Live Debate: Lords Chamber

Lords Chamber

Friday 20th March 2026

(began 3 hours, 55 minutes ago)

10:07

Legislation: Terminally Ill Adults (End of Life) Bill - committee stage (day 12)

Has Has to Has to be Has to be again Has to be again in Has to be again in committee Has to be again in committee on Has to be again in committee on the terminally ill adults end of life. Bill Lord Falconer of Thoroton. Bill Lord Falconer of Thoroton.

10:07

Lord Falconer of Thoroton (Labour)

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Move that the House do once again resolve itself into a committee on the bill.

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The question is that the House do now again resolve itself into a committee upon the Bill. As many as committee upon the Bill. As many as are of that opinion will say content. To the contrary, not

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content. The contents have it. My Lords, before we begin, I

10:08

Lord Kennedy of Southwark (Labour)

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will make my usual brief remarks. Firstly, I reiterate the thanks on behalf of the whole House to all behalf of the whole House to all staff across the House for supporting this sitting today. I know noble Lords were aware of the huge amount of work it takes to place takes place. Enable us to sit today. End of another long week and a very long late night on Wednesday. I will not repeat everything I've said before at length, but I should, as usual, remind noble Lord as usual, remind noble Lord Stoneham key points.

I will adjourn proceedings today at around 6 p.m. and in. Noble Lord, can of course seek to bring the debate to an end earlier by moving the motion to the House. Do not be now resumed. I hope we can conclude the group we are on when we finish at around 6 p.m. but if necessary, I will adjourn the house during the middle of the group. The clerks will compile a list of all noble Lords in attendance at that beginning, and noble Lords will be able to check there at the table with.

Their names being recorded properly. Only those present at the start of the start of the group can participate. When we. When the adjourn debate begins on the next committee day. It is now easier that we all work together to ensure we complete the group we are on and to get close to rising time rather than having to break mid group. My noble friend Lord Falconer of Thoroton has set a target for today's Committee stage. As I've said before, I hope that with discipline and the usual courtesies, we will progress towards the target.

The whips will facilitate a short 40 minute break lunch break at a convenient point around 1 p.m. to assist everyone. For general guidance on how Lords should conduct themselves, I highly recommend the companion in particular, paragraphs 4.29 on page 60 and paragraphs 8.81 and 8.82 on page 103. Finally, my Lords, I am very conscious that next week is the final week before the Easter recess. A noble order due a well earned break. I therefore decided the next Friday I will seek to adjourn the house at around 3 p.m.

rather than 6 p.m. Hope that helps noble Lords with travel planning. With that, I think we should move on to the business.

10:10

Amendment:165 Baroness Coffey (Conservative)

10:20

Deputy Chair of Committees. Baroness Morgan of Drefelin (Labour)

and therefore, I beg to move 165. >> Amendment proposed clause five,

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Amendment proposed clause five, page three, line 11 leave out or Wales.

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Wales. My Lords, I rise to speak to my amendments in this group. amendments in this group. Amendments 844, 903 and 905. However, I would first like to turn the House's attention to the LCM debate, just as the noble Baroness, Lady Kofi did, that took place in the Senate on February 24th. At the beginning of the debate, Jeremy Miles, the Cabinet Secretary for Health and Social Care, set out to the CNO. I wish to be clear about what may happen if the Senedd were to withhold consent today.

The sponsors of the bill have confirmed that in those circumstances, they would seek to remove clause 42 from

10:21

Baroness Smith of Llanfaes (Plaid Cymru)

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the Bill. That would mean the law in England and Wales were changed to permit assisted dying. But there to permit assisted dying. But there be no powers in the Bill for Welsh Ministers to implement assisted dying services in Wales, or to oversee or to regulate such services. And I think that clarification is important for the House and throughout the debate, many MPs stated dissatisfaction on many MPs stated dissatisfaction on how the Senedd was being treated and I do apologise. I am going to quote several M's today because I think it's important that they're heard here.

We're being asked to vote in the dark. We're being asked to sign a blank check. We're legislating with a blindfold over our eyes. This is no way to treat a parliament, and this is no way to treat a nation. My Lords, the Senedd was in an impossible situation by this Parliament. A vote against this LCM would result in assisted dying services available only privately, and a vote in favour at least retains some power for the Senate to shape, such as services through the NHS and Wales.

And that was what the vote was about. Specifically, I

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thought this was concisely put. Oh yes, I. I do beg your pardon, my friend.

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I do beg your pardon, my friend. The reason that the Senate were was voting in the dark was because this voting in the dark was because this bill had not reached its conclusion in the House of Lords. If it had in the House of Lords. If it had have done, then there would have been. They would have been legislating in the daylight.

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legislating in the daylight. I thank. I thank the noble Baroness for her intervention. However, that is not not the case in terms of the practical reason why the Senate members raised those points. It is also in relation to the fact that they did pass an amendment to the Salcia, which I was likely going to touch on, which does state that the Senedd regrets that this Parliament hasn't properly considered the constitutional implications for Wales of this bill, and I think that's important to note that, yes, they passed the LCM, but they amended it with a point about the fact that this Parliament hasn't done its duty and gone through the implications for Wales in detail, and a lot of those in Wales that are supportive of the bill as well, just don't feel like they've had an opportunity to shape this bill.

So I think I thank the noble Baroness for her intervention. I hope that clarifies a little bit further, but I thought this was concisely put by Adam Price during the debate. Supporters of assisted dying do not argue for access determined by wealth. Opponents do not argue for a system outside NHS governance in a matter as grave as this. No country's parliament should have to stand aside while another decides the terms on which its own citizens live and die.

I sincerely hope that this vote is the last time that the Senedd puts is put in that situation, and also other devolved parliaments. The Senedd passed the LCM with an amendment that read as I. As I just mentioned, that the Senedd regrets the lack of thorough consideration of the constitutional implications of this bill for Wales during the legislative process. And my Lords, as I just said, I believe that the passing of that amendment is also showcases that we have failed our own duty here in relation to those implications.

Amendment 903 and 905 are my name. AIM to restore an amendment that was agreed in committee in the Other place. This amendment was later taken out at. Report without resolving the purpose behind the amendment being put forward and agreed at committee. Simply. This amendment gives the Senate a vote on the final bill passed here before the regulations can be created by Welsh Ministers for the delivery of an assisted dying service in Wales. The reason for this amendment is simple. As I already highlighted during Second Reading.

Although the criminal law is a reserved matter, the legality of assisted dying in this case, the delivery of such a service is a devolved matter, so not allowing the Senedd to have a vote, nor the opportunity to fully scrutinise and amend this Bill is infringes on devolution and disrespects the roles and duties of members of Senedd. Health and social care make up over half of all spending from the Welsh Government budget. Therefore, do noble Lords not agree that it is essential that members of Senedd are able to scrutinise all health spending, not allowing members of Senedd to shape this bill limits their ability to do this.

The Covid pandemic is the most recent prominent example of how Wales do things differently when it comes to health. This Parliament needs to wake up to this reality and let devolved parliaments do their job. This matter is an anomaly from a devolution perspective, as in Scotland, this is a fully devolved area and the Scottish Parliament recently had the opportunity to debate and shape its own bill that could be suitable for Scotland. If the Scottish Parliament has the right, why can this not be the case for Wales? I now turn to amendment 844, which creates a new clause in order to address this exact issue.

This amendment delivers parity between Scotland and Wales on this matter by amending the Government of Wales Act by removing offences related to suicide from reserved matters. This would allow the Senate to, if they choose to do so, introduce their own bill on assisted dying. This would allow the Health committee to take their own evidence, including from NHS Wales and the Welsh Government. Health Secretary. Your Lordships will be aware of the list of witnesses that were called to recent select committees ahead of this bill.

The Chief executive of NHS England was called to give evidence and there weren't representations from Wales. I do respect the work that members on that committee carried out, however, with those members agree that the Senedd should also be able to take evidence from within Wales and be able to make decisions on the establishment of a new service in Wales for the people of Wales, based on Wales specific information, I do believe amendment 844 is the best course of action for us.

In order to recognise that this bill has not been designed with Wales for Wales and align Wales with Scotland in terms of making a decision on this matter. And now I finally turn to the noble Baroness, Lady Coffee's amendments that are also in this group. In the hypothetical scenario that we pass her amendments alone, we will be leaving Wales in a grey area. Wales would be taken out of this bill, however, with no way for the Senate to legislate on this matter.

So I do believe as a House, we must consider the full consequences and where those decisions will then lie. What my amendment 844 does is avoid that scenario and ensures that the Senate has a way of legislating on this matter if they choose to do so. To conclude, as I have already highlighted in my Second Reading speech, I do support people's right to choose how they die. However, in the case of a of services being made available in Wales that must be shaped and designed by the people of Wales, that must be an ability for the Senedd and not for us here in Westminster.

10:29

Baroness Fox of Buckley (Non-affiliated)

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My Lord. that was a tour de force and goodness knows we rarely agree. And I'm hardly applied supporter, but I am from Wales and I wanted to just reflect on just a couple of tiny things that she said and why I wanted to speak. Family and friends in Wales were completely confused about what the vote meant when it happened. They thought that have we just voted for assisted dying? It wasn't always clear the way it came over.

They weren't sure what was being voted on and they weren't alone in a way, because I think that when I talked to people, I also feel very uncomfortable that the Senate were basically asked to vote on a blank check, as was said, because M.S. didn't don't couldn't know what the bill will look like yet, because you can blame us here that we haven't got very far. But the truth of the matter is, it seems rather presumptive for the Senate to be asked to give consent in advance when we don't yet know if amendments will get through this place, how, what, how they'll change the bill.

And that includes amendments by the noble and learned Lord, by the way, the sponsors of the bill, it just seems also disrespectful to this House and the process to treat the bill as finished, as a given in relation to the Senate. So, as I say, family and friends were saying to me, what did we just vote for? Have you passed the bill? And it was very difficult. I know we haven't passed the bill, but you are voting that regardless of what bill we pass, you're giving consent.

It didn't feel like the kind of consent. I've got much faith in. The only other things to add are that I think it would be wrong to see this as pro or pro or anti assisted dying. I mean, I was struck by James Evans, Ms. who's a supporter of assisted dying, who explained the question before us today is not whether I support the principle. I do support the principle of assisted death. The question is whether it is right to grant legislative consent to legislation that is still evolving, still subject to amendment and still under scrutiny elsewhere.

I think it's very important to recognise that the disquiet is not about assisted dying, but about the process. And then I suppose I finally want to say that I know that everyone here is, or that the sponsors of the bill are very hot on Democratic decision making, which is. And in in elected houses. And I did think it was very odd that this presumptive this presumptive consent motion was given when there actually was a principled vote on the principle of assisted dying not that long ago in an elected house, which this consent motion appeared to undermine.

The Welsh Synod, such as it is voted against assisted dying on principle. I'm not saying it should stand, but why we here in this House think we can wander along with the consent motion for a bill that hasn't yet been decided and say, oh, forget your principles, you've got to sign up to this consent or else I think is bad form.

10:32

Baroness Finlay of Llandaff (Crossbench)

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Yeah, yeah. >> Yeah, yeah. >> My Lord, I'm most grateful to the noble Lady Baroness Smith of Llanfaes for her excellent tour de Llanfaes for her excellent tour de force on the constitutional issues facing the Senate in the face of Westminster, particularly as we move into elections. And there are a few background comments. I would like to make much more from my own professional angle in Wales. We mustn't forget that there is a long history of health and social inequality in areas of Wales, with Rurality creating many problems.

My colleagues in palliative medicine across palliative care in Wales have described end of life care in Wales now being at breaking point because the demands of the terminally ill bill risk drawing away funding from the sector that sorely needs funding. And we have seen bed closures in Wales, which have been quite tragic. There simply do not seem to be the resources to deliver assisted suicide in Wales. The Welsh Cabinet Secretary for Health and Social Care, Jeremy Miles, has admitted that ensuring the availability of Welsh speaking staff would be challenging, but people would find it much more difficult to communicate in a language which is not their first language, and it is much harder to ensure understanding the tech coercion detect difficulties unless you can communicate in your own language.

I know we're coming on to interpreters later, but I would remind the House that Welsh and English have equal standing in Wales. The amendment that was removed in the other place, I think, was unfortunate that it was removed because actually the government has own impact assessment, indicates two and three older people in Wales struggled to make suitable appointments or communicate with their GP for many, many reasons. That is not because of the problem of the GPS. It is a problem of rurality, of access, of recruitment, of resources.

So there was a major concern to that. Actually, the the Senate's Health and Social Care Committee detected, and they warned the lack of a dedicated voluntary assisted dying Commissioner for Wales would risk the Post-holder, as in the bill, being less familiar with the operation and impact of the Act in Wales and a risk of further inequity as a result. And this is the tension between health and justice in terms of the route. So my amendment, which I'm delighted that the noble Lady Baroness Coffey has co-signed seven six, four, respects the devolved competency of Wales and removes a sweeping Henry, the eighth power that the Delegated Powers and Regulatory Reform Committee on which I sit and which I serve has objected to, as I quote, highly inappropriate.

Both clauses 41 and 42 provide for the regulation of voluntary assisted dying services, health services provided for or in connection with assisted dying in England and Wales respectively. I will now focus on Wales. The 32nd report of the committee expressed, I quote, particular concern that the powers can provide for anything that an Act of Parliament can do without the scrutiny that an Act of Parliament would receive. And the report went on to discuss some of the things that such a power could be used for that might evade proper parliamentary scrutiny.

To quote from the 49th report, follow up report expressed particular concern that the powers can provide for anything that an Act of Parliament can do without that scrutiny, because allowing a power to provide for anything that an act of Parliament can do makes it unknowingly broad, even when there are expressed limitations on its exercise. Describing this as a fundamentally flawed approach to delegated powers, the report continues the exercise of delegated powers is subject to significantly less effective scrutiny than a bill.

Little, if any time, is devoted to line by line scrutiny. Statutory Instruments are unamendable and their rejection, as your Lordships know, is exceptionally rare. My Lord. Such wording that we've seen in this clause only appears in two Acts of Parliament, the European Union Withdrawal Act of 2018 and the European Union Future Relationship Act of 2020. Basically, the Brexit changes. On the day of the Senate vote, Lord Faulkner wrote a letter already referred to which was copied to members of the Senate, implying that without legislative consent from the Senate, a person in Wales eligible under the act could only legally access an assisted death through a private provider or by travelling to England, and went on to state that he would seek to remove clause 42 from the Bill.

The whole of the clause. Additionally, I suggest that by removing 42 little three, which is in my amendment, is because the Bill doesn't state that Welsh Ministers must be consulted. If the Secretary of State makes regulations about the provision of voluntary assisted dying services in Wales, nor the limits on the powers of the Secretary of State to override the school and impose aspects of such provision on Wales. Hence my very short but I think,

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crucially important amendment. Can I say that you see, back in

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Can I say that you see, back in her place the noble and learned Lady Baroness Prentis of bamboo. Lady Baroness Prentis of bamboo. She has been very much missed and I hope this is the first stage on the hope this is the first stage on the road to full recovery. Yeah, milord. She, like me, may have a feeling of She, like me, may have a feeling of Groundhog Day to day because since she was last with us, we have made

10:39

Lord Pannick (Crossbench)

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lamentably slow progress on this bill. We're on day 12 of committee, bill. We're on day 12 of committee, and we're still on clause five of and we're still on clause five of 59. And as the noble Baroness Baroness Coffey mentioned, of Baroness Coffey mentioned, of course, she began our Committee course, she began our Committee stage proceedings on the 14th of November with her moving the first of her 111 amendments to this bill in relation to Wales.

And here we are again. My Lords, I say simply to the House. Of course, of course, this bill should apply to Wales. The Bill seeks to create an exception to the prohibition on assisted suicide, and that's an aspect of the criminal law of England and Wales. And criminal justice, we all agree, is a matter reserved to Westminster, and it would be bizarre were this House were Parliament to approve this bill, but not approve it in relation to Wales, there is simply no sensible reason why people living in Wales should be denied the same options as people living across the border in England.

I listened very carefully to what Baroness Smith said, and she suggested that there's been some parliamentary mischief that the people of Wales have not been listened to. But it's the case, isn't it, of course, that the people of Wales have a number of representatives in the House of Commons? My understanding is that

10:41

Lord Stevens of Birmingham (Crossbench)

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10:47

Lord Deben (Conservative)

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10:59

Lord Carlile of Berriew (Crossbench)

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this Parliament decides whether we pass this bill. If this bill is pass this bill. If this bill is passed, then the government will have to provide the resources to have to provide the resources to enable it to work. And I apprehend that if this bill is passed, if it is given enough time to reach the end of its parliamentary stages, which I think it should be allowed, though I do not support the Bill in principle. By the way, then the money would have to come from somewhere and the adjustment would be made to enable Wales to provide the services which are required.

Now back to my 2900miÂ² of Wales. In fact, the old county of Montgomeryshire, now part of Powis, now part of a bigger constituency, has no acute hospital in it. It has a number of cottage hospitals, as they used to be called, local hospitals, and very good they are too. The local medical services are, on the whole, excellent. But there is no acute hospital. So when people would go, for example, to their GP and in rural Wales, most people surprisingly know the name of their GP and are on first name terms with them when they meet them in the street.

The GP would ensure that they had the best possible advice, including advice on palliative care, but most of that advice would come from hospitals in England as it happens. So the need for uniformity in the provision of services is essential, but that uniformity would not be provided by the principal. The conceptual principle behind the bill, but by the way in which it was put into effect. Now let's go back to the conceptual principle behind the bill, because I agree with my noble friend Lord Pannick.

This is not a health bill. This is not a bill about the provision of palliative services. This is a bill about allowing a citizen to help another citizen to die. This is about life and death, and it's about the law. Because if a citizen today helps another citizen to die, and I am, I too am delighted to see the noble Lady back in the house because she's a very fine lawyer and has been a law officer noble and learned Lady, I should say.

We know. She knows, my noble friend knows, and I happen to know because I'm a lawyer and was a Welsh MP, that the decision that would be made would depend upon a change in the criminal law of the United Kingdom, which is a reserved matter. So what I suggest to you, Lordships, is that we should get on with deciding whether this bill is passed or not, as the case may be. And as I've said, I'm not in favour of this bill, but let's get on with the parliamentary procedures which are placed upon us.

And then later, if this bill is passed, adjustments may have to be made to enable Wales to have the funding which would be administered by the government in Cardiff Bay.

11:02

Lord Weir of Ballyholme (Democratic Unionist Party)

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My Lords, my Lords, I rise and first of all, I would join with first of all, I would join with others in welcoming. It's good to see Baroness Prentis back in her place. I'm sure the whole house welcomes her back. I cannot claim like Lord Carlile, to have had a particular background in representing Wales. The closest I've been is a few childhood holidays, but I do have experience in one of the three main devolved parliaments throughout the United Kingdom, and we do have a unique constitutional settlement in the United Kingdom, part of which I think is the right level of irregularity and rough edges so that Northern Ireland, Scotland and Wales are not.

Devolution does not happen in exactly the same format. Can I say I? I find myself in complete agreement with Baroness Meyer in her excellent speech. I do not know if she should be more worried that I am agreeing with her, or whether I should be more worried that I find myself in full agreement. But the reality is that her speech clearly indicates that the amendments in this group, which I think are worthy of support, go to the heart of important issues on the constitutional settlement that we have in the United Kingdom, and therefore, I think they are worthy of support.

Whether you are the strongest supporter of this bill and of the principle, whether you're the most fervent opponent, because I think they tie in. Importantly, it is important that the will of the Parliament of Northern Ireland, Scotland and Wales are fully respected and I think there is on occasions, I think, a danger of Parliament at Westminster showing a little bit of a tin ear to the desires of the Parliament's in the devolved institutions. We have seen it as has been alluded.

I'm not going into the details of it at times where things have been imposed on Northern Ireland against the wishes of the Northern Ireland Assembly, and I think similarly, we need to be sensitive towards the wishes of the Welsh Senate. It is the case that in terms of the. The consent motion was. The Senate was left in a virtually impossible situation, and I think it is very concerning that that has been in many ways misrepresented by some as the Welsh Senate embracing a bill on assisted dying.

That has been some of the spin that has been put upon that, whereas we know what has been the case, is that the one vote that has taken place in terms of principle within the Senate was to say that they didn't support legislation of this nature. Now, I think that we do have to say that assisted dying has clearly a very large element of this is within the health implications, and as such, I think we should be respecting the devolved positions of the Welsh, Scotland and Northern Ireland this week.

Within Scotland, they have looked at their legislation and I agree it is not the same as before this House. Of course, we were told by the supporters of the legislation in Scotland that it was, quote, Bullet-proof, which then was held as not actually seen quite level of safeguards, which then does slightly call into question the oft repeated phrases regarding this legislation, the safest in the world. Those phrases seem very similar, I have to say, but it is important that we do actually respect the wishes in the devolved institutions.

Lord Pannick is right, I think on one particular point, whenever he highlights that, actually, I think in the very first day of Committee stage, there were a number of amendments which also touched on this area, I think particularly brought by Baroness Coffey. One of the disappointments, which I think is symptomatic of the way that this has been dealt with, is those concerns were raised on day one, and yet there has not been a, I think, a proper addressing of those, rather than Wales falling into line with what is brought forward here.

It does seem to me that we should actually be taking action, which enables this place to retrofit whatever decisions are made in Wales for the Welsh people, and I think that is right. Can I conclude, I think by slightly oddly, agreeing with one point that was made in intervention? It was said, I think, by one noble Lord, that essentially we've had enough talk about this lack of funding of palliative care. In one sense, he is right. Perhaps it is important that we had less talk about funding of palliative care and more action on funding of palliative care.

11:07

Lord Harper (Conservative)

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11:18

Baroness Fox of Buckley (Non-affiliated)

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But I can't let the noble Lord Lord Paddick get away with that. I, I first of all, what happened on Wednesday night was a separate Wednesday night was a separate issue. And as it happens, I argued for a change. I argued for a change in the law in relation to decriminalising abortion. And I'm on this side, this sort of easy, swatting away culture, war style argument is unhelpful. People in good faith are concerned about the lack of safeguards in this particular bill.

The idea that no one wants to get to Report stage. I would much prefer to be voting on aspects of this particular bill, because a wide range of concerns have been raised, had been tabled through amendments by the sponsor of the bill, so that we could get on with it. That would be what I'd want. And the only reason we're discussing Wells, by the way, is, as far as I was concerned, was because of what happened, since we've discussed it in the first day, apart from anything else, which is in relation to the Senate's decision, and I think it's a perfectly appropriate thing to raise it.

The idea that we're wasting time talking about Wales said, from people who apparently respect devolution does seem a bit rich, but we want to get to the Report stage and we should keep the insults out in order to do so. insults out in order to do so.

11:19

Lord Goodman of Wycombe (Conservative)

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I rise to move my amendment 765, which has been supported by the noble Lord, Lord Rooker. And what my amendment would do is to delete from the bill subsection four of clause 42. Let me just briefly read the subsections. It's not very long. Regulations under subsection 3rd May make provision that A could not be made by an Act of Parliament, and B would not be within the legislative competence of the Senate if it were contained in an act of the Senate.

Now, I won't repeat the case put by the noble Lady Baroness Finlay, who quoted the report of the Delegated Powers Committee on which I sit, which argue that this clause is highly inappropriate. Rather than do that, I have a simple question I'd like to put to the sponsor of the bill that I'd be grateful if he'd address when he winds up. And if I may quote from the report of the committee, delegated powers that can be used to do anything that an Act of Parliament can do are very rare, with the wording currently appearing in just two acts the European Union Withdrawal Act 2018 and the European Union's Future Relationship Act 2020.

Now, I wasn't on the committee when that report was produced, but my understanding is that the argument at the time was that the exigencies of Brexit required business to be done by regulation, rather than by an Act of Parliament. My question for the sponsor of the bill is what is the exigency in this case that requires the provision that he believes needs to be made to be made by regulation, which necessarily has to be dealt with on a take it or leave it basis, rather than by an Act of Parliament which peers and members of the other place can amend.

I'd be grateful if you could answer that question when he replies to the debate. And if he can't? I look forward to returning to this committee report if we ever get that.

11:21

Baroness Blackstone (Labour)

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Regrettably, we're never going to get to report. Members of the House keep referring to report. And can I say that my noble friend, the sponsor of this bill, has frequently said he will come back to some of the questions that have been put by the noble Lord Lord Harper and others. Normally, that would happen at Report stage, whether a more disciplined and focussed approach to scrutinising this Bill by those who oppose it, we would have perhaps got to the Report stage, but we haven't.

Given that we haven't. Can I just finish? I want to make one more point. I think we've had a long debate about Wales, including all sorts of questions about the devolutionary

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arrangements, and I wonder whether we can now hear the frontbench. Yeah, yeah, yeah. For the noble Lady sits down.

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For the noble Lady sits down. Would you perhaps like to make it clear whether she believes it's inappropriate for the sponsor of the bill? To reply to the question

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the bill? To reply to the question I've just put in this Committee stage. I hope I will be permitted to

11:22

Lord Thomas of Cwmgiedd (Crossbench)

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>> I hope I will be permitted to say something about Wales. I was say something about Wales. I was going to make a much longer speech, but my noble friend Baroness Smith of Llanfaes has made an excellent argument on the merits of the issues relating to Wales and what is at issue. It seems to me, in the short point to which I wish to draw attention is the. Is the issue in this case. Is it an issue about criminal law, or.

As often arises in questions within a federal form of government, which in reality we have here? How do you characterise this issue? And does anyone really think this is about the criminal law? The criminal law is part of finding the solution. But if you look at the debates, it's the debate about a moral issue, and it's a debate about how you use the resources of the NHS. But the criminal law should not be seen as an impediment. And I wanted just to draw attention.

I would have said a lot more about other things, but being accused of wasting time, I will not make that speech, but just draw attention to the problem that arose in 2016 2017. Wales wanted to pursue its own policy in relation to what is old fashioned, known as the chastisement of children, and of course, the chastisement of children is governed by the criminal law. And as they wanted to do it at a time when there was a conservative government in London and a Labour government in Wales, there was discussion as to how this issue should sensibly be dealt with in an intergovernmental discussion, and it was decided that an exception ought to be written into the Government of Wales Act and the very complicated schedules permitting Wales to make its own decision.

And so it was excised from the reservations of powers to Westminster. And it seems to me that in this bill, all that amendment 844 seeks to do is to make a minor alteration so that if you look at the issue for the people of Wales, should they be entitled to deal with this issue comprehensively? And I don't say anything about what happened in the Senate, and nothing has been said about that. Just remind you there'll be a new Senate after the 7th of May before this bill is dealt with, and a very different attitude may be taken.

Having heard what has been said about the desire that the people of Wales should not be entitled to make their own decisions, I very much hope we are able to try and focus. What is the issue? Is it one Wales ought to be able to make? If it's not, then the simple solution is a technical one which can easily be made through

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amendment 844. The inference. From some comments during the course of this debate has been that course of this debate has been that somehow the issues raised in Wales and by the Senate are peripheral to the centre of this legislation. Not at all. The issues that have been raised by this debate are raised by this debate are absolutely central to this legislation. As we have heard throughout this debate, the bill throughout this debate, the bill seeks to change primarily the criminal law, and it goes into some specificity about that.

But as has been pointed out very effectively, by Lord Stevens of Birmingham, by Lord Goodman of Wycombe and others, the bill carries with it certain consequential and potentially hugely consequential changes to the National Health Service, changes that will be made by regulation and which are not on the face of the bill. And that is precisely the point that was at issue when the legislative consent motion was debated in the Senate, as we have heard, as my friend Lord Harper pointed out, when the Senate had voted, Senate had voted on the broad principle of assisted dying, not this legislation, but the broad principle.

The Senate was against it. When invited to vote on the legislative consent motion, the Health Minister in Wales, Jeremy Miles DCMS, explained to the members of the Senate that a legislative consent motion would be necessary because in the absence of

11:27

Lord Gove (Conservative)

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a legislative consent motion, as he understood it, it would be criminally possible to assist criminally possible to assist someone in dying, but he would not someone in dying, but he would not be able to provide the appropriate detail about whether or not the NHS would be responsible for that would be responsible for that service. So the Spectre was raised in the minds of those legislating in the Senate that, in effect, you would have assisted dying, but that would be provided privately.

Now, Jeremy Miles might have been confused in his interpretation, but he is the health Minister in the Welsh Government, who had previously been the Minister responsible for constitutional relations between the Welsh Government and the United Kingdom Government. So it is hardly the case that he is a naive stumbling into this argument without a background in the two most telling areas that this legislation covers. It was also the case that the Senate, in that same debate, voted by a clear margin, to say that the whole issue had been constitutionally mishandled, that the way in which criminal legislation was being used as a Trojan horse, as has been pointed out to, in effect, potentially dramatically change the Constitution and the provision of the NHS was simply not good enough.

And the Senator was very clear in voting in that way. And it brings us again to the heart of the problem with legislating for these measures through the private member's bill procedure. In a previous incarnation, I was the Minister for Intergovernmental Relations. I may have been a bad Minister. I may have been a good Minister, but the one thing I was was a Minister conscious of the fact that the devolution settlement relied on government to government operation, when there were disputes between the legislative or the executive decisions of devolved legislatures or devolved governments, they were resolved by intergovernmental relations and in particular by means of a dispute mechanism.

At the moment, as has been pointed out, there have been a variety of questions which have been raised about the nature specifically of regulation to do with the NHS, which Ministers at the Dispatch Box cannot answer, not because they are unwilling or because they're truculent or obstinate, but because, as they clearly say, they are neutral on this bill. So the Welsh Senate granted the legislative consent motion because they feared they feared that they would not be able to be in the driving seat of a vehicle, the ultimate destination of which they were uncertain of, and the design of which they had little part in.

But they felt that this was the only way of ensuring their continued relevance. It was not, and indeed, supporters of the Bill in Wales made it clear it was not an endorsement of the principle of assisted dying, let alone an endorsement of this legislation. It would be, I think, not just dismissive of the people of Wales and reckless in regard to the devolution settlement, to interpret that vote as endorsement of this legislation. What we should do is realise that this legislation, as the Senate has quite rightly pointed out, is not simply about criminal law, which is understandably, and I believe, rightly reserved to this place.

It is about the future of the NHS. Its resourcing, as my right, honourable and noble friend Lord Stevens pointed out. But it is also about the constitution of the NHS. As Lord Stevens of Birmingham has pointed out, those issues were raised by me and by others briefly at the beginning of consideration of this legislation. They have not subsequently been addressed and I fear that they cannot be addressed unless and until this is a government bill. Down.

11:31

Lord Winston (Labour)

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Can I just ask this question? Because I'm genuinely a very simple doctor and I don't really understand this problem. It is clearly a problem in ways that I think is a humanitarian one. For example, at the moment in the House of Lords, we're discussing very complex issues regarding precision medicine, which involves the use and manipulation of genetics, some of which will certainly require, for example, ethical considerations by this House, I have no doubt. But the issue is that clearly these advances in medicine cannot be denied to the people of all the United Kingdom, because they might change healthcare in amazing ways, but they will be far more expensive, for example, than assisted dying.

So how does that work? Perhaps the noble Lord could just briefly explain to me why it seems wrong that we might be depriving the Welsh of something that is much wanted, simply because we can't find the way to go through this on a legal basis.

11:32

Lord Gove (Conservative)

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Well. >> My remarks, but briefly, I'm very grateful to the noble Lord for raising it. Precision medicine, precision medicine, and the precision medicine, and the advances that it potentially holds for all of us are wonderful, wonderful potential breakthroughs, but changes not just to the legislation, but to the regulations governing that will be brought forward by the government. Any concerns that the devolved legislatures have about the operation of them will be addressed by government means, by the Cabinet Office or any other Minister who is responsible for intergovernmental relations.

We had a situation in Wales where the Minister responsible was operating on the basis of assurances that he had been given by the sponsors of this Bill relating to clause 42. In this bill. Now, it may well be that the sponsor of this bill can clarify what was meant, why it was that Jeremy Marles believed that if a legislative consent motion had been denied, that we would have legal assisted suicide assisted dying in Wales without the capacity of Westminster to determine the future of the NHS as they wished.

Perhaps that can be cleared up, but having to clear it up here when we already had the legislative consent motion and the relevant Minister told other members of the Senate that the only reason that they should back that motion was because of the fear he had of the effective privatisation of killing in Wales. Well, we cannot have a situation like that, and that is why we must have essentially government legislation rather than proceeding by Private Members' Bill, which is clearly inadequate when we are dealing with the future of the NHS, not just for the people of Wales, but for the people of the entire United Kingdom.

11:34

Lord Wolfson of Tredegar (Conservative)

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Yeah, yeah. Brilliant. >> My Lords, may I first. >> Take a moment from the front bench to say how wonderful it is to see my noble and learned friend Baroness Prentis of Banbury. She Baroness Prentis of Banbury. She was here a moment ago. Causation. Causation is denied. Lord Paddick. It'll be in Hansard. I did speak to her outside. I was going to say it's a testament to her dedication that she's been following this on TV. I don't know whether that shows how poor daytime TV normally is, although those of us who were here on Wednesday remember that your Lordships' House is also very late night TV as well.

My Lords, I spoke on the amendment when we first touched on this topic right at the beginning of Committee stage. And of course, as my noble friend Lady Kofi said, those amendments interrelate with what we've said and has been discussed today. And so far as the front bench is concerned, we are focussed on the question to make sure that we do not end up with a situation where different citizens and residents in the United Kingdom have very substantially different rights in areas as important as this, and I listen very carefully to what Baroness Smith of Llanfaes said about what actually happened in the Senate.

And the phrase voting in the dark was a stock phrase, and one which I think we ought to remember so far as the question as to what this bill actually does is concerned. It reminded me of when I studied private international law, where you have something called the characterisation question, something that lawyers often like. And it basically goes like this. In order to get the answer you want, you rephrase the question to focus on the bit of the problem which you want to focus on.

So in this case, you ask the question, well, what does this bill do? And Lord Pannick the noble Lord Lord Pannick and the noble Lord Lord Carlile of Berriew rightly say, as a matter of form, this bill amends the criminal law, and therefore it is a competence of Westminster. But of course, in reality, assisted dying won't be provided by the criminal justice system. Assisted dying in practice will be provided by the health service. And that's why I listened carefully to what the noble Lord Lord Stevens of Birmingham and noble and learned Lord Low Lord Thomas of Cwmgiedd said that in practice, this is a bill which touches on health, which is a devolved competence.

And it's that that brings me to the wider and I think more important point. Earlier this week, the noble and learned Lord, Lord Falconer of Thoroton, raised the issues of Jersey, Guernsey in the Isle of Man, the Crown dependencies in the debate on the Crime and Policing Bill. And of course, we also learned this week that the Scottish Parliament has chosen not to proceed with the version, and it was a different version of this bill proposed there. If this bill were to receive Royal Assent, we would end up in a position, therefore, where different rights would exist very substantially to different residents and citizens in the United Kingdom.

And that raises an important point of principle on which I'd be interested in the noble and learned Lords view. Does he see it as a success of devolution, that on an issue as significant as this, people living in different parts of the United Kingdom and for these purposes, for these group of amendments, Wales might have different rights in law. Or does the noble Lord have potential solutions to create a situation where as close as possible, people have the same or substantially the same rights? And I would also respectfully ask the noble Lady, the Minister, to respond on this point as well, because frequently from the front bench we've heard the phrase we are neutral.

We are only interested in workability. We'll look at these issues as and when they arise. But this is a deep constitutional issue. The government can't be neutral on the point. I would suggest, whether it's content in principle, that people in England could or might have very different rights on assisted dying to people in Wales. The government must or ought to have a stance on that fundamental constitutional position. And they also, I would suggest, ought to have a position on the point raised by my noble friend Lord Deben as to whether, if this bill were to go through.

And. Palliative care is such an important part of the overall process, they would be equalising the funding to make sure that residents of Wales have the same access in practice to palliative care as those of us who live in England do. And for those reasons, I look forward to the responses both of the noble and learned Lords and also the noble Lady, the Minister.

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VSED Lord Wolfson. My Lords, I'm grateful for the

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My Lords, I'm grateful for the views that have been expressed today and as usual, I will keep my remarks to those amendments that are raising significant legal, technical, operational workability technical, operational workability concerns. I would also like to very much associate myself with the much associate myself with the welcome from these benches to the noble and learned Lady Baroness Prentis. We were delighted to see her return to your Lordships' House

11:39

Baroness Merron, The Parliamentary Under-Secretary for Health and Social Care (Labour)

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11:47

Lord Falconer of Thoroton (Labour)

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12:08

Deputy Chair of Committees. Baroness Morgan of Drefelin (Labour)

House that the next debate will be joined by a remote speaker, so I will call the remote speaker directly after the next. After the next amendment has been proposed. So my Lords, amendment 167 Baroness Fraser my Lords, can.

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I bring you back from Wales. To the issues of speech and language and communication issues language and communication issues which affect everybody equally,

12:08

Amendment:167 Baroness Fraser of Craigmaddie (Conservative)

right across the United Kingdom? My amendments in this group one, six, seven and four 546 seek to ensure that people who have serious speech and language and communication issues have an element of protection in this bill, and they are supported in accordance with best practice. I remind my Lords of my interests as Chief Executive of Cerebral Palsy Scotland, and I have drawn on my organisation's experience supporting people with serious communication issues to inform my remarks. Now, amendment 167 is a probing amendment designed to explore the specifics around what is meant by seeking assistance.

This is not about the requirement to self-administer, which, if we get to it, will be explored later in clause 25. This section is to do with the preliminary conversation. An amendment 546 simply adds communication and speech difficulties to the list of those who may be provided with an independent advocate. In clause 22. The bill currently sets out in section four that if a registered medical practitioner conducts such a preliminary discussion with the person, the practitioner must first ensure the provision of adjustments for language and literacy barriers, including the use of interpreters.

Now, I have taken this to cover those for whom English is not their first language, but I'm not convinced it covers a situation when someone has to communicate using augmentative and alternative communication known as r c. And let me explain why I have specific concerns in this area. This population can be divided into those who have moved on to AAC because of disease progression. For example, those with neurological conditions like MND or Parkinson's, and those who have always required assisted communication.

Those with complex cerebral palsy or severe autism. This population may be deemed to understand English, but they have never been able to speak, so AAC is their de facto first language. Experience illustrates time and again how those who experience communication difficulties, and especially those for whom AAC is their first language, struggle to deal with difficult conversations. At Cerebral Palsy Scotland, we work with people with very complex needs, including those with learning disabilities, who need symbols to support understanding and communication.

This group will express themselves in a way that isn't typical, as they will be restricted to a limited vocabulary. There are tools. Baroness Grey-Thompson. Amendment 172 specifies Makaton, but there are others, such as talking mats that are designed to support big decision making, and these are currently used to understand a person's desire to, say, live independently or express what type of care they wish to receive. However, these methods of communication need to be facilitated by a professional who will suggest options option A or option B, and the individual themselves does not have free choice of the words they can select.

So my Lords, now put this individual in a context where they have been diagnosed with a terminal disease, and they meet all the criteria of this bill, and yet they might not be privy to the right vocabulary or the right specialist professional support. How can we be confident that they have fully understood the process, and it is their free and settled choice to die? So much of our communication with people who have complex, complex communication needs is co-constructed.

Tools such as talking mats or makaton rely on a professional making the initial choices, making assumptions. And. How many times have we seen carers or family members talk for a person because they know them best and they know what they are trying to say? And again, I ask, in these situations, how can we be confident that this is truly the settled opinion of the person who is being talked over? Baroness Grey-Thompson amendments 322322A and 406. Speak about communication in accordance to a person's needs and wishes, and providing translation in a format of the person's choice, and recording that if communication needs have been identified, how have they been met? And I support all these amendments.

People who do not have a learning disability and may come to use AAC because of their disease progression, or like many adults with cerebral palsy that we support, they may be literate and use devices that use typing and predictive text. They may have the vocabulary to make their views known, but only if they are given the time and the space and the support to do so. Now, I don't know if any noble Lords have actually ever tried to communicate through an AAC device.

Often I have, and often you have to scan through a word at a time, picking up which row you choose, and then you go down which word. It requires incredible skill, incredible concentration, and it is exhausting. You do have to really, really concentrate because otherwise your eyes go off and you don't say what you want to. And it is essential to allow sufficient time within the appointment to retrieve longer messages. And fatigue and frustration are common. AAC users time and time again report to us how they are not listened to, and this affects how much control they feel they have over situations like housing, social care and health, how much real choice they have now, how will they feel in a preliminary conversation? We know this population feel misjudged because of their communication requirements and are often considered by others, including health professionals, as not having the ability to communicate their thoughts, feelings, needs, opinions and this has a direct impact on mental health and social isolation.

I mean, to give you an example, at Cerebral Palsy Scotland, around 15% of adults that we who access our services are AAC users. And of those, over 40% request mental health, wellbeing and psychological support so those with complex communication and speech difficulties who wish to access assisted dying will require significant access support that goes way beyond provisions for literacy barriers or interpreters. And more concerning, given the two, often two perfunctory conversations that I know occur with this population regarding health services, care packages, housing or any other life choice, I cannot be confident in the average GP surgery having the expertise, knowledge and time to facilitate a meaningful conversation that establishes that enables the full range of options to be explored and and understood without employing assistance outwith that currently envisaged in the process laid out in the bill.

So amendment My amendment 546 refers to clause 22 and the role of independent advocates, and section four says you can have the help of such an advocate if they may experience substantial difficulty in understanding the processes or information relevant to those processes or communicating their views, wishes or feelings. Now, AAC users, I argue, may be perfectly capable of understanding processes and information, but it is the communication, the communication of their views and their wishes that are far, far too often ignored and not given the time and support to be aired.

There are populations who will undoubtedly require to seek assistance. These are populations that would undoubtedly require to seek assistance from others to navigate the process, and yet how they can go about seeking such assistance from whom and at what stage, and that there are safeguards in place that we know the person who is being, who is being spoken for, has clearly decided to end their own life is not clear. So does the noble and learned Lord accept that his earlier amendments to lessen the duty on doctors to support communication issues have increased our concerns and that have resulted in the amendments in this group being necessary? My Lords, if informed consent at every stage, is at the heart of this Bill, then he will have no objection to the amendments that ensure, as the GMC guidance urges, all possible efforts are made to ensure effective communication with

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patients. I beg to move. Amendment proposed in clause

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Amendment proposed in clause five, page three. Line 12 leave out seek assistance to.

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seek assistance to. My Lords, I rise to speak to amendment 167 in the name of my amendment 167 in the name of my noble friend, Lady Fraser of Craigmaddie, and in doing so I should make clear that I support the other amendments in this group, and I also join with other noble Lords in saying how good it is to see my noble and learned friends. Baroness Prentis, of Banbury,

12:18

Deputy Chair of Committees. Baroness Morgan of Drefelin (Labour)

backed in her place. My noble friend Lady Fraser outlined how comprehension and communication can be a real challenge for some people because of their disability. My Lords, this amendment invites us to think differently, to view the need for clarity from their perspective, not ours. That means our accepting that what may appear to many to be an unnecessary clarification will to others be essential. Whatever position one takes on either the principle of assisted dying or indeed the bill, surely.

The taste

12:19

Lord Shinkwin (Conservative)

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for making the language in this bill as clear as possible for both bill as clear as possible for both the many and the few is the many and the few is overwhelming. Doing so is ultimately about meeting the anticipatory duty to make a anticipatory duty to make a reasonable adjustment on account of disability. It was your Lordships' House which helped write that duty into law when it passed the Disability Discrimination Act 1995 Disability Discrimination Act 1995 and 2005.

And Equality Act 2011. Amendments 167, therefore gives us an important opportunity to show that we, as a law making body, honour the duty to make reasonable adjustments, just as we require by law others to abide by that duty. My Lords, I hope the noble and learned Lords will recognise our responsibility to be seen, to lead by example and to ensure that the wording of this Bill is in keeping with that duty, clearly and unambiguously.

I hope the Noble and learned laws will consider my noble friends remarks very carefully, because she speaks with considerable professional experience and authority, which should not be ignored. I hope that he will accept her amendment.

12:22

Baroness Berridge (Conservative)

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My Lords. >> I rise to speak to amendment 174 in my name and I'm grateful to them. Noble and learned Lord for the meeting on this issue. This meeting on this issue. This amendment states that any interpreter provided under subsection four must be aged 18 or over. It's a probing amendment, and if you put two lawyers in a room and give them wording from the NHS guidance saying inappropriate to use children, you're going to have a fascinating discussion about discretion versus mandatory, and that is the point behind this amendment.

It may be that a different age, say 16, might be the appropriate age, but since meeting with the noble and learned Lord, I have looked at certain NHS guidance from or guidance from particular hospital trusts like Leicester Partnership. NHS trust states you must not use children. Milton Keynes University Hospital says children should not be used as interpreters, so we have the overall NHS guidance using the word inappropriate, which seems to imply discretion. But then we have certain hospitals and obviously I haven't checked everybody but who using mandatory language.

So I think it is very important that we consider whether in this scenario, there should be any discretion to use children, whether that's under 18 or, as I say, under 16. My Lords, the Tia process, it should be mandatory because it's a substantial process here. This is the communication of a profound state of affairs. It includes numerous complicated stages, from a preliminary discussion to different coordinating doctors. It involves a Mental Capacity Act assessment, and it could involve the discussion of quite sensitive information about the administration of lethal substances and potential complications from that.

It is a serious and, as we said, irrevocable decision. So my submission to the noble Lady, the Minister, is that this should not be an option to lie in the hands of a child to be interpreting. But we should provide for qualified, skilled adults to be present and provide that service. So any relative, including children, can sit, support and have their own needs potentially met. So I'd like to ask the noble and Leonard Lord whether he is satisfied that this should be a service provided by the National Register of Public Service Interpreters.

It is not, of course, my Lords, a small problem from the census in 2021. There are around 7.1% of people in the UK speak English as a second language, and around 5% do not speak English well at all. From the NHS website. There are 1 million people that don't speak English well at all, and they will need assistance in terms of communication. If we don't provide this within the bill, it may be that relatives are used on particularly, children are used in situations where the interpretation services might be underfunded in that particular area because that is local commissioning that provides the interpretation services.

I acknowledge that the noble Lords may want that lower limit that some hospitals use of 16, but I do find it interesting to note that perhaps in the past the limit has been too low. And the former member of the Other place, Sajid Javid, talks about, and I quote, I used to go to the doctor's surgery with her. I think that's his mum, not because I'm ill, but because I had to interpret for her. I was 6 or 7 and an interpreter and I.

My Lords, I believe that we should make sure that children in our jurisdiction are not placed in that. In that situation, of course, from the evidence that was given to the Commons public Bill committee from Doctor Jamila Hussain, who's a palliative care specialist, this is an issue that disproportionately affects, of course, ethnic minority communities, not solely, of course, and there are numerous reports, numerous reports of poor communication and interpretation that lead to adverse health effects and life threatening illnesses being more prevalent in those communities.

So I do think it would be the safest way possible if we put something mandatory on the face of the bill and not allow for the possibility of situations where the young person feels they can't say having been alongside their parent or guardian for many years, putting along, putting something mandatory actually can protect those young people in relation to other clauses as well. In the Bill we have spoken and I believe it is relevant, not repetition here to say that the effect we now know on young people's brain and development can be profound through traumatic events, such as the death of a close family member.

It casts a new light on the possible neurological impact on the. The interpretation by a child. For a relative, seeking assisted dying could impact them and give rise to further health conditions as they develop. Reports state that if a child's hypothalmic pituitary adrenal axis is faced with traumatic stress, in this instance, the loss of the primary carer carer, it can lead to long term functional and structural changes in key areas of the brain's development, and it can. This can contribute to various psychopathologies, including, of course, obviously PTSD.

So putting something mandatory on the face of the of the bill so that children can't be placed in this situation and making it clear for all of the NHS hospitals who may have to deliver this is, I think, important and goes to a conceptual point. When I met with the noble and learned Lord about autonomy and choice. There are circumstances in which, particularly with children, we don't. We limit autonomy and choice and say it's better for all of us as the legislature, to have taken the decision to protect those children, and that those under the age of 16 in this context should not, should mandatory not be taking part in the process of interpretation.

And it may be as when we discuss this, that there are situations in terms of terminal illness and advice about treatment that children. It should be mandatory that children are not involved as interpreters in those circumstances.

12:28

Baroness Nicholson of Winterbourne (Conservative)

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12:35

Lord Moore of Etchingham (Non-affiliated)

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Lord Stern. I was deeply interested by the remarks of the. Nobel Baroness Fraser and. And very interested in her amendment. And just like to confirm from personal experience, a young man very well known to me who basically can't, can barely speak or hardly hardly speak at all, but through a and has therefore been effectively silent for all his life, but through a system called spelling to communicate. It turns out that he has a vast range of knowledge and high conceptual skills, which have only been discovered really very late and.

And he is now communicating by these means, though he can only communicate by them really at this stage, at least through his mother. So I very much support what she's what the barrister is saying, but forgive me if I've missed something. I don't quite understand how the wording of her amendment achieves the effect, achieves the effect that she intends.

12:36

Baroness Fraser of Craigmaddie (Conservative)

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What I'm trying to to, to, to explore with probing the word seek assistance is what assistance is provided, because the noble Lord is quite right in the example of his his friend. There are people who cognitively absolutely can understand what's going on. And therefore, if you put it in the context of this bill, would understand the assisted dying process. But what they need help with is the tools by which to communicate their will and the time and the space, and sometimes the vocabulary to do that.

And I note that the noble Lords example said that, you know, his particular friend has only recently come to it. That is an issue, is understanding what is the right thing for some of these people. And he also said at the moment can only otherwise communicate through his mother. And that's my other fear that that far too often this population, people speak for them because they know them best. So I hope that clarifies my my intentions.

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You support the amendments in Group. Two and in particular, amendment 171 in the names of the noble Baroness Nicholson of Winterbourne Baroness O'Loan clause Winterbourne Baroness O'Loan clause five. As we have heard, my Lord introduces a key element in the introduces a key element in the infrastructure of assisted dying in this bill by providing what is intended to be a safe but not mandatory introduction to the subject of death with the assistance of another human being.

For proponents of the Bill, the advantages of such an introduction are obvious, and, in their minds will remove a good deal of unnecessary distress on the part of those who wish to proceed with such an option, and on the part of those who do not. However, my Lords, as we have heard, and from those of us who have long experience of pastoral encounters, the experience is likely to be rife with pitfalls. This amendment, and the one that follows it, about which I shall say a little, leaving it to others to say more, is designed to correct some very obvious impediments to mutual understanding.

A good deal

12:39

The Lord Bishop of Southwark (Bishops)

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of communication is picked up visually. Visual impairment requires an extra dimension when communicating. My twin brother, my Lord, was born with severe hearing impairment, so I speak with lifelong experience of what it is lifelong experience of what it is to communicate thoughts, directions, information, and feelings appropriately to someone who has a hearing impairment. Finally, and briefly, my Lords, for I understand that the right reverend Prelate the Bishop of Newcastle wishes to say more. I also commend amendment 171A my experience of more than 40 years of ordained ministry is that there are those who purport to represent a religious or cultural identity and do so for less than an individual's best interests.

That may cut both ways in this debate. I hope that the noble and learned Lord Lord Faulkner of Worcester will look favourably on these amendments, which are designed to provide assistance to women who may face coercion. Should this bill become law, it will make the vulnerable more vulnerable as it currently stands. This is why so very many amendments, including this one, are so vital. Although I continue to fear that assisted dying itself would make the vulnerable more vulnerable.

12:40

Baroness Hollins (Crossbench)

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12:45

Lord Blencathra (Conservative)

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Yeah. fundamental safeguard in the entire bill, whether the person's true wishes are understood, expressed and protected. If we cannot guarantee that risk, then other safeguards becomes illusory. Amendment 167 in the name of the noble Baroness, Lady Fraser, my noble friend Lady Fraser does something very simple but profoundly important. It restores clarity. It ensures that clause five refers explicitly to a person's wish to end their own life, rather than the rather softer and more ambiguous phrase seek assistance, too. If Parliament prefers language designed to obscure the harsher aspects of what the law will permit, we must ask what message that sends to clinicians interpreting the law in practice.

If the bill itself is imprecise, does that does this not draw out the risk that the doctors may be also imprecise in their interpretation? And this amendment is not a rhetorical flourish. It's about informed consent. A person cannot meaningfully consent to something that is not described plainly, and a doctor cannot meaningfully assess capacity if the statutory language itself avoids naming the act. Precision is not pedantry, it is protection. My Lords Amendment 171 addresses a glaring omission. The bill currently requires adjustments only for language and literacy barriers that the government's own inequality impact assessment states explicitly that, quote, persons with learning disabilities or deaf persons may struggle to understand the information provided to them in written or oral form, unquote, and that BSL is not a translation of English.

With evidence from New Zealand, my Lords, where a deaf man could not even access the assisted dying service because he often had to ring a phone number and he could not hear what was going on. We do not need to repeat those mistakes here. The Mental Capacity Act requires that a person be able to understand, retain, weigh and use information for someone with a hearing or visual impairment that is impossible unless the information is provided in a form, they can actually access.

The National Down Syndrome Policy Group, put it starkly, quote, adjustments on accessible content are essential, unquote, and current easy read materials are often wholly inadequate. If we are legislating for a process that ends life, my Lords, then the minimum we must do it must guarantee is that the person can see, hear, or otherwise access the information on which their life ending decision depends. And finally, amendment 171A addresses a form of vulnerability that is too often invisible in legislation the cultural, religious and sex based pressures that can shape a woman's decision making long before she enters a consulting room.

The evidence is sobering. Naz Shah MP told the Commons committee that she was coerced into marriage at 15, not through overt force, but through the power of influence from those she trusted. She warned that such pressures can lead people to make decisions neither in our best interests nor of our own choosing. Professor Jane Monckton Smith and Colonel Henry Leach told the Lords our own Lords select Committee that victims of coercive control routinely deny their being coerced, and that GPS frequently miss the signs.

And Doctor Jamila Hussain, already referred to, described ethnic minority women in Bradford who are structurally disadvantaged, fearful of services and lacking culturally competent support. So if we do not explicitly recognise these barriers on the bill, then we risk creating a system in which the most vulnerable women, those least able to resist family or community pressure, are the least protected. So amendment 171A simply ensures that our cultural, religious or sex based barriers exist. They are acknowledged as potential barriers to communication and consent.

It is a safeguard rooted in lived experience, not abstraction. So these amendments all share a simple purpose to ensure that when a person says they wish to end their life, we know, we really, truly know that it is their voice, their will, and their informed decision. Amendment 167 ensures the bill speaks plainly. Amendment 171 ensures that people with sensory impairments can understand what's being asked of them. Amendment 171 ensures that women facing cultural or religious coercion are not unprotected. I conclude my Lords by saying, if we cannot guarantee their clear communication, accessible information and freedom from coercion, then we cannot guarantee informed consent.

And if we cannot guarantee informed consent, then we have no business legislating for assisted dying at all. I urge the noble Lord, Lord Falconer of Thoroton noble and learned Lord, to accept that proposition. I urge the House to support these amendments.

12:49

The Lord Bishop of Newcastle (Bishops)

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I'm very grateful to the right reverend Prelate, the Bishop of Southwark for preparing the way for some of my comments that I wish to make briefly now broadly to this group, which seeks to address issues around communication, language barriers and interpreters, I support the amendments that are laid before your Lordships House in that regard. Amendments 171A and 174A in the name of the noble Baroness, Lady Nicholson requires the provision of an advocate for women who might have additional vulnerability to coercion, especially due to cultural and religious factors.

It's a very interesting and significant idea, and I think it highlights the complex factors at play in considering certain groups of people. Because, my Lords, it is often those who are subject to health inequalities, who hold the most distrust towards the health service, and understandably so, since we are still in the shadow even now of the pandemic. My noble friend Baroness Berridge has already raised the evidence given by Doctor Jamila Hussain in the earlier passage of this bill, and Doctor Hussain warned us about failing to recognise this issue of inequality.

She said introducing this bill without addressing structural inequities and mistrust will likely result in widening disparities. Poorer end of life experiences for already disadvantaged groups and potentially inappropriate deaths. The provision for raising assisted dying with people is currently in the Bill could be highly damaging to an already strained trust in the health service. Secondly, my Lords, and briefly, I want to make a general point about issues of communication, language and interpreters. Again, doctor Jamila Hussain talked about the challenges of having end of life conversations.

She said these are nuanced, sensitive conversations. Understanding is not always straightforward. I know myself as your Lords. How when I worked and lived in New Zealand, how I had to work very hard both to communicate in another language to Maori, but also for my words and my thoughts to be conveyed into that language and into that cultural context. This bill assumes a sense of clear, individual and fully informed choice. However, when it comes to communication, language barriers and interpretation, this is so often mediated, culturally shaped, and indirect, and it seems that we are left with a very difficult decision about are we prepared to live with the degrees of uncertainty that this then gives us, or are we going to somehow restrict access to any assisted dying service? I expect neither of these is satisfactory.

So I support these amendments, and I urge your Lordships to consider them. Lordships to consider them.

12:52

Baroness O'Loan (Crossbench)

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My Lords, I. Which I have put my name excuse me to amendments 171171A172174 and 174A in this group. And the group of course, deals with obligations placed on a registered medical practitioner conducting a preliminary discussion to ensure that it will be possible for the patient to communicate well with the doctor, to hear and understand what is being said and to respond, and in so doing, to be understood. The bill provides for adjustments for language and literacy barriers, including the use of interpreters in amendment 171 so articulately prepared by Baroness Moyo Baroness Shah Baroness Nicholson.

She rightly seeks to add provision for hearing and visual impairments, and also by 171A the noble Baroness seeks to ensure that provision is made also for cultural, religious and sex based factors. This covers a wide range of situations, my Lord, perhaps the most simple of which might be the reluctance in a woman to speak through a male interpreter in a discussion which might include matters of great sensitivity. Similarly, men may be uncomfortable or even distressed by having such conversations with a woman.

Religious considerations may also be profoundly important to the person having the discussion. Many religions seek to deter suicide. This has to be taken into account, particularly ensuring that the person understands exactly what they are agreeing to and the consequences of taking whatever lethal drug is prescribed by amendment 174A the noble Baroness Baroness Nicholson introduces an advocate with particular characteristics safeguarding experience in relation to cultural and religious issues, and being of the same sex as the person contemplating asking for assisted suicide.

Both profoundly important as they will facilitate trust in the advocate and hence trust in the process. Similarly, there are those who use sign language, a matter covered by the noble Baroness Baroness Gray Thompson's Amendment 172. Of course, under the British Sign Language Act 2022, which was sponsored by the former MP Rosie Cooper, British Sign Language is now an official language of England, Scotland and Wales, and I would say that the noble Baroness, the Rosie Cooper MP, was the child of two profoundly deaf parents.

She described to me the dying days of her father, who was dying at an advanced age, with many complications. But the problem was it was not possible for interpreter to be there, a sign language interpreter to be there when they needed to talk to him. And. And Rosie was finding it that she had to go so often to try and make sure her father was safe and understood the discussions and what was being put to him. This is a profoundly important matter.

In addition, those who are blind or partially sighted may may use amanuensis or Braille as provided for in amendment 173. It's not appropriate, though it does happen for children to be used as interpreters when their parents or family members are sick. The noble Baroness Baroness Berridge has referred to this as one who dealt with complaints in a northern health trust. I did receive complaints in respect of children being used at the age of 10 or 11 to discuss their parents, or particularly their mothers intimate medical conditions, something which was entirely inappropriate for children.

And I would suggest to noble Lords that if it's inappropriate for children to be involved in that kind of discussion, it is equally inappropriate for a child to be involved in the discussion of matters of life and death. And therefore I support the noble Baroness Baroness Berridge her amendment to preclude the use of children as interpreters. I support all these amendments and those of noble Baroness Grey-Thompson three, two, two and 322A that a version of any report must be provided in their preferred language or in an accessible format of their choice.

Amendment 408 seeks to assure compliance with this requirement by requiring a record to be kept of the communication affecting any patient. My Lords, in a country in which there are almost a million people with learning difficulties, in which over 100 languages are spoken, many of which do not contain words which are present in the English language, such as safeguarding. There are even languages which do not contain the word suicide, and in many cultures there are difficulties in discussing suicide.

So any discussion about whether a person wants to be described, prescribed and to take lethal drugs which will end their life, must be conducted with the utmost rigour to ensure that those making this final decision are under no pressure and have a full and complete understanding of what is being proposed and what the what the consequences, including any complications, may be. Can I ask the noble and learned Lord, Lord Faulkner, whether he will now support these amendments to make the requirements cover needs beyond language and literature? Surely this is proportionate to the seriousness of the discussions communications in this bill? Does the noble and learned Lord accept that his earlier amendment to lessen the duty on doctors to ensure effective communication, have increased concern in the House, and that these specific amendments are necessary? My Lords, the noble and learned Lords use of the words take all reasonable steps to which the noble Baroness Baroness Hollins has just referred implied that there are steps which can be taken to ensure effective communication, but which are too much effort or perceived to be disproportionate.

My Lords, in discussing whether to take your own life, aided by the state, crystal clear communication is essential. What must be required is all necessary steps, and those steps must provide explicitly for the categories of people referred to in this group. Noble Lords, I

12:59

Baroness Nicholson of Winterbourne (Conservative)

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follow the noble Baroness with reference also to our shared reference also to our shared amendment 174 A. I apologise for not raising this in my previous discourse, but the differences are discourse, but the differences are so acute that I just did not feel it right to share them in the same it right to share them in the same comment. And I believe that the companion allows me to speak twice companion allows me to speak twice in Committee stage. I declare also interests in this particular amendments are matters that I have worked with in closed communities worked with in closed communities for most of my life.

My most recent. Responsibilities have been with the charity, the AMA international charity International Charitable Foundation, which I founded about 35 years ago, and we have worked consistently, for example, with the sort of enforced enclosed community of the Marsh Arabs and with the enclosed communities of the Yazidis, the genocide victims, and with other enclosed communities which have more or less covered different parts of the globe. I work particularly closely, for example, with The Church of Jesus Christ of Latter day Saints, the former Mormons, as they were known, and with others who are in close communities.

My concern today is with Muslim women. We have two minority faiths in the United Kingdom, where women are deemed to be secondary to men. And as the noble Lords under the noble and learned Lord Wood realise, I know very well that women are superior to men, most certainly not inferior. However, that being accepted to be the case, and I'm not quite sure whether I will cause a dispute between the right reverend Prelate, the Bishop of Newcastle and the right reverend Prelate Bishop of Southwark on this.

But either way, I welcome and endorse what both of them have said about minority faith communities in the United Kingdom. I speak particularly strongly about Sunni women who don't speak English. And I'm sorry to say that because we in the United Kingdom have made so little effort to help them become literate and numerate in the language of this country. There are at least a quarter of a million, and there may be more. And those ladies and some of the men who are their family, their family members, and even those who are running the religious side of their lives, they may believe that verse 74 of the Holy Quran, which places women subservient to men in all cases and at risk of physical violence if they disobey, those ladies will believe that this is the norm here.

They don't speak English and they don't know the law. Many of them I know they are illiterate, functionally illiterate, and non-numeric in their own language of the countries from which they came. And some of those countries I refer particularly to Afghanistan, women do not legally exist in Afghanistan at all. They don't exist. The World Health Organisation tells me that this is the only nation in the world of which this is ever known. You come here from a country like that, that that is a unique country in that women don't exist.

You won't understand that. Actually, here you are a fool. You have rights. You are on the same level as everyone else. It doesn't matter whether or not you have money. It doesn't matter who you are. You are a citizen of the United Kingdom, or a visitor, or even an illegal immigrant, and you will still have that right as a woman and as a citizen. And indeed, if I think about children and my colleague on on the Crossbenches referred to children in this context, the United Nations Convention of the rights of the child was drafted here in this chamber by our former member Baroness Bakewell great great lady and the United Nations rights of the child on which I've worked all my life is very clear about the rights of children, and the rights of children won't exist in the minds of these ladies because they don't know about it.

This is artful. This is our failing as a nation. We've made no effort. We haven't helped them learn English. We haven't helped them get out. We haven't helped them understand their rights here. And of course, it isn't just coming from Afghanistan, Sistan and Baluchistan, where you believe that you have to drape yourself completely. That's not in the Holy Quran at all. Nothing like that. It's not in the Quran at all. I hope that all members of this noble Lordships House have read the Quran.

It's much more interesting and rich and full document. I read it a number of times and it is very important indeed that we understand it. It doesn't say what some of its practitioners claim or offer that it says. So I would suggest very clearly also that UK law predominates. These ladies and the men who work with them, who are their families, maybe they're the groomers even they believe they're doing the right thing. The new law in Iraq, a country I know intimately, declares that girls of 9th May be married to men of any age.

You come from Iraq, and a huge amount of people come from Iraq. It's very well organised by northern Iraqis and Iraqi Kurdistan. A wonderful business going, bringing illegal immigrants by boats across the channel to Britain. You come with that thinking and that background. Unless you're taught British law, you won't have any understanding at all of what you are. And this, of course, marks on our discussion here today. When you're nearly dying, or possibly or not nearly dying, but your family wants to get rid of you.

And it is worth remembering at the moment that I think it's 11% of all deaths, which is the highest number come from those who have Alzheimer's or similar diseases. So mum's a bit of a burden. Granny's even worse. Aunt can go as well. And what about cousin? What about my sister? I don't actually like her. They would do as they're told. And of course this will really, in a true sense, crucify them. Because as my colleague has just said, certainly in Islam, suicide is outside.

So they will be declaring themselves outside their own faith. Do we really expect them to understand enough to do that? I don't think so. My suggestion to the noble and learned Lord, Lord Faulks now is that perhaps he would grant me a meeting, because since this is not a government bill, I've taken this round to various religious centres in London, for example. This time nobody's consulted them and they would really like to be consulted because suicide is against Islam.

The question to me is why hasn't the government been to see us about

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this? So I put this forward. May I request.

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May I request. The noble Baroness to speak to the amendment, please? Yeah.

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the amendment, please? Yeah. So this private member's bill has not been discussed with the has not been discussed with the with the with the mosques in the United Kingdom in London. And I don't believe anywhere else. So my don't believe anywhere else. So my suggestion is that we have a meeting that I bring suitable people with me, and we start to open this up. It is against the faith to commit suicide, and I think it's very important.

13:07

Lord Polak (Conservative)

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I agree to a meeting. And of course, the noble Baroness should bring anybody she thinks bring anybody she thinks appropriate to the meeting.

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I want to raise this of a. 50% of a registered interest, that I'm of a registered interest, that I'm 100% deaf in my left ear. I think. I think, I think the maths works I think, I think the maths works right. Thank God. As you know, my my right ear is quite good, but my right ear is quite good, but it's also useful in many aspects of my life. When I pretended that I didn't hear it at all. But I actually support all the amendments in this group.

I wasn't going to speak, but I, I'm moved to speak to Baroness Nicholson, who I've known for many years, and her amendment 171, and I want to pay tribute to her bravery and courage that has enabled her success in her life of service to vulnerable people. And if I may say to my my noble friend Baroness Fraser her amendment 167, which she so eloquently introduced, it's been said, but her professional work with people who often cannot communicate for themselves is well known.

And I think the real point I want to make to people opposite, not opposite people who are supporting and want to rush this bill through that. This group of amendments shows the vital importance of the process that we are going through, and shows that those who are intent on trying to rush it through and rush this flawed legislation through without this sort of vital discussion, is a is a is a real, real disgrace. Actually, these amendments may affect one person who by accident, by unable to communicate, by unable to hear the wrong thing happens to them.

And this bill should be and work for every individual. And that's why I urge the the noble Lord, Lord Faulkner, to find a way, find a way to include these matters, these important aspects into the bill.

13:10

Lord Empey (Ulster Unionist Party)

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I think everybody must have been affected by the comments of the noble Baroness, Baroness Nicholson, because it is very sobering revelations of her experience, which is very broad and much to be admired. But this group of amendments, I think, brings into sharp focus the sheer scale of the complexity of bringing assisted suicide into the NHS context. We have heard pleas from the movers of some of these amendments that specific provision be considered because of the needs of those with complex communication difficulties, whether that is, for example, hearing language, cultural challenges.

But I want to draw the House's attention to other matters which have not been addressed in the context of a busy hospital with overworked staff. I said in addressing other groups of amendments that many, many people seem to be viewing the operation of the current NHS through rose tinted glasses. Hospitals these days are not as portrayed in a TV series like the 1960s Heartbeat or Call the Midwife. Gone are the days when consultants have time to come round for friendly chats at their leisure, with patients and family.

Parliament and governments have demanded that targets be met because of increasing demand and relentless growth in our population. Meeting targets means throughput, and throughput means patients and patients out as quickly as possible. So I struggle to see how the current bill, if enacted, can be safely implemented in current hospital settings. In a busy NHS ward, consultants during their ward rounds in the mornings have only a few minutes, maybe once or twice a week, to assess a patient and give instructions to registrars and nurses as to what treatment is to be applied.

Introducing complex processes involving safety, providing the means by which patients can take their lives themselves with poisonous substances, coordinating all the relevant personnel together at the right time to oversee. This is going to be a mammoth task in our overstretched NHS. Let's look at some of the realities upon which this group of amendments draws attention. For instance, we've discussed language in London alone. I was astonished to learn there are 300 languages spoken, 1.7 million Londoners don't have English as their first language and 300,000 or more don't speak English at all.

Now, that's equivalent to the population of a city like Cardiff or Glasgow. Yes.

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I declare an interest as. A non-executive. Director of the Whittington. Hospital. Where we serve many of these

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Where we serve many of these communities. I can. Assure you, the noble. Lord. We put a lot of resource very

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We put a lot of resource very successfully into supporting our clients, supporting our patients clients, supporting our patients from whichever group they come from and whatever capacity problems they and whatever capacity problems they may have. I think that you have to live in these communities to understand. The NHS is completely aware of the need to do that. Yes.

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Well done. Delighted to hear that. But I'm also complex. I'm also very aware also complex. I'm also very aware of the pressures of a NHS possible, of the pressures of a NHS possible, perhaps not in London, but in other places where the staff are run off

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places where the staff are run off their feet day and night and we're imposing it. Come from Bradford, where all my

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Come from Bradford, where all my family live and we do the same there too. But it's not a universal situation, I can assure you. And if I may continue, there's 1.7 million numbers, don't have English as their first language and 300,000, as I said, who don't have English at all. So that's equivalent to a significant size of a city. According to the 2021 census, only 63.8% of households consisted of members who all had the same main language.

And I think Baroness Berridge mentioned the 21 census and 6% of the population, or 1.5 million houses, consisted of people who are different main languages in the same house. So those figures are five years out of date. And with the surge in immigration since, I'm sure the figures are much greater. Baroness Nicholson has highlighted the circumstances of people with hearing difficulties. But add to that, in a traumatic situation of discussing whether or not a person wishes to be assisted to die, how a patient may be able to absorb such difficult information from a medical practitioner who does not, perhaps have English as his or her first language, and vice versa, where a medical practitioner may have a patient whose first language is not English, these matters cannot be swept under the carpet.

They are critical to establishing exactly. If a patient is fully informed and determined to be making an informed decision, which is the core of this legislation. So I have to say, my Lords, as this bill has been progressing and more than ever convinced that the NHS is not a suitable place for assisted dying to take place.

13:15

Baroness Grey-Thompson (Crossbench)

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My Lords, I. group 172322322A and 406, which address the requirements of accessibility, BSL and also Braille. In speaking to amendments, Baroness Fraser of Craigmaddie raised a number of issues and while I tried to put. I put all my amendments in before the start of committee. I think in her debate in. It showed some of the areas where we should still have some cause for concern, certainly around things like programmable tax and the way that it's used.

Now, my noble friend Baroness Campbell of Surbiton is not able to be in her place today, but she has raised the issue. Lucinda Ricci, who was a woman who used communication aids, had to go to a care home. The nurses were not able to set up these communication aids. And then this woman essentially became voiceless. And I think if there's one thing that the debate today is highlighted in the words of the noble Lady Baroness Nicholson, if this chamber can't provide reasonable adjustments for members, actually, I think that highlights a bigger problem that exists outside in terms of actually whether people can really understand what's going on.

So the bill takes its foundation from the Mental Capacity Act, and we have to really get to grips whether someone can understand, retain and use information. And I'm really against the process of assisted suicide being called treatment. But actually, if we can't communicate with people properly, then actually the individual might be confused in terms of what's being told. It's all been raised about New Zealand where people have to ring a phone number. Doctor Jan Snellen has said that it's completely inappropriate.

A deaf person can't ring a phone number, so might not actually be able to access the service that they want. And I do have amendments on reporting mechanisms, but I'm really keen to understand what issues also might be highlighted from these discussions. Whether one impairment group is disproportionately affected accessing this service. And that's why 406 the amendment 406, says that we need to record when people's accessibility needs are not met. Now, clause 39 D does give power to the Secretary of State to introduce codes, and I do hope the breadth and depth of debate in this group will inform that the National Down Syndrome Policy Group, as already mentioned, has said that it's essential that people are able to understand what's going on.

But the easy read document from the NHS on the Mental Capacity Act is 28 pages long and is complicated to understand, and it's difficult to get true consent when we know that people with down syndrome are already suggestible and potentially eager to please others. And we know that people with learning disabilities and deaf people already have lower health outcomes than others. It's tragic to see the case of Adrian Poulton, a man with down syndrome and dementia who starved to death in a British hospital because the doctors put nil by mouth above his bed and he wasn't able to communicate and the staff weren't able to or were not listening when he was asking for food, they just looked at the nil by mouth and assumed that he didn't know what he was talking about.

The equality impact assessment has identified that there are some areas of concern. And yes, it should be noted British Sign Language is not a direct translation of English. I do think we missed a trick when we were doing that legislation, not to go integrated depth with it, but we have to be clear about how we provide appropriate translation. Noble Baroness Lady Fraser raised about difficulty speaking. I met someone for the first time recently. We had no issues communicating at all, and it was only after about ten minutes they mentioned to me that they'd had a stroke and they felt that they were struggling to speak and to find the right words.

And you could easily make an assumption that someone's communication skills are very good, when indeed they are not. In terms of the numbers of people who are able to use British Sign Language, I think we've got some issues there in terms of there's not enough, and I accept that makaton is not a language, and it should in no way be confused. But there's about 100,000 people that use it as a communication aid. There's 1200 licensed tutors, and they train about 20,000 people annually.

I think I should have probably made that clear in the amendment that they weren't interchangeable. And if I think about it in a different context, you know, we don't and we certainly shouldn't replace Quebecoise with French or Swiss German with German. When we talked in the earlier group about Wales, I'm Welsh. I do think it's important that that we discuss these issues. I grew up in a Semi-fluent household. Actually. My mother spoke very colloquial Welsh. So while I think I understand quite a lot and it depends who speaks to me how much I understand actually my understanding and what you take from a conversation can be very different.

And that's why I'm concerned about these group amendments my noble friend Baroness O'Loan raised about the the issue of translation. In 2017, I did a work for the then government on duty of care and support. And the word safeguarding is not translatable into other languages. And even where it is, it's meaning can be very different. So I think we we need to be concerned by that. A survey by the Royal National Institute for Deaf People found that 77% of BSL users had difficulty communicating with hospital staff, and 33% left consultations with their family doctor, unsure about instructions or taking the correct medication doses.

And we we've seen in the media a deaf man was wrongly told he had HIV after hospital failed to provide an interpreter. There's a case in the states of Durlin Roberts, an American woman who famously pretended to be a sign language interpreter at a high profile news conference in Tampa, Florida, the police were announcing the arrest of a serial killer she couldn't sign at all, and experts described her interpretation as gibberish. Members of the deaf community were very upset, and a deaf mother of one of the victims of the serial killer was present and was relying on the interpretation.

You know, just think how distressing that is. But there are good examples. Saint Helena Hospice, where people who have a preference to use BSL can communicate with a single point nurses from the home by clicking the BSL live button, so it is possible to provide appropriate translation. And so deaf patients or visitors have the choice of using this. And I think we should also not presume that the person with the communication barrier is the patient. It might actually be that the doctor has some challenges in translating, understanding or indeed communicating.

And I'm delighted to learn, you know, I think through the training, you know, doctors are getting much better training on how to communicate with patients. But I do think this could be improved. The GMC guidance says steps must be taken to meet the needs of individuals, but each stage of the process is reliant on being an open choice. But if these discussions are not accessible because of a language or communication barrier, then any perceived safeguards in this bill are simply worthless.

The noble and learned Lord has said many times that he believes that everyone should have equal access to the process. But for deaf or disabled people or people who have a combination of impairments, it is really important. They are genuinely given equal access to the process and they understand every step of the pathway.

13:23

The Earl of Effingham (Conservative)

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My Lords. >> Before I speak to the substance of the amendments in this group, may I please pay tribute to the may I please pay tribute to the noble Baroness, Lady Nicholson, Lady Berridge, Lady Fraser of Craigmaddie, Lady Grey Thompson, Craigmaddie, Lady Grey Thompson, Lady Holland's Lady O'loan and the Right Reverend Prelate, the Bishop of Newcastle. They have all stood up for a particularly vulnerable group of people during this debate, and they are absolutely right to do so. The noble and learned Lord, Lord Faulkner, will be, I am sure, listening most carefully to their arguments.

So, my Lords, individuals with speech, language and hearing difficulties are particularly vulnerable, and it is imperative that they fully understand the process, their rights and the terms of this bill before they can access the provisions made within it. My noble friend Lord Blencathra said, we really, really need to know that an individual understands what they are doing. And Baroness O'Loan used the phrase crystal clear, and they are both absolutely right. Surely how society cares for the most vulnerable of its citizens is an unmoveable benchmark.

Society must protect people with communication difficulties. The noble Baroness, Lady Berridge, specifically questioned the government, and His Majesty's loyal opposition believes it is fair and reasonable to ask the noble Baroness, the Minister, Lady Maron, what specific work both officials and Ministers have undertaken to establish the core risks posed by this Bill to those with hearing, speech and language impediments in the view of His Majesty's government, how effective are the safeguards currently in place and can the Bill be improved? From a neutral perspective of workability, to ensure that no one who faces the challenges we have discussed in this group ends their life without being given the obvious support they need to fully understand the life changing decision on which they are embarking.

As the noble Lord Lord Winston referenced in the previous group. Often during the course of this bill, noble Lords have debated detailed provisions and address complex moral issues with a laser focus. However, my Lords, please allow me to suggest the question at

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