suicide is within the margin of appreciation of any state, rather than emphasising that the position only stands on the guilty and implementation of each law safeguards. Then we write, we risk giving the commissioner a green light to push boundaries potentially beyond the limits of article two, and only finding out after they have been breached.

Much too late, as I am sure everyone will agree, my Lord, I believe it must be the latter. And I urge the sponsor of the government to send that important message. And I trust that the Minister will take time today to address that issue.
12:00
Baroness Maclean of Redditch Portrait Baroness Maclean of Redditch (Conservative)
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Thank you. 145 and 439 standing in my name. And it is a good thing that I gave way previously to Baroness O'Loan, who I think is no longer in her place because she covered a lot of points I was going to make about care homes. This is the first time I've spoken in committee, even though I have attended virtually every day of the proceedings, and I just wanted to put on record that lots of people have earlier spoken about their personal experiences.

I don't intend to go into extensive detail, but I do want the House to know that I have, for the last eight years, had power of attorney for my 88 year old mother, who has been in a care home for that time. She has advanced dementia. She can't speak, she can't read or write. She doesn't know who I am. So I've got first hand practical experience of fluctuations in capacity and how that can be dramatic from one day to the next. And so I do come at this for a very practical, family based perspective as well.

And those of us who have been former MPs have seen this in our surgeries, seen those family situations. And so that's where I'm coming from. And we need to make sure that family and care home staff always have best interests at heart. For my mother, as I know they would wish to, but we just don't know what those interests are given that she just simply cannot communicate. So turning to my amendment 145 and this amendment is very much in line with what's already been said about the appointment of the very important role of the voluntary assisted dying Commissioner, Lord Garnier Baroness Finlay and others have already mentioned ways in which we can ensure that the public trust is commanded by the appointment of this person.

So it may well be that there's better ways of achieving this than my amendment. So I would urge the sponsor of the bill, the noble and learned Lord Dubs, to come back on the points raised by a good number of us. My suggestion is that the Cabinet Office creates and maintains a register of interest for the Commissioner's office, and also for the panel members, and I make the reference again to the to the point that this appointment is in the sole authority of the Prime Minister, as Baroness Fox has remarked.

So I just think this is very important for public trust. It doesn't matter what government is in office, it just means that we have to have that transparency and that confidence when this person is appointed. And Lord Garnier has suggested this should be an appointment of His Majesty, and it may be that that is also a more effective way of achieving the end result. Moving on to my amendment 43 nine, and this hasn't been discussed in detail so far in this group.

This would require the Commissioner to notify specified and interested parties of a person's referral to an assisted dying panel, and here, the noble and noble Lord Falconer. He will be aware of practice direction nine B in the Court of Protection Rules. And this is where we're coming from with this amendment. This states and I quote, the applicant must seek to identify at least three persons who are likely to have an interest in being notified as an application form has been issued.

And the direction goes on to make clear that ordinarily, although there are some exceptions, close family members are likely to have an interest in being notified, and this can then enable them, if appropriate, to submit a formal witness statement to the court. And I can't understand why it should be any any different here. Assisted dying panels are given extensive powers to make judgements under the Mental Capacity Act of 2005, just like the Court of Protection and surely the same powers of notification and for that matter, summoning witnesses should apply.

And if the sponsor doesn't agree with this, or he can't accept it, perhaps he can explain why he thinks that the panel process should be more secretive than the Court of Protection proceedings. This brings me to the importance of emphasising how important it is to involve families in these significant decisions. And one of the problems with this bill is that it does seem to treat assisted suicide as as entirely autonomous decision, which can be considered in isolation from the context of other complex care needs.

And those of us who got that first hand experience with loved ones will know that this this could well be a patient crying out for further support in some way with their care needs, or how they feel or their emotions at that moment. And I raise this because the NHS guidance on complex care planning repeatedly emphasises the involvement of family and how important that is. I quote from NHS England's guidance it is important to involve families and carers in decision decisions about someone's care and support, with permission of the person being cared for.

It is important to be led by the person with their family, carers or supporters to make sure they can be involved in decision making and similarly, the statutory guidance under the Care Act promotes a whole family approach to assessment. And that's a principle that I'm sure we all recognise that the provision of care involves several parties, including the family, who also need to be supported. And this is significant here because many people who request assisted suicide express a concern that they feel a burden.

And we've heard that time and time again expressed in these proceedings. And but it may well be that if discussions involve family or carers, which then allowed further support to be offered, then that motivation would disappear. So I want to address the objection before I sit down, that there might be circumstances where it's argued that the family should not be notified. Perhaps most obviously, in an instance where they express the view, they don't, they don't, they don't want that. And I accept that the Court of Protection rules are referred to earlier, provide a certain degree of discretion as to which relatives are notified, considering who is practically closest to the person.

But the rules there also include a provision which is entirely absent in this bill. And that is, and I quote, where the applicant chooses not to notify a person listed in paragraph ten, the evidence in support of the application form must also set out why that person was not notified. That same explanation, exploration and recording requirement on this point is set out for social workers in the Nice. Guidance on social work with adults experience complex needs and there are good reasons for this.

A person who doesn't want their next of kin to be involved. It might be a red flag that could indicate coercion and inheritance dispute, or some other significant issue. And that should be a material fact that's taken into account by the panel. And I know that this somewhat anticipates amendment 389 in the name of the noble Lady Baroness Grey-Thompson in another group, which would require the assessing doctor to discuss, although I don't think record the reasons why a person doesn't want to notify their family.

But as it connects to my amendment in this group, could I ask the sponsor if he's not minded to accept my amendment because it doesn't allow the person to decide whether they want their family involved? Why? The bill doesn't include an explicit recording requirement on their exclusion in line with usual practice.
12:08
Lord Stevens of Birmingham Portrait Lord Stevens of Birmingham (Crossbench)
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Yeah. 129, I think the bill gets it right in requiring at clause 43 that the voluntary Assisted Dying Commissioner must hold or have held office as a judge of High Court, the Court of Appeal or the Supreme Court. This is quite clearly not a medical role. Its principal functions are to ensure that the statutory processes and safeguards that Parliament would have established are being adhered to. However, I think we also have to accept that simply because a post holder may have been a judge does not mean that automatically they will not come with personal views about the scope of the law that Parliament has passed, and therefore the debate that the Committee has just had on how to make sure that there is transparency about the views that such an individual might hold before their appointment is ratified, I think have merit.

I, for example, was very struck by an important interview that the noble and learned Baroness Hale of Richmond, the former president of the Supreme Court, gave in prospect magazine in December 2024 when she recorded that in the case, for example, of Tony Nicklinson back in 2014, who wanted it to be declared that it was lawful for people to assist him to take his own life because he had a disabling illness but wasn't terminally ill. Baroness Hale says that two of us, two justices on the Supreme Court, quote, would have been prepared to make a declaration that the current law on assisted suicide was incompatible with the human rights convention.

She goes on to say, there were nine of us on the court. Five of us took the view that when the time was right, the court might make such a declaration of incompatibility. But three of those five thought the time was not yet right. Close quotes. So I infer from that that at that particular point in time, anyway, five justices of the Supreme Court would have taken the view that the bill before us, if passed by Parliament, would fall foul of their reading of the European Convention.

I think it is helpful to think about mechanisms by which Parliament itself could know of the views of such judges, were they to be being put forward for appointment as the Voluntary Assisted Dying Commissioner. And therefore, I think the thrust of amendment 127, in Lord Best name has merit to require, for example, pre-appointment hearings by one or more select committees in the House of Commons, which would give us the opportunity to probe these questions and make sure that a nominee was going to stick to the faithful implementation of the legislation.

That Parliament, after such careful deliberation, would have produced, rather than, for example, interpreting the role of voluntary assisted dying commissioner as in some way akin to that of the Children's Commissioner, which clearly is an advocacy role for the rights of children.
12:11
Baroness Coffey Portrait Baroness Coffey (Conservative)
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This is a really important clause and in really important schedule. It's the one time that a judge, whether current or retired, will be involved in any of this process. After the Commons chose to strip the judges away from the original proposal. Now I put about stand part opposing these because I prefer a judge led process, and I have a lot of sympathy with what the noble Lord Lord Carlile articulated several weeks ago. Now, I will say at the start, I completely disagree with the noble Baroness.

Lady Cass, on her idea about the should start to become like a children's commissioner, victims commissioner or similar. It's simply not the case, not only because of the legal powers in the bill. Clause 18 in particular, is where they have to make judgements about whether there have been errors of law on determination by the panels. But I am very keen, which is why I have tabled, in effect 913ZD that we should be getting this back to a focus, particularly if the role of the Commissioner to be thinking about this being the judge and therefore not a Secretary of State, and I do agree with it, should be the Lord Commissioner.

Sorry, the Lord Chancellor, I apologise the Lord Chancellor. So to some extent, and I do somewhat agree with my the noble Lord, Lord Beith about Parliament. Select Committee should be required to be able to go through this process as well, but it should be the Ministry, the Department of Justice, whichever the relevant committee is in the Commons and there is precedent for that. My Lords, I think it was the noble Lord Lord Tyrie who managed to get into law a particular role for the Treasury Committee in determination.

In fact, having in law a power of veto on the appointment of the chair of the body, which I think was the CMA, but I can't quite recall right now. So there is precedent in that regard. I agree with the what the noble Lord Lord Stevens has just said about the bills. Right. There should be a retired judge, and there's a lot of views about a variety of opinions. So far, I think there's only one judge I've been able to ascertain has not publicly who's retired, has not publicly come out against the bill.

Those who've expressed views a bit like what has just been articulated, they're very much in favour of the bill. In fact, it should go a lot further than what the bill sets out. So there is some sensitivity that all will be required by who gets to make the decision on who the commissioner should be in terms of thinking through my noble friend Lord and learned friend Lord Garnier would like this to be done by His Majesty. There is a certain irony here that it's good to see so many of the Lords Spiritual here.

I had tried to see if I could get an amendment to this bill to strip out at the very beginning that with the advice and consent of the Lords spiritual and temporal. Well, the Lords Spiritual have already been very clear. They do not consent to this Bill and won't be why we should put that onus, then, on the Supreme Governor of the Church of England to make that appointment. And I appreciate there have been some recent difficulties with the current Prime Minister and his appointments, but I I'd be surprised if anything quite so careless would happen again in future appointments of this or indeed other approaches.

So more broadly, I support the proposals to get into into the public appointments process. Now 134I completely support my noble friend Lord Moylan and to try and stop mission creep. There is this risk. And that's why, to some extent, I've put probing amendments in regards to in effect 913Z, z b, z c and D914914B, and to some extent 914C. So if we look at schedule one of the bill. The Secretary of State, as it says is will basically hand over as much money as they think fit.

They'll decide pay, they'll decide pension arrangements. They'll basically give them offices. All the things that you might expect for a sole corporation. None of the employees, as far as I can tell, unless there is a civil servants, will be civil servants. But there's still the Katona principle put into place in schedule one. In that regard particularly, I'm thinking of staff general and that's in schedule one A2, and it will only not apply in to two very specific functions in terms of appointments to the list of people eligible to be mandibles and the determination of basically the appeal through clause 18 of the bill, which is where the person applying will say, I think it's been unfair, rational, and the commissioner will then make a decision without hearing, without a hearing, in order to decide whether to refer it to another panel in the future.

So there are key elements that require this to be a lawyer. And that's why I'm very keen to make sure the Lord Chancellor is in charge. But in terms of I very specifically want to try and get a sense. And my concern is that if we don't put some kind of guardrails on what this commissioner will do or the size of it, it will just start to spread and spread and spread. And you can see we can the Lords can see that your Lordships can see that that has happened in many other bodies and soul corporations created where perhaps there's not quite as much work as they thought they were going to have, and they start to look for things to do.

And this should be pretty functional. It should be pretty functional. And that is why I don't really understand at all why there's the need for a deputy. It says it must. The Prime Minister must appoint a deputy commissioner, who, by the way, has every single power that the Commissioner has as well. Well, they're already going to be staff in this organisation. You can do everything except two things. So I would say that's a completely unnecessary role. And frankly, it will probably be quite a costly role because the same role still has to be done by a person of the legal standing set out.

And by the way, I have to assume these are going to be judges of the United Kingdom or indeed England, Wales who served here. But that's not specified on the bill either. So in terms of the reason why I want to get into this is that the impact assessment suggests that in the Department of Health, I think is suggesting and I assume the sponsor agrees with this, that it's likely to start happening in October 29th, and in the first year it's going to be there, estimated between 164 and 767 people.

Well, I've put in a proposal that it's just a figure at the moment. It's not particularly overly designed, but it does reflect a quite an efficient organisation with hopefully not tons of work that would cap this at ten. And by the way, I would include that anybody who is seconded, which I think will highly be likely of civil servants in a similar to to do that. And indeed if the Department or the Ministry of Justice wants to common people to the Commissioner to support the Commissioner, they should pay for it.

In terms of the other thing, and I think the tenure does matter to me in particular on this, and that people should not be reappointed. Now, it could be the proponent of the sponsors of the bill have put forward five years. It may be that it should be 6 or 7. I haven't gone into that level of detail, but I do believe it should be a one term appointment and people should not be reappointed. And that way we don't. While I understand there might be an element of people saying, well, they're only getting used to the role and so on and so forth, but actually recognising the fairly narrow number of people who are likely to be eligible for this role.

I would hope that recognising that it shouldn't matter what the judge or retired judges view of the legislation is, but that we should be able to find people who would act on this. We certainly do seem to be able to find judges to run public inquiries that go on for multiple years. So I don't see why this would be any different in regards to I mean, for what it's worth, I would potentially go further and put a block on members of this House or members of the House of Commons not being allowed to take up this role, and that certainly applies to certain roles already created in previous legislation.

So I think one of the other amendment that I thought was really interesting was one for six. And we will come back to this in a different way later in the debate. But I know I'm worried about the Harold Shipman effect, and there's supposed to be an element. I get it that two doctors are looking at this, and we've got these others. And but as we've debated, I'm not repeating at the moment, the panel doesn't actually have to be together in order to make their considerations.

They don't necessarily have to meet the person who is put forward the proposal. So this is a way I thought of starting to think. And other other noble Lords have put forward amendments about duties and statistics and reporting. I think in order to have confidence in whether this is going to work or not, we can't just wait for the annual statistics that might come out three years later. We're still waiting for a variety of things. And by the way, I would make sure that we try and get into looking at information of what could be made available a lot more quickly, but I appreciate I've gone past the ten minutes, so I will bring my.

Remarks to a conclusion. So there were a series of questions there about how is this going to look like? I noticed I note that the noble and learned Lord Lord Falconer of Thoroton has put forward 80, which is getting into panels. We are talking about panels later, so I'll respond to once. I won't ask to clarify again once he's spoken, but I may return to it in group three. My Lords, I prepared to.
12:22
Baroness Lawlor Portrait Baroness Lawlor (Conservative)
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Move the amendment for Baroness Eaton on care homes and a duty on the Commissioner to identify emerging risks, to monitor, to report systemic risk to this Secretary of State, and to show that preventative steps can be taken. But as the noble Baroness Baroness O'Loan has so ably proposed it, I simply conveyed the apologies from Baroness Eaton, who sent them last night. But the other amendments I support in this group, I will not go into in the interest of clarity, but I want to say they are 146 apart from one four, 6436439 and 913.

The last one is about conflict of interest, but the others deal with putting a duty on the commissioners to put such a duty on the commissioners to serve as an extra safeguard, so that the exercise of the commissioner will not simply be either to tick boxes, but to request further paperwork if necessary, or the families will be notified as an Baroness Maclean, and that can act as a trigger, perhaps for a discussion with the families and perhaps prevent the coercion which can happen.

But just to say a word on amendment 913 and I was surprised. It's so that those involved in organisations promoting, assisting, assisted dying, whether as a volunteer or an employee, to prevent them from being a commissioner, a deputy commissioner or on the staff. There is a conflict of interest for those who have a responsibility of seeing that procedures for assisted suicide are not abused, should that those people should themselves be actively committed to the cause of promoting assisted suicide.

Indeed, the conflict of interest is so self-evident. I would imagine that it's an oversight that a clause to this effect was not included in the original bill, and perhaps the noble Lord, the sponsor, could comment on that and tell tell us, does he envisage a conflict of interest and how best can we prevent it? And just before I close, I would like to associate myself with the very strong expression of support for the noble Lady Baroness Finlay who brought amendment tabled amendment 913, and the support was to give sympathy against the attack on one of the leading medical authorities in this country, a specialist in palliative care, who has put her knowledge and expertise and time at the service of those most needy of palliative care, and has done so with her time and her knowledge.

And not only that, she has served this country in all kinds of ways in teaching students, in seeing patients herself and in building up her profession, which is one of the most important specialisms in medicine. She also gives such service to this house of her time selflessly, not only by her knowledgeable contributions, but what she does as she sits in the chair night after night after night. And I think we owe her an enormous debt of gratitude, not only in this chamber, but in the

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whole country. Well said. My Lords.

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My Lords. I have two amendments in this group. The first is 125, and I'm concerned, because the bill is written leaves the responsibility of appointing the commissioner to the Prime Minister alone, with no the Prime Minister alone, with no guarantee of the usual safeguards that are applied to public appointments. As a crossbencher and
12:26
Baroness Grey-Thompson Portrait Baroness Grey-Thompson (Crossbench)
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appointments. As a crossbencher and someone who has been through the independent process, I owe my seat in the chamber to that process. I believe it is absolutely vital. In October 2025, the Cabinet Office released an updated governance code on public appointments. Now, the first two requirements are for integrity. Ministers must declare and resolve any interests and relationships, and the second is openness. Processes for making public appointments should be open and transparent. My amendment seeks to bring more transparency and openness, but leave the final decision with the Prime Minister.

Of course, once they've consulted with Welsh Ministers, there are no such requirements in the bill for this, just that the Commissioner must hold or have held office as a judge of the Supreme Court, the Court of Appeal or the High Court. I think that is a reasonable assumption to make that they should have held those roles. But there's no requirement for the Commissioner to declare and resolve any interests and relationships over the appointment process to be open and transparent. My Lords, we have to declare virtually everything we do.

So I don't think it is inappropriate. The Commissioner should have to do so as well. I strongly agree with the noble Lord Lord Deben, and the points he raised in terms of that person has to command respect. But the reason I'm asking for this is also to safeguard the individual as well. And I think what we see with this bill and the amendments that are here today, that the bill is weak on data and reporting provisions, my noble friend Baroness Finlay raised the issue of what's happened in New Zealand.

And I'd like to quote Simon O'Connor, a former New Zealand MP, who described some very troubling incidents there in terms of the two doctors. Doctor Dana Wensley resigned due to her concerns regarding serious problems with the committee's ability to oversee the implementation of assisted suicide and euthanasia. Doctor Wensley is an ethicist. Doctor Jane Greville, a palliative care specialist, was pushed out its thought because she was raising too many concerns about the operation of the new law. Both Doctor Greville and Doctor Wensley went public and stated that the committee's oversight of the law was so limited that wrongful deaths could go undetected, and they cited being extremely concerned about how little information they received relating to patient deaths, leading to and feeling constrained to the point of irrelevance.

They both said that the system was so broken, they wouldn't have been able to identify if somebody had wrongly died. My Lords, if normal standards are not followed, we could compare it to, say, someone who has significant shares in a drug company being able to decide what drugs the National Health Service could use, the assisted dying commissioner, as others have said, have tremendous oversight. They can make appointments to the list of persons eligible to sit on the assisted dying review panels.

They make arrangements in relation to panels to determine applications for reconsideration, and monitor the operation of the act, and I believe that this role should be defined by Parliament, not by their own ideas. And I'd very much like the Noble and learned to give assurance that this appointment process will be looked at, to see how we can ensure that the Nolan principles for public appointments will be adhered to. I mean, when I look at the possible scenarios, you know, this individual could actually be called into a meeting with the Chief Medical Officer to discuss the future of palliative care.

They hold a great deal of power in their hands. But the Lords select committee, a justice Minister, Sarah Sackman, confirmed there had been no support to engage or challenge the commissioner and I'd be very interested in the noble and learned Lords view on whether legal aid would be possible to do this, because in the case of exceptional funding in coroners cases, we might actually have to be in a position where the person is dead before they'd actually get any support to challenge the decision that was taken, the noble Lady Baroness Coffey talked about the size of the commission, and this leads me to my Second amendment, 916, where I ask that the Commissioner keep records of the number of full time, part time and seconded staff working for them, and this information must be included in the annual report under section 49.

This amendment is again to provide transparency for a public appointment. As sensitive as this, the British public has a right to know what it's going to cost and as we know from previous experience, it's very easy for these organisations to grow. My Lords, my background is from sport. I work in sport. I declare I'm a chair of Sport Wales. That was done through a public appointments procedure. I I'm sorry that the noble Lord, Lord Moynihan is is not in his place.

He was here earlier in 2017. I recommended that sport needed an ombudsman. It was an idea that was stolen from him from several years before. It was a really simple ombudsman. It was there to deal with the matters of integrity and safeguarding. But one of the consistent messages I've had from several governments is that not that we don't need it. It's recognised there are issues with safeguarding integrity in sport, but the reason given to me for not having it was I couldn't predict the size and scale of that body and it might grow.

Last year, The Times reported that in 2022 2023, spending by arm's length bodies represented 29.6% of all public sector spending, which is more than double than in 2012 to 2013, when it was just 13.2%. The assisted dying commissioner's office would fall under the arm's length body category and would join this public sector spending that seems to grow even when there's been attempts made in the other place to impose restrictions. Our public sector should be accountable to the public. This office has powers over matters of life and death, and needs to be fully transparent to the public.

My, we need to make sure that real accountability is embedded in this bill and is not something that can be dismissed later on. I would like to draw attention to the part of this amendment where I asked that the number of staff seconded into the organisation are recorded. My Lords, I've seen this in other places. It's quite a smart way of making organisations look much smaller than they are. And again, this is about providing true transparency. So I'd like to ask the noble and learned Lord whether he could give assurance that the assisted dying commissioner and the size of the body will be recorded and will be transparent.
12:33
Lord McCrea of Magherafelt and Cookstown Portrait Lord McCrea of Magherafelt and Cookstown (Democratic Unionist Party)
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My Lord, I'd like to follow the. On the issue of the Commissioner, On the issue of the Commissioner, we do certainly have a shift from the High Court to Commissioner compound, because they were originally proposed that a High Court judge would authorise every assisted death and feature. That is the feature that the sponsor and the Other place initially championed to make it the United Kingdom's law, the safest in the world, with the most robust safeguards. However, that has dramatically changed now, and we have a new structure with Commissioner appointed by the Prime Minister now.

This is an important role for the Voluntary Assisted Dying Commissioner is given powers both to run and to monitor the service. This creates obvious risks of inadequate public scrutiny and independent review. It is judicial in the broad sense of involving a judge, but also does not appear to have a judicial function. Now the Commission will both. The Commissioner will both run the service and monitor. This means that a highly, highly controversial and important service will be run with little proper oversight.

The Commissioner will be responsible both for establishing the regime, overseeing appeals, as well as monitoring and reviewing its operation. This is effectively allowing them, as others have said, to mark their own homework. Now, Doctor Luke Geoghegan, a policy lead British Association of Social Workers, told the select committee that an independent regulator for VAD was essential. And I quote the other thing that I wish that I think would give assurance is that no public sector organisation should mark its own homework.

The voluntary assisted dying service needs robust external inspection, and the Law Society has written evidence was we recommend the establishment of an independent monitor to review and report on the operation of the act annually. Now the Commissioner could be an assisted dying campaigner or someone linked to an advocacy group. Other countries have experienced problems when the assisted dying service is run by an advocate, yet nothing in the bill prevents this risk of conflict of interest as a result.

Now, I would like to ask the noble and learned Lord, Lord Faulkner, as part of the Constitutional Reform Act 2005, the noble and learned Lord developed a new judicial appointments process designed to guarantee both an independent, impartial judicial appointment process and enshrined statutory duty requiring respect for the independence of the judiciary by Ministers. Yet, in the office of the Commissioner, we see a potential patronage office in the political gift of the Prime Minister without any internal or external safeguards.

How, therefore, would the noble Lord tell noble Lords in the House? How will the Commissioner's impartiality be guaranteed? Why has the noble and learned Lord changed his mind on the importance of statutory guarantees of independence? And will the public have any right to view and to know the views of the Commissioner now coming to amendment 1 to 7, in the name of Lord, Lord, Lord, be. This amendment would make the Prime Minister's choice for Commissioner, subject to scrutiny and approval by the House of Commons.

Health and Social Care Select Committee. Now, there is a lack of accountability and transparency around the appointment process for the Commissioner, which is entirely in the gift of the Prime Minister. And therefore, I would ask the the Minister who responded, how has the government followed Cabinet Office guidelines regarding appointments, Cabinet office guidance on pre appointment scrutiny by House of Commons Select Committee 2019 requires that, and I quote, when establishing a new public body, departments should ensure that they consider whether any public appointments to that body would meet the criteria for a pre-appointment hearing.

They should seek guidance from the Cabinet Office and also discuss this with the relevant Select Committee chair in a timely manner before establishing the new body. Can the government and can the Minister respond, confirm whether they have discussed the matter of a Pre-appointment hearing with the Commons Health and Social Care Committee?
12:39
Lord Harper Portrait Lord Harper (Conservative)
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Yeah.

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My Lords, a couple of points to make on this group of amendments. The first one, let me start on a The first one, let me start on a note of agreement with the sponsor of the bill, the noble and learned of the bill, the noble and learned Lord, Lord Falconer. He has an amendment in this group, amendment 131A, which is about adding in the. Before making an appointment under this section, the Prime Minister this section, the Prime Minister must consult the Welsh Ministers.

I for myself, think that's a very sensible approach. We have had disagreements about whether this bill should or shouldn't apply to Wales, but given that it does, then I think it's sensible that Welsh Ministers are consulted. I think it's worth just noting that Welsh Ministers do have some views on on this matter, and this is probably given we're talking about consulting Welsh Ministers. The time to just note them briefly in the vote in the Senate this week, Wales health Minister, one of those who would be consulted, made it clear that two points he first of all, said the motion in the Senate wasn't a referendum on legalising assisted dying, with only this parliament able to make that decision.

But he also said, which is quite important given that there are those outside this House who pretend that the only people that think this bill has any flaws are a small number of peers. When that isn't the case, it's worth just noting that the Labour Welsh health Minister said that he voted against the legislative consent motion because he said that I'm also clear in my own mind. He said that the fundamentals of the bill as it's going through Westminster, don't provide sufficient safeguards for patients.

So the Welsh health Minister, who would be one of those responsible for helping to implement it, thinks that the bill currently doesn't have appropriate safeguards. And he went on to say although the vote yesterday was on the devolved areas, the net effect is to give powers in Wales to deliver a service that I don't think I would be supporting if it was operating over the border. So actually I think for all sorts of reasons, it's very helpful, I think, to consult Welsh Ministers and we've heard from them this week and they're very clear that this bill is currently flawed.

And therefore I think we're doing the right thing on scrutinising it and asking questions and putting forward amendments to improve it. And we can see, therefore, that it isn't just members of this House who have concerns, but it's also elected members serving in the Welsh Government who have concerns. And I think it's worth getting that on the record. The fundamental thing that I wanted to talk about was about the prime ministerial appointment process in in the bill. Now, I was quite surprised, not particularly, that the Prime Minister was making the appointment, but I was surprised there was no other process around it.

So the bill at the moment just says the commissioner is to be appointed by the Prime Minister. The one constraint on that is that the person appointed must hold or have held office as a judge of the Supreme Court, the Court of Appeal or the High Court. But other than that, there is no process set out that the Prime Minister has to follow. And I think there are two flaws with that. There's the one that my noble friend Baroness Fox set out, which is that the given this area of policy, the Prime Minister may have their own views about the issue and that may influence the person that they choose.

Now, Lord Markham was quite right in as far as he went, in the point that the person would be simply implementing the law. I think the worry is if you appoint somebody who has a very strong view about the issue and is prepared to use holding this office to prosecute advancing it, which is the concern that my noble friend Lord Moylan set out. I think that is a problem. And the the concern that I've got with the bill as it's currently set out, is the Prime Minister could appoint such a person, and we would have no way of knowing in advance or testing what those person's views were before the appointment was made, and we would only find out about it afterwards.

And I think that's a real problem. And the second area is that I'm afraid we have seen examples. I'm afraid of the current Prime Minister making staggeringly bad appointments. And the rather obvious one is Lord Mandelson, and I see the Minister shaking her head. But I'm afraid it's shockingly bad, shockingly bad appointment. And it's an example of where an appointment, the decision was made to appoint somebody, and then the process was circumvented in order to get the right result. And I want to make sure that in this appointment, which is responsible for life and death issues, which, as my noble friend Lord Deben said, it is extremely important that it commands the confidence of the public, not just those people who are in favour of assisted suicide, but also those who are against it, but want to see that there's a proper process with proper safeguards, that that person holds

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public confidence. Now, there are, of course. My noble friend, agree that

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My noble friend, agree that given the surreptitious. But nonetheless. Very firm support the current Prime Minister has shown for this Prime Minister has shown for this bill, it's almost impossible not to believe he would not be personally

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involved in this appointment. Well. I think that's right. And I think that is a concern. And think that is a concern. And Baroness Fox set it out very well. So there are two approaches in this group of amendments to deal with that issue. And I want to just explain why I've come down on one side rather than the other. There's the approach that my noble and learned friend Lord Garnier set out, which is to take it away from the Prime Minister and make it an appointment by His Majesty the King, on advice from the Lord Chancellor.

That's one approach. I actually think the alternative approach, which is that set out by the noble Lord Beith's amendment, is a better one, which is to subject the person concerned to a pre-appointment hearing of a select committee. And the reason why I think that's better is that it's more transparent. And as Baroness Falkner set out, it's actually quite a tough process where the candidates can be grilled about their views, about their qualifications, whether they come with any intention to use the how they intend to use the role, whether they intend to use the role to advance the law in any way.

And they can be questioned on that. And I think there is also a precedent, as has been mentioned in the debate, I think, by my noble friend Baroness Coffey, that the appointments that are made to the office for Budget Responsibility not only have a pre-appointment hearing by the Treasury Committee, but the Treasury Committee actually has a veto and has to consent to those appointments before they can be made by the government. And I think actually that's a good model. So I think I come down rather than changing who makes the appointment, I'm content for it to remain a prime ministerial appointment, with the amendment to consult Welsh Ministers.

But I think for the Prime Minister before the Prime Minister can make such an appointment, we should ensure that there is a pre-appointment hearing by a select committee of the House of Commons. I'm not convinced it should necessarily be the Health and Social Care Select Committee, but as an argument, it should be the Justice Committee, given the nature of this role. But that's a secondary question about which select committee it is. But I think having a pre-appointment hearing where the person's qualifications can be interrogated, their motivations can be interrogated in public for the public to see.

And then that committee can make a decision. And only if the committee, a cross-party committee, whether it's of just the House of Commons or whether it should be a joint committee of both houses, that may be something worth considering. But it would mean then that only with the consent of that committee could the Prime Minister proceed, and that would mean that it did achieve, I think what Lord Deben was arguing for was a transparent process, held in public, so that the public could have confidence in the person that was appointed, and then the Prime Minister could then move forward with that appointment, knowing that it wasn't going to generate an enormous amount of partisan controversy, which is the last thing we would want for this important appointment.

So I think on balance, I'm very happy if if the noble and learned Lord Woolf Walker moves his amendment 131, I would certainly have no problem with adding that to the bill. And I, I'm, I think, attracted to Lord Booth solution in having pre-appointment hearings with the select committee having a veto on the appointment, and only when that's taken place can the Prime Minister move forward. I think if we do that, we'll have a robust process in which we can have tremendous confidence.
12:48
Lord Carlile of Berriew Portrait Lord Carlile of Berriew (Crossbench)
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I have. >> I have. >> For listen to 2.25 hours of this debate on this group. And I wasn't really intending to speak, but I'm afraid I can't resist. And I told you so moment, and I'm not speaking because I was name checked by a number of noble Lords in various parts of the House. But because I think it's important to emphasise the background to that name checking. But first I want to say that we've been focusing on the appointment of the commissioner, looking only at clause four of the bill, and I say in credit to the noble and learned Lord, that it looks as though a large number of your Lordships have not read schedule one to the bill because it is an absolute clear fact and a matter of law, that if the appointment of the Voluntary Assisted Dying Commissioner under clause four was done improperly and not objectively, it would immediately be opened to a host of judicial review cases, which would be brought by every interested party group.

In looking at this issue. But I wanted to say something quite different. And here comes my I told you so moment. Some of your Lordships may just about recall that early in the process of this Committee stage, I proposed clause, amendment 120 to the bill which returned to a court based model architecture for this bill and amongst others, the noble Lady Baroness Coffey referred to that earlier. If we were to follow the provisions of amendment 120 and 137, which would remove from clause four, sub clause four B, C, and D, then we would have a clear court based procedure, which of course can improve on clause 120.

And I think I'm going to be given for some facilities with the noble and learned Lord to talk some to some officials in the near future about that and how it might be designed, but it would mean that the voluntary assisted dying Commissioner would then have a much more limited role, which would be to monitor the operation of the act, receive documents under the act and report just as other independent reviewers report on functions, that they're placed in some position of authority over.

And I would suggest to you, Lordships, that we wouldn't need to have spent the last 2.25 hours having the debate we've been having. If we had that simple architecture which inspires the confidence of being supported by the courts, knowing that it's not subject to normal court and appeal and evidential procedures. And I think maybe we should come back to that at a later stage. And I hope that the noble and learned Lord may
12:51
Lord Hamilton of Epsom Portrait Lord Hamilton of Epsom (Conservative)
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change his mind about that once he considers carefully and in detail what has happened this morning, I'd what has happened this morning, I'd like to address the issue of mission creep. I have actually put down amendments that come so late down amendments that come so late in the procedure that I don't think we'll ever reach them, but I am very concerned that this bill, if very concerned that this bill, if it becomes an Act of Parliament, it will morph into something entirely will morph into something entirely different from what we've all voted on.

My Lords, I have a confession to make. I voted in the early 1980s to the amendments to Lord Steel's abortion bill, which went through at that stage. One of the concerns we had with that bill is it morphed into a motion on demand, and abortion on demand was not what we voted for in Parliament. And therefore, we've got to be reassured that this bill will not do the same thing, because I'm very, very concerned that if it morphed into a euthanasia bill, we would have a consultant in geriatrics walking through a ward saying, I want to see all those three people in that those beds dead by the morning because of the bed blocking issue and so forth.

And I'm sure nobody in the house wants to see the bill become a euthanasia bill. So can we have an explanation from the noble Lord, Lord Faulkner, what actually happened to the abortion bill, why it morphed without Parliament having any input whatsoever into abortion on demand? Because I'm very, very concerned that this might happen with this bill as well, under the commissioner that we're talking about. And what checks can Parliament have to ensure that this bill does not go down the same road as the Abortion Act? Oh, God.
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12:54
Baroness Levitt Portrait Baroness Levitt, The Parliamentary Under-Secretary of State for Justice (Labour)
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My Lord. the speaking limit, I've taken a rather different approach to the structure of my speech. I hope that your Lordships will find helpful rather than going through the amendments, the thematically or in chronological order, I'm going to structure my speech by setting out first some observations about the legal implications of some of the amendments. Then I will outline what the government sees as operational workability issues presented by some amendments. And finally, I'll turn briefly to drafting considerations.

So essentially what I'm going to be doing is flagging issues by theme. But if your Lordships have any further questions relating to the workability of any amendments, I'm very happy to to write, to set out the government's views in more detail and place a copy in the House library. I'm not going to comment on all the amendments. If I say nothing about a particular amendment, it's because the government has no concerns. Finally, as my noble friend, the Health Minister Baroness Merron and I have set out many times, the government's position remains that it is for Parliament to consider the policy.

So I am not going to be providing a government view on the merits of any proposed changes, nor make any observations in a personal capacity. My Lords, in other debates on this Bill, your Lordships have asked how the government plans to implement the bill. I am just going to set this out at the outset. Government has not taken has not undertaken any detailed implementation work that would precede the parliamentary process. Should Parliament pass the Bill, the government will then undertake detailed work to develop a delivery model, which would involve engaging with stakeholders and delivery partners, including the judiciary, and to answer the point made by the noble Lady Baroness O'Loan.

This also relates to NHS England and providers, though your Lordships may wish to note that the Bill does not specify where the the provision of assistance may or may not take place. My Lords, a number of your Lordships, including the noble Lords, Lord Harper Lord McCrea, noble Lady Baroness Finlay, and the noble Earl Howe, have asked questions about the role of the Prime Minister. Now I remind the House that this is a private member's bill. So the proposal to designate the Prime Minister as the person who is to appoint the Voluntary Assisted Dying Commissioner was made by the sponsor, not by the government.

It's got nothing to do with the government. It's up to noble Lords whether they wish to retain that provision. The noble Lady Baroness Finlay asked me to confirm whether the standards in the Cabinet Office government Code would be adhered to. If it is the will of Parliament that the Prime Minister is the person who's to appoint the commissioner, then the standard recruitment arrangements for prime ministerial appointments will be followed. These are made through an open regulated appointments process, which includes selection by an assessment panel containing an independent member, whether or not the select committees were involved will be a matter for the sponsor.

And the reason I shook my head at the noble Lord, Lord Harper. And I meant no discourtesy to him as I did so, was that I thought, and continued to think, that it's a shame that he didn't pass by the opportunity to make a party political point when, for example, his noble friend, the noble Lord Lord Deben, was assiduous to ensure that he didn't. I felt it didn't help and it wasn't constructive, but I didn't mean it. Discourteously my Lords, I turn now to the first of the three groups in my speech.

The legal considerations, specifically the compatibility of some proposed amendments with the European Convention on Human Rights. The articles in question are. Article 14, protection from discrimination and article six the right to a fair Trial. Turning first of all to article 14, amendment 903, in the name of the noble Lady, Baroness Finlay would prevent the employment of a person as commissioner or a member of their staff should they have links with any agency promoting assisted deaths. Government wishes to highlight that the amendment as drafted is unbalanced, which creates a risk of breach of article 14 of the convention, and this would be avoided if it also prevented employment of individuals.

Individuals who campaign against assisted dying. In addition, the amendment has drafted would also prevent the employment of a person in the commissioner role or a member of their staff should they have links with any agency that provides assisted deaths. But if assisted dying were to be provided through the NHS, that would prevent the Commissioner from employing staff with relevant NHS experience. Amendment 496 C in the name of the noble Lord Lord Weir, would involve differential treatment as between how reconsiderations of panel decisions would be made in the cases of, on the one hand, identified groups of people in the amendment and on the other hand, those not belonging to those groups.

If that is the intention behind the amendment, consideration would need to be given to whether the approach is proportionate and justified to avoid a risk of breach of article 14. But if the intention behind the amendment is to afford everyone a right to a hearing with the Commissioner, but for only remote hearings to be permissible in the circumstances specified, then drafting changes would be needed. Turning to article six, my Lords, the amendments which the government wishes your Lordships to note could interfere with the individual's right to a fair hearing under article six.

Are our amendments 430 and 431 in the name of the noble Lord Lord Sandhurst, because this would introduce a new triage process enabling the Commissioner to allocate a case to be decided at first instance, either by them or by panel members. But in doing so, it introduces a disparity in the review process, allowing those whose case has been considered by panel members to access the simple review process provided by the Commissioner in accordance with clause 18, whilst those whose cases the Commissioner had considered at first instance could only be reviewed by the more complex and expensive process of judicial review.

I now turn to the other two other amendments where the government wishes the House to note operational workability concerns. I deal first with a group of amendments dealing with the functions of the Voluntary Assisted Dying Commissioner. First amendment one, two, eight in the name of the noble Lady, Baroness Finlay would place a responsibility on the Commissioner to ensure compliance with all statutory safeguards, but in other places it creates a duty to identify or investigate, and the Committee may wish to note that as the bill is currently drafted, the Commissioner currently has no powers to ensure or enforce those actions.

Amendment 146. In the name of the noble Lady, Baroness Eaton would place a distinct responsibility on the Commissioner to monitor, identify and mitigate risks relating to the operation of the Bill on care and nursing Homes. The House. The Committee may wish to note that requiring the Commissioner to take preventive actions to mitigate such risk would suggest a significant change in the role of the Commissioner, and further amendments to the bill would probably be required to make it workable. If that were the wish of the House amendments dealing with resourcing of the Assisted Dying Commissioner, both in the name of the noble Lady Baroness Coffey.

The government has concerns that amendment 914 might have an impact on the operability of an assisted dying service by placing arbitrary limits on the resourcing of the Commissioner's office when the demands of that service are currently unknown, and amendment 913ZA removes the role of the Deputy Commissioner, which would mean only the Commissioner would hold responsibility for appointment of panel members and the reconsideration of panel decisions. So if the Commissioner were unable to perform their role through, for example, absence or illness, this could lead to significant delays in a process where time is of the essence.

Finally, I turn to drafting considerations. If, as a matter of policy, the committee decides to support these amendments, the government may need to revisit the drafting to ensure coherence with the statute book. I am not going to set out every example of this in the interest of time. But for example, amendment 144 A in the name of the noble Lady Baroness Freeman contains ambiguous terms. For example, it is unclear what personalised information means in

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practice. And that's it from the government for this group. My Lords, could I first of all

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My Lords, could I first of all pay tribute to Baroness Maclean, who referred to her own personal circumstances? And every one of us circumstances? And every one of us who've heard individual personal circumstances realise it's difficult to do so. I pay a tribute difficult to do so. I pay a tribute to that and I appreciate what she has done. Secondly, could I ask the has done. Secondly, could I ask the House indulgence for 30s to mention Mr. Nathaniel Dye, who is somebody who has been a campaigner for assisted dying, who has been enormously helpful to me and has travelled through the whole process that has been going through the Commons and the Lords and tragically and suddenly died at the end of last month.

And today is his funeral. And I know that his family and everybody who knows him would

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appreciate if that is involvement was recognised. Yeah.

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Yeah. Thirdly, could I join with everybody in the House in deprecating vicious attacks on the deprecating vicious attacks on the noble Lord Lord Sandhurst, the noble Baroness Baroness Finlay? Any one of us who have been involved in one of us who have been involved in this get vicious attacks outside. I this get vicious attacks outside. I agree with the Baroness Fox when she says the slightly testy atmosphere from time to time in here, and the best that we can do to try and fight off those attacks,
13:04
Lord Falconer of Thoroton Portrait Lord Falconer of Thoroton (Labour)
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is be as good natured and funny and is be as good natured and funny and warm as we normally are. And I'm looking forward to the noble Lord Lord Deben being warm and funny again. Thirdly, could I mention my amendment clause 131A which the noble Lord, Lord Harper mentioned, noble Lord, Lord Harper mentioned, which is to add an element that the Prime Minister has to consult with Welsh Ministers before he makes the appointment. I hope that nobody objects to that.

It's what the Welsh Senate effectively agreed to by passing the LCM. So when we come to that, I'm going to move that. I detect no objection to that. Finally, in relation to the noble Lord, Lord Moore of Etchingham, I am afraid that I am not going to provide him assistance in relation to the way he conducts himself in relation to the House. He always conducts himself, if I may say so, with impeccable manners and courtesy. But it's for each one of us, I think, to determine what's appropriate and what's not in relation to it.

Could I go to the amendment and I can deal with them quite quickly? The amendments are all to deal with the question of the voluntary Assisted Dying Commissioner, which is provided for in clause four, the Voluntary Assisted Dying Commissioner will be appointed by the Prime Minister. As my noble friend. Baroness Levitt. The Minister has indicated. As long as that stays in, then it will be subject to an open appointments procedure involving an assessment panel. As far as the noble Lord, Lord Beith's idea, which is, I think, a perfectly commendable idea.

Should a select committee look at the appointment, the way that that works in practice is for the Cabinet Office and the individual select Committee to agree whether or not the particular appointment should be subject to a select committee procedure. I myself would be in favour of it. I do not think it is appropriate to put it into the bill, but I can see real merit in it, and I not only would have no

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objection to it, but would would think it's a good idea. Given that noble and learned

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Given that noble and learned Lord thinks it's a good idea. And given that part of the reason why, and I think Lord even touched on and I think Lord even touched on this, many of us have concerns, is so much of the detail of implementing this is not set out, but is left for decisions. What is but is left for decisions. What is his objection and his rationale for not coming forward with an amendment and actually putting it amendment and actually putting it in the bill so that it has to be done by a pre-appointment hearing decision.



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For the select committees in the other place, they should be consulted and decide whether they consulted and decide whether they want it going on in relation to the particular amendments that have particular amendments that have been made. First of all, the Baroness Cass amendment. She draws attention to the fact that the assisted dying Commissioner has a function under the bill, and that function under the bill, and that function is to receive documents, make appointments to the assisted dying panels, make arrangements in relation to such panels which mean he or she is responsible for making sure the process runs properly.

Determining the applications for reconsideration of panel decisions. That means that if a panel says no to a applicant who wants an assisted death and the panel says no, you cannot have one, then the assisted sorry, the the the voluntary assisted dying commissioner has the power under clause 18 to say another panel should look at it and he or she has that power in a semi judicial function. If there is an error of law in some way in relation to it. So that's a function.

And then finally he has a function to monitor the operation of this act. And if noble Lords go to clause 49, he is given he or she is given the power to make reports, give an annual report, identify things that may be of significance in relation to it. Now, one should not confuse his role with monitoring, for example, the performance of doctors in relation to their role. I don't see the particular very specific functions he's got there, and the obligation to monitor and give reports, as in any way in real conflict.

I think they could be done by the same person, particularly if there is a deputy to be appointed as well. So I note what the noble Baroness says, but I don't think it is necessary to, as it were, make a make in the provision of the Bill a separate role for somebody to do both. But I've thought very carefully about it. And the noble Lord Lord Garnier has been kind enough to indicate that he's had to leave. But could I could I deal with his point? He wants not the Prime Minister to make the appointment, but the Lord Chancellor, the Prime Minister and the Lord Chancellor are both political appointments.

The reason we have chosen Prime Minister is because even though I think there's practically nobody more important than the Lord Chancellor, the political world, for reasons that I'm completely unable to understand, regards the Prime Minister as more important. So we have taken the most important person in the government to make the decision. And I don't think with the greatest of respect for the noble Lord, Lord Garnier, that we should change, that the noble Lord, Lord we're raises the question of why should we have a judge? The reason we have a judge is twofold, and I am a great admirer of judges.

I should declare an interest. I'm married to a judge. The reason we have a judge is twofold. First of all, ex members of the Supreme Court, the Court of Appeal or the High Court of England and Wales. And just to answer the question is England and Wales, we've got in mind they have high standing. They are regarded as people of calibre and that's why they're put in. That's the first reason. And the second reason is because one of the specific functions in the bill is to consider whether or not the rejection by a panel is an error of law.

That seems to us to be appropriate, to be dealt with by somebody with high legal experience. Secondly, and separately, the commissioner is somebody who has got to issue rules and a process for dealing with it. So that's the

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reason for doing that. I wonder. Whether the. Noble and learned not would not

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Noble and learned not would not think to himself that if that's the argument he puts forward, which I entirely agree with, doesn't that entirely agree with, doesn't that lead him to understand that the proposals that the noble Lord who proposals that the noble Lord who spoke unwillingly earlier on to put spoke unwillingly earlier on to put this back where it was in the first place, as basically under the control of judges, would not be a very good thing to do.

And why has he not accepted that? That really is something that most of us would be able to be supportive of, and therefore we would cut down the time which we're spending dealing with the situation when it isn't there, if it's necessary, as he says now, why not do the whole hog?

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The reason why we have rejected or changed from a judge to a panel or changed from a judge to a panel was because after very considerable debate in the Commons, it was debate in the Commons, it was thought having a legal person in the middle and a psychiatrist and a the middle and a psychiatrist and a social worker gave greater reach and understanding of those issues. and understanding of those issues. That issue we debated in full over a particularly long period of time on an earlier Friday.

So I'm more than delighted to redebate it all. However, I think that issue has been laid to rest. That does not mean that one does not have to have a process whereby the doctor's pass their findings to a panel, and that's the role in part of the assisted dying. Commissioner. Could I go on in relation to it? Lord Moylan. Oh, sorry. Sorry.

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Briefly. You talked about putting it to rest. I think for many of us that is an issue which is not at rest. I certainly supported the noble and learned Lords amendment 120, and I got the Lords amendment 120, and I got the impression you were still thinking about its possible value. So it's not been put to rest as far as many

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not been put to rest as far as many of us are concerned. I. I. Was pretty clear in the remarks

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Was pretty clear in the remarks I made that I favoured the panel process. When I say it's been laid to rest, I completely accept that the House may take a different view from me, which I would completely respect. They deal with that. Obviously there'll be a vote at report and we decide whether we wanted the panel or we wanted the court process, and I hope it has been laid to rest. But if it hasn't, then so be it. I will lose it.

But what I would earnestly hope is we get there and reach a decision in relation to it. The noble Lord, Lord Moylan, would like to replace the word principal with the word sole. Two points in relation to that. First of all, all that the assisted dying Commissioner can do is that which is prescribed in the bill because he is a creature, or he or she is a creature of statute, and therefore there's nothing more that he can do beyond that. The reason why the word principal and not sole is used is because you do not want to get into a completely barren argument.

Subsequently, whether or not the something that he does, which would be collateral to the principal functions, is covered or not, and that is why the word principal is used, and that is why I would not be in favour of

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changing the wording of the bill in relation to that. Well, that that point.

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That he makes. Seems to me to be covered by the general power in schedule one, that the assisted dying commissioner has to do anything which is appropriate or necessary for carrying out his or necessary for carrying out his functions. So so I don't think that functions. So so I don't think that is a reason for not using the word sole and, and giving some assurance

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to those of us who are concerned about creep. I think. We'll have to disagree on that. It's it's the it's the normal way It's it's the it's the normal way it would be dealt with in drafting. So I'm content with that. And I'm sorry to disagree with him, but sorry to disagree with him, but that is my view in relation to it. Could I go on now to the noble Lord Lord Frost amendments, which are Lord Frost amendments, which are amendments one, three, five and I think one, three, nine, which is you're placing a duty on the assisted dying commissioner to check that all the paperwork is in order.

Again, I thought very carefully about that one. The role of the assisted dying commissioner, as far as the panel is concerned, is once the assisted dying commissioner receives the two reports from the doctor, then his job is to pass it on to the panel for the panel, then to consider whether it's in order and whether it meets the criteria. Are they satisfied there's not coercion? Are they satisfied on capacity? I don't think it is either appropriate or necessary to add yet a further safeguard in that respect, because that's why the panel is there.

I think it would lead to overlap, and I think it would lead to unnecessary delay without there being, in practice, any additional safeguard could. Could I go then to the noble Lord? Lord Evans of Rainow supported that. I think for the same reasons I would reject that in relation to the Baroness Finlay's point in relation to no conflict of interest. Of course, there would obviously be a conflict of interest if the assisted dying Commissioner had a financial or commercial interest in any sort of provider of assisted dying services, and that would be covered by the principles to which the noble Baroness Baroness Levitt referred in relation to the way that the appointment would go.

So I completely agree with the point that she said, but I don't think there's any need to put anything into the bill in relation to it. There is a suggestion all the time, not all the time, but a number of noble Lords have referred to the risk of mission creep. The idea that you have an enthusiast or a proponent of assisted dying who would in some way operate in a inappropriately biased way. All that the assisted dying Commissioner can do is act in accordance with the terms of the Bill, as the noble Lord Lord Carlile said, if, for example, he stuffed the panel with people he knew would take a biased view, he would be acting both improperly and illegally under the terms of the bill.

And as the noble Lord Lord Carlile said, and I agree with this schedule one opens the door to every sort of judicial review. If that were the position, if the position were, let me finish. If the position were that people became concerned about this. And that goes to the noble Lord, Lord Wolfson's amendment, which is you could make complaints to the Prime Minister. Well, of course you could make complaints to the Prime Minister. You certainly wouldn't need the bill to make that possible, because there will be political accountability for the conduct of the commissioner in the Prime Minister, because he or she has made the appointment.

But equally, there would be legal accountability as well, in the form that the noble

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Lord Lord Carlile referred to. Noble and learned Lord Stern

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Noble and learned Lord Stern encyclopaedic knowledge of the statute book. Can you tell us what went wrong with the abortion bill that morphed without parliamentary that morphed without parliamentary consent, much to the concern of its sponsor, Lord steel?

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sponsor, Lord steel? Because I think I think what one's got to do is to focus on this

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particular bill. Yeah. Sorry, sorry.

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I thank the Lord for giving way. I think it's all very well. You I think it's all very well. You know, my Lord, to talk about access to judicial review when things go wrong. But the reality for the wrong. But the reality for the ordinary man in the street is that judicial review is largely out of his, out of any possibility. It his, out of any possibility. It just costs too much. And therefore we need in this bill to make sure that things are so laid down that they don't have to be multiple requests for judicial review.

And for that reason, I would ask the

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noble Lord to consider further. Could not agree more with the noble Baroness Baroness O'Loan. And noble Baroness Baroness O'Loan. And that is why, in addressing these issues, we have been very specific issues, we have been very specific in what the Voluntary Assisted Dying Commissioner can do, both in Dying Commissioner can do, both in clause four and in the schedule. And what's more, that is why we've And what's more, that is why we've had such a limited panel that can be made for voluntary assisted dying Commissioner, because it's got to work, and that's why it's been drafted in that way.

Because you're absolutely right. Judicial review is an expensive process. It provides a guardrail, but ultimately there's got to be sufficient detail in the bill to give the public confidence that the system will work. And that's why we've, for example, restricted it to a Supreme Court judge, a Court of Appeal judge, or a High Court judge, because we're absolutely on the same page in relation to that. Could I go to the noble could I just deal with Lord Sandhurst, then come back to you? Can I deal with the noble Lord? Lord Sandhurst? I understood, though I may not have understood his amendment 430 as being that where the two doctors agree, then the assisted dying commissioner, if he or she agrees, can short circuit the need to go to the panel.

That's my understanding of it. Which which is interesting. My anxiety about that would be that you are in every single case, almost getting rid of the panel, because the position would be you only ever get to the panel if both doctors have agreed, and the sponsors present the bill to this House on the basis that in every case, the safeguard is shortening it. Two doctors and a panel. So I, I respect the thinking because it's trying to streamline the thing, but I don't think it's appropriate.

I

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would undermine the safeguards. Lord is right. And I did I think

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Lord is right. And I did I think when I introduced it, say that there might be problems with it, but I thought it was something

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which should be looked at. Baroness Berridge. Thank you. And I'm grateful to the noble and And I'm grateful to the noble and learned Lord for his realistic acceptance of the difficulty of judicial review as the remedy for judicial review as the remedy for many people, so I'd be grateful if he could also reflect then, on the fact that for family members, if the panel approves assisted assisted dying, their remedy to challenge that is indeed judicial review.

And we heard evidence from the select committee and particularly, for instance, from Senate Mostyn, that that's just fine. And and many of us, myself particularly did not feel that that is satisfactory for family members to have to resort to judicial review if they have evidence, for instance, that there's been coercion, etc. So could he reflect?

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And that may avoid further amendments later down the line? I will. Certainly reflect that. Could I

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Certainly reflect that. Could I express my gratitude to the Baroness Berridge for facilitating Baroness Berridge for facilitating the meeting that she arranged with with Professor Keen? Thank you, who was incredibly helpful, and I do genuinely appreciate that. Yes, I genuinely appreciate that. Yes, I will reflect on that. It is a similar answer, I suspect, to that which I gave to the Baroness O'Loan, which is you've got to be as specific as you possibly can in the bill, because judicial review is difficult for normal people to do, but for, for people to do, particularly in those circumstances.

That's why the bill has got because whether it's a court system or any other system, you've got to try and make it as clear as possible. Can I go to clause one to amendment 146, which is Baroness Neville-Jones amendment, saying that the the, the there should be the ability to investigate patterns on the part of the of the assisted dying commissioner. And in particular, she cites what may happen in relation to care homes. I agree that the assisted dying commissioner should have that ability.

He does have that ability. Under clause 40 91A, B and C. And so, for example, if he was concerned about a pattern developing in care homes, he has the power already to monitor that. The noble Lord Lord Morrow raises issues about the, the, the, the, the, whether or not there should be a further Equality Act assessment. And I dealt with that last time, and I said I'd looked carefully at what the former commissioner had said, and I didn't think that it was appropriate to have a further impact assessment, because if you constantly make particular points, they're covered in general.

You're never going to get to an end of it. And I don't think the point that the commissioner raised were ones that hadn't already been considered in the impact assessment.

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Thank you. Noble and learned Lord Rogan. I accept that there's a general power to look at what's general power to look at what's happening in relation to the regime in section 40, clause 49. But I would say to him again that there would say to him again that there is an issue raised by amendment 146, which definitely requires further consideration, and that I would ask consideration, and that I would ask him to reflect again on how not just the monitoring of, excuse me, the monitoring of of delivery of service, but also the arrangements for the delivery of assisted dying process in care homes where people are vulnerable, isolated, largely unsupported.

In many cases there is a very serious problem given the remarks of people like age UK care homes. ET cetera, et cetera.

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I will certainly reflect. Upon it, but the issue of

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Upon it, but the issue of somebody who is isolated and alone in a care home, that is why there in a care home, that is why there is the five steps before you can get an assisted dying. And the question is whether or not doctor question is whether or not doctor number one, doctor number two, doctor number one, again, the panel doctor number one, again, the panel doctor number one. Again. Is that a sufficient safeguard. And my own view is that it is a sufficient safeguard.

And the it's particularly focussed on protecting

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the vulnerable. Just just one. I should. Go on. I apologise, but Baroness,

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Go on. I apologise, but Baroness, the noble Baroness has had a very fair crack at that particular whip. fair crack at that particular whip. Can I go to. Can I go to Baroness McLean's point, which is, should McLean's point, which is, should there be a register of the interests of the of the of the assisted dying Commissioner? I assisted dying Commissioner? I understand what motivates that. I don't think that that is necessary because, as the Baroness Levitt said, that is something that will be dealt with by the normal process and conflict of interest.

There wouldn't necessarily be a record of it, but it would be something that would have to be disclosed before a decision was made. I think that I have dealt Baroness Grey-Thompson indicated various issues in relation to the appointments process, but I hope that I've dealt with them by referring to the process that would would apply. I think I've dealt with all of the other ones, including the noble Earl Howe point about amendment 913. A thank you.

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I'm still not genuinely not quite clear who the noble and learned Lord thinks that the Commissioner, and indeed this whole process is ultimately accountable to with the rejection of Baroness Cass amendment. And I'm trying to work out who ultimately is going to work out who ultimately is going to monitor this. If there's public concern about this law being interpreted much too, too loosely interpreted much too, too loosely or things are going wrong, who is going to keep a permanent eye on

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what is happening? The nature of the appointment is it's an appointment by the Prime it's an appointment by the Prime Minister. He is politically a accountable for the appointment. accountable for the appointment. The assisted dying commissioner, like so many other appointments like so many other appointments made by a Minister, is got legal duties. But if you're looking for political accountability, it is the political accountability, it is the person who is responsible for him, his or her appointment. And that is

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the way that public appointments operate. I'm sorry. The noble and learned

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Lord Hannan addressed 144I. Apologise, I completely apologise, Baroness Freeman apologise, Baroness Freeman emphasised by her amendment 144A the importance of providing the importance of providing personalised information and assistance in relation to reaching a structured decision in relation a structured decision in relation to it. And she speaks from considerable experience, and can I express my gratitude to the Baroness Freeman for talking to me about it, and providing me with real assistance in relation to it, the way that that would be dealt with, it seems to me, would have to be by codes of practice issued by the Secretary of State under clause 39, if there were problems in relation to it.

For example, the codes of practice for thought not to be adequate or were giving rise to problems, then it would be for the assisted dying Commissioner under clause 49 one to give report or an indication that something was wrong in relation to it. But the point she makes are important and I

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very much apologise for not dealing with them. Noble Lord, did not. The noble

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Noble Lord, did not. The noble Lord did not speak to his amendment 480 at all in this group? So will 480 at all in this group? So will he be planning to address that later in group three? I'm conscious later in group three? I'm conscious he didn't particularly address my amendments, but I assume it's just because he disagrees with them, because he disagrees with them, which I understand. But 480 is not. It hasn't been talked about at all. And it's OK if he wants to address

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it in four, in group three. You're talking about 481 week.

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You're talking about 481 week. Four 484. Are you. Sorry? This is my fault.

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Sorry? This is my fault. 480480. Got it in group three. Could I talk about could I talk about that in group three I apologise. Yes. Yeah.

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Thank you. Long speeches are unpopular at the best of times. But particularly as I now stand between you and lunch. So I'll try not to do that. It's been a very useful group. I think we've had a lot of discussion about the appointment process, transparency, conflict of interest and how we ensure public confidence
13:31
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14:14
None Portrait House Adjourned During Pleasure Until 14:14.
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But.
14:15
None Portrait House Resumed
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14:15
Lord Moylan Portrait Lord Moylan (Conservative)
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Lord Sewell Lord German. >> Lord Moynihan amendment 140. >> My Lords, it's a pleasure to be

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My Lords, it's a pleasure to be addressing your Lordships House immediately after the lunch break. immediately after the lunch break. I have a number of amendments in this group, my Lords, and they do two things. They work together to do two things. The majority of them prevent any public money from being spent on the assisted dying service. One of them, 917, creates an alternative funding structure. Now, I'll say immediately, I think my alternative funding structure is robust and effective.

But I'm not saying that there aren't others that couldn't be put forward that would have a similar effect. The main point is to say that there needs to be a justification given, and so far none has been given as to why this service, when it is created, should be a charge on the taxpayer. Noble and learned Lord has made much in his comments about the bill so far of the principle of autonomy. The right to dispose of what happens with your own body, I suppose.

Now, I would say that the principle of autonomy in this respect has been in place in law since 1961, when suicide was decriminalised. In my view, this bill goes a great deal further than establishing the principle of autonomy. What it does, in fact, what it is in fact, is coercive on the rest of us. And one of the ways it's coercive is by envisaging that we're all going to pay for it. Now, the bill doesn't say explicitly that the service is going to be paid for by the taxpayer, and it doesn't say explicitly that it's going to be free.

But it's certainly the case that the bill envisages public expenditure, because the Secretary of State is going to have to pay for the maintenance of the Voluntary assisted Dying Commissioner and the staff and activities of the Voluntary Assisted Dying Commissioner. And it's implicit and assumed, I believe. But if I'm wrong about this, the noble and learned Lord can certainly tell me that the provision of the service at the individual level is going to be free, so to speak, at the point of use by the person applying for what is called assistance.

In my. Why? Why should this be a charge on the taxpayer? It is not, after all, a medical treatment. That's absolutely clear. We do provide free medical treatments through the NHS, but the the principle of free medical treatment has been established at the point of use for many, many years in this country. We do that, but this is not a medical treatment, so why should it medical treatment, so why should it be provided free? Giving someone permission legally to do something which has previously been prohibited, in this case, giving them permission to assist a suicide which at the moment is legally prohibited, doesn't imply that the government has to pay for the person to do what they're now permitted for the first time to do.

So I don't think that argument follows in any sense at all. It might be said that voluntary assisted dying is an act of compassion. Well, it is the it is not the case that the state pays for every act of compassion. There are many organisations that do charities mainly. And of course individuals provide compassion and express their compassion. Donations and acts of compassion. Government isn't the only source of that. And anyway, the truth is that many of us do not consider the bill to or assisted suicide to be an act of compassion.

We consider it, in fact, to be an act of cruelty. So this, as I say, my amendments will prohibit the expenditure of public funds on any activity. Activities related to clauses 34, 35 and 36, which are the clauses that create criminal offences. Of course, the investigation and prosecution of criminal offences is something that we would expect the government to pay for. That is that is a state function, but the other functions under the bill, it would be prohibited.

What I've done in clause nine one, amendment 917 is to show at least that an alternative is possible, and the alternative would involve the assisted dying commissioner establishing a budget at the beginning of the year. The budget, of course, might not be exactly what he ends up spending. Anyone who's been involved in a local council will know that you're legally obliged to set a balanced budget at the end of the year doesn't guarantee that at the end of the year, it turns out to be a balanced outcome.

But he's obliged to set a budget. And on the basis of that budget, and on the basis of the assessment of demand, which in the first year would be difficult, but in later years should be fairly predictable. I'd imagine, on the basis of that, to set a fee, and that fee would be payable by those applying for assistance. Provision is made for the applicant to pay the fee in stages, so that you might be charged so much at the preliminary discussion stage, so much later on, so much after that.

People already pay for assisted dying. I don't know what it's going to cost, but I don't see that it would be any more expensive necessarily than going to Dignitas and people pay to go to Dignitas. Why should we assume the expenditure they make at the moment and put it as a charge on the taxpayer? Of course I could be rotted if people were to say that this is an argument about nothing, that in fact we're going to say the Treasury is going to save so much money from assisted dying because we won't have all these sick and elderly people around having to pay to look after them that were going to be quids in.

If any noble Lord wishes to make that argument, I invite them to do so. I just add finally, that this is not in itself an argument about whether the service should be provided by the NHS. I know it sounds as though it might be, but it isn't the NHS I have. I have amendments later about whether the service should be provided by the NHS. This is a question about whether it should be free. The NHS can provide services and charge for them.

It already does. Many hospitals in London at least have private wings, where the NHS provides services to which it charges. Just conceptually, I'm making the point. It's a distinct question. The question is should it be free or should people pay for it? Should it be a charge on the taxpayer? That case, the case that it should be free and a charge on the taxpayer has not been made by the proponents of this bill, if they wish to make it. As I say, it's a little ambivalent in the bill whether they do.

But if they wish to make it, now is their opportunity to do so. I beg to move.
14:23
Baroness Fraser of Craigmaddie Portrait Baroness Fraser of Craigmaddie (Conservative)
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Amendment proposed clause four, page two, line 39 at end. The words as printed on the Marshalled List. My Lords, I thank my noble friend for opening this after lunch debate and outlining that an alternative is possible. I'm going to speak to my amendments 83 five and 86 eight, which I moved into this group because my amendments seek to ensure that an assisted dying service is clearly separated from NHS provision, and that therefore there is clear and transparency in funding for the taxpayer.

Such a service could be set up and funded privately or charitably, in the same way that we currently provide and fund care provision or hospice services. Such a service would be clearly separate from the NHS, but could operate potentially in partnership. The NHS could commission services if it's so chose, and they would have to share data and patient records, and they would need to be a system for regulation of such services. Subsection three of amendment 85 requires for regulations on what the definition of privately funded organisations would be, and if such a service were to work in partnership with the NHS.

As many hospitals, hospices and third sector service delivery organisations currently do, then further subsections require the establishment establishing of the means through which NHS providers can commission privately funded organisations to provide services, and the data sharing arrangements to ensure the necessary sharing of records and a system, most importantly for regulating the provision of services by privately funded organisations. Now, some noble Lords have expressed to me concern about the use of the words private organisations in my amendment.

However, I point to the kaleidoscope of entities that currently provide health and social care already, some of whom my noble friend Lord Moylan has just mentioned. Many people have made a profit from care homes. Many charities provide health services instead of the NHS, and private hospital care co-exists with NHS provision, often with the same consultant working in both. I'm a conservative, so I don't think that making a profit per se is a bad thing, but I do accept that making excessive profit out of death and dying is not particularly morally acceptable, and hence the need for robust and transparent regulation of any service.

And as I have said before at committee, I feel that this is an area where the supporters of the bill and those that support the principle of legalising assisted dying have missed a trick. I agree with my noble friend Lord Moylan in posing the question why should assisted dying be taxpayer funded? And I believe it's essential to ask the sponsors of the bill at this stage how the establishing of an assisted dying model would would impact on our current healthcare systems and healthcare professionals we know.

The Secretary of State for health has stated there is currently no budget for such a service. And Stephen Kinnock, the Minister of State for Health and Social Care, who voted for the bill, has said that the government will have to reprioritise spending in order to fund assisted dying. It appears funds will have to come out of the health department's existing budget. And he also stated that as it stands, the bill includes the potential for the provision of assisted dying services privately, as well as free on the NHS.

So in this group of amendments, I believe we are asking the sponsors to ascertain what they intend and also how do the government feel about the requirement to reprioritise NHS budgets? What services would then be de-prioritised? The bill currently going through the Scottish Parliament makes it explicit that assisted dying would, if the Bill is passed in Scotland, be delivered by the NHS. However, this Bill is silent and the Scottish Bill is accompanied by a financial memorandum which outlines the cost to a range of public bodies of implementation of providing assisted dying, the majority of which will fall on the NHS and cover things, amongst other things, the cost of anticipated clinician hours, staff training, the costs of the substance provided to end life, both the storage of it and the monitoring of it, data collection, support and navigation services and many other all our extra costs the NHS will be expected to bear.

Or do the supporters of the bill, as Lord Moylan referred, to expect the service to be what is referred to in the financial memorandum in Scotland. Cost neutral, as the Scottish Bill identifies. I quote Unutilised healthcare savings the obvious, but to me rather unsettling statement that every person who has assisted death will not require further care. Now, I accept that saving health and care costs is not the motivation of the sponsors of this bill. However, there are many expressed concerns from individuals and organisations that implementing the bill will have real cost implications and will also necessitate clinicians diverting time and resource from their already stretched patients to support assisted dying.

I would suggest we need to find a balance between what this bill sets out to provide and what is best for our current health and care services. Creating a service that is separate to the NHS. As many hospices and care homes already are, would ensure such a solution. My Lords, the NHS is not a solution to all issues. I come to this from my experience in the third sector, where often the medicalised approach to care and service provision, as would be delivered by the NHS, does not lead to optimal outcomes for the patient, whereas a medicalized social model can often be preferable.

Hospices provide holistic care, not just medical care, and include support for emotional, social, practical, psychological and spiritual needs, as well as support to the parents, family and the person's family and carers. Hospice teams may include doctors, nurses, healthcare assistants but also social workers, therapists, counsellors, chaplains and trained volunteers. Is this not what the bill's sponsors want for terminally ill adults, family members and carers and friends must not be forgotten. They need support whilst their loved one is going through the procedure and also after death.

A de Medicalised model could include the offer of bereavement counselling. Such services could be extended to those who are not party to the decision of the person that they wanted to die, and then find out afterwards and feel excluded. It is highly unlikely that these wraparound services would be available within the NHS, or that taxpayers would be willing to fund them. Why then leave such services and care to charities and private organisations, while setting up a fully funded dying service within a health service? In my advertising days I would have said this goes against the NHS brand guidelines and values.

My amendments offer another alternative, and I hope the noble and learned Lord will take the opportunity to clarify in his response. Today. response. Today.
14:31
14:33
Baroness Finlay of Llandaff Portrait Baroness Finlay of Llandaff (Crossbench)
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I added my name in support of amendment 827, although I also do support the amendments, which make it clear that the delivery of the service must not be provided by the NHS and NHS trust, or anybody or agency holding itself out to be part of the NHS as an as in amendment 835 from the noble Lady Baroness Fraser of Craigmaddie. The amendment to which I added my name would allow a collaborative funding model for the service to be developed based on a means tested formula whereby those who are able to pay adequately and would otherwise have paid the fees charged by Dignitas in Switzerland, whose accounts are not open for examination, the collaborative funding model could be based in part on the principles behind cooperatives.

The accounts of a collaborative scheme would need to be completely open to public scrutiny. Cooperative funding models leave a shared ownership, democratic control and member investment to finance enterprises, prioritising community benefit over profit maximisation. The shared ownership would relate to those who use the service, with levels set depending on the aspects that they access. Because some might access information only, others might access the whole process. There are five interconnected component parts to a cooperative model.

First, the policy and regulatory framework defined by government would give proportionate oversight and regulation. Second, it would ensure adequate training across the whole system. Further, clearly defined market environment would be restricted to the provision of an assisted death service. And fourth, the culture of the of the cooperative collaborative would be shaped by those wishing to avail themselves of an assisted death without jeopardising their ability to access clinical care and without jeopardising the clinical care of others through diversion of NHS funds.

This could involve crowdfunding and allow specific donations, in memoriam and so on. The fifth component relates to the networks of knowledge exchange to inform the criteria used in the financial assessment based on needs. This bill is based on a principle of choice, and this principle could run to the funding as well. People may choose to have a slightly less extravagant funeral and pay into a collaborative system, allowing others who would not be able to afford a fancy funeral to still access the service, even if they couldn't pay for the components of the service.

After all, we have people who pay high rates of taxes or council tax to fund our public services, whilst they benefit those who are in a much lower financial bracket and they benefit equally. These amendments overall are important because they ensure that the NHS funding is not eroded. We hear consistently about NHS deficits in all parts of the system. The palliative care and hospice sector is withering under extreme financial pressures, since it has no secure rolling contracts for the services, it delivers.

Pressures on commissioners are resulting in difficult decisions. Already there is no spare money to pay for an assisted death service. The noble and learned Lord, Lord Faulkner, has tabled amendments requiring Icbs to commission this service, but the Minister has admitted that funding will come from reprioritisation of existing budgets. How will the ICB balance its legal obligation to meet the palliative care needs of its population, with the provision of an assisted death service? The noble and learned Lords Amendments 749 b mandates provision of assisted deaths by Icbs, meaning it will be fully funded by the NHS.

In contrast to hospices who are heavily reliant on donations for a major portion of their funding. I hate to suggest this, but it does sometimes look like a way to save money, since each assisted death has been estimated to cost around £2,000 and yet would save about £13,000. A full months of healthcare costs. So a net saving of 11,000. Overall. The money has to be found from somewhere, and at the moment there's a serious risk that clinical services will be eroded to fund the multiple payments that will need to be made to the different professionals involved, and that will become particularly important too.

When we looked at

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funding within a devolved model. Sorry, I just. Confused because I think I heard

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Confused because I think I heard from you that the that actually a concern that there be savings concern that there be savings generated of 13,000 a week if assisted dying happened. And then I heard you say afterwards that there was costs in other people. So obviously you can't have it each way. And I've heard a few times way. And I've heard a few times that made that sometimes it's where's the money coming from? And in other words, and other people saying, well, there's an incentive because there's a saving from it.

So I was wondering if you could clarify this.

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We're asking for the clarification. I did not say a week.

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I said four months. And actually, with the severe deficit that we have. Your general point was that

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Your general point was that there's a danger because savings would be made from an assisted would be made from an assisted death. And, and and on the other hand, you're saying, well, where are the costs going to come from? So I was just wondering which way,

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So I was just wondering which way, which you believed in, whether there would be savings or whether there would be additional costs. My concern is that if you take it out of a healthcare budget, which is already in deficit, you will end up with an incentive on people to go down the road of saving money by working towards promoting assisted deaths for patients for whom additional care would mean that they would no longer feel in any way in despair, and could have their quality of life returned to them.

And I think the NHS budgets appear to be in such a difficult and parlous state that we have to be very, very careful that we don't spend NHS money on what is not a healthcare
14:40
Baroness Fox of Buckley Portrait Baroness Fox of Buckley (Non-affiliated)
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treatment. I think this group of amendments in the name of the noble amendments in the name of the noble Lord Lord Moylan and the noble Lady Baroness Fraser of Craigmaddie, are Baroness Fraser of Craigmaddie, are very useful in making us think and making us think about what would or should an assisted dying service should an assisted dying service look like. If this bill is enacted, and what the implications are for funding it? Public funding? Who's going to pay? We're going to come to a more detailed discussion on this in later groups.

But just to kind of raise a few things as I understand it, and I and I think I probably need some clarification from the noble and learned Lord, Lord Faulkner, the idea would be that integrated care boards will be mandated to provide a fully funded assisted dying service, but just to kind of get a sense of what it is that's envisaged, I think we have to ask the question if that's what's envisaged, is that reasonable? Because, as others have mentioned, contrast that with hospices that only receive a portion of their funding from Icbs and are heavily reliant on donations.

I'm sure we've all been to those coffee mornings and bought cakes and sold cakes and all the rest of it, trying to raise money for hospices. Meanwhile, palliative care services rely heavily on charity funding, recovering only 30% of their funds from the government. Now, I have understood and noted that the Baroness phrase is important caveat here, which is I'm not trying to say the state should run everything at all times, and anyone who's doing anything in the charitable sector is a problem.

But I do think underfunding of end of life care, at the same time of fully funding ending your life non care is a bit of a peculiar. The danger is that if the sponsors aspirations come to fruition, if I've got them right, funding for assisted dying will start competing with and risks diverting resources away from palliative and end of life care, and both will compete for a share of a limited health budget. I note that professional bodies such as the Royal College of GPS and the Association of Palliative Medicine argue that assisted dying service must have a distinct funding, have distinct funding to avoid such competition.

I do think it was very important that that the health secretary, Wes Streeting, was frank with us when he noted that setting up this quote, setting up this service will take time and money, and that is in short supply. Politics is about prioritising. It is a daily series of choices and trade offs. So I would like to address a couple of questions to the noble Lady, the Minister, who I know, of course, is confined to discussing workability, but to ask how this prioritisation will work, as the government considered this, because if I can ask the Minister if funding will come from reprioritisation of existing budgets, are we not being asked to legislate at this point a direct conflict of interest, where integrated care boards will have to choose between, for example, funding palliative care or funding assisted dying, or if it's not palliative care, because I've overused that, what other services will be deprioritized in these choices? In order to fund this, there's a limited budget.

We keep being told that there's a scarcity of funds. So I want to understand that. But another reason, just finally to kind of raise this, and it's not directly to do with funding, but I think it it counts, is that if assisted dying is, is is going to be paid for by the public purse and or associated with the NHS, and that could mean that assisted dying is treated as a kind of standard healthcare solution, and that surely could have a corrosive impact on trust between patients and clinicians.

Breaking the first do no harm contract with the public and really kind of flouting the Hippocratic Oath. Should doctors be expected to cooperate, ending life into their routine roles if it's publicly paid for? When the major professional bodies explicitly warn against this, as the BMA says, quote, our view is that assisted dying should not be part of the standard role of doctors or integrated into existing care pathways. It is not something a doctor can just add to their usual role, and that kind of more existential question, or that question about medical ethics will obviously be compromised if public funding and the taxpayer is paying for assisted death, then those taxpayer funded NHS doctors are going to surely be asked to do something which will go against

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their ethical code. My Lords, I think the noble Lord, Lord Moylan and noble Lady Baroness Fraser raised some really interesting points in this group of amendments. Now, I don't have the amendments. Now, I don't have the noble Lord Lord Moylan experience of local councils, although I do declare I'm President of the LGA, declare I'm President of the LGA, but that is largely an honorarium, an honorary role. Sorry, there is
14:45
Baroness Grey-Thompson Portrait Baroness Grey-Thompson (Crossbench)
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not an honorarium, but I do have. There is not. I do have a lot of experience of wheelchair services. Also declare that I'm president of the Wheelchair Alliance in a service that should be incredibly easy to provide. It has become one of the most complex parts of NHS funding. In the good old days, when I was a child, there was two choices a chair, a small one and a large one these days, because actually we want to provide better wheelchairs for people, which is a good thing.

Commissioning and provision of those services have become so complicated. So in different areas, different prices are paid for exactly the same chair. And my concern is that if we can't do it as something as simple as wheelchair services, how are we going to do it for this process? And a system where in wheelchair services, many should be provided in 18 weeks? I know cases where it's taken years to provide a chair for a child, so I think we should learn from previous experience.

Now, other noble Lords have mentioned the potential competition that could come from funding for this service and also the challenges for palliative care. But the consensus among several professional bodies, including the Royal College of General Practitioners and the Association for Palliative Medicine, is that assisted dying should have distinct funding. Others have mentioned about the way that palliative care is is currently funded in the UK. But Nancy Preston, who gave oral evidence and also in written evidence co-written with another professor at Lancaster, Suzanne Öst, expressed concern that it will communicate the wrong symbolic message.

Now one of the seven peers who was also in the Guardian for my number of amendments, I am receiving lots of emails telling me I need to uphold the will of the people, but I'm not sure the people have been asked how they would like to reprioritise the funding of the NHS. Yes, I accept there's a lot of people who think the services is is needed, but actually are they beginning the choice of what else they might lose? And I think it's really interesting, the comments made by Stephen Kinnock, who said about the need to be reprioritisation and I think we need to be really clear what we're going to lose out.

The noble Lord Dear Lord Markham raises some interesting points about savings and cost, and for me, that's more about how you schedule the payments and how you work through it. But I am also concerned with the comments that my noble friend Baroness Finlay said about the incentive to encourage people to to go down this route. If we look at Belgium, the service is paid for through the National Health and the doctors receive a fee of 180. If you look at Canada, the cost of the procedure there is $2,327 and it's estimated that they spend about 22.3 million a year to put this service in place, but they save 149 million.

But for provincial healthcare, that is negligible saving. It's 0.08% of of their budget. Stephen Kinnock also talked about doctors receiving a reasonable expense. Now I've raised the issues with reasonable in terms of the Equality Act before, what actually is reasonable for a doctor to be paid? In Australia, 27% of the doctors were unpaid, 32% got direct state government reimbursement. But there's a conversation going on there at the moment that clinicians shouldn't be have to be altruistic to provide this service.

So doctors are already talking about having a standardised price for voluntary assisted dying assessment, which would be $860 as an out of pocket expense. And I do think it's important because there's a lot of assumptions made about where this service is going to be provided. And the reality is that, you know, if we're going to be giving people choice, we we need to be giving them a real choice in this. I think they're probably going to come up in later groups as well.

But I've also noticed a shift in change of language, talking originally about doctors to now talking about medical practitioners. So does this mean it could be physician assistants? Does it mean nurses? Does it mean that it could be someone else who'd be trained to do this? Could there be a career path in this service? Would it be something that actually, you know, people might think would be a good step in their career to be able to provide this? The reality with this, my Lords, is that somebody pays, somebody always pays.

The question is just who and when.
14:51
Lord Empey Portrait Lord Empey (Ulster Unionist Party)
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And my Lords, to some extent, this group of amendments goes to this group of amendments goes to the core of a lot of the potential downsides of this bill, because whether we like it or not, it is going to be a source of of coercion, in my view. Now, if we go back a few weeks to the issue that was drawn to our attention by the noble Lord, Lord Stevens, about the actual role and the purpose of the National Health Service, clearly that would need to be changed, because we're talking here about a mechanism for ending life rather than a service that does its best to preserve life.

And anybody who's had to spend a lot of time around hospitals, either as a consumer or a family member of a consumer of NHS services, or if you've had any role in a government, even at regional level, dealing with health services, it's inconceivable to me that the potential of looking at the balance sheet is not going to be an issue for a clinician and a trust. It is the nature of the beast. If you see the finance director of a trust and they're over budget, they nearly all are.

In Canada. We see there are actually some people are boasting about the money they have saved by providing assisted deaths. And I just do not believe for one moment that that factor can be airbrushed out of this equation. As far as this legislation is concerned. And that is why, while I don't necessarily accept or agree with every amendment in this group, it does draw our attention to the principles that are at stake. And it is not circumstances that we have got into the habit.

In this debate of euphemisms, we say we call one thing by a certain name, but we know it actually means something else. And if I could just in that regard, draw the attention to the House to debate on assisted dying that took place during the last iteration of this bill by Baroness Meacher in on the 22nd of October, 2021. And I think this is the point I want to try and get across at the end of an.

Incidentally, that Bill had 13 clauses and ten pages, compared to 51 clauses and 59 clauses and 51 pages that we're looking at today. But after Baroness Meacher had proposed her. Bill at Second Reading is not in his place, I think at the moment. But the noble Lord Winston proceeded to move an amendment, and his amendment was that the bill should refer to euthanasia rather than assisted dying. That was proposed by Lord Winston, and he said that the bill's title does not represent what is really intended.

And he went on then to from the Greek to define what the word euthanasia means. So it seems to me that these amendments go to the core of a couple of issues. First of all, the rationale behind the National Health Service in the first place and the way it would be changed and turned if it is actually carrying

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out a service, which is anything but order. The point you're making, the noble Lord is making is very noble Lord is making is very interesting. But in terms of Lord Winston, as you may have heard him say on past occasions in this current debate on the bill, he has changed his mind, and I think that changed his mind, and I think that he may well have changed his mind about the actual words that we use dying.

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dying. That is not well, I. Accept that may well be his case. All I'm simply referring to is what is in Hansard in 2021. He may have changed his mind. We all do on things over over our lifetimes, and rightly so. Because if you have a completely solid view of everything throughout your life, I don't think that's a good thing. So I'm not in any sense trying to demean his position in any way whatsoever. He's a very highly respected member of your Lordships' House, but the point is the point he was getting at the the euphemism as he referred to is still a valid point in my view.

So if we come to the actual nuts and bolts of how things would work in practice during the Second Reading of this bill, and indeed of its previous iterations that have had any role, I drew attention at Second Reading to what I believe is the one of the key issues here, and that is the changing of the nature of the service that we are funding. So if it is the case that we decided as a Parliament to make assisted dying or whatever phrase one wishes to use, a legal activity, it does not necessarily mean that the National Health Service has to pay for it, and to get into an argument, can you imagine the finance committee of a trust sitting discussing their budget and they're getting into an argument? It doesn't matter.

The sums may be modest, but even to put something like that in this context, and we're talking about life and death, I think is fundamentally flawed morally and in every other way. And I think the noble and learned Lord, I think, needs to reflect on some of these matters.
14:57
Lord Harper Portrait Lord Harper (Conservative)
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I think grateful to my noble friend Lord Moylan for tabling these amendments and also for to Baroness Fraser as well. I think they've raised some important questions which I think are worth raising explicitly to hear from the sponsors of the bill about what their first of all, what their intentions are, and then secondly, how they've reached those conclusions. And so my concerns in this area, there are a number. And let me just set them out. So first of all, the Minister and I think it was the Minister who's currently on the front bench on a previous day confirmed when we were debating, I think, resources previously that if Parliament were to pass this bill, then the government would ensure that all of the requirements in the bill were funded.

And that's perfectly right and proper. It was also clear from that debate that there would there was no guarantee of any extra resources, and therefore money would be reprioritised. And that's not just from the National Health Service. That was also from the court's budget for the impact that this bill would have on that as well. And that's clearly been reflected by what I think Stephen Kinnock has said in evidence. And also the Health Secretary, who was commenting on the need to do prioritisation as well.

Now, I don't make as much of the cost of this as some people because I do accept, I think what what the noble and learned Lord, Lord Falconer said on a previous occasion, compared to the NHS overall budget, the cost of providing this service is relatively modest. But I have a different concern. And it's it's twofold. First of all, I think and it has been raised already in this debate, I think it would be perverse if Parliament were to pass this bill, if the taxpayer were to fully fund an assisted suicide service when, as has already been said, it only partially funds palliative care.

I think that would send a very it would set out a very weird set of priorities and choices to the country that the taxpayer should fully fund, helping to kill people and not fully fund helping them to live well. And so my question to the Minister, which I don't think, which does not trespass on the government expressing view on this bill, is this in the event that Parliament were to pass this bill and and rightly, the government would ensure it was funded in that circumstance, would the government ensure that palliative care was fully funded by the taxpayer? That is not a question about being taking a view on this bill.

It's about making sure that when the government publishes in the autumn, this is why doing it in this order, I think, is not helpful, that we're not going to hear about palliative care services until the autumn. I would expect that the government will fully fund those services, and the taxpayer would ensure that that any individual facing a choice had a proper choice, and that if they chose palliative care, they would they would have properly funded, fully funded by the taxpayer palliative care in the same way they would have a fully funded assisted suicide, because if you don't fund it on that basis, you aren't providing people with a proper choice.

So I think that's a question for for the government. The second area of concern I have about making this a NHS service, and of course the bill isn't explicit. The Minister I think, has said it would be an NHS service, but the bill itself is not explicit about that. My worry is that if it becomes part of NHS services, my worry is about what strings are attached to those and what I would not want to see is the 30% of funding that already goes to hospices from the taxpayer, being conditional on those hospices having to participate in providing assisted suicide services.

I think that would be appalling and I would want to see that ruled out. And I think that's something that is protected effectively by my noble friend. Lord Moylan amendments. The final thing is actually coming to the point that the noble Lord, Lord Markham, made, and this is about the incentives we set up and my concern if you make this a taxpayer funded service integrated into the National Health Service is that there will be a pressure to look at a financial calculus about the services we deliver to patients and finance people, and those responsible for providing the NHS will look at the cost of providing assisted suicide, compared to the cost of providing people with palliative care or other health treatments.

And this is the thing that's really concerning for disabled and vulnerable people, is that you set up a world in which people start working out, whether it is cheaper, that you're dead or more expensive to keep you alive, and pressure is then exerted in that direction. That I think, is the real risk. It's not the cost of the service, it's what it then drives in terms of other decisions that I think is the thing we need to guard against. And that, I think, is the main benefit of keeping the funding.

Funding and delivery of this service completely separate to the National Health Service. And then and then health trusts are not tempted and don't have that explicit temptation to push assisted suicide, because it's cheaper than providing people with proper health care. So I think my noble friend Lord Warner's amendments raised some very important questions, and I think I want to hear from the sponsors the point about from the Minister about funding palliative care in full. If the government thinks that assisted suicide should be funded in full, I think palliative care should be funded in an equal way.

And secondly, this risk of setting up a structure where you incentivise the health service to push people towards assisted suicide rather than providing proper health care. And I think that is a question properly directed at the sponsor rather than the Minister.

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If I may just again, I'll let you. Sorry, I let my noble friend finish. I just wanted to give a bit of my own experience. Obviously being a former health Minister, in that, I think we would all that, I think we would all completely agree that actually clinicians always look at what is the best outcome for their patients, regardless of cost. And I just want to put very, very clearly here to put very, very clearly here today that I'm sure it's not anyone's intention to suggest that somehow clinicians will be incentivised to push one course of treatment, be it assisted dying or versus another, for reasons of cost, because I think all of our experiences of the health service is that clinicians will always put the welfare of their patient first, and the financial considerations don't come into it.
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15:05
Baroness Murphy Portrait Baroness Murphy (Crossbench)
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My Lord. Somebody please forgive >> My Lord. Somebody please forgive my voice. As a clinician for 50 years in the NHS, I find the noble years in the NHS, I find the noble Lord suggestions quite offensive and we've been asked to be kind today. I would ask him to be a little kinder to the NHS, clinicians and their decisions to try and help people at the end of life. I would just point out the noble Lord Harper that when you're talking about fully funded palliative care service, you are talking about millions and millions and millions and what has to be allocated exceedingly difficult for the NHS to come to that decision, particularly in the light of the fact there being insufficient clinicians trained in that area.

As I'm sure the noble Lady Findlay will agree with me. But certainly the assisted dying service we're talking a few thousand. Yeah, not anything like the sort of sums of money that the palliative care service costs. Let's be realistic about what we are asking for here.

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Briefly intervene, and I'm sure that my noble friend will answer this later, but I would just want this later, but I would just want to put on record that that nobody who is a supporter of this bill, an who is a supporter of this bill, an amended bill as it goes forward, would ever put costs as the major

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would ever put costs as the major reason for supporting this bill. And I just want to put that firmly on the record here. Yeah, yeah.

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Yeah, yeah. Can I come back on that? I never said that it was a major reason. I just said that it was a consideration that had to be made. And budgets are very strapped in the NHS at the moment. And if they can ensure that people have beds and can get them to vote for assisted dying, then they'll save the hospital money. And that's just
15:07
Lord Deben Portrait Lord Deben (Conservative)
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a fact of life to speak on this particular amendment until something happened at lunchtime and something happened at lunchtime and I have to apologise to the noble and learned Lord, because I'm not and learned Lord, because I'm not sure that I can make a joke concerning it, as he has requested me to in any speech I make. But the me to in any speech I make. But the fact of the matter is that at lunchtime I discovered that the lunchtime I discovered that the local health trust has withdrawn its payment to Marie Curie, which means that there will no longer be Marie Curie nurses helping those in the final years, final months of their lives, because that support has been because of the tight budgets which they are on the National Health Service.

I am appalled that we are in that situation, but it does remind me very clearly of the fundamental problem of a single issue private member's bill, because what it does is to ask us to consider something not as part of a series of priorities amongst which government has to make choices, but as something on its own. And that inevitably is a real problem. The second problem is that any of us who've been a Minister know how the Treasury works, and that is, if you ask the Treasury to give you some money to spend and then say, but we're going to make these savings, they always count the spending and refuse to acknowledge the savings.

That is a Treasury mechanism, which we have all learnt. And I see that a former health Minister knows precisely what I mean. Now, the problem with this issue is precisely that that money will have to be spent out. But the savings. Let's forget whether this is a suitable balance, but the savings will certainly not be considered, which is why the deputy health Minister said there would have to be reprioritisation. So I come to this House having been shocked at lunchtime.

Perhaps to Chief Whip shouldn't have allowed us off for lunch, then I wouldn't have been able to have seen this. But the truth is shocked by the fact that one of the most important palliative care services are now going to be ceased for the part of the country in which I live. And that therefore brings me back to the amendment. I do think we do have to say to ourselves very clearly that if we are proposing to spend money on this, it is quite clear from the government that that will mean Reprioritizing prioritisation, which actually means cutting other money in order to save enough to pay for this.

Now, one of my problems with the government, and I hope the noble Lady will not be upset by this, but one of the areas I do not understand how the government fails to do this. In all the advice it gives us, it refuses to tell us how much it thinks this will cost. I think that's a duty of the government. It should tell Parliament if it's a private member's bill of this sort, that I

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will give way. Impact assessment. That the detail.

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That the detail. Of the bill provided by the health service. So to suggest to the House that the government has the House that the government has not provided the costing is inaccurate here.

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Noble and learned Lord, that we have already told him what we think about this impact assessment. We've about this impact assessment. We've been asking to an updated impact assessment, which will take into account the debates which we have had and the assessments which we have made. The government has said it will not do that. That is to which I am referring. I would want to know an absolutely up to date impact assessment based on the debates where we have expressed and explained real issues which have not been raised before, so that we can first of all know how much it costs.

Secondly, begin to ask ourselves, is this the priority? And I'm going to end on this. Is it a priority to provide people with the free chance to kill themselves and not provide people with Marie Curie nurses in order that they may live their last lives in a happier and better place? Anyone who suggests that we get that priority right by funding assisted suicide rather than Marie Curie nurses, seems to me to be saying something that the public would not accept.

And one of the problems with this whole debate is that we have never been prepared to tell the public what the real effect of this is, and therefore I very much support this amendment, not that I would normally support the kind of position which my noble friend raises in this particular way. But he did it most elegantly. I support it entirely because I think at long last we're talking about the facts. What this really means for the people of Britain.



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It's now, would my noble friend be interested to know that we have been here before? He will know that been here before? He will know that in 2012, as a result of replies to freedom of information requests about the discredited Liverpool Care Pathway, that £12 million was promised to various trusts across the country to hit targets in respect of the Liverpool care Pathway. So there was a fiscal inducement to facilitate the death of their patients. So this is not something that's a scare story.

This is something that within

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living memory, we have seen evidence of. Absolutely very good point. That intervention. And it's an

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That intervention. And it's an important one. I've been trying to be very careful and not to suggest be very careful and not to suggest that those who are in favour of this Bill are in favour of it as a money saving operation. I don't money saving operation. I don't believe that that's true. But what I have to challenge them with is I have to challenge them with is simply this. Once this were in the system, then it would in fact be a serious temptation.

There are two big temptations in this bill. The first is summed up by that old phrase where there's a will, there's a relative, a real issue about coercion. The second great problem is that you change the fundamental relationship between the ill person and the doctor, and you also create circumstances where it is very likely that it would be cheaper for people no longer to be there. If anyone thinks that that creates confidence, either in the medical profession or in the

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National Health Service, I don't. Before my noble friend. Sits down. I think it's

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Sits down. I think it's important for the accuracy of the record, and I'm grateful that he referred to a story that I presented to him at lunchtime presented to him at lunchtime because it was relevant to Suffolk, and it's that Marie Curie's and it's that Marie Curie's overnight nursing service, that part of the service that offers palliative care in Ipswich and palliative care in Ipswich and Suffolk, will end after an NHS withdrew funding. The service supported 470 patients and delivered 15,385 hours of vital care in the last financial year.

So it relates to his that my noble friends particular area of the country, I know I wasn't here at the start of the group for the acts of the record, I've intervened.
15:16
Baroness O'Loan Portrait Baroness O'Loan (Crossbench)
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I would like to thank the noble Lord Lord Moylan and the noble Baroness Carr Baroness Fraser for for bringing these amendments. There really is a very serious issue here, and I think it is evidenced by the nature of the conversation which we're having, because it's a conversation about realities. The noble Lord Lord Empey said that it was time we started using the language which described exactly what we're doing, and I think that's what we're doing now. We're talking about how is this going to be paid for? And.

How is it going to be paid for, and who should pay for it? How should it be managed? We've seen the Canadian experience and the noble Baroness, Baroness Grey-Thompson, spoke about wheelchair access in Canada. This regularly reported that people who can't get wheelchairs are offered assisted dying instead. Now, I grant you that that wouldn't necessarily apply in this particular bill, but you can see how with mission creep and with changes, this could happen, that we could end up in this situation in which we're making the kind of decisions which the noble Lord has just referred to in this matter.

I must declare that I do have an interest, because I am a trustee of a hospice and unpaid trustee, and my dad is not in my register of interest for that reason. But it's relevant to this debate. The noble Baroness Baroness Finlay defined the variety of costs attaching to the proposals. I think quite clearly, and I have to ask, following on from the noble Lord Lord Deben is the estimate of £2,000 in any way realistic as a cost of providing a service which requires for each individual the costs of clinicians, commissioner panels, admin, staff, communications, monitoring, audit, etc.

etc. to say nothing of maybe a national Health service and independent advocates and all sorts of other things. We do know that to die at Dignitas and places like that costs an average of £10,000, not £2,000. So I'd like the noble Lord, the Minister, to ask, sorry, I'd like the noble Lord noble and learned Lord, to ask the noble Baroness, the Minister, please, can we have a proper assessment of what what is currently planned might cost and where is it to come from? And I've got another question now for the noble and learned Lord, because, you see, it's not the government that pays.

It's us. It's taxpayers who pay. And if the noble and learned Lord, Lord Faulkner rejects this, these proposals, or something which approximates to taking the cost away from the National Health Service, which is in such a parlous state that, as the noble Lord Lord Deben says, palliative care services are being extinguished or diminished very significantly. If he does that, does he think that the public and the voters will think well of a government which funds suicide while not funding hospices properly? Does he think it will enhance trust and confidence in the government?
15:19
Baroness Levitt Portrait Baroness Levitt, The Parliamentary Under-Secretary of State for Justice (Labour)
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OK. >> My Lords, I rise to speak only to those amendments about which the government has significant operational workability concerns. operational workability concerns. But before I do so, I want to say a few words on the general points about funding that have been raised by a number of your Lordships, including the noble Lord, Lord Harper, the noble Lady Baroness Fox, the noble Lady, Baroness Thompson, Grey Thompson and others as well. And I make it absolutely clear that I entirely understand the point that the noble Lord Lord Deben is making, and why it is that it seems like the choice is being restricted if you don't actually know the, the, the amounts involved.

But I have to reiterate that it's for Parliament to decide whether this service should be provided and if so, whether it should be publicly funded. And then if that decision is made, the government will fund it. And I am not evading the issue when I say that. I simply can't explain how that could be done, because that would be to put that ahead of Parliament's own decision. We cannot possibly start, for example, putting aside a war chest for something that Parliament may decide that it doesn't want.

And as far as priorities are concerned, it's not as I say, it's not a matter of evasion. It's a matter of principle. It's also not right to assume from this that funding this, if that is the will of Parliament, would involve taking money away from other parts of the health service. That is not what the government is saying, simply that the funding will be made available if that is what Parliament wants. And my learned friend, my noble friend, my noble friend, the Health Minister Baroness Merron has written twice on this subject.

In those letters are available in the library for anybody who is interested. As far as palliative care is concerned, there is an absolute commitment by the government to increasing funding for palliative care and making sure that palliative care is offered properly, irrespective of what happens in relation to this. As far as the noble Lord Lord Stephen is concerned. Again, of course, I'm not upset by what he says about the impact assessment, as if I ever would be from anything that he says. But we are doing what is usual, which is to deliver the impact assessment at the outset.

And then, as with other bills, a further updated impact assessment will be provided following Royal Assent. If we get to that stage. And there is a logic to this, because there are so many different elements to what have been what has been debated in your Lordships House that provide a costing for each and every one would probably keep us here for as long as we're here debating all these amendments anyway. It's simply can't be done. It's not practical. So I'm not upset, but I'm simply saying we can't do it and we won't do it until Royal Assent.

My Lords, turning to the amendments in the name of the noble Lord Lord Moylan. These collectively are, as we have heard, are intended to prevent the establishment and running of this service being publicly funded. Your Lordships may wish to note that if passed, these amendments would create an internal inconsistency in the Bill with clause 41 Subclause five, which requires that the Commission voluntary Assisted Dying service must be provided free of charge. Turning briefly to amendments 83 five and 86 eight.

In the name of the. In the name of the noble Lady Baroness Fraser. These proposed a delivery model whereby the Secretary of State must make regulations for the assisted dying service, which would only be delivered by private providers. The key workability risk here is that the new clause, created by amendment 85, would duplicate clause 41, but with additional constraints, and that would create legal uncertainty. When the bill was looked at in the round about the limits on the government's powers when commissioning a service.

Your Lordships' House may also wish to note this amendment may have implications for the devolution settlement, as Wales and the Welsh NHS trust are implicitly included, which potentially constrains the powers for Wales and Clause 42.
15:23
Lord Falconer of Thoroton Portrait Lord Falconer of Thoroton (Labour)
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This concern this. This group concerns the question of the concerns the question of the funding of an in particular. First of all, Lord Moylan raises the question should the people who benefit from it have to pay for it? Secondly, the noble Baroness Baroness Fraser amendments raised the question of whether it should be free or not to the patient. Could it be provided by provided private providers? And then separately, there are questions along the lines of does this change the nature of the relationship between the doctor and the patient? And then finally there were questions about will this lead somebody to urge people to take an assisted death? May I start with the provisions of the bill at the moment, the provisions of the bill at the moment and subject to the amendments that are going to be proposed by me in relation to.

Clause three, clause 41, they require that the Integrated Care Board or NHS England, or the Secretary of State Commission, the services and a separate provision that. 753 A in the amendments makes provision. They have to be free for the person getting them. In practice, the principle that underlies that approach and the noble Baroness Nye noble friend Baroness Levitt is right. That's a choice that the Bill is making, is that it will be available free to somebody who wants it and satisfies the conditions.

The reason for that is we do not want to create a two tier system where you can only have an assisted death if you can afford to pay for it. In evidence to the Commons Public Bill Committee, Doctor Michael Mulholland, the honorary secretary of the Royal College of GPS, said whether it occurs in the NHS is not our decision, but we would be very concerned about health inequalities creeping into any part of the health service. If the bill comes through, we would want to make sure that there is not a differential in who is able to to access it.

The noble Baroness. Baroness Fraser's amendments don't affect that. The noble Lord Lord Moylan amendments do affect that, and it is for that reason that I oppose them. Could I just deal with. Thank you. Baroness Fraser's amendment Baroness Fraser would be restricting the model that could be used to private providers only, albeit that she is not saying it should be free, should should not not be free. I agree with what the noble, my noble friend, the Baroness Levitt, has said to the effect that you shouldn't restrict the way that is delivered.

So I would not be in favour of her

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amendments in that respect. Sorry. For giving way, does he? Does he not see that the argument he's just made in favour of having a fully funded assisted suicide service is exactly the mirror of the argument I made on palliative care, and the I made on palliative care, and the argument here, from the quotation he gave, is exactly the argument I made. If you don't fully if you made. If you don't fully if you fully fund this proposal and you don't fully fund palliative care and make that university available at high quality, then you do have an inequality where wealthier people can get palliative care, poorer people can't.

And on previous occasions, the noble Lords made it quite clear that he's comfortable with those being reasons for people seeking an assisted death. And I don't think they are. And I think you have to fund both services on an equal basis. Does he agree.

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The the impact assessment suggests that in year ten, assume suggests that in year ten, assume the highest number. So I'm taking the the the highest possible cost the the the highest possible cost it would cost to do assisted dying. And that includes not just the And that includes not just the health elements but also the panel and the assisted dying commissioner. It would cost in total. And this is It would cost in total. And this is not by reference to any savings, £37 million.

It is plain that palliative care, it should get as much funding as possible. It's patchy throughout the country. It needs more funding. For me, it is not right to delay the option of assisted dying, particularly when the amount of money that we are talking about to fund assisted dying is so much less than the amount of money which I would fully support being provided as much as possible. So I understand what the noble Lord, Lord Harper, is saying.

I'm fully behind him. If he's saying, let's all put our backs into getting as much money as possible for palliative care. But I don't accept the argument that the inadequacy in some parts of the country of palliative care is a reason for delaying the assisted dying bill. Can I move on to the.

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As a point of information, does the noble and learned Lord accept that there is evidence that if specialist palliative care was available across the country on an available across the country on an equal basis, that in itself would equal basis, that in itself would result in a saving of around £800 million a year, because patients would be getting better care, unnecessary investigations and so on would be avoided. So there is a cost transfer. The problem at the moment is that we have areas without services and therefore patients don't have choice.

And if we're talking about patient choice, then there must be equipoise in

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that choice argument. Earl Attlee sure that if there

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Earl Attlee sure that if there was proper specialist palliative care of the highest quality, which we would hope that there would be, we would hope that there would be, that would lead to savings, I honestly don't think that the 37 honestly don't think that the 37 million, which is the cost of this, is a reason for delaying because it is a reason for delaying because it would in some way hold back the provision of better specialist palliative care. We're all in favour of that.

Could I can I go on for a bit longer. The, the, the next argument I should deal with is this suggestion that because there might be savings, because people will not be cared for for as long, this will lead people to encourage people to have an assisted death. I do not accept nobody who is in favour of this is in favour of this, because it's a cost saving. The Treasury is not driving this. It is people who want to see those that they love and for themselves to have a better death.

I do not accept for one second that the consequence of this bill being introduced is that doctors and other medical people will start to encourage people to do that. Finally, the change of the relationship between the doctor and the patient. If you go to other countries where it's been introduced, far from it, leading to a change in the relationship, it's been something that is very often promoted a better relationship between a doctor and an individual patient. Because of the options that are available.

Baroness O'Loan.

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I'm just concerned. About this figure of 37 million, which is being articulated as the which is being articulated as the absolute cost of this service, because I find it somewhat difficult to believe that it could difficult to believe that it could be the cost, if we have regard to the costs of similar public organisations which are set up, and the running costs alone run into millions, we are going to be talking about a national service talking about a national service for England and Wales, which will be provided in the location where the patient is.

Presumably the death will take place not where we want it, but where they want it, and therefore there will be a lot of costs which I believe firmly believe have not been costed into the figures which which the Noble and learned law gives in which the noble Baroness, the Minister has given us. You know, my Lords, when I go shopping, I look and see if I can afford what I want to buy. Yet we as a parliament are being asked to decide do we want to do this? And one of the things that we should responsibly take into account is cost.

Otherwise we wouldn't have an impact assessment. Yet we're being asked to consider it on the basis that it will cost £37 million. And that's peanuts. Well, I wish I had £37 million to put into palliative care now, but this is not an accurate figure. And that's the only thing I want to come. The noble and learned Lord put his hand on his heart and say to me that he really believes this is what this service will cost in the numbers of people who may avail of it, and the number of safeguards which do need to be introduced into the bill because of the very

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significant flaws it has. I'm grateful to the noble

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I'm grateful to the noble Baroness for a speech rather than a question clarifying. Secondly, in relation to the figure of 37 million, that is a figure that has been provided in the impact assessment. As I said, for the 10th assessment. As I said, for the 10th year, I note the points that the year, I note the points that the Baroness alone has made may be the right course for the Baroness O'Loan is to send a detailed letter raising the questions with the Department of Health and Social Care and the Ministry of Justice, because it is there, it is there assessment which I do not dissent

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from. Oh, sorry.

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Oh, sorry. I just wonder whether I could ask a question. I mean, I entirely accept that those who are proposing accept that those who are proposing this bill do not propose it for any, for any, for any reason in trying to save money, I entirely accept to save money, I entirely accept that. I also entirely accept the desire from everyone in this House desire from everyone in this House for better funded palliative care. But what I need to be explained is taken, that there is inadequate and and underfunding of palliative care and taken that there are huge regional variations.

What what I, what I don't understand is, is your confidence that this will not lead to coercion of vulnerable people in places where palliative care isn't available and cannot be afforded, and that will lead to unintended consequences, which I entirely accept. You don't want those consequences either. But, but, but,

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but give me some confidence, if you can, that this will not follow. Well. Let me.

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Let me. Try and give you confidence. First of all, decisions about First of all, decisions about treatment at the moment are have to be made in the context frequently of what everybody in this House would think was inadequate palliative care. There is scope for palliative care. There is scope for coercion there with no safeguards. Secondly, there is the ability of people to go abroad to get an assisted death. There is scope for coercion there. In both of those situations.

There are no safeguards whatsoever. And the landscape in which those choices are made, whether it be about continuing other treatment or whether it is about going to Switzerland, have absolutely no protections whatsoever. This bill provides five levels of protection. So for me, I am completely satisfied that this is a safer system than the current law. And I very, very, very much hope that gives you confidence that the bill is the right thing to do. As far as the question of funding of palliative care, I very, very much hope that the government and other people will provide more money for palliative care.

And actually the experience in many countries is that the introduction of an assisted dying bill leads to an increase in the amount of palliative care, because what happens is people debate and think about how you die. I hope those things put you your mind at rest. The risk for coercion is already there. This provides safeguards. I hope the introduction of the bill will produce more money for palliative care, but unfortunately I can't give you any guarantees of that.
15:36
Lord Moylan Portrait Lord Moylan (Conservative)
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My Lords, I shall be very brief.

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This short. And valuable debate. I tabled these amendments in the

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I tabled these amendments in the first place to give the noble and learned Lord the opportunity to explain why this proposed service explain why this proposed service should be funded by the taxpayer, by the unwilling taxpayer. It might be said, in the case of those who be said, in the case of those who have a principled objection to it. I listened very carefully to what he said, and he gave one reason he said, and he gave one reason only, and that is that failure to make it available free would contribute to an increase in health inequalities.

My Lords, that proposition rests entirely on the assumption that this is a health treatment. It is not. It is poisoning people and and it is completely unpersuasive that this should be justified as contributing towards health inequalities or otherwise. For that reason, I would be certainly want to bring these amendments back on report and invite the House to take the view that we should not be funding this from public resources. In the meantime, however, I beg leave to withdraw the amendment.



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Your Lordships pleasure that this amendment be withdrawn. Amendment is by leave withdrawn. Amendment 141 which has already Amendment 141 which has already been debated. Not moved. Not moved. My Lords, we now come to a group of My Lords, we now come to a group of amendments beginning with amendment 142, clause four, amendment 142

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Lord Murray of Blidworth. My Lords, it's a long time since I last spoke on this bill. At about 320 on the Friday the 12th of September, which was, of course, the Second Reading, the first day of Second Reading. In that speech, I outlined my concerns about the proposed panels in the bill in clause 17, and it gives me great pleasure to introduce the group of
15:38
Lord Murray of Blidworth Portrait Lord Murray of Blidworth (Conservative)
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amendments to those panels, and my amendments I will come to in a moment. But my concerns in my Second Reading speech, which were Second Reading speech, which were reflected by a number of others, were also seen in the evidence provided to the Bill Committee, both in the Other place and the both in the Other place and the Bill Committee. Here. Of course, the addition of the panels was something that happened organically during the passage of the bill through the Commons, and as a result, there have been numbers of adverse comments in particular, as we will see by legal stakeholders who are concerned about the way that the proposed system works and the lack of detail in the Bill in relation to the panels.

It is of note, perhaps, that the Justice Minister, Sarah Sackman, when asked by noble Baroness Lady Scotland about the lack of policy definition regarding the process and fitness of those adjudicating, said this that the Commissioner in establishing the office of the Commissioner will be responsible for producing the procedural rules governing the panel's activity and potentially guidance that will govern about how they go about their work. And then she said she that's Lady Scotland is absolutely right.

But what it does is give the commissioner the powers to go away and develop the governing practices of the panel. And the Minister suggested that that was not unusual in the establishment of bodies of similar nature. Many don't share the somewhat laissez faire approach that the Minister adopted there. The Law Society raised specific concerns about how the panels would operate. Kirsty Stewart noted in her evidence that it was unclear at the moment where the panels will be held, and how people would know about them, and whether they would be public or private.

And in her written evidence, it was said that Parliament should clarify how assisted dying panels would deal with and decide cases. Substantial details about how the scheme would operate are left to be dealt with in secondary legislation and guidance, and Professor Charles Foster also criticised the lack of statutory requirements for the panel's procedure. He noted that there was no requirement for the panel to ask anybody, including the applicant, anything at all, or to test the evidence in any way, and that cases can be held in private without an obligation to publish reasons.

And Professor Ruck-keene, and if I might declare an interest, he and I are in chambers together. Professor Ruck-keene noted that the panel's design suffered from being developed on the fly, and it was neither fish nor fowl regarding its powers, and noted that the policy had not been formed and said that it had too few powers to deal with more difficult cases. So to turn then to my amendments, I hope to address some of those problems that have been highlighted.

My First Amendment that I wish to refer to

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is that number 925A. Well, I. Do mind. And in that amendment.

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Do mind. And in that amendment. It concerns the power to appoint the members of the panel. At the the members of the panel. At the moment, the position is that the panel members would be self-selecting this amendment, by self-selecting this amendment, by which various criteria are set for the appointment of panel members. the appointment of panel members. That risk is being reduced because a person may be appointed to the list following an independent appointments process involving tests, interviews and role play, and then, perhaps topically, professional vetting, and then, in the case of a legal member of a panel, a recommendation from the Judicial Appointments Commission.

would would introduce that requirement. My amendment 937 makes that mandatory. And and my amendment 938 requires that that guidance must be produced following consultation with various relevant bodies. The tribunal Procedure Committee, experts and domestic abuse experts in old age psychiatry, experts in neurodivergence and disability groups. And then my amendment 46 three is intended to address how the procedure is to work. Finally, my Lords, my amendment 46 four deals with powers of evidence gathering. And as I noted in my Second Reading speech, at the moment, the panel has fewer coercive powers than a parking adjudicator.

And this is going to be a body who is determining matters of life and death. And ultimately, they need to know whether there is coercion, whether the wishes are all in Volved have been taken into account. And my amendment four, six, four is drafted in such a way that the panel shall have the powers and privileges of the High Court. I appreciate that it's far from perfect, and it's by way of being a probing amendment to the Noble and learned law, but I would like to hear what proposals he may have to improve the powers of the panel and to rectify the obvious deficits that exist in the current system

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that is proposed in the bill. My Lord, I beg to move. Amendment proposed in clause

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Amendment proposed in clause four, page two. Line 38, line 39. Insert the words as printed on the

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Marshalled List. Nicole. Sorry.

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Sorry. My Lords, I'd like to put

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My Lords, I'd like to put forward amendment 941. As a medical professional, I know only too well that medical interventions can be driven by financial motives motives. For example, organ harvesting for a
15:45
15:46
Lord Sandhurst Portrait Lord Sandhurst (Conservative)
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together. So it gives me about 30s on each one. It's really important, on each one. It's really important, however, that the powers of the panel are clearly defined and that panel are clearly defined and that what we end up with is actually in accordance with what Parliament accordance with what Parliament wants and intended. All these amendments, each one I put down comes either from the Law Society comes either from the Law Society or the clad group. The. And to this extent, I endorse entirely what my noble friends, Lord Murray and Lord McColl have just said.

The management of the evidence gathering in the process is vitally important, and my amendments are aimed to try and put that into some sort of proper regime, which is set out in paper, on paper, before the bill becomes a statute, my Lords. 9 to 9 A is very simply aimed at panels being able to consider cases, having the right expertise appropriate to the particular nature of the case. And so the Commissioner must have regard to the nature of the expertise required to determine the particular circumstances of the person in question.

There is a lack of psychiatrists in this country. We know that it's in the public press all the time, and it's very important that that when this process kicks off, there are sufficient psychiatrists willing and able to sit on these panels and to devote the time necessary because they are going to have to make assessments. And there's a risk that the Commission may struggle to find enough of them. Moving to 9 to 2 and 9 to 3. These ask that there be sufficient people and that they must be specified in regulations and in particular have expertise in the relevant matters set out in the regulation.

So the Secretary of State must identify what expertise will be required and who's to address it. And in nine, two, 7A1 of those must be a legal member. We can't possibly have panels who haven't got a lawyer on them. There must be a legal member with the expertise to deal with the particular case. And indeed, I note that in the when giving evidence to the committee, Sarah Hughes of Mind said it was really clear that the safeguards described in the present bill are not adequate, and the British Association of Social Workers said the current safeguards are not enough, so these are disinterested, important bodies with expertise in this area.

Amendment 9 to 8 is aimed at the target of medical expertise. There must be someone on the panel who can take a properly informed view of the diagnosis, which has been given to the applicant. The next point, which is very important is for 73, and that is to insert the word evidence, because it's not clear what the status is to be of these panels and what the status is to be of the material given to them.

The word evidence means or will have the effect that the panel is clearly operating as a formal body. It doesn't make it a tribunal, but it makes the process formal and will make the panel act properly. 479 inserts a requirement that the panel may require a local authority or NHS body to arrange for a report to be made dealing with such matters relating to the person, as the panel may direct, or such other person as the authority or the NHS body considers appropriate.

And there's more to it. This is the equivalent of section 49 of the Mental Capacity Act 2005, which gives the power to the Court of Protection to get reports from the NHS or local authorities in order to allow it to discharge its inquisitorial powers. And we need something similar here, and it will reinforce the seriousness of the of the panel. The panel is going to have to and there are other provisions in this to make it plain that the panel can appoint an expert to test evidence.

If it hasn't got its own expertise, it needs to have that power, and it may in an appropriate case, but it will be under no obligation to that subparagraph H to be inserted in the bill here. Evidence on oath. There may be cases where it's really very anxious about some of the things it's heard, and it may think that putting someone on oath makes them think very seriously about telling the truth, the whole truth, and nothing but the truth. We can move on then, I think, and I'm trying, as I said, to take this at a gallop.

Four, six, five is another law society amendment. It's to show that although it's not a court, the body is a formal body, and that's using the word evidence in the provisions. The word evidence will make the panel take it seriously. I'm not suggesting they're going to be lightweight people, but the process is important process. We all know those of us who are lawyers in particular. Process is important and it affects how panels and tribunals conduct themselves. If it's not to be called evidence, then it won't have that same effect.

And it's unclear at the moment. The Law Society suggests precisely what status the information being received will have. It won't be a court, but it will be a formal body. And that provision occurs in some other amendments four, seven, four, seven, six and possibly elsewhere. How? And this is a question for the noble and learned Lord. I ask, how does the noble and learned Lord understand the panel's evidence gathering powers? Will it be exempt from the normal rules of medical confidentiality and data protection? Can it gather evidence and witnesses, even if the patient doesn't want evidence to be details to be shared? Is it an executive public authority subject to the limits that apply to government, or is it a judicial body with unique powers and saying it's quasi judicial doesn't answer the question.

It's either one or it's the other. And we need to know what powers the it's to have. Is it those of an independent tribunal or not? And this picks up the an observation by my noble friend Lord Murray just now moving to 494. This amendment would mean that the panel would have to notify relevant bodies if it considers that the person meets the criteria, but the request was made because the service provisions had failed in the past. This will be important for monitoring the impact on of the bill on health and social services.

It will show up. Someone's come for this because provision is not being made and that will be important for looking forward and seeing how we can improve delivery of health services to the to the public. It's not a barrier, but it will be a provider of valuable information. 934 Another law Society amendment will require the Secretary of State, by regulations, to make provision for how the chair of a panel is to decide whether to grant the person's request that the panel sit in private, including the factors to be taken into account in the processes to be followed.

So will they be sitting in private? Will they be sitting in public? How is this to be addressed? These are really important practical questions which are bound to arise on the ground. And then 934 another law society, one for the purposes of the law of contempt, where a panel determines a referral in public, then, unless the panel provides the contrary publication of the information about the person to whom the referral relates shall be treated as a contempt of court, as if in any relevant legislation for the word court was substituted.

Panel. The panel won't be a court, but it will be hearing very sensitive information in public hearings. By default, these amendments seek to ensure that such information about a person is not made public. The late and I would suggest great, Sir James Munby remarked. Judges are kept up to the mark by two things having to comply with proper procedure and being exposed to the public gaze. And he said the same thing should apply to panels. The Law Society told the select committee.

What is unclear at the moment is that where the panels will be held and how people would know about them. Obviously, the consideration as to whether the panels are private or public and then where the powers would come from, potentially to restrict the information and then being able to be made.

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Can you wind up, please? You're over your time. Thank you. I hope the house will indulge me

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I hope the house will indulge me a little. It's not well. There are 20. There are more. All I would say 20. There are more. All I would say is this. Then I would ask you to read carefully my amendments, which all come from the Law Society. All-clad. And I will say only one thing. I hope noble Lords will thing. I hope noble Lords will forgive me. It's clear that this group will go beyond today. I'd have thought, looking at the number of amendments there, and the fact we only have two hours left.

If I do need to leave down now and come back. Still on this debate, I'm hoping. Thank you very much.
15:57
Lord Weir of Ballyholme Portrait Lord Weir of Ballyholme (Democratic Unionist Party)
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My Lords. I rise to move two amendments in my name in this group. Four nine, six A and 496F and can I say at the outset of that, I want to assure you that both the sponsor and the to the the House as a whole, an apology that in line with the Chief Whip procedural recommendations, given that I suspect that this will carry on at least until 6:00, that unfortunately I'm in the position that I will have to leave almost certainly before the end of this this debate to catch the last flight home to Northern Ireland.

Can I say both these amendments, as indeed a number of the amendments that I have submitted? Are dealing with concerns that have been raised with me by disability groups, and we are aware, again, without reiterating the detail of this, that there has been a wide range of concerns that have been raised by a large number of groups representing the disabled who have, if you like, varied between having some concerns and total opposition to the bill. There isn't, as we know, a disabled group which has expressed support for the bill.

So we're concerns are being raised. I think it is important and incumbent that where we can try and improve the bill by trying to take on those concerns, we do listen to them. Dealing with the two amendments briefly, four, six, nine A is, I suppose it adds an additional ground, potentially on the grounds for reconsideration, that looks at one of the grounds of being a failure to adequately to consider or indeed inconsistent with evidence of disability related vulnerabilities.

Now, from that point of view, this is I suppose the aim of this is to provoke an examination of the extent to which reconsideration focuses in on the particular needs of the disabled as a route. It may not necessarily be the route that I would pursue at at Report stage, but I think the purpose of this is to ensure that the Commissioner, when looking at this, focuses our minds on explicitly on the impact on disability and vulnerability. We know that, again, there has been concerns that have been raised that there is a concern that disabled people will feel that they are being pushed down one particular route.

And I think it is important, therefore, that there is that proper level of examination and ensure that that is not the case. If autonomy is to mean fully what it should mean, then that means that there's got to be a level of choice both ways in relation to it. And can I highlight those remarks that have been made again by the UN Committee on the Rights of Persons with disabilities? They have said that that when examining jurisdictions with assisted dying regulations, it can lead to discrimination against disabled people if it is not grounded in a rights based understanding disability.

And I suppose they have been particular concerns that they've raised from examining the situation in Canada. So can I say in conclusion, in 490 six A, I think we cannot simply be a situation where assisted dying is seen by disabled people as the escape from the cycle of pain and financial pressures on that basis, which is why we want to raise this issue here on 4496F. Briefly, this puts an unnecessary additional protection where there's been a reconsideration of a previous refusal.

And in doing so, I think it makes a requirement that the that it's then got to show in how it's addressed. Each safeguarding concern, which was identified in the initial refusal and satisfied that the that this has not been because that indeed the sorry the decision is free informed and not being markedly influenced by disability related disadvantage in the plans. I think that's where we see a situation where there has been a previous decision which has said there are concerns, and the the situation is such that there's been a refusal.

I think we do have a particular safeguarding issue that we do need to take into account. In particular, care needs to be put in place there. Again, if I look at what has been said on the Committee on the Rights of, of Persons with disability, assisted dying should not be a solution to socially created suffering. And to quote the Scottish Human Rights Commission, that requires, quote, robust, multilayered approach to safeguarding. It is important that we do have proper safeguarding.

And without reiterating the the argument about the issues of mission creep, even without changes, there can be quite often safeguards put in at the very start, which then, from a practical point of view, as time moves on in practice gets watered down. I think it is important that if we are to try and counteract that, to have the most robust safeguards, particularly for the disabled and vulnerable people, and making those at the start, I think having a high water mark, there is the best form of protection that we can provide in this particular aspect.
16:03
16:04
Lord Jackson of Peterborough Portrait Lord Jackson of Peterborough (Conservative)
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My Lords, I rise to focus my remarks on amendment four six, two B in my name as as well as supporting the amendments to which I have attached my name four, six, three four, six four and 465. And like my noble friend Lord Murray of Blidworth, this is the first opportunity I've had to contribute to the deliberations of this committee. And like him, I last spoke in the Second Reading. The amendment requires a public notice to be issued 28 days before the panel intends to sit, which would enable members of the public to attend and potentially engage with the proceedings.

I also want to say in advance that this is a probing amendment. I understand further work would need to be done, probably through regulations, to specify what any notice must entail and to consider any further matters around privacy. I am also very open as to whether the 28 days is the right notice period. I'd also add that I think that the amendment 439 in the name of my noble friend Baroness Maclean of Redditch, does a good job at addressing many of these concerns in a way that aligns closely with the existing practice directions in the Court of Protection.

But those caveats aside, I trust that this amendment probes an important point. Schedule two, paragraph six states that ordinarily, panels are to be determined, referrals to determine referrals in public, unquote. But the public nature of the panel is surely illusory. If interested parties are not notified that a panel hearing is taking place, how would anyone know when and where to turn up? I don't think we can gloss over this as a minor omission. Giving evidence to the House Select Committee at page 143, the Law Society listed this issue amongst the things they are, and I quote really concerned about as they explain.

What is unclear at the moment is where the panels will be held and how people will know about them. That needs to be clarified and there needs to be further information provided around that. The point has also been well made by the late Sir James Munby, the former president of the Family Division, whose comments continue to have an important influence on our deliberations. He described the bill's silence on a notification mechanism as, and I quote, an astonishing omission. He went on, and I'm going to quote at some length here, because I think it's helpful to hear his words, quote, quite apart from all the other reasons why it might be thought desirable to make such provision in the Bill, the participation of others is necessary.

One if the process is to have that degree of rigour, which is essential if it is to be capable of identifying and preventing possible abuses, and in particular be adequate to detect what may be very subtle external pressures. And two if it is, it is to command public confidence, unquote. He was absolutely right. Supporters of the bill have talked about how they intend this proposed law to bring end of life decisions, quote, out of the shadows. But as drafted, the bill provides for individuals to die in secrecy with the intentional assistance of the state.

We cannot ignore the impact that this secrecy will have on the grief of families who only hear that their loved one has died by assisted suicide after the event, particularly if they possess relevant facts such as evidence of coercion or mental illness. The committee be aware of the tragic death last year of Maureen Slough, from Cavan, Ireland. Her family reported their devastation at being informed of their mother's assisted suicide via a WhatsApp message from a Swiss clinic. The same message also informed them that her ashes would arrive by post.

The circumstances behind Miss Slough's death were even more tragic. Firstly, her brother, a UK solicitor, said Maureen had provided the clinic with, quote, letters of complaint to medical authorities in Ireland in respect of bogus medical conditions, unquote, which the clinic allegedly used to support her application. And secondly, the clinic claimed to have received what appears to have been a forged letter from her daughter, Megan, acknowledging her mother's plans. These details, together with the fact that Miss Slough had long struggled with mental illness, suggests that there were potential red flags which may have been identified had the family been duly notified.

While supporters of the bill may argue that the panel process is designed precisely to avert this kind of situation, I would respectfully ask, how can we be so sure? Remember that the panel are only operating on a civil level of proof. In other words, on probability. To use an example from Miss Lord Storey, it is likely that the panel would have concluded without hearing Meghan's claim that she did not write it, that the letter was more likely to be a forgery, and so warrant further investigation.

Perhaps, but we cannot be sure. And that is the problem. I think we must also consider, my Lords, the importance of notification in the light of the fact that the Bill provides no clear mechanism for families to intervene at a later stage once an eligibility certificate has been granted to refer once again to the late Sir James Munby, again, in his very eloquent words, the amended bill is entirely silent as to how the panel is to deal with the kind of issue exemplified by the Canadian case of AI versus NB, where the patient's partner intervened and obtained an interim injunction because of concerns about what was happening.

What if the patient's partner and relatives, excluded from participation in the panel process, discover only after the panel has granted a certificate facts of the kind which in AI versus MB prompted an 11th hour intervention by a Canadian judge, unquote. This is a major hole in the bill, but it also means that, as it stands, if interested parties are to intervene, it must be at the panel stage. And to do that, they must be informed of the panel meeting so that they can apply to submit evidence as necessary.

Finally, I want to address concerns that some noble Lords may have around the amendment's requirement to publish the names of people referred to the panel and the potential impact this may have on privacy. I have to say that I have thought long and hard about this. As I alluded to before, I think there's a great merit in the proposal by my noble friend Baroness McLean in amendment 439, but one weakness is that it requires the Commissioner to notify any other person properly interested in the welfare of the person.

There is no clear way of establishing establishing who they might be. How is the Commissioner to know which friends to contact yet? 1st May just have vital information. So I think there is a benefit in requiring a more general notice. I also observe that there are times where public interest is so great that it outweighs privacy concerns. Marriage as a public institution is a good example of this. And in fact, I based the amendment from its notification requirements. In that context, the interest we all have in defending that public institution means that a general notice is issued so anyone can come forward with the evidence of coercion or any other legal impediment.

I think in considering public interest, we need to appreciate what is going on here. In the words of my noble friend, lady May of Maidenhead at Second Reading, this bill does give the state a licence to kill. Whatever our views on this subject. In handing the state this power, there is surely great public interest, demanding maximum oversight and and safeguards. The panel process should not be seen as totally analogous to the situation in the Court of Protection, where greater anonymity protections would normally apply.

It is important to note that most cases in the Court of Protection involve patients who clearly lack capacity and have not consented to the process. Instead, cases usually involve best interest disputes between families and medics, but in this process it is a basic requirement that the patient is able to consent. My Lords, in closing, I would add this even if the House desires a more anonymised process, then we need to debate the details of that. What restrictions would be? Would there be on media reporting? Who would determine the circumstances in which these restrictions apply? And perhaps the noble and learned Lord, the sponsor, would address these issues in his remarks.

Without answers to these and other questions, the bill risks the assisted suicide process being more shadowy and less transparent than would apply in cases in the Court of Protection. And I do not think, my Lords, that this is acceptable.
16:14
Baroness Hayter of Kentish Town Portrait Baroness Hayter of Kentish Town (Labour)
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My Lords. >> I'm still quite shocked at what I've just heard. But before I respond to that, I would just like to say to Lord Mark, I'm sorry, I'm really quite shocked to Lord Murray. He talks again and it was objected He talks again and it was objected last time I raised this, that this was a life or death matter. These people are dying anyway and therefore a refusal of assisted death doesn't mean the person will continue to live.

They're going to die anyway, and indeed they may still commit suicide. And we seem to forget that, that if they don't get the assisted dying, they may still go to abroad or they may commit suicide by themselves in ways that we know are not always reliable. But I, I think I'm quite shocked, really, about the idea that we would put out a notice and all the ghouls who used to be outside when I was still young ones with prison, when hangings were taking place inside, could all turn up to either watch or stand outside a panel hearing intimate details about someone's life.

I truly, deeply shocked that we would think that this was possible, that someone's request, someone who is dying, in a bad state, could have their personal details, first of all, publicised 28 days in advance, and then, you know, I think this has to be put aside. I find it extraordinary. But it does bring me, and I hope that the noble Lady Baroness Finlay will forgive me for actually responding to one of her amendments before she's had a chance to move it, but it enables her to maybe rebut what what I've said.

But I had to say that straight away, because I think the idea that this all has to be done in such a public way without any. Acknowledgement of what the person who's dying is going through, is this extraordinary. But I would like to refer and I say Baroness Finlay will be able to come back to its Committee stage. You can come in later. Baroness Finlay is going to be able to move or speak to, I should say sorry for 95459 afterwards, which is one of the considerations has to be has to be that the person has informed their children of their decision for an assisted death.

Well, I can't be the only person who knows people who have completely no relationship between parent and child. The child could be aged 60, could have been living abroad for years, might not know their parents ill, and may not have been in touch with them for 40 years. But somehow we're going to have to try and track down children. And and also, the ill person may not want their child to know that they're ill. I we all were old enough. Now we've got lots of friends been through this, had a friend who did not want his daughter to know who was seriously ill, terminally ill because she herself was facing her own health issues at that time.

But this would somehow lay down that despite the will, the desire of a father in that case, that nevertheless that child has to be found and has to be told that their parent is wanting well, not only that their parents wanting sister death, but the parent is dying and wants an assisted death. I really just wonder about this denial of agency and and that if that person themselves doesn't want to tell their child, then according to amendment 459, that person has to make adequate arrangements for another person to inform their children who might live abroad or whatever, of the assisted death and provide bereavement support.

I just wonder what world we're living in when someone reaching the end of their death and their life and that some agency, some agency of the state has to it has to demand that they tell them whether they've got any children, whether they know those children are still alive and where they are. That has to tell that child that their parent is ill and that they are, in a way, a smaller matter, and they actually want to bring forward that, that death a little bit so that it's not too bad at the end.

I mean, some of these ideas seem to me to have excluded from our consideration the patient concerned. They seem to be putting everybody instead in a position of taking decisions. The noble Lady Baroness Cass, I can't see her talked earlier. She was here about the amendment once more and more advisors brought in more specialist advisers. Can we just sometimes revert to remembering that we're talking about seriously terminally ill people who surely have some agency over their life, and if they are refused this, they can still commit suicide, but they will probably do it.

As you know, a friend's father did, by going into the garage by clogging up all the. You know, the bottom of the of the door and things, and no thing got through and turning the engine on and and killing themselves. Then I do wonder sometimes whether we are remembering that we're people facing a terrible end, and we just them.
16:19
Baroness Finlay of Llandaff Portrait Baroness Finlay of Llandaff (Crossbench)
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Here, here, here. >> Here. >> On that. Given that my amendment here has been questioned. And let me explain when looking after me explain when looking after people who are parents, conversation very often is what are the children know and telling children about someone's impending death is extremely difficult for most parents. And I had a concern. Usually it is because the person who's ill wishes to protect those children, and they think that by not telling them and preparing them, somehow they are protecting them.

And the way children inform needs to be age appropriate and appropriate to where that child is. I didn't, in this amendment suggest it should be an agent of the state. I've said that made adequate arrangements for another person, and that could be anybody. And it's asking whether they have somebody who will inform those children or not about the death. And in terms of bereavement support, that might simply be telling them in person and letting them talk about it for an hour over a cup of tea.

Or it might be much longer, depending on the needs of the individual, because bereavement is very individual as well. And I'm concerned that we could legislate and somehow believe that by someone having an assisted death rather than a death, for which there has been preparation, that the impact on any children in the family will be less, because the evidence is that it won't.

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I don't know if I'm allowed. Intervene because I don't know if you're intervening. OK, well, I

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apologise then. You're moving. Your amendment at the moment. I'm coming to my amendments. I'm

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sorry. I'm coming to my amendments later. That's very good.

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That's very good. Perhaps I can speak. I'm speaking actually in support of
16:21
Lord Farmer Portrait Lord Farmer (Conservative)
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speaking actually in support of amendments on behalf of my noble friend Baroness Maclean of Redditch, who unfortunately can't be in her place at this hour on Friday afternoon. And the amendments are afternoon. And the amendments are four four, 5483495B and 941A. First Amendment 445 would require the panel to consider signs of fluctuating capacity. This issue has been addressed in previous groups but needs raising. Again, just briefly here, as Professor Martin Vernon told the Lords Select Committee, fluctuating capacity is an extraordinarily common issue, but nonetheless somebody may retain capacity at some point during their dementia diagnosis, sufficient to make a determination as to whether they wish to end their life, unquote, as has already been stated, about two thirds of people with dementia have never received a formal diagnosis, so it is incumbent on the panel.

It's incumbent on the panel to consider this possibility and to take evidence on whether this could be the case, given that the coordinating doctor is not required to be in the room at the actual moment of administration, fluctuating capacity could raise vital issues of consent. Amendment 483A probes whether the panels have sufficient powers to gather all necessary evidence to decide on eligibility. It ensures that panels can refer the patient for any further assessments it considers necessary. Can the noble Lord, the sponsor, explain why the panel does not sit within the usual tribunal structures, as doing so would give them more expansive powers to request further evidence where necessary.

For example, the tribunal procedure rules for the first tier tribunal health, Education and Social Care Chamber empowers the tribunal without restriction to give direction to matters such as one the issues on which it requires evidence or submission to the nature of the evidence or submissions it requires. Three whether the parties are permitted or required to provide expert evidence, and, if so, whether the parties must jointly appoint a single expert to provide such evidence, and then finally the time at which any evidence or submissions are to be provided.

It would be helpful if the noble Lady, the Minister, could confirm whether the powers given to the panel in section 17 for D and E are as extensive. Finally, my noble friend's connected amendments four, 95B and 941A would require the panel to provide a report to the person containing recommendations to address any unmet social and palliative care needs, in addition to determining whether an eligibility certificate should be granted. More fundamentally, these amendments also probe what the panel is intended to be.

The bill's sponsors have previously tried to argue that the panel is akin to a multidisciplinary team. My understanding is that on this point, they have been rebuffed. After the Learned and noble Lords cited the Associated Association of Palliative Care as Doctor Sara Cox in his defence on the 9th of January, the APM responded in a letter that the bill's sponsor had misrepresented Doctor Cox's position. They said, and I quote, this panel fails to replicate a true multidisciplinary model and essential protection, unquote.

Further, they say the bill's current provisions, quote, renders the panel a mere administrative review, stripping it of the very nuance and human understanding that defines robust, compassionate decision making. At the end of life. My noble friend's amendments are intended to help the noble and learned Lord by providing ways his panel process can be strengthened, so it operates more like a multidisciplinary team. An important first step would be to expand the panel's scope, so it includes explicitly the ability to provide assessments or treatments for unmet health and social care needs.

This would enable each panel member to assess individually and then together, the holistic needs of the patient and contextualise the decision around assisted suicide. The noble Baroness amendments four, nine five and 941A build upon this and a recommendation of the Royal College of Psychiatrists, that the panel should be able to recommend interventions addressing potential drivers of a desire to hasten death, such as depression, social isolation or difficult physical symptoms. It should be remembered that the bill does not guarantee the person will ever have met with a psychiatrist or social worker before this stage in the process, we cannot deny the patient the benefit of their holistic experience and expertise in favour of a rubber stamp.

Rubber stamp. My noble friend would also tie her amendments to the sponsor's commitment to consider a requirement for the coordinating and independent doctors, though not the panel, to ask why a person has requested assisted suicide. Ultimately, what is the point of exploring motivation unless the attempt intent is to establish whether drivers can be addressed? Another way, my Lords, to conclude, the heart of the problem is that due to the way it was added to the bill and the other place, the panel process suffers from a fundamental identity crisis.

Are the members trying to be a kind of tribunal, or are they designed to be a kind of multidisciplinary team? It would be helpful if the sponsor could enlighten us, because currently

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they fall short of both. My Lords, I will speak. I will speak. Briefly in support of. My

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Briefly in support of. My amendment 483. This amendment simply ensures that in-person hearings remain the default when hearings remain the default when assessing applications under this bill, with remote evidence via video or audio link used only where video or audio link used only where extraordinary circumstances make an in-person hearing wholly impracticable, given the gravity of the decisions involved, it is essential that scrutiny is of the highest standard. An in-person hearing allows the panel to observe the applicant fully their demeanour, their interactions, and look for any signs of pressure.

This cannot be reliably assessed over a video link and certainly not over the phone. Indeed, California's assisted dying law requires assessments of coercion or undue
16:28
Baroness Keeley Portrait Baroness Keeley (Labour)
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influence to take place outside the presence of any other person, a safeguard that remote evidence safeguard that remote evidence cannot guarantee. The Civil Justice Council's review of remote hearings during the Covid pandemic found during the Covid pandemic found that the majority of respondents considered remote hearings to be worse than in-person hearings overall, and less effective in facilitating participation. A critical component of procedural critical component of procedural justice. Many respondents. For many respondents, they found remote hearings tiring, difficult to follow, and more prone to misunderstanding.

The Civil Justice Council found that nearly 13% of participants in remote hearings experienced significant technical difficulties, and in a process as sensitive as this one, even a small risk of technical or technological failure is a risk too far. There is also a contradiction in the bill. As drafted, it requires live evidence while simultaneously allowing pre-recorded testimony. So a short pre-recorded voice note could, in theory, constitute the entirety of the applicant's oral evidence, with no opportunity for questioning from the panel, and that cannot be inadequate.

Safeguard exceptions will, of course, be necessary. In very rare cases, an amendment 483 allows for them. The panel will have to be clear that it is wholly impracticable for the person to attend in person before allowing the video or audio link happening. What it prevents is remote evidence becoming the norm. So I do have two questions for my noble and learned friend Lord Falconer. Does he accept that the bill as drafted would permit a single pre-recorded sentence as evidence? And how would he ensure that there is not someone in the room exerting pressure on an applicant giving testimony remotely, particularly if that is pre-recorded? And a question to the Minister? The Equality and Human Rights Commission found in 2020 that video hearings can significantly impede communication for people with a learning disability or people who are autistic.

What assessment has been made of the equality implications of allowing evidence to be given to the panel by video or audio link? My Lords, in legislation on the matter of assisted suicide, the safeguards must be robust. Amendment 483 helps ensure that they are.
16:31
Lord Moylan Portrait Lord Moylan (Conservative)
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Lord German. >> I have two amendments in this group related to each other. They are probing amendments. They are are probing amendments. They are 926 and 929. They relate to schedule two and the operation of the panel. It's something that's been niggling away at me and worrying me. I'm perfectly prepared, of course, to be told by the noble and learned Lord that there's nothing here for me to worry my little head about. But let me let me raise the question nonetheless.

Schedule two makes provision for appointments to the Assisted Dying Review Panel, as I understand it, and I'm sure I'll be corrected if I'm not, the commissioner can creates a list of people who are eligible to serve on panels, so that is if one likes the panel up at the top, and these people can be appointed for a term of five years, and they can be reappointed for a term of a further five years. And then from that large group of people, the commissioner then in each individual case will draw and appoint the members of the panel.

The three members with the specific skills that we have been discussing, and the decision of those panels needs to be unanimous. Even an abstention would count as a negative vote, so to speak. That is how I understand paragraph five of schedule two. Now that is therefore the background to work properly. Of course, the panel members need to be independent of each other and reach their own view, and it seems to me quite possible that they will have different personal thresholds as to what they regard as the appropriate level of evidence required to persuade them.

Persuade them to say yes. And in that light, it's more more than possible that 1 or 2 of them, some of them might turn out to be slightly awkward in the sense that they tend to say no, rather more often than they say yes, which of course is fatal to the process because one no, and the whole thing is over. You've been through the doctors. You've been through the preliminary discussion, the two doctors, and you're now at the panel and you're being knocked back because of one rather awkward person.

And and I think that there will be pressure on the system as a whole, essentially, to eliminate those people from it, those who are difficult and who generally are more likely to say no than, than otherwise. So I have amendments that say in nine, two, six that if. That when deciding whether to reappoint somebody for a further five year term, no account can be taken of what might be called for this purpose. Their voting record in panels and similarly the decision whom to appoint to a panel.

This is 9 to 9 whom to appoint to a panel cannot be taken on the basis of their past, I shall say, voting record of that is obviously a slightly, maybe an inappropriate phrase, but I think noble Lords understand exactly what I mean. The background to this, of course, is and it's been mentioned earlier in the course of the day, the Abortion Act, the principal safeguard in the Abortion Act is that two doctors, two doctors separately must agree that there is a threat to the woman's health.

That was when the act was introduced, quite possibly a genuine safeguard. And there may have been occasions when doctors said no, that they did not consider there was a threat to the woman's health that justified an abortion. But it has become entirely routine. I think there would probably be a flag run up. A poll at DHSC headquarters if a doctor were to say no on an abortion application nowadays. So it is to prevent something like that happening to prevent the panels from becoming routine, to ensure that those people who have the higher threshold of evidence, the more cautious approach, the slightly more sceptical attitude are not eliminated from the panels either through having their term not extended or through simply not being appointed.

When each opportunity comes up that I put these amendments down, there may be better ways of dealing with the concern I've expressed. I'm certainly open to that than the ways contained in my specific amendments. They are, as I say, probing and and I'm open to those improvements. But I do believe that we have to ensure that this does not go the way of the Abortion Act, and the panels are robust and say no when it's appropriate to say no, which might be quite often.

And that's what I'd like to hear the noble and learned Lord comment on when the time comes.
16:36
Baroness Berridge Portrait Baroness Berridge (Conservative)
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I rise to speak to amendment 462 >> I rise to speak to amendment 462 in my name, which outlines that before approving any application, the panel must be satisfied that the person requesting assistance has had the requisite assistance from the local authority in in relation to the delivery of statutory services. The amendment deals with this problem that is caused, I believe, by the basic principles of the Bill, that it is based on a very narrow concept of procedural autonomy.

If it is only this that matters, then for the panel, as long as they can tick the boxes saying there's no coercion or pressure, the person has capacity, etc. then the application is approved. It is approved on the current state of the bill. Even if the panel believe and have evidence that the person is applying because, for instance, their housing is inadequate, the care package fell apart, or they're actually grieving for other relatives or they're poor. The amendment.

This amendment would mean that before any such approval is made by the panel, they must be satisfied that the local authority has received a referral to look at the statutory provision of services for this person. And in relation to this, I'm grateful that the noble and learned Lord enjoyed his meeting with Professor Alex Ruck-keene, because I think he's put this a number of times in written and oral evidence, and I think it is worth quoting about the the concept of the panel and its powers.

I quote he says, you have to think carefully about what purpose any there is for any of this oversight is actually serving society. If the oversight panel, whether that's a judge or a panel, cannot decline to approve an application if it considers that the reason the individual is seeking assistance in dying is because of service provision failures by statutory bodies responsible for meeting their health and social care needs. Now, I know that the noble and learned Lord has answered many questions and commented about the access to this service for the poor.

This is a different question. I am not saying that poor people should not be able to apply. I distinguish that from a situation where the panel has concluded on the evidence that although they satisfy all the tests under the act, the evidence is that they are before the panel because they are poor and there are many instances from other jurisdictions, for instance, particularly in relation to homelessness, that people have come forward for Made in Canada because they are homeless. And that's particularly available in Canada because it's not just for terminal illness in Canada.

So I do it may be that in relation to the amendment, it may be that the drafting needs to be different. It might be that not just before the provision, it might be twin tracks. So you approve the application, but at the same time you make sure the local authority deals with the provision of, of services. So I do hope that the Noble and learned will take seriously this additional power for the panel to ensure that people are there for the reason that they are exercising their autonomy in relation to the act, and not pressured because of lack of statutory services.

Yes.

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Refers to it as an additional power. As I understand the amendment. It's saying this is an

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amendment. It's saying this is an additional requirement before a certificate of eligibility. Being grateful to the Lord. I

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Being grateful to the Lord. I accept there may be drafting changes that might be needed between now.

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between now. Drafting changes is a fundamental difference between saying this is an additional saying this is an additional condition that the panel had to be satisfied of, as opposed to giving them a power. And I'm understanding the Baroness Shah the noble Baroness amendment to be an additional requirement that needs

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to be satisfied. Mentioning drafting changes. I mean, in relation to the timing of mean, in relation to the timing of this, because you may have how it's drafted is before the application is granted. It may be that the is granted. It may be that the power to go to the requirement to go to the local authority is at the same time as actually having same time as actually having approved it, not before, but yes, this is an additional requirement that would be on the panel.

The that would be on the panel. The second point I wish to raise in relation to the principle of the bill, and I hope that the noble learned Lord, the sponsor or the noble Lady, Lady Finlay can actually help with this. The noble Lady, Lady Hayter referred to the situation based on the autonomy. The individual wants to do this and does not want to tell relatives. Now, if we are strictly purists about that, and we had evidence that the select Committee that we could be in the situation in this bill where the first anyone knows about the death is when the medical examiner is telephoning a relative.

Now, if you could just let me finish, please, if you could just let me finish. I have laid amendments at that are in a different group in relation to a requirement to nominate next of kin who are over the age of 18. I think it would be useful to your Lordships House for us to know what is the situation. If someone does act completely autonomously like this and the body is there, are we actually saying and does the noble and learned Lord, the sponsor, need to actually bolt on a provision that that becomes a public health burial, because that is the continuation of the logic of this, that you can alone do this and no one in your life, it knows about it.

And therefore, to actually exercise fully that autonomy, it needs to be a public health burial. And everything is done before anyone in your family knows. And that's the conceptual difference. But I think it would be. I know that the noble and learned Lord Knight did actually speak about this in a meeting in relation to what is the law, and it would be good for him to clarify what is the situation. Can the medical examiner actually not call anybody and actually go

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forward with a public health burial? I understand that quite often

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I understand that quite often people die and their family don't know about it. And therefore the medical

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And therefore the medical examiner's evidence is that when they've got the body in that circumstance, they are under an circumstance, they are under an obligation, we think, to actually locate and find a relative before. Obviously, if bodies are not, sadly, Obviously, if bodies are not, sadly, it's more frequent than we would like to think that actually then the local authority powers, which is to do a public health burial, then become apparent. So yes, there are these situations. But in relation to this bill, I think it is important to clarify, because we had this evidence from the medical examiner that the first the family might know is when they're called by the medical examiner.

We need to be clear about that. And for the position of families and and is this personal autonomy? That's the conceptual point. So, so fully enacted properly and that actually it's a public health burial, not any obligation to inform anybody that this is happening.
16:43
Baroness Lawlor Portrait Baroness Lawlor (Conservative)
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My Lord. I rise to support >> My Lord. I rise to support amendment 72, moved by Baroness Gray of Tottenham, to which I've Gray of Tottenham, to which I've added my name along with Lord Goodman of Wycombe. I also support the noble Lord Lord McColl of Dulwich amendment 941 and I just say a few words about that amendment 941 to schedule two on the assisted dying. Line. Panel one requires that the social worker should take account of the financial dependence, potential financial pressure, and potential coercion from some benefiting sorry, benefiting financially from a person's death.

Now we heard the noble Lord, my noble friend Lord Debden refer to the Apophthegm earlier, but I first heard it and it from Lord the noble and learned Lord Lord Grabiner. Where there's a will, there's a relative. And this is a very important amendment, and I hope that the noble Lord and Leonard Lord, the sponsor, will consider it seriously. But on amendment 472 by Baroness Gray of Tottenham, on which I'll focus, it requires that the panel must ask the person seeking an assistant death whether they have discussed the matter with the next of kin.

Now, we've been discussing this in different ways today. At the very least, this requirement on which requires will prompt reflection about those most affected by this action. It may be that it will prompt such a chat by simply in virtue of asking it, which, as in the case of many suicides, the revelation being seen, and indeed is a plea for help from those who love you most. It would take an extraordinary perversity to refuse such an amendment, if that would be to ignore an opportunity to prevent perhaps the most terrible suicide of all, the deliberate planning to kill yourself through a lethal substance enabled and supported by the state.

And supported, I might add, with all the bureaucratic paraphernalia of permission and enforcement funded, as we've repeated in this debate, an earlier debate by the taxpayers, this would ignore the impact on those on whom you have depended, in one way or another in your life, and on whom you may still depend. Sorry.

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Thank you. Baroness Lawlor will know that there are quite a lot of cases at there are quite a lot of cases at the moment, and I have two in mind where the first that somebody hears where the first that somebody hears now of the suicide of those that they love is when they are told about their death. And I've got two examples in mind. One, Mr. Paul Blomfield, who described his father hanging himself and not involving hanging himself and not involving him because he feared that he might be investigated by the police, and the other is the wife of Stuart Broad's father, Chris Broad, who hoarded pills and as a result of not wishing to involve her, his husband.

The first he heard of it was when an email came from her. What does the Baroness Lawlor say to those people? Under the current law?

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They're not. Proposing a piece of legislation

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Proposing a piece of legislation at this moment and we are debating it. We are concerned about the it. We are concerned about the safeguards in the current piece. Proposed piece of legislation Baroness Gray of Tottenham has Baroness Gray of Tottenham has proposed that the panel, which is proposed that the panel, which is reviewing panel, must raise with the the person considering assisted suicide, whether they have discussed it with their nearest and dearest. That is a different matter to what the noble and learned Lord has raised.

We are discussing a piece of proposed legislation, and I am discussing an amendment proposed by another noble Lord. And and it's very important that those on whom we depend, or whom we may still depend or have depended, we form a society. And as human beings, we give to one another support and love a mother or father to their child, perhaps terminally ill, who who only wishes to support them through their life as best to live it as best they can, and a daughter or a son or a sibling who are supporting their loved parents, or sister or brother or a spouse or a best friend.

I don't agree with the premise of the the bill, that we are autonomous human beings to dispose of ourselves just as we wish. Whatever freedom we have as human beings is rooted in a network of social relations responsibilities, especially to our kith and kin. We need, therefore, to do whatever is possible to ensure that a person's ultimate decision to end their own life is taken within a familial and social context. And amendment, which I support, promotes.
16:49
Baroness Berger Portrait Baroness Berger (Labour)
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My Lords, thank you. I rise to speak to. speak to. >> My amendments 466 471 and 474 and also amendments 472 and 484. and also amendments 472 and 484. And the name of my noble friend, the Baroness Gray of Tottenham. And I'll make perhaps some different points on those specific amendments. These are all a form of amendments that were actually tabled but not debated in the other place, and all of which seek to strengthen the effectiveness of the voluntary assisted dying panels as a safeguard.

Because that is what we have been told. They have been put forward to provide. My first two amendments would mean that questioning both the coordinating or independent doctor and the person seeking an assisted death is mandatory and not at the panel's discussion. I think it's extraordinary that in light of all the evidence that we heard across the 13 panel sessions in the select committee, that this bill currently does not ensure that the panel asks questions of every person seeking an assisted death.

Noble Lords will be aware, as we've heard, that the panels were added to the bill in the other place, and it was done so two thirds of the way into the committee process in order to replace the High Court, which we were told originally was this judge led process, that proposal, that that process has never been piloted or consulted upon. And it appears to have been based on the Spanish system. They have a system of guarantee and evaluation commissions. But of course, the Spanish law is very different from the bill that we are scrutinising, which we have been assured is narrower and safer.

The Spanish system, which allows for both assisted dying and euthanasia, does not require a terminal illness from which a person is likely to die within six months, as in the bill that we are scrutinising, but only and in translation, a serious and incurable illness, or a serious, chronic and impossible condition. The Spanish legislation provides for considerably wider categories. And for those of us that are concerned about vulnerable people being made to feel that they are a burden, I'm sure that we're very glad that the sponsor has not proposed them here, but the requirement for a terminal illness with a six month diagnosis is only really a meaningful safeguard if it is properly tested.

And how can it be said that a panel has done its job if it has not asked a single question of the doctors? And how can it establish that the person has not been pressured or coerced just by passively hearing their prepared statement, which may have been drafted under the eye of their abuser? In what way is any of this a suitable alternative for the rigour set out in the first iteration of this bill, which included the High Court? Which is why I believe that these amendments are necessary.

This concern was expressed very well to the Lords Select Committee by Doctor Luke Gergen. He represents the British Association of Social Workers, and he set out the following about how safeguarding usually works in this country, and how this differs from the approach of the panels, which is currently set out in this bill. Doctor Gergen said, and I quote, an allegation is made or a concern is raised and that concern is investigated, and then that allegation or concern is either upheld or it is not.

The challenge for the panel, the voluntary assisted death panel is here. This model is flipped. Can we be sure that this person is not affected by safeguarding or coercion issues? It is often impossible to prove a negative, but we can make reasonable assessments on the balance of probabilities. The real issue here is that the panel system means that there is no other side. Seeking to show that the test for eligibility has not been met, and there is no cross-examination of the witnesses who say that it has, in the absence of such a legal process, usually the hallmark of our British system, having the panel at least ask some questions of every applicant for an assisted death is surely the absolute minimum that must happen if we are to have confidence in it as a safeguard, amendment 474 would make a more discretionary change.

It would add a requirement to consider hearing from a person's family and other treatment and care providers. And I would just like to reiterate that the amendment as set out, is not mandatory. Family members, I should just set out in advance of kind of explaining this amendment to provide perhaps a counter view from some of the things that we've heard so far. We've heard the discussion about family members in the context of agency. I want to talk about it in the context of the variety of autonomy, and also in the context of establishing coercion.

Family members and those who have provided care for the person are really likely to be privy to information that has a significant bearing on the panel's deliberations and decision. Perhaps a son or daughter knows that someone new has recently entered the life of their vulnerable parent, has slowly taken control of their finances, and has encouraged them to cut contact with others. And I set out this point, reminded by the evidence that we heard from age UK and the existence of a number of different types of abuse, but particularly romance fraud, we heard that age UK had been contacted by families who say and I quote, hang on, I'm really worried that there is this person, my mother or father's life.

I'm not sure what their intentions are. Evidence went on to talk about, and I quote that about the moral hazard for people who stand to gain from an older person in their death, perhaps a carer who knows that the person has struggled with suicidal feelings long before their illness worsened, or knows the reason behind the source of their despair, or perhaps while quietly attending to the needs of their patients that they are responsible for. A carer has overheard a friend or family member suggest to the patient that it really would be easier all round if they were to end things at this time, sooner rather than later, and with the help of trusted professionals.

And I know that we'd like to think this doesn't happen. I've spoken already in this House about the first hand experience of hearing, unfortunately, how that is unfortunately the case in some instances. And I'm aware that there is a power in the section of the bill to hear from any other person, but this has left so open as to add little in the way of assistance or direction to the panel. My amendment responds to the evidence we heard from the professional bodies, and provides that explicit steer, while still allowing for the panel to conclude that additional evidence is not likely to be helpful, or that the process of seeking it would be too onerous.

I also wish to speak in support of amendments 472 and 485, in the name of my noble friend Baroness Gray, who unfortunately is unable to attend today. Amendment 472 would require the panel to ask the person whether they have discussed their request for an assisted death with their closest relatives, and to discuss the reasons if they have not. Amendment 485 makes provision that this requirement would not apply in the exceptional circumstances where a panel chooses not to hear from the person.

These amendments, like mine, seek to highlight the vital insight that family members may have into the person's wishes or eligibility. If the panel is able to place the person's request for an assisted death in the context of their relationships, they're more able. They're more likely to be able both to understand and undeclared motivation behind the request, and to detect any coercion or undue influence. As the bill has progressed, it has frequently been noted that doctors rarely make serious decisions on their own.

The sponsor, my noble and learned friend, has acknowledged this, which is why the panel itself is so often referred to as multidisciplinary. And I must note here the expertise of the noble Baroness Finlay and Baroness Cass and others who rightly point out that the medical assessments themselves should also be multidisciplinary. But it is also true, as we heard at the Lords Select Committee, that patients rarely make decisions on their own. We heard from the Royal College of Psychiatrists that there is, of course, very pure personal autonomy where somebody makes a decision, aren't influenced by anybody else, but that does not reflect the way that people usually make decisions.

People usually make decisions as part of their relationships with others. That is very normal. Professor Charles Foster told us that in the real world, decisions about how we exercise our autonomy are made in the context of rationality. We discuss it with our relatives, we discuss with our relatives what should happen if someone is choosing not to tell their immediate relatives or loved ones about such a momentous decision as ending their life prematurely, that is noteworthy. There may be good reasons for it.

As set out by my noble friend Baroness Hayter, but that should be for the panel to establish these amendments. Do not offend against autonomy. They do not oblige a person to tell their family or friends anything, but they would enhance the information available to the panel and so move it further towards being an effective safeguard against coercion and undue influence, or an otherwise unwanted assisted death. And a secondary point to these amendments is to make it at least a little less likely that families will have to go through the trauma of finding out about the death after it has happened.

Our select committee was told by the Royal College of Pathologists that in cases where death is unexpected, families often find out about the death of a loved one when they receive a call from the medical examiner, and if passed, this bill is likely to increase the number of cases where that happens and will put a great strain not only on families themselves, but on the professionals who find themselves in that position. I'm conscious of time, and it's worth reflecting, and I'll enable members to look at the comments from the Royal College of Pathologists as that was explained to us.

I would just say that these amendments, 472 and 485, seek to minimise these impacts as far as possible. They do not create an obligation on the person to involve their next of kin, but they might encourage them to have the conversation if they feel able to do so. And ultimately, the more information that is available to the panel about a patient, their circumstances and their relationships, the more confident we can be in the panel's decisions and in the regime that it would create.
17:00
Baroness Fox of Buckley Portrait Baroness Fox of Buckley (Non-affiliated)
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My Lords, listening to some of the schemes that have been put the schemes that have been put forward, quite intricate schemes, sophisticated about the nature of sophisticated about the nature of the panels. And I was thinking when I was listening to the noble Lord Lord Sandhurst, you know, how fascinating it was, the kind of things, the kind of ways that the Law Society approached this. But we've heard a lot of very fine speeches, every everything from the size of the panel, the powers of the panel, whether they should have investigatory, prosecutorial, even quasi judicial panels.

I suddenly felt like I was in sort of some episode of, of CSI or something. And I thought, they're only panels at this stage. It's getting so demanding and so confusing, potentially so overlayered and bureaucratic, that I thought that we should maybe take a step back. Now, I, I'm very sympathetic to why this has happened, because it's driven by safe by the desire for safeguarding, is driven for a desire that these panels have teeth and it's created by the loose wording in the bill, poorly drafted, in my opinion.

That then means that people are going, well, what are these panels able to do? What should they be able to do? And can we kind of fill in the dots? But anyway, I want to go back because I more simplistically, if you want to take at face value the panels as described by the sponsors of the bill, three members of the panel, a social worker, a legal person and a psychiatric, and a psychiatrist or somebody from the psychiatric profession and say.

What do we expect of them? And the reason I want to do that is because I do think that just announcing that is not sufficient. And so I raise why. So I've got my name on amendment 95, A in the name of the noble Lord, Lord Murray of Blidworth, who I thought explained very well what he was trying to do with his amendments. I think it creates what I think is needed is a process for how you end up on a panel.

If you're one of those three people that the sponsors want, and what amendment 95 does is it sets up an independent appointments process. It talks about appropriate tests, it interviews people, there's vetting and so on. And I do think that is very important because the one thing that we do know from all these speeches that we've heard is that these panels are going to be important. They're making important decisions, and you can't just kind of say, you know, you can't an ad in put the paper.

Are you a social worker call in? I mean, what's you know, we've got to think what is being required of them. And so I would say that the noble Lord Murray has done a real service by just quite straightforwardly saying, this is, you know, we need to have a system and that this is necessary or by no means sufficient to counter any risk that panels would be inadequately staffed by the wrong people, if you want, or by inappropriate people. And I think to fulfil the aspirations of the the Bill sponsors and it's absolutely necessary, I think, to counter any notion that panel members are just, yes, men and women who've kind of turned up on the panels.

We need to know that they are of of the right calibre. In my opinion, the role of panels is not only crucial in terms of safeguarding for those who go down the assisted dying route. And I and I, I think we've heard some very important speeches about safeguarding, but also I think we've got to consider that a proper process is required to to protect panel members themselves from potentially what's likely to from the blame game.

Now, I, I, I do have some qualms about the, the privacy issue that the noble Lord, Lord Jackson of Peterborough, you know, raised some issues, conceded there might be some problems with it. I was a little bit another of those testy exchanges with the noble Lady Baroness Hayter, but I but I actually think we have to consider both sides of that exchange as being valid, because I think that the panels themselves are going to have to do to take on some difficult issues.

And I do, if you remember, I'm sure that the noble Lords, the noble and learned Lord will remember. I thought it was a tricky exchange being referred to here on Newsnight last year when he was asked about a situation where there could be a 21 year old who had successfully requested an assisted death, and then their parent would only find out about it after they were dead. And reference has been made. Well, that would happen with suicide. But in this instance, the difference is that that heart broken, you know, grieving mum and dad or family members would find out not only that their 21 year old child is dead, but that they'd been to a panel of social worker.

And so they'd been all okayed and they didn't know about it. And I think it's only fair to to note that they would want to know exactly on what basis that panel made the decision they'd start asking. They could be all sorts of they'd say, what are the qualifications of people on that panel? And that, by the way, that 21 year old has to be said, could be a learning disabled or a somebody with Down's syndrome or someone who had a previous history of mental illness, who had tried to commit suicide in the past.

And then any of those people who were similarly ill could actually be granted by that panel. The right for assisted death. So you can imagine all the multiple scenarios. So I thought of that because I remember at committee in the other place and the Labour excellent, thought provoking contribution, which he said when such cases happen, the public, including family members of the person who has died, will rightly demand answers and so will the media. They will want to know who the panel members were, they, why they made the judgements they did, etcetera.

And there's a lot at stake here. So I don't necessarily go with the noble Lord. Jackson's kind of like everything should be in the public, but there will be demands to know what's going on. Is it being hidden away. And so I do think that the way that the amendment that I've been talking about sets up a process will, in the end, protect people, because I think otherwise panel members are likely to be on the receiving end of some intrusion, whether they like it or not.

And I think that we also have to make sure that that they're the right people on the panel. I also just wanted to raise staffing these panels. These are this feels like very banal after some things that people have been talking about. But is there enough social workers around and psychiatrists around to go on the panels? I mean, this seems to me to be a rather practical problem before we get anywhere. I mean, I think that, you know, at the moment, in terms of professional panellists, I think there's one psychiatrist on each panel, as we know.

And yet, in the most recent workplace, workforce data shows that 1 in 6 consultant psychiatric posts are unfilled, so that shortfall must cause problems, the Royal College of Psychiatrists has said. As things stand, mental health services simply do not have the resources required to meet a new range of demands. So I'm just worried that if the commission struggles to find enough psychiatrists, the temptation will be to appoint anyone available and willing who can be tick boxes under the mental health professional box.

And I mean, that's a bit nerve wracking, which is why, again, this sort of interviews, qualifications and so on, I think is important. The same resource deficit challenges exist in terms of legal members who are, after all, we're told, were kind of replace judges in a way, according to the noble and learned Lord. But who are these legal members? I mean, where will they be found, given the immense financial and resource constraints on the justice system that are so bad? We're told that the government is embarking on judicial vandalism, in my opinion, in sacrificing jury trials.

But, you know, if working, if there is a problem of scarcity, what is the guarantee of recruiting real legal expertise to the panel? And then finally, over the third panel member, the social workers, given what the British Association of Social Workers have said, that the sector is at capacity and has noted that the panel proposals is not resourced. Right. I think you can see there could be a problem and these shortages of all three panel member professionals is not evenly distributed throughout the country, by the way.

So a question for the noble and learned Lord, Lord Faulkner is what about a postcode lottery? What if you can't find a legal and social worker and psychiatrist in one part of the country where there's a great need? And has he consulted as the sponsors of the bill, consulted with the likes of the Royal College of Psychiatrists, the British Association of Social Workers, about workforce pressures? And my final question would be to the Minister with regard to the panels, what assessment has the government made of their workability, given the problems raised by the professional bodies of social workers and psychiatrists? If there aren't enough people available, surely the panels won't be workable and therefore this part of the bill needs to be sorted out.

Otherwise there's no point passing it as it stands because it'll never happen.
17:10
Baroness Hayman Portrait Baroness Hayman (Crossbench)
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I'm pleased to follow the noble. least because I often don't agree with her, and I did agree with several of the things that she has just said. She started off by saying the dangers of intricacy in what we.

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Lay down on the face of the bill about how the panel should conduct about how the panel should conduct themselves. And the more I listened to the speeches and the more I read to the speeches and the more I read the amendments, the more worried I was again about not only the overbureaucratic nature of this and the overengineering of the processes that the noble Lady referred to, but also the invasion of privacy on many levels that's concerned here.

I think we all recognise the role of the panels in safeguarding against abuse, but there will be a range of people. I was thinking of how I would feel on one of those panels being interrogated along the lines of some of these amendments. The amendment in the name of the noble Baroness Baroness Gray of Tottenham, says that I must be asked whether I have discussed the request with my next of kin and any other persons I am close to, and where they have not done so, to discuss their reasons for not doing so.

I think that is way too intrusive and way beyond a way of finding out whether I have been coerced in these situations. I really think it is much too far. I think it is overengineered, and I don't think in the words that we started off with today, it is kind to the majority of people who will be seeking in circumstances that they find intolerable, the way in which they are dying, they find intolerable.

Not that they want to end their life, that they wanted to die, but because they are dying. And I find the whole tenor of this conversation is not thinking about the people who are going to be involved in this process and subject to this process, and I think we have to think about that as well and balance it with the sort of protections that are needed to make sure that bad things don't happen within these processes.

And I must say that I was also surprised about the sort of level involvement in the noble Lady, Lady Findlay's amendment. And she and I agree on on many things about children and the information of children. This is desperately personal stuff within families, and the idea that not only should you be consulted, why you haven't spoken to a child about this, but that you should have to nominate someone else to. Report your death, and then that you should make sure that there are bereavement services.

Now that to me opens up a whole area, just like palliative care, bereavement services are very patchy all over the place. They vary tremendously. Why should this category of parental loss be subject to the obligation of the state to provide bereavement services as against every other sort of parental loss? When? When my father died, a psychiatrist who was working at the hospital that I then chaired said to me, however old they were, and however old you are, the loss of a parent is a deeply emotional and important event in your life.

I'm sure there are many different circumstances in which children are bereaved of their parents, but there are other relationships as well. The obligation is to talk about children in this amendment. What about talking about your husband or your wife, or your partner, or the person who's meant most to you in your life? And people say, yes, it should be the person who meant most to you in life. Therefore, the panel's got to find out who means most to you in your life.

This seems to me that we are really going into a granularity on this. That is not needed, and that actually is not very kind.

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I want. At this point, firstly, just

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At this point, firstly, just factually, to point out that the amendment that I had put down does not state bereavement services. It not state bereavement services. It states support. That's completely different. The second thing.

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different. The second thing. Definition and that then we're going to have to define what is support and how that is different from bereavement services. And then complications.
17:16
Baroness Finlay of Llandaff Portrait Baroness Finlay of Llandaff (Crossbench)
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Perhaps it might be relieved to know that I don't intend to take my move, my amendment. I'd like to speak to it now, and I then will not be moving it just in terms of the next of kin. Routinely, when you go into hospital, you are asked who is your next of kin? That's a routine question and it's entered in your medical record. It has no legal status. That person has no legal status in terms of making medical decisions, although they may be consulted if a best interest decision has to be taken.

Sorry, but if you die, that will be the person that the ward will phone to say that you're dead and that your body is going to be moved to the mortuary, and that will be the contact number that will go for the medical examiner to phone you later, which was the point that I think the noble Lady, Lady Berridge, was trying to extract. I think it was very helpful that the the noble and learned Lord Gold Faulkner described the shock of discovery of a death that you didn't know about, because the shock of the discovery of a death has been described by relatives who suddenly discovered that their parent had died by some form of assisted suicide or euthanasia when they hadn't known about it beforehand.

And that is documented. And the other thing which I think is worth remembering is that there is no evidence that suicide rates fall when these type of assisted death services come into play. But there is evidence that when people get the care they need. Suicidality i.e. thinking about ending a life early does fall. So people do need to have care. Anyway. If I may speak to my amendments now.

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To amendment 459.

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To amendment 459. I. I had already spoken to amendment 459. I'm finishing off amendment 459. I'm finishing off speaking to 459. If I might move to speaking to 459. If I might move to 475 and 939 in schedule two, there is concern over the operation of is concern over the operation of the panels and safeguarding responsibilities. Just in terms of the information that comes forward. So they would allow someone with relevant information to come forward to the panel with appropriate evidence and to be afforded whistleblower protection in the type of situation that the noble Lady Baroness Berger described, where there is a new person on the scene who others may feel has got malintent for one reason or another.

In the bill's current model, medical assessments that have gone before to the panel will not be monitored contemporaneously. They could be poorly reported, they won't be reviewed, and it could hide errors, unconscious bias and discrimination. So the role of the panel will be to issue a certificate. If I go to amendment 493, I've suggested that that certificate should have validity for six months. But in the event the person does have a longer prognosis and we have many examples of that, that it is actually renewable rather than having to start the process again because they've outlived their prognosis.

However, the appeal mechanism to a panel seems to be one sided in that the person can appeal against a refusal, a refusal to give them a certificate. But there doesn't seem to be a mechanism for appeal. So my amendment 499 has attempted to allow information to be brought to the panel that they may not have known about at the time, that they gave a certificate relating specifically to domestic abuse that had been hidden to coercion or pressure to any information that the diagnosis may have been wrong.

Recent emotional or psychological trauma or depression or metabolic disturbance, which might have disturbance, which might have impaired capacity. My amendment. Sorry, I've. I'm slightly distracted. My amendment 932 is just a very practical one concerning the provision and distribution of panels around England and Wales, because it hasn't been clear how many panels there would be, or that there needed to be fair distribution. So I've suggested that there should be a minimum of three per region in England and a minimum of three in Wales.

I think, for the geography and topography, the topography and population, the three would work for Wales, but there will be areas of England with high population density or very large rural areas that would probably need more to enable the panel to visit the patient face to face for an assessment, because it's completely inappropriate, it seems to expect a patient to go to see a panel when they're already ill, or to rely on remote consultation rather than having the ability for face to face discussion.

And those face to face discussions must be subject to the confidentiality that you would expect in any medical consultation. So the thought that this would be publicly available, I don't. I hope that we will not be suggesting that. I would just suggest that, as has been said, these panels came in two thirds of the way through and a panel can take testimony from others. But as the Minister of State for Courts and Legal Services on the 12th of March last year, in committee on this bill, said it is not a court or a tribunal.

They can make the request, but they cannot compel somebody to attend in terms of getting information about the person.
17:23
Baroness Grey-Thompson Portrait Baroness Grey-Thompson (Crossbench)
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My Lords, I just want to pick up >> My Lords, I just want to pick up a couple of points that have already been debated this afternoon and those raised by the noble Lord Lord Weir in terms of the impact on disabled people, I seem to have completely failed in all the debates to get across the fear that disabled people feel. With this bill being debated, and if I look at the case in Canada of Jennifer Hatch, she had Ehlers-Danlos syndrome, and a consequence of that, she experienced organ failure and was approved for Maid.

And it made me think of the letter that noble Lady, the Minister Baroness Merron, wrote to noble Lord Lord Moylan this week in terms of a combination of illnesses, would actually enable a person to qualify for this service and that is why disabled people are so worried, because the combination of their disability and other conditions would actually make them eligible, even though we've been told there's nothing to worry. So I was wondering if the noble Lady, the Minister, could confirm what I understand.

Baroness Merron wrote to us was that a combination of impairments would actually enable somebody to to enter. I really strongly support the amendment by the noble Lady Baroness Keeley. And I think that's really important because another case from Oregon, Joan Lucas, who had ALS and was approved for this service, her children filled out the form, which there was no question about it. They just took it and she was approved, which I think is is quite worrying. And I thought it was really interesting, the debate on somebody dying by suicide.

And I'm going to use this dying in this context, because one of the reasons we're told we can't use assisted dying is because dying by suicide. And this process is completely different. I've just not really sure that we can have it both ways. I think we need to give a little bit more thought to that, and I am. I do get quite upset when we're constantly told people are dying anyway. And I'm really sorry the noble Lady, Lady Hayter, but I think we have to find a better form of words.

People may be dying, but the process and the experience they have as they go through might vary considerably. And I think sometimes the language that we use in the chamber can be quite dismissive, certainly, of the amendments that we're trying to bring to make this bill safer. And we still don't ever seem to hear the word safe. We just hear workable all the time. My amendment in this group is 9 to 4, and it's about protecting older people and being able to make sure that any abuse or risk of coercion can be assessed.

And it's really about how the panels gather this information. It's already been mentioned. The British Association of Social Workers have said that the safeguarding is not enough. Hourglass have said that 1 in 5 of over 65 year olds have experienced abuse. And on the 15th of June last year, which is World Elder Abuse Awareness Day, there was calls from numerous organisations to do more. The British Psychological Society has said that elder abuse is a hidden epidemic and the scope is huge physical, emotional, financial, sexual.

There's also neglect and self-neglect. And while the Domestic Abuse Act of 2021 does give a framework, challenges still do persist of social isolation. Caregiver abuse, the power dynamics and again, back to financial abuse. So the role of professionals in this is really important and how they report back. And I absolutely understand what the noble, my noble friend Baroness Hayman saying about not making the system overly complicated, but I think we have to find a holistic way of of supporting people.

Safe lives said that older people experience abuse for twice as long before seeking help as those who are under 61 years of age and age. UK last year reported. The fact that older people are overlooked by policymakers, service providers and programs that are designed to support victims and survivors. And until 2021, people over 75 were not even asked about their experience of domestic abuse. So lack of data means that there's an assumption of actually who is being abused.

ONS introduced new survey questions, which renders comparison nearly impossible. And of course, the perpetrator of the abuse could be an adult child. What we found out is women are women are at higher risk from their partners, and men are at higher risk from adult children. And many organisations have talked about the need for professional support. And this is really important. I do slightly wonder when I'm sitting in the chamber when we talk about older people or people becoming older at the age of 61, where the average age of the House of Lords is, I still believe 71, and everyone is incredibly active.

But this is not the real world, and I think we have to be. I'm so many levels. This is not the real world. Sorry, I didn't mean to be funny, but you know, we're using old data or data that's incomplete. The data that I found, which is from 2017, 2018, 139,500 women and 74,300 men aged between 60 and 74 experienced domestic abuse. My Lords, they are huge numbers. Hourglass estimates that 2.7 million older people experience abuse, and in Australia, the Royal Commission for Aged Care Quality and Safety said that 39.2% of older people experience neglect, emotional and physical abuse.

I'm very sorry that my noble friend Baroness Hollins isn't able to be here today because I think her experience of assessing patients and probably the thousands of patients that she's worked with would be quite important. But we were told by the hon. Member for Batley and Spen, Miss Leadbeater, that there will be detailed conversations. So not to worry, because those detailed conversations, but I have to question what these detailed conversations will look like. I think my husband and I have a very different view on what is a detailed conversation, and just to cover the panel's very briefly, I have no experience of panels like this.

The only experience of panels I have is for Olympic and Paralympic selection and very, very different. But you're talking about someone's life in sport and potentially, you know, their career can be ended by a decision that's made. I'm in no way conflating these two things, but in that process, an athlete who hasn't been selected is only able to appeal the process, not the decision. And that's a really important thing because most athletes never understand what they're trying to appeal to get to go to a major games.

So I think that it needs to be very clearly understood. What that appeal process should look like. The Royal College of Psychiatrists were not consulted on the panel. I think we have to be very clear whether they're operating to a balance of probabilities. What if the individual wants a family member there and the family member doesn't want to be there? And I think we have to look deeper at the standard of investigatory knowledge that is required. But Professor Monckton in evidence said, you know, we're always told it's it's about more training.

Every time a disabled person has a failure in transport, whether that's trains, buses, taxis, we're told the answer is more training every time there's a failure in education for disabled person, we're told there's more training. If it's a Senedd failure, more training, if it's a housing failure, more training, if it's a DWP failure, it's more training. And I don't think in this case, more training is necessarily the answer. It is the right training. How much more training do we need? And coming back to the beginning about why disabled people are worried because in so many cases, lack of training is either used to almost get away with poor service or to actually hide how disabled and older people are treated.

So I think this is a really interesting and important group of amendments, and I think there's still far more work that needs to be done in this area to make the bill safe.
17:32
Lord Harper Portrait Lord Harper (Conservative)
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Speak briefly to the three >> Speak briefly to the three amendments that I tabled in this group to start off with. So first group to start off with. So first of all, amendment 472 A, which slightly tightens up the requirement for the panel to speak to the person's proxy where they have a proxy. Currently, the way the bill is drafted, they may speak to the person's proxy, but I think they should speak to the person's proxy. It seems to me that there's no criteria set out about how they make that distinction, and given that the person's proxy will have signed the declarations which kick off this process and I think they should speak to them, I don't anticipate that being a very long conversation.

But I do think it's essential that that they do so. So that's amendment 472 A and amendments 495 D and 496 D reference the appeal mechanism. That's in clause 18. And it simply sets out a time limit which is in line with normal tribunal and administrative appeals that somebody has to appeal against the panel's notification of the refusal of the grant of a certificate within ten calendar days. I'm not going to labour the point that I just think that's sensible to have a time limit to make sure there's a clear process.

Now, my Lords, I had intended to limit my remarks to that, but obviously I've done the dangerous thing of actually listening to the debate, and I did just want to reference my noble friend Lord Jackson of Peterborough amendment, because actually, I think it does actually highlight and I think it came out in Baroness Fox contribution as well as well as the noble Lady Baroness Hayter is perfectly reasonable difference about exactly where we need to have transparency and balance it against privacy.

Now, I have to confess, Baroness Hayter is perfectly at liberty to disagree with Lord Jackson, and she obviously does. I was surprised that she appeared to take against his in, even just having had the temerity to table his amendment and look shocked, because the presumption in the in the bill as drafted, as far as I read it, the presumption in the bill is that the and this is in the, in the, in schedule two, that the panels are to determine referrals in public.

That is their default

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procedure. They of course, I'll give way. And then say what I said to my noble friend in private, which was had we been doing this bill in the sort of speed that I had hoped we sort of speed that I had hoped we would do, I would have been put down, put down an amendment that it should be in private, because my personal view is it should be because of the way things are happening and say, no more. I happening and say, no more.

I haven't put down those sort of amendments.

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So but it enables me, though, just to make this point, because this is where we do actually have a disagreement. And I think it disagreement. And I think it therefore gives the sponsor of the bill the opportunity to set out why bill the opportunity to set out why the bill is drafted as it is. I'll set out why I think my noble set out why I think my noble friend's amendment is broadly right, but also perhaps there's a comparison of what we already do in similar cases, which, again, may give the noble Lord Carlile the opportunity.

You may not wish to say so, but it will be another told you so moment, I think, because it's a judicial comparison. So the the presumption in the bill is that panels will do the referrals in public. There is a there is a, there's a subject to, to that, which is that the chair of the panel can decide to do it in private if they feel that is appropriate. Now, I accept there is a there is a balance to strike here because obvious reasons.

These panels are making decisions about person and private matters. But it is also right. I think that that you do have some transparency. Now, Lord Jackson's amendment had quite a big window 28 days to publish that notice of of the panel meeting. It also said it would include the name of the person. Now, the comparison I looked at, which I thought was a reasonable one, was to look at what the Court of Protection does, which makes decisions about sensitive financial and welfare matters.

Now that's changed over time. It used to be the case that the Court of Protection's presumption was that it would sit in private and and not hear cases in public, and that's changed over time. And the presumption now is that cases are heard in public. And again, my understanding is that there is the ability for the the judge presiding on those cases for them to be in private, if that is felt to be necessary, and even where they're in private. I understand members of the public can make applications to go and listen to those cases.

Now, the bit where now I think that is all right and proper and that's that that appears, I presume, to be when noble Lord, Lord Falconer is nodding the sort of of course, no, no, absolutely.

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Issue this this is the let me say what I think the purpose of say what I think the purpose of this is, so that it can be properly debated. The panels should the norm, and the noble Lord Lord Harper is and the noble Lord Lord Harper is right. Should be it sits in public. But it's such a thing that should But it's such a thing that should be determined by the the patient. If the patient says he or she wants it in private and they very, very regularly will, then the chair can say, OK, it's in private.

And the expectation would be that it would normally be in private. If the person asks. However, there's still a discretion in the chair. It's not like the Court of Protection where what the where, what the judge in the Court of Protection is doing is making a decision in a much wider public interest. The reason it's drafted like this is there does need to be some transparency, but if the person wants it in private, they should generally be entitled to have it in private because it's so personal.



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In a sense, because it's helpful to have fleshed out the noble and learned Lord's intention. It's not helpful in the sense that he's made helpful in the sense that he's made the bill less attractive to me than I had thought it was, because I thought the presumption was more in thought the presumption was more in public. Now, the thing. You know, I public. Now, the thing. You know, I do know the reason why I'm I partly agree with my, my, my noble friend Lord Jackson is I had a look at Lord Jackson is I had a look at what the Court of Protection does in terms of the publicity, the bit, the noble Lady Baroness Hayter objected to.

And what they do is they do publish hearings. They do them in advance, but not not 28 days. But what they do is they don't publish the full name of the individual, they publish initials and they publish what the case is about. So the the broad category of decision being decided now, it strikes me that that's quite a good balance that that that does provide transparency. But it may be avoids the the the question Baroness Hayter what she concerned people might come and want to watch a spectacle.

But I do think there is some necessity to be in public. And the reason for that is also that what set out in the bill, because the bill says that the panels must hear from and may question the coordinating doctor, must, subject to subsection six, hear from the person to whom the referral relates. And I do at this point agree with Baroness Berger. I think that should absolutely be a must. There shouldn't be an exception. And if it's the case, as I understand from the noble Lords, his his and his appearance on a media programme that would.

The exception is designed for cases where the person's medical situation is very severe. They shouldn't necessarily have to come to the panel, but at least one member of the panel should absolutely still have to go and talk to them. I really don't think it should be OK for the panel to authorise somebody to have an assisted suicide without ever having spoken to the person

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concerned, of course. Doing this, but I mean, the person will be at home very often person will be at home very often and bedridden, and we're actually expecting that a panel would actually go to their home into actually go to their home into their bedroom and do this here. I mean, again, this isn't the sort of world that I know from some of the people who I see living in, in, in surroundings, that it would be quite difficult even to put a spare chair into their bedroom for someone to, and they could be on oxygen or whatever for someone to

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to see it there. Well. I it's. Difficult issues but we are the panel is being asked to authorise panel is being asked to authorise their death. So this is a serious issue. I accept that that's uncomfortable. And I'm not suggesting the entire panel would rock up at their home, but at least one member of the panel ought to one member of the panel ought to have to talk to. And the idea that the panel would authorise somebody to assist their death, and never having spoken to them, I think having spoken to them, I think would be, frankly, appalling.

So I as I said, I well, let me just finish because I want to stick to time, although I'm conscious noble and learned Lord didn't nick a bit of it for explaining to the house, but so let me just finish. So I think, I think the amendments that have been put down are very helpful actually, because we have fleshed out this very sensible issue about how much should this take place in public. And I think the other reason for it being in public, just to conclude, is because otherwise there are two groups of people the panel is asked to talk to, and they may hear from and may question any other person and may ask any person appearing to it to have relevant knowledge.

Now, the problem is, if these hearings are done in private and no one knows they're happening, I don't know how the panel is supposed to know who any of these people are, and these people are not going to be able to make themselves known to the panel. So there's a clear argument about where you draw the line, and there's clearly a balance to strike between openness, transparency and privacy. But it seems to me that that is a good debate for the House. And I want to hear about why where the proposers thinks that should be struck.

And we have heard a little bit of that, and we can hear a

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little bit more about that later before. He sits down. Could can I just very quickly just say that I'm conscious of the time? It's nearly a 5:45. So I think it's quite clear this debate is not going to finish tonight. is not going to finish tonight. We're going to adjourn with group, which is absolutely fine. But I would think that maybe the question from the Order, order Jackson, from the Order, order Jackson, maybe one other contribution. And then probably going to have to

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adjourn then mid group. Thank the Chief Whip for his
17:43
17:45
Baroness Coffey Portrait Baroness Coffey (Conservative)
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Lord Dobbs I tabled a handful of amendments. A couple to do with amendments. A couple to do with clause 17 and then some more to do with schedule two, and I think it's fair to say it's perfectly acceptable for the noble Baroness Hayter of Kentish Town to be appalled by some of these amendments. That's OK. That's her perception. That's her reality. And it may not be what my noble friend intended, but we are dealing with very serious situation. My noble Lords have talked about how finding somebody dead.

Well, of course, it would have been devastating if the if the family around them had not known that somebody was thinking the only way life could get better is if they didn't have a life at all. And that is why some of the aspects about whether it's aspects about bereavement services, connection to next of kin, to have that contact, to see if there's a way that where somebody is in a very dark place is terminally ill, or doctors have suggested they've got less than six months to live, that's still quite an interesting area that we're discussing about where, what's the tipping point for somebody to choose to accelerate that, to take that poison and for the state to help them do it without being in touch with the next of kin? Now, I know there are other groups.

We'll be getting to that in more detail, but this is why it has become so sensitive. I look, I haven't. I held my mother's hand as she died. She had less than a month to live and we looked after her. My other my dad. Sorry, that was my mother. My dad actually died while I was on a plane, and I found out when I landed in Heathrow airport. So I can't watch The End of Love Actually, because the end of love Actually is everybody meeting their families.

It's the most I've ever cried in my life and have to switch off the film before the end. But so these are very significant moments, and I'm conscious what people have, noble Lords have said about whether they should be in public or not. I think the balance should be it should be in public because we are having this effectively quasi judicial process, which is at the end of a line to some extent, of making sure that somebody is doing this of their own volition and not being coerced.

And that's why all the different safeguards are in. So one of the things that I've put in for data is, and I appreciate the noble Lord, perhaps next time we'll speak to his amendment for 80, but it is referring to how the panel will operate. And I do believe that an audio link is not enough in terms of discussions with the coordinating doctor. The person doing it, and indeed the person's proxy. So in person or by live video would be good.

And then my four eight, three see is because in subsection five this amends subsection five where it says it may make the panel considers it appropriate for medical reasons. It may make provision for the use of pre-recorded audio or video material for the purposes of subsection four. And I can completely understand that, but I would only understand it for the person applying. I don't understand why a doctor, the coordinating doctor, would not be available to go in person or a video link in order to have that interaction with the panel.

So I've chosen to put that amendment in at that point. The panel's a really important part, and it's why schedule two is vital to get to the bottom of my noble friend. Another noble friend asked me to say, ask the sponsoring member whether or not there would be immunity from suit for the for the the panel members. But I wanted to get into a few amendments that I tabled there. And some of this is coming from I'm trying to work out how this is all going to work.

I actually see this very rarely meeting in person. I very I see can see this evolving quite quickly. It will all be done by zoom or teams. And that concerns me. It really does. But if the intention is this is going to be available effectively, probably 365 days a year. I'm trying to get a sense of how this is going to work, and I appreciate the government won't want to answer that unless they haven't done thinking. But somebody has done the thinking because this is what the legislation is about.

We've now gotten parts of schedule two where panel members even started talking about they can have pension contributions. Who is going to be doing these roles? Is it going to become a full time job? It's one of the reasons why I've put a suggestion 99 be it's just a number maximum of 25 years for panels. I don't know if that's a panel per day or a per day, or whether it's a multiple people be in a panel or whether it's a one off panel.

I think the Law Society and its written evidence to the Commons suggested they think it should take a day per panel, per application. I think the government has costed in in its equality impact assessment. Two hours is their estimate. So I'm trying to get a sense of who is going to be doing this. And actually I haven't put an amendment in about this, but will there be a register about who is there? I don't want this to become a thing for, dare I say, vigilantes to go and try and intimidate people.

But there is a sense of how we do some of the vetting, which I won't repeat. What my noble friend said earlier. I'm also genuinely concerned that we're going to make this an international element. I don't mean about the person applying necessarily. We've already covered that some time ago, but the people on the panel, that's why I've put things like a judge in England and Wales, you can be a King's Counsel and be in Canada or Australia where there are other all these other things.

That doesn't stop at the moment in law. That being the case now, people might think I'm over imagining things, but I'm trying to be precise about what the law allows and try and understand how it might work. And if I'm wrong, that's fine. I'm happy for it to be said on the floor of the house. That's not going to apply, but I want it to be on the floor of the house so that if anything does evolve like that, we can start the judicial views to stop that practice.

So there's a couple of things here. In 91 ZB I suggested it doesn't need it shouldn't be King's Counsel. I was actually inspired by that by the noble Lord, Lord Wolfson of Tredegar, in his Second Reading speech. But it did make me think a little bit more. I'm not trying to do this, as hardly anyone can do this role. What I'm trying to think is why we talk about high judicial office being needed. You know, a pretty high level judge or a KC without being too rude to cases.

It's not exactly the same comparison. There are plenty of other deputy court judges, district judges, who all are regularly used to having this arbitration approach in effect or tribunal approach. So I don't understand why we've limited in one sense of that or it be a case. And then 9.3 two A, I don't see why the lawyer is the person who has to chair it. This happens quite a lot in decision making bodies. In government. Things just evolve. The reason why the Local Resilience Forum in Buckinghamshire is actually across Oxon and barks.

It so happens by default, not in law, but in practice. The Chief Constable always is gold command. It's always the police that run it. So therefore what's happened over time in practice is that the Lf is across those three counties automatically. And so these sort of things start to become habit, start to become the way it's done. And it can't be changed. So I just want to be clear, I don't think in any way I understand why it should be the lawyer making the decision as the chair of the panel, I don't understand why it should be the legal person who gets to determine whether or not the sitting should be in private.

So I think that's an unnecessary addition in that regard. And then finally, in line 33, a what I've suggested is that if I prefer would prefer the panel to be in public, I completely understand the sensitivity. So I've suggested in line 33 A that it can sit in private in or the impact of. My amendment is designed to be the council it improvement, but only for the interaction. Basically the part that's directly involving the appellant, the applicant, not the appellant.

And the reason for that is sensitivity to people at a very difficult time in their lives. But I don't understand why that should also apply to all the other people who've been involved at some point, why their interactions with the with the panel need to be in private. It is this sort of thing. When people go behind closed doors that we start to get perhaps not understanding of what is actually being said and what patterns. It's why later in the bill I'll be mentioning on other protections I want to see.

That's why I'm conscious or concerned that we shouldn't be having being a panel member, effectively becoming your full time job. I think that would be a bad step in this regard. And with that, there are many other moments. I would love to talk to you, but I am conscious of the time. But my Lords, this is a really important moment in considering how this final safeguard will actually work in practice. And is it what we were expecting when the bill arrived in this House?

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My Lords, I've, the clerk of the parliaments confirmed to me that the clerks have recorded the names of every noble Lord that was here of every noble Lord that was here at the start of this debate. They will now be circulated to the Chief whip, through myself and the convenor of the crossbench peers convenor of the crossbench peers next week. And with that, my Lords, I'd like to move the debate on

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amendment 41, 41, 42. Be adjourned. Question is that the questions

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Question is that the questions of the House will be resumed as many. Sorry. I move that the amendment debate and amendment 142 be adjourned.

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Question is that the amendment debate on this amendment be adjourned. And that content,

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adjourned. And that content, contrary not content the contents have it. Now to move that House be now resumed.

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resumed. Question is the House not be now resumed, as many of that opinion shall say, content, not content,

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the contents have it. I beg to move the House. Do now adjourn.
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