Lords Chamber
10:05
10:06
Lord Kennedy of Southwark (Labour)
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Lord Kennedy of Southwark (Labour)
>> My Lords, before we begin, I will make my usual brief remarks. Firstly, I reiterate our thanks on behalf of the whole House to all staff across the House for supporting this city. I cannot today do justice to the thanks that the staff of the House deserve, not only for today, but for all other days. Only in the last few days we've seen the care, kindness and dedication, the staff looking after members when they're taken ill. Yeah, yeah, this has been another long week and the recess is upon us.
I will not repeat everything I've said before at length, but I should, as usual, remind Labour Lord Stoneham key points. I will adjourn proceedings today at around 3 p.m. I hope we can conclude the group we are on, but when we finish. But if necessary, I'll adjourn the house during the middle of the group. The class will compile a list of all noble Lords in attendance at the beginning of. And the noble Lords will be able to check the table. Sure. Their name is properly registered.
Only those present start of the group can participate when the group resumes. My noble
I will not repeat everything I've said before at length, but I should, as usual, remind Labour Lord Stoneham key points. I will adjourn proceedings today at around 3 p.m. I hope we can conclude the group we are on, but when we finish. But if necessary, I'll adjourn the house during the middle of the group. The class will compile a list of all noble Lords in attendance at the beginning of. And the noble Lords will be able to check the table. Sure. Their name is properly registered.
Only those present start of the group can participate when the group resumes. My noble
10:07
Business of the House
Lord Kennedy of Southwark (Labour)
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Business of the House
Lord Kennedy of Southwark (Labour)
friend Lord Falconer of Thoroton has set a target for today's Committee stage. As I said before, Committee stage. As I said before, I hope that with discipline and usual courtesies, we may progress towards the target. There will be towards the target. There will be no lunch break, but kata facilities are open and the long room will stay open until the house rises. For general guidance on how noble Lords should conduct themselves, I highly recommend the companion. In highly recommend the companion.
In particular, paragraph 4.29 on page 60 and paragraph 8.81 and 8.82 on page one four, three. Finally, my Lords, as we start the Easter recess, as I did yesterday, I wish all noble Lords, staff and the House along with families and friends, a well deserved break over the Easter recess. Either myself or one of my colleagues will be back at 3 p.m. to adjourn the house and then, with everyone rested, we will be back on Monday the 13th of April for the final day and report of the English devolution Bill, with several divisions expected.
With that, I think we should move on to
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the business. My Lords, Baroness Campbell of Surbiton will be taking part remotely. I remind the committee remotely. I remind the committee that unless they are leading a group, remote speakers speak first after the mover of the lead after the mover of the lead amendment in a group and may therefore speak to other amendments in the group ahead of members who in the group ahead of members who tabled them in clause five. Amendment 189, the Baroness Fraser
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of Craigmaddie. My Lords, this group of
In particular, paragraph 4.29 on page 60 and paragraph 8.81 and 8.82 on page one four, three. Finally, my Lords, as we start the Easter recess, as I did yesterday, I wish all noble Lords, staff and the House along with families and friends, a well deserved break over the Easter recess. Either myself or one of my colleagues will be back at 3 p.m. to adjourn the house and then, with everyone rested, we will be back on Monday the 13th of April for the final day and report of the English devolution Bill, with several divisions expected.
With that, I think we should move on to
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the business. My Lords, Baroness Campbell of Surbiton will be taking part remotely. I remind the committee remotely. I remind the committee that unless they are leading a group, remote speakers speak first after the mover of the lead after the mover of the lead amendment in a group and may therefore speak to other amendments in the group ahead of members who in the group ahead of members who tabled them in clause five. Amendment 189, the Baroness Fraser
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of Craigmaddie. My Lords, this group of
10:08
Baroness Fraser of Craigmaddie (Conservative)
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Baroness Fraser of Craigmaddie (Conservative)
amendments seek to establish an opt in model for healthcare professionals, as explicitly professionals, as explicitly requested by the various royal colleges, including the Royal College of GPS, the Royal College of Psychiatrists, the Royal Pharmaceutical Society and the Royal College of Nursing. They seek to protect doctors and all healthcare professionals, not just with a vague, formal right to opt with a vague, formal right to opt out, but with a clear framework in which their rights are clear. My amendment 189, supported with many thanks by the noble Lord Carlile and the noble Baroness, Lady Lady O'loan seeks to strengthen the transparency of medical practitioners involved in delivering an assisted dying service by setting up a publicly available register of medical professionals who are willing and able to conduct preliminary discussions.
Now, whilst the bill's sponsors have confirmed that the bill is based on an opt in system. It is imperative that this opt in is explicitly referred to in the Bill to ensure participation is a positive choice, to avoid it being presumed or open to pressure that all professionals would participate unless they opt out. Now, in clause five, subsection six, it says that if a doctor is unwilling or unable or unwilling to participate, they must ensure the person is directed to where they can obtain information and have the preliminary discussion.
But, my Lords, where should that be? Would not a publicly available register be the perfect solution for the patient to seek out a medical professional on the register at their convenience? The noble and learned Lords amendments 42 and 42 three. Leave it to the Secretary of State to make provisions through regulation at some later date and 699A only covers coordinating and independent doctors, and only adds an opt in option to providing or participating in training. And I believe that this isn't good enough.
And I'm sure the noble Lord noble and learned Lord will also refer in his reply to clause 31, which I appreciate was expanded in the other place at Report stage. However, serious gaps remain, schedule three of the Bill may indeed provide for protection against detriment by incorporating existing employment rights, but this doesn't resolve the issue because it leaves individuals to resort to the tribunal system, a system that is already crowded and where the remedy is damages, not rehiring.
So potentially forcing individuals to have to choose between their conscience and their career. Now, we know that not all medical practitioners will want to participate in assisted dying. 45% of doctors in the BMA's 2020 study indicated they would not be willing to participate, with a further 19% undecided. It is my belief that a clear and public register of those professionals who do wish to participate would enhance transparency and enable everyone to know where they stand. Amendment 189 requires the Secretary of State to set up such a register, ensure there is a process to keep it updated and to make it publicly available.
A medical practitioner could only conduct preliminary discussions if they are in the register. My Lords concerns have been expressed that assisted dying will forever change the doctor patient relationship. Vulnerable patients would not be able to trust that clinicians had their best interests at heart. Such concerns illustrate the importance of ascertaining whether assisted dying is or is not to be considered a treatment, which amendments three, eight three and 657 in the names of the noble Baroness Cass and Fox are exploring.
But with amendment one, 89 patients would know if their GP was a willing participant, whether or not they wish to avail themselves of assisted dying, and presumably they could choose or not choose to register with such a practice. And patients would also know if their consultant or other medical professional had opted in, and thus providing a context for, say, discussions around future options. And it also protects to clinicians, protects clinicians who can point to the register if they wish to have nothing to do with assisted dying.
The BMA have advised that they are against the reintroduction of a requirement on doctors to refer patients, which would undo a change from refer to direct made in the other place. But I understand that not all royal colleges are at one. On this point, I take the point that my subsection nine in my amendment does read that a professional who is unwilling or unable to conduct the preliminary discussion must refer the person to the Register of Medical professionals, and I know that the BMA attached a specific meaning to the word refer, and as I am sure, the noble Lady.
The Minister will tell me in her reply, my amendment has not had the advantage of technical support in its drafting, and frankly, if the BMA would prefer the word direct, then I would be perfectly happy with that. But even if you remove the last clause, section nine of my amendment, the point remains, which is to set up a publicly available register for those who want to opt in. Such a register also has the advantage of being able to be tracked. We could review whether certain areas of the country were being better or worse served.
We could monitor the practice of doctors on the register to track concerns of doctor shopping, and we could analyse which professionals or specialisms are or are not participating in assisted dying. And all of this would assist with the regulation of assisted dying. My Lords, the bill is ambiguous about how far conscience protections actually extend. Amendment 673 in my name protects the rights of anyone involved in the care of someone who might want assisted dying to opt out of supporting that person to die.
We know that in practice, a much wider remit of health and care team members will be affected by supporting someone in an assisted death, not just the lead clinicians. The noble Baroness, Lady Watkins, reminded us last week of the multidisciplinary nature of support for the terminally ill people, and care workers in particular, are ignored in this bill. These health and care workers, whether they're registered or unregistered, should be able to refuse to participate if they wish to conscientiously object without penalty, and they should be afforded the same protections as lead clinicians.
Those of us who are following the debate in the Scottish Parliament last week will know that one of the reasons MSPs changed their minds was exactly because of the lack of clarity of the protections for conscientious objectors. Their ability to refuse to participate in assisted dying was not clear, and that Bill has now fallen. So can the noble and learned Lord, please confirm what is his response to the Royal College's call for an opt in system to be adopted? And how can he guarantee that no one will face legal or professional repercussions, including indirect ones, for refusing to participate in assisted dying? I beg to move the.
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Amendment. Proposed clause five, page three, line 30 leave out page three, line 30 leave out subsection six and insert the words as printed on the Marshalled List.
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as printed on the Marshalled List. My Lords, I have added my name to my noble birth. My noble friend. to my noble birth. My noble friend. Baroness Finlay amendment 190 and I have also supported amendments 268359383617 and 657 in this group. This basket of amendments as my noble as the noble Lady, Baroness Fraser said, seeks to ensure that no doctor or associated healthcare professional is under any pressure to participate in the process of assisted dying unless actively opting in to the process.
Amendment 190 provides an important safeguard against pressure on doctors by making it clear that the obligation to refer a patient to relevant information and another doctor applies only when the patient has specifically requested a preliminary discussion on assisted dying. It also ensures that doctors who do not wish to be involved are
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not required to take part beyond that point. My Lord's last summer I spent
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My Lord's last summer I spent six weeks in Saint Thomas's critical care after an accident at critical care after an accident at sea in the Bay of Biscay. I came home broken, bruised and in home broken, bruised and in terrible pain, but my salvation was the compassionate, dedicated team the compassionate, dedicated team of health professionals whose combined efforts brought me back to life and back to this chamber. This was what they were born to do. As ever, I took the opportunity to ask each person who came to my bedside what they thought of the bill and would they participate in its application should it become law.
Hand on heart. Not one doctor, nurse or allied professional said yes. What they did say was, it's
Now, whilst the bill's sponsors have confirmed that the bill is based on an opt in system. It is imperative that this opt in is explicitly referred to in the Bill to ensure participation is a positive choice, to avoid it being presumed or open to pressure that all professionals would participate unless they opt out. Now, in clause five, subsection six, it says that if a doctor is unwilling or unable or unwilling to participate, they must ensure the person is directed to where they can obtain information and have the preliminary discussion.
But, my Lords, where should that be? Would not a publicly available register be the perfect solution for the patient to seek out a medical professional on the register at their convenience? The noble and learned Lords amendments 42 and 42 three. Leave it to the Secretary of State to make provisions through regulation at some later date and 699A only covers coordinating and independent doctors, and only adds an opt in option to providing or participating in training. And I believe that this isn't good enough.
And I'm sure the noble Lord noble and learned Lord will also refer in his reply to clause 31, which I appreciate was expanded in the other place at Report stage. However, serious gaps remain, schedule three of the Bill may indeed provide for protection against detriment by incorporating existing employment rights, but this doesn't resolve the issue because it leaves individuals to resort to the tribunal system, a system that is already crowded and where the remedy is damages, not rehiring.
So potentially forcing individuals to have to choose between their conscience and their career. Now, we know that not all medical practitioners will want to participate in assisted dying. 45% of doctors in the BMA's 2020 study indicated they would not be willing to participate, with a further 19% undecided. It is my belief that a clear and public register of those professionals who do wish to participate would enhance transparency and enable everyone to know where they stand. Amendment 189 requires the Secretary of State to set up such a register, ensure there is a process to keep it updated and to make it publicly available.
A medical practitioner could only conduct preliminary discussions if they are in the register. My Lords concerns have been expressed that assisted dying will forever change the doctor patient relationship. Vulnerable patients would not be able to trust that clinicians had their best interests at heart. Such concerns illustrate the importance of ascertaining whether assisted dying is or is not to be considered a treatment, which amendments three, eight three and 657 in the names of the noble Baroness Cass and Fox are exploring.
But with amendment one, 89 patients would know if their GP was a willing participant, whether or not they wish to avail themselves of assisted dying, and presumably they could choose or not choose to register with such a practice. And patients would also know if their consultant or other medical professional had opted in, and thus providing a context for, say, discussions around future options. And it also protects to clinicians, protects clinicians who can point to the register if they wish to have nothing to do with assisted dying.
The BMA have advised that they are against the reintroduction of a requirement on doctors to refer patients, which would undo a change from refer to direct made in the other place. But I understand that not all royal colleges are at one. On this point, I take the point that my subsection nine in my amendment does read that a professional who is unwilling or unable to conduct the preliminary discussion must refer the person to the Register of Medical professionals, and I know that the BMA attached a specific meaning to the word refer, and as I am sure, the noble Lady.
The Minister will tell me in her reply, my amendment has not had the advantage of technical support in its drafting, and frankly, if the BMA would prefer the word direct, then I would be perfectly happy with that. But even if you remove the last clause, section nine of my amendment, the point remains, which is to set up a publicly available register for those who want to opt in. Such a register also has the advantage of being able to be tracked. We could review whether certain areas of the country were being better or worse served.
We could monitor the practice of doctors on the register to track concerns of doctor shopping, and we could analyse which professionals or specialisms are or are not participating in assisted dying. And all of this would assist with the regulation of assisted dying. My Lords, the bill is ambiguous about how far conscience protections actually extend. Amendment 673 in my name protects the rights of anyone involved in the care of someone who might want assisted dying to opt out of supporting that person to die.
We know that in practice, a much wider remit of health and care team members will be affected by supporting someone in an assisted death, not just the lead clinicians. The noble Baroness, Lady Watkins, reminded us last week of the multidisciplinary nature of support for the terminally ill people, and care workers in particular, are ignored in this bill. These health and care workers, whether they're registered or unregistered, should be able to refuse to participate if they wish to conscientiously object without penalty, and they should be afforded the same protections as lead clinicians.
Those of us who are following the debate in the Scottish Parliament last week will know that one of the reasons MSPs changed their minds was exactly because of the lack of clarity of the protections for conscientious objectors. Their ability to refuse to participate in assisted dying was not clear, and that Bill has now fallen. So can the noble and learned Lord, please confirm what is his response to the Royal College's call for an opt in system to be adopted? And how can he guarantee that no one will face legal or professional repercussions, including indirect ones, for refusing to participate in assisted dying? I beg to move the.
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Amendment. Proposed clause five, page three, line 30 leave out page three, line 30 leave out subsection six and insert the words as printed on the Marshalled List.
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as printed on the Marshalled List. My Lords, I have added my name to my noble birth. My noble friend. to my noble birth. My noble friend. Baroness Finlay amendment 190 and I have also supported amendments 268359383617 and 657 in this group. This basket of amendments as my noble as the noble Lady, Baroness Fraser said, seeks to ensure that no doctor or associated healthcare professional is under any pressure to participate in the process of assisted dying unless actively opting in to the process.
Amendment 190 provides an important safeguard against pressure on doctors by making it clear that the obligation to refer a patient to relevant information and another doctor applies only when the patient has specifically requested a preliminary discussion on assisted dying. It also ensures that doctors who do not wish to be involved are
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not required to take part beyond that point. My Lord's last summer I spent
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My Lord's last summer I spent six weeks in Saint Thomas's critical care after an accident at critical care after an accident at sea in the Bay of Biscay. I came home broken, bruised and in home broken, bruised and in terrible pain, but my salvation was the compassionate, dedicated team the compassionate, dedicated team of health professionals whose combined efforts brought me back to life and back to this chamber. This was what they were born to do. As ever, I took the opportunity to ask each person who came to my bedside what they thought of the bill and would they participate in its application should it become law.
Hand on heart. Not one doctor, nurse or allied professional said yes. What they did say was, it's
10:19
Baroness Campbell of Surbiton (Crossbench)
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Baroness Campbell of Surbiton (Crossbench)
not what I trained for years to do. My job satisfaction is making patients as comfortable as possible patients as comfortable as possible and supporting life, however long or short. I must admit, it made me or short. I must admit, it made me feel a great deal better and yes, safer, knowing they would go the safer, knowing they would go the extra mile to help me whilst in extra mile to help me whilst in their care. My Lords, we know that a number of the Royal Colleges have raised concerns about the pressures on healthcare professionals to clear hospital beds and meet treatment targets.
This, in turn may pressurise them to participate in the assisted dying process as a result. A subtle yet deadly form of unconscious coercion causing division within medical teams and undermining patient trust. This was clearly illustrated in the sobering BBC documentary Better Off Dead last year. Throughout our exchanges in this House, I've heard the term treatment option to describe assisted dying. It is not. Assisted dying as a treatment does not accord with the fundamental principles of medical practice.
Medical treatment is to alleviate symptoms and support life, however short, in the least distressing way possible. To do otherwise would fundamentally alter the nature of medical practice, shifting the focus from supporting life to suggesting its end, leaving patients feeling pressurised or fearful when seeking care. Amendments three, eight three and 657 in this group address this issue. The evidence is clear that without these amendments, we are in danger of travelling the same road as the Canadian legislation, a law which began as tightly drafted legislation but soon gave way to systemic pressures on healthcare professionals, many of whom see assisted dying as part of the end of life treatment.
Now, my Lords, we must not allow the introduction of assisted dying to disrupt the fundamental principles principles of healthcare. The opt in system proposed by Baroness Finlay Finlay and others in this group is not about protecting the rights of healthcare professionals. It is about preserving the very essence of patient care, the noble and learned Lord Faulks amendments fall short of addressing these concerns by limiting the statutory opt in solely to the bespoke training for coordinating doctors and independent doctors.
He leaves significant gaps in protection for the wider medical workforce. They are seen as too narrow and procedural to meet the fundamental concerns raised by the Royal College of General Practitioners
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and the Royal College of Psychiatrists. I urge your Lordship to support
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I urge your Lordship to support the amendments I refer to understand the Royal Colleges in understand the Royal Colleges in their call for a clear opt in system, a system which respects the system, a system which respects the rights and dignity of all healthcare professionals, providing healthcare professionals, providing them with a safe, ethical healthcare environment and protecting the integrity of their relationship with patients. Thank you.
This, in turn may pressurise them to participate in the assisted dying process as a result. A subtle yet deadly form of unconscious coercion causing division within medical teams and undermining patient trust. This was clearly illustrated in the sobering BBC documentary Better Off Dead last year. Throughout our exchanges in this House, I've heard the term treatment option to describe assisted dying. It is not. Assisted dying as a treatment does not accord with the fundamental principles of medical practice.
Medical treatment is to alleviate symptoms and support life, however short, in the least distressing way possible. To do otherwise would fundamentally alter the nature of medical practice, shifting the focus from supporting life to suggesting its end, leaving patients feeling pressurised or fearful when seeking care. Amendments three, eight three and 657 in this group address this issue. The evidence is clear that without these amendments, we are in danger of travelling the same road as the Canadian legislation, a law which began as tightly drafted legislation but soon gave way to systemic pressures on healthcare professionals, many of whom see assisted dying as part of the end of life treatment.
Now, my Lords, we must not allow the introduction of assisted dying to disrupt the fundamental principles principles of healthcare. The opt in system proposed by Baroness Finlay Finlay and others in this group is not about protecting the rights of healthcare professionals. It is about preserving the very essence of patient care, the noble and learned Lord Faulks amendments fall short of addressing these concerns by limiting the statutory opt in solely to the bespoke training for coordinating doctors and independent doctors.
He leaves significant gaps in protection for the wider medical workforce. They are seen as too narrow and procedural to meet the fundamental concerns raised by the Royal College of General Practitioners
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and the Royal College of Psychiatrists. I urge your Lordship to support
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I urge your Lordship to support the amendments I refer to understand the Royal Colleges in understand the Royal Colleges in their call for a clear opt in system, a system which respects the system, a system which respects the rights and dignity of all healthcare professionals, providing healthcare professionals, providing them with a safe, ethical healthcare environment and protecting the integrity of their relationship with patients. Thank you.
10:22
Baroness Finlay of Llandaff (Crossbench)
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Baroness Finlay of Llandaff (Crossbench)
Amendments 193268359617 and 660 in this group. The crux of this group is that assisting suicide is not a medical treatment, and products to bring about the death are not being used as medications, but in massive overdoses for their poisonous properties. The Human Medicines Regulations 2012 defines a medicinal product as a substance or combination of substances with properties of preventing or treating disease in human beings, or that may be used or administered to human beings to restore, correct or modify a physiological function by exerting a pharmacological, immunological or metabolic action, or in making a medical diagnosis.
The noble, my noble friend Baroness Campbell has described excellent care and complex care very well. After considering the issue about what is a medicine, let us consider treatment the Health and Social Care Act 2012 states the Comprehensive Health Service is designed to secure improvement in the physical and mental health of the people of England and in the prevention, diagnosis and treatment prevention, diagnosis and treatment of physical and mental illness. This is then embodied for patients in the NHS Constitution.
In debates to date, proponents have focussed on assisted dying as an existential choice, not a treatment. Canada considers it a treatment and the problems, as my noble friend Lady Campbell have explained, have emerged over time. But in Switzerland and Germany, it's fundamentally not a healthcare matter, and it's important to remember that outside life there is no health. So what are the role of doctors? The main conscience clause now, clause 31 was expanded at Report stage in the other place to include explicit carve outs to protect any person from a duty to participate in the provision of assistance in accordance with this act.
But I ask the noble and learned Lord, Lord Faulkner, how is this assistance defined and what are its boundaries? Is the assessment process for eligibility to lethal drugs, or is it only the provision of lethal drugs, or only actually helping the person to ingest the drugs, or setting up a delivery device for the lethal substance? Those boundaries are really important. Clause five of the six originally required doctors unwilling to conduct the preliminary discussion to refer a patient to another doctor who could conduct the discussion after objections from the medical organisations, this was changed to a duty to direct the person where they could find information.
Although the Royal College of Psychiatrists have said this may fail to adequately respect conscience, however, clause five still doesn't meet the requirement of expert medical bodies who request an opt in system. Amendment 268 states the coordinating doctor and in three five, nine the independent doctor. And in 617A substitute doctor have all explicitly opted in for these roles. Currently, freshly qualified medical graduates could act as coordinating doctors under my amendments. No one could be a coordinating doctor unless they had explicitly met training and competency requirements to be on a new, separate GMC register, eligibility for which would be would require specialist training and has, as has already been so well explained in the introduction of this group.
As has been said, the BMA, the Royal College of GPS both specifically requested an opt in system and the BMA requires an opt in model for doctors who opt in to provide assisted suicide to be able to choose which parts of the service they're willing to provide. Yesterday I had confirmation from the Royal College of General Practitioners that they strongly support my amendments 268359617 saying the College believes that any assisted dying provision must be separately funded and delivered through a distinct pathway, and that the college would support explicit clarification on the face of the bill.
To make it clear there is no expectation on any doctor, including GPS, to participate, and it is only those who positively choose to do so for an opt in who would have the training and participate. I note the amendment down in the name of the noble and learned Lord Dear Lord Falconer of Thoroton. That would make training the opt in, but it wouldn't deal with institutional expectations. And I'm uncertain how you. You may. If you can't be legally compelled to take the training.
But how you could, in the event, still be involved in the discussions or assessments, because it isn't clear that this amendment would mean that you should be on on the specialist register as explained. The only way to protect clinicians from detriment is by opt in. Evidence in the Other place from Canada suggests that physicians find it very hard to opt out, despite a right to describing how assisted dying has completely changed the practice of medicine in Canada. Doctors are expected to facilitate access to death if not willing to provide it themselves, even when a doctor knows reasonable options for care have not been provided.
And they went on to voice their concerns. And that's all in the written evidence. I've heard from Australian doctors who've been intimidated, even driven out of their job, for refusing involvement. Pressure does not only come in the professions, though. A recent study of Dutch GPS reported the majority of Dutch physicians feel pressured when dealing with the request for euthanasia or physician assisted suicide, particularly emotional blackmail. Control and direction by others. Doubts about fulfilling the criteria. Counter pressure by patient's relatives.
Time pressure around referred patients and organisational pressures. That creation of an expectation and of a culture of assisted death is why medical experts want a clear opt out system. OPT sorry, opt in. I beg your pardon? OPT in allows the NHS work to continue unhindered. Ensures patients seeking assisted suicide are seen by doctors who are fully trained in the process. The BMA survey has already referred to, has revealed that 6% of members of the Association for Palliative Medicine would be prepared to administer lethal drugs, but would opt in for staff and for and would risk an organisational exodus of staff.
Doctor Sara Cox, of the Association for Palliative Medicine, told the Other place in all evidence, for 43% of palliative medicine professionals say they would leave if assisted dying were made part of the organisation in which they work. And this leads on to another difficulty, which is the logistic workability of an opt out system. The bill's impact assessment working on the assumption of an opt out, notes that there is a high degree of uncertainty around the level of opt out in England and Wales.
Surveys conducted by Royal colleges and professional bodies suggested it could range from 35 to 76% for specific groups of staff. Consideration would need to be given to the impact of a high level of opt out on the workability of a national service model. My, my Lords, there are defects in the conscience provisions as written. Despite the amendment of the noble and learned Lord, Lord Faulkner. And I would suggest that any rewrite of this bill opt in, as required by the professional bodies, must be absolutely explicit.
And I would ask the noble Lord, Leonard noble and learned Lord, to explain why his amendment has come so late in the day, despite the fact that the evidence from the royal colleges was there from the beginning.
The noble, my noble friend Baroness Campbell has described excellent care and complex care very well. After considering the issue about what is a medicine, let us consider treatment the Health and Social Care Act 2012 states the Comprehensive Health Service is designed to secure improvement in the physical and mental health of the people of England and in the prevention, diagnosis and treatment prevention, diagnosis and treatment of physical and mental illness. This is then embodied for patients in the NHS Constitution.
In debates to date, proponents have focussed on assisted dying as an existential choice, not a treatment. Canada considers it a treatment and the problems, as my noble friend Lady Campbell have explained, have emerged over time. But in Switzerland and Germany, it's fundamentally not a healthcare matter, and it's important to remember that outside life there is no health. So what are the role of doctors? The main conscience clause now, clause 31 was expanded at Report stage in the other place to include explicit carve outs to protect any person from a duty to participate in the provision of assistance in accordance with this act.
But I ask the noble and learned Lord, Lord Faulkner, how is this assistance defined and what are its boundaries? Is the assessment process for eligibility to lethal drugs, or is it only the provision of lethal drugs, or only actually helping the person to ingest the drugs, or setting up a delivery device for the lethal substance? Those boundaries are really important. Clause five of the six originally required doctors unwilling to conduct the preliminary discussion to refer a patient to another doctor who could conduct the discussion after objections from the medical organisations, this was changed to a duty to direct the person where they could find information.
Although the Royal College of Psychiatrists have said this may fail to adequately respect conscience, however, clause five still doesn't meet the requirement of expert medical bodies who request an opt in system. Amendment 268 states the coordinating doctor and in three five, nine the independent doctor. And in 617A substitute doctor have all explicitly opted in for these roles. Currently, freshly qualified medical graduates could act as coordinating doctors under my amendments. No one could be a coordinating doctor unless they had explicitly met training and competency requirements to be on a new, separate GMC register, eligibility for which would be would require specialist training and has, as has already been so well explained in the introduction of this group.
As has been said, the BMA, the Royal College of GPS both specifically requested an opt in system and the BMA requires an opt in model for doctors who opt in to provide assisted suicide to be able to choose which parts of the service they're willing to provide. Yesterday I had confirmation from the Royal College of General Practitioners that they strongly support my amendments 268359617 saying the College believes that any assisted dying provision must be separately funded and delivered through a distinct pathway, and that the college would support explicit clarification on the face of the bill.
To make it clear there is no expectation on any doctor, including GPS, to participate, and it is only those who positively choose to do so for an opt in who would have the training and participate. I note the amendment down in the name of the noble and learned Lord Dear Lord Falconer of Thoroton. That would make training the opt in, but it wouldn't deal with institutional expectations. And I'm uncertain how you. You may. If you can't be legally compelled to take the training.
But how you could, in the event, still be involved in the discussions or assessments, because it isn't clear that this amendment would mean that you should be on on the specialist register as explained. The only way to protect clinicians from detriment is by opt in. Evidence in the Other place from Canada suggests that physicians find it very hard to opt out, despite a right to describing how assisted dying has completely changed the practice of medicine in Canada. Doctors are expected to facilitate access to death if not willing to provide it themselves, even when a doctor knows reasonable options for care have not been provided.
And they went on to voice their concerns. And that's all in the written evidence. I've heard from Australian doctors who've been intimidated, even driven out of their job, for refusing involvement. Pressure does not only come in the professions, though. A recent study of Dutch GPS reported the majority of Dutch physicians feel pressured when dealing with the request for euthanasia or physician assisted suicide, particularly emotional blackmail. Control and direction by others. Doubts about fulfilling the criteria. Counter pressure by patient's relatives.
Time pressure around referred patients and organisational pressures. That creation of an expectation and of a culture of assisted death is why medical experts want a clear opt out system. OPT sorry, opt in. I beg your pardon? OPT in allows the NHS work to continue unhindered. Ensures patients seeking assisted suicide are seen by doctors who are fully trained in the process. The BMA survey has already referred to, has revealed that 6% of members of the Association for Palliative Medicine would be prepared to administer lethal drugs, but would opt in for staff and for and would risk an organisational exodus of staff.
Doctor Sara Cox, of the Association for Palliative Medicine, told the Other place in all evidence, for 43% of palliative medicine professionals say they would leave if assisted dying were made part of the organisation in which they work. And this leads on to another difficulty, which is the logistic workability of an opt out system. The bill's impact assessment working on the assumption of an opt out, notes that there is a high degree of uncertainty around the level of opt out in England and Wales.
Surveys conducted by Royal colleges and professional bodies suggested it could range from 35 to 76% for specific groups of staff. Consideration would need to be given to the impact of a high level of opt out on the workability of a national service model. My, my Lords, there are defects in the conscience provisions as written. Despite the amendment of the noble and learned Lord, Lord Faulkner. And I would suggest that any rewrite of this bill opt in, as required by the professional bodies, must be absolutely explicit.
And I would ask the noble Lord, Leonard noble and learned Lord, to explain why his amendment has come so late in the day, despite the fact that the evidence from the royal colleges was there from the beginning.
10:31
Lord Carlile of Berriew (Crossbench)
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Lord Carlile of Berriew (Crossbench)
To speak. Signatory of Baroness >> To speak. Signatory of Baroness Fraser's amendment number 189, and I am strongly in favour of it, for reasons which I'll explain, I hope, briefly. I'm not a doctor, but I am a patient when I can't avoid it. And let's take an example which many of your Lordships House either have or will face when your eyesight begins to deteriorate, you go to the optician and the opposition says, well, I've examined your eyes. You've got the beginnings of a cataract, and you can make choice between either continuing with your spectacles as they are now, or you could go and have a cataract operation, which might even mean you don't have to wear spectacles ever again.
So what happens in order to decide which choice you make, you are sent to a specialist. Since the 1st of January 1997, there has been a GMC specialist register and it covers all sorts of specialities, including some which do not have the sort of high formality of gynaecology or obstetrics or orthopaedics. And it works very well. It's publicly accessible. It's just the sort of register that the noble Lady is referring to, although albeit as a specific one for this.
So when you face the choice of having less than six months to live and you want to or dying by assisted dying and you want to make your decision, you want to go to someone who has exactly the same sort of disciplinary approach as that specialist who would be advising me on my incipient cataract. And that is a specialism. And I cannot understand why there should be any other approach to this than having a specialist register, so that when you go and have that advice, you have it given clearly to you so that that's specialist, not any old general practitioner.
If I can forgive me, forgiven for using that phrase, I'm the son. I'm the son of a general practitioner who, by the way, was not any old general practitioner. But even the noble Baroness knows that the skills of general practitioners are not uniform and vary a good deal. And I think her surprise is falling from what I said. Now, as I say, that it's not a role of a general practitioner, it's a role of a specialist, and that specialist must be able to tell the patient, what are the options for their continuing with life, what palliative care is available, what caring systems are available if there are unable to do certain things?
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I'm very grateful to the noble Lord to give way for just a brief moment. It's the noble Lord, aware moment. It's the noble Lord, aware that virtually no specialism has 100% of those posts filled. In fact, 100% of those posts filled. In fact, in most cases in the UK. As you can check with the recent figures from the Department of Health that many the Department of Health that many specialists. Many specialisms are down to about 30% and there are many specialist areas which are not
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many specialist areas which are not covered by specialists at all in medicine. Well, I'm giving my. Answer to that is they jolly well should be. No, I don't see that. That is a point against the argument I'm making at all. I would say exactly what I'm saying in relation to any specialism, and it's a very simple point. Do I want someone knowledgeable to explain to me what palliative care is available to me or not? Or do I want it given by a generalist who may be extremely good, like the noble Lady Gerada, or maybe rather less good like one of her.
I used to be on the General Medical Council as a lay member. I have a disciplined, very large numbers of doctors as a result of that experience. And I think that having this specialist care is an absolute essential requirement of what we're discussing.
So what happens in order to decide which choice you make, you are sent to a specialist. Since the 1st of January 1997, there has been a GMC specialist register and it covers all sorts of specialities, including some which do not have the sort of high formality of gynaecology or obstetrics or orthopaedics. And it works very well. It's publicly accessible. It's just the sort of register that the noble Lady is referring to, although albeit as a specific one for this.
So when you face the choice of having less than six months to live and you want to or dying by assisted dying and you want to make your decision, you want to go to someone who has exactly the same sort of disciplinary approach as that specialist who would be advising me on my incipient cataract. And that is a specialism. And I cannot understand why there should be any other approach to this than having a specialist register, so that when you go and have that advice, you have it given clearly to you so that that's specialist, not any old general practitioner.
If I can forgive me, forgiven for using that phrase, I'm the son. I'm the son of a general practitioner who, by the way, was not any old general practitioner. But even the noble Baroness knows that the skills of general practitioners are not uniform and vary a good deal. And I think her surprise is falling from what I said. Now, as I say, that it's not a role of a general practitioner, it's a role of a specialist, and that specialist must be able to tell the patient, what are the options for their continuing with life, what palliative care is available, what caring systems are available if there are unable to do certain things?
**** Possible New Speaker ****
I'm very grateful to the noble Lord to give way for just a brief moment. It's the noble Lord, aware moment. It's the noble Lord, aware that virtually no specialism has 100% of those posts filled. In fact, 100% of those posts filled. In fact, in most cases in the UK. As you can check with the recent figures from the Department of Health that many the Department of Health that many specialists. Many specialisms are down to about 30% and there are many specialist areas which are not
**** Possible New Speaker ****
many specialist areas which are not covered by specialists at all in medicine. Well, I'm giving my. Answer to that is they jolly well should be. No, I don't see that. That is a point against the argument I'm making at all. I would say exactly what I'm saying in relation to any specialism, and it's a very simple point. Do I want someone knowledgeable to explain to me what palliative care is available to me or not? Or do I want it given by a generalist who may be extremely good, like the noble Lady Gerada, or maybe rather less good like one of her.
I used to be on the General Medical Council as a lay member. I have a disciplined, very large numbers of doctors as a result of that experience. And I think that having this specialist care is an absolute essential requirement of what we're discussing.
10:35
Baroness Gerada (Crossbench)
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Baroness Gerada (Crossbench)
My Lord, my Lord, my Lord, my Lord. First of all, many thanks for Lord. First of all, many thanks for the any old comment. I'm an any old general practitioner there. There are a few issues I would like to just pick up please. One is around the register being made publicly available. I certainly, absolutely, totally would not want my name on a publicly available register. As somebody who is provides the services of assisted dying. Not because. Not because I'm ashamed, but because of the hate mail that I would get.
And the and the the distress of which I already have. That does not mean that I'm against some form of register. Of course there can be. Just as there is for those doctors who do. Section 12 approvals under the Mental Health Act, and just as those doctors that do all sorts of issues. But to have a publicly available register, I think goes one too far. The second thing I would like to just pick up is around. The second issue I would like to put out is we are already getting confused, as I am about the opt in opt out.
And we saw that that earlier all doctors if this law, if this becomes law, must be trained in assisted dying, whatever that training compiled and the royal colleges will will determine that as all doctors are trained in termination of pregnancy, that they may then not deliver termination of pregnancy or may actually opt out of delivering any of the services is up to them. But all doctors must be competent in this area. I've been a GP now for nearly 40 years, and I've worked with doctors who do not want to get engaged at all in the delivery or any aspect of termination of pregnancy, but nevertheless, they're there to counsel their patients and then to direct them to a place of a doctor that is available and willing.
That is why they must all. And finally, I'd just like to pick up the point
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that was made by. Grateful to the the noble Lady.
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Grateful to the the noble Lady. I just wanted to ask her a question on her point about a publicly available register and that she available register and that she doesn't want one. Does she think that the patience of a general that the patience of a general practitioner have the right to know whether that general practitioner is willing to provide assisted
**** Possible New Speaker ****
is willing to provide assisted suicide services? Yes. I said before about using the word assisted suicide, but with respect to the. If this becomes available, patients that. This is going to be an unusual event that happens of patients wanting to have an assisted death. So we're not talking about hundreds of them. We're also within each local area, there will be available a list, I suspect, held at the local health authority or wherever it's going to be held, of those doctors who will be willing to participate.
And if any of you came to the event where we had the Australians coming over to say how it's done in their country, it's done by doctors of all professional groups because it's competence and capabilities, not the specialities of those doctors who wish to pursue the training in order to become competent at capable of doing this. So this is all feasible. We're not talking about me and my consulting room nipping off at lunchtime and administering assisted assisted death.
We're talking about a regulated system that will be properly managed with small numbers. So I hope that is the answer. By the way, I just wanted to pick up the last final point about the use of drugs and the use of drugs that are there to treat disease. Well, I'm sure my noble Lady will know with her expertise in palliative care at the end of life, we use drugs, sometimes an extraordinarily high doses that we know are going
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to accelerate death. Just before the noble Lady sits
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Just before the noble Lady sits down, I'd like to intervene on her comment about training, because, yes, everybody is trained in, for example, abortion as they go through medical school. But by the time you're practising clinically time you're practising clinically and you're on a specialist register, you are no longer keeping up to date with those skills at all. And your revalidation depends on you keeping up to date with those skills, which is the benefit of having a specialist register.
And if I might comment on her opening remarks about being worried about having hate mail, perhaps she might have some sympathy for those of us in palliative medicine who've been receiving a great deal of hate mail because we're known to be specialists in palliative medicine, and because we've been flagging up concerns over this bill. And as for the numbers, perhaps I would ask
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her. If I'm interfering. You can't intervene. Order, order!
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Can I see it? Baroness Finlay. But if you intervene, if you keep it short and the people kind of
**** Possible New Speaker ****
don't intervene on it, people are intervening. Repeatedly intervening on the different points. As for the numbers, the estimates based on the evidence from other countries suggests that the estimates in the impact assessment are very, very low. And actually, the demand for assisted suicide would be much higher. So it would come into the purview of a large number of clinicians. Hence the need for specialisation.
**** Possible New Speaker ****
I'm intervening if I thank you, some diffidence, my Lords. First of some diffidence, my Lords. First of all, to put on the record that this bill is abundantly clear that it is bill is abundantly clear that it is an opt in system. Clause 31 no obligation to provide assistance. No person is under any duty to participate in the provision of assistance in accordance with this act. No registered medical practitioner is any under any duty
And the and the the distress of which I already have. That does not mean that I'm against some form of register. Of course there can be. Just as there is for those doctors who do. Section 12 approvals under the Mental Health Act, and just as those doctors that do all sorts of issues. But to have a publicly available register, I think goes one too far. The second thing I would like to just pick up is around. The second issue I would like to put out is we are already getting confused, as I am about the opt in opt out.
And we saw that that earlier all doctors if this law, if this becomes law, must be trained in assisted dying, whatever that training compiled and the royal colleges will will determine that as all doctors are trained in termination of pregnancy, that they may then not deliver termination of pregnancy or may actually opt out of delivering any of the services is up to them. But all doctors must be competent in this area. I've been a GP now for nearly 40 years, and I've worked with doctors who do not want to get engaged at all in the delivery or any aspect of termination of pregnancy, but nevertheless, they're there to counsel their patients and then to direct them to a place of a doctor that is available and willing.
That is why they must all. And finally, I'd just like to pick up the point
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that was made by. Grateful to the the noble Lady.
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Grateful to the the noble Lady. I just wanted to ask her a question on her point about a publicly available register and that she available register and that she doesn't want one. Does she think that the patience of a general that the patience of a general practitioner have the right to know whether that general practitioner is willing to provide assisted
**** Possible New Speaker ****
is willing to provide assisted suicide services? Yes. I said before about using the word assisted suicide, but with respect to the. If this becomes available, patients that. This is going to be an unusual event that happens of patients wanting to have an assisted death. So we're not talking about hundreds of them. We're also within each local area, there will be available a list, I suspect, held at the local health authority or wherever it's going to be held, of those doctors who will be willing to participate.
And if any of you came to the event where we had the Australians coming over to say how it's done in their country, it's done by doctors of all professional groups because it's competence and capabilities, not the specialities of those doctors who wish to pursue the training in order to become competent at capable of doing this. So this is all feasible. We're not talking about me and my consulting room nipping off at lunchtime and administering assisted assisted death.
We're talking about a regulated system that will be properly managed with small numbers. So I hope that is the answer. By the way, I just wanted to pick up the last final point about the use of drugs and the use of drugs that are there to treat disease. Well, I'm sure my noble Lady will know with her expertise in palliative care at the end of life, we use drugs, sometimes an extraordinarily high doses that we know are going
**** Possible New Speaker ****
to accelerate death. Just before the noble Lady sits
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Just before the noble Lady sits down, I'd like to intervene on her comment about training, because, yes, everybody is trained in, for example, abortion as they go through medical school. But by the time you're practising clinically time you're practising clinically and you're on a specialist register, you are no longer keeping up to date with those skills at all. And your revalidation depends on you keeping up to date with those skills, which is the benefit of having a specialist register.
And if I might comment on her opening remarks about being worried about having hate mail, perhaps she might have some sympathy for those of us in palliative medicine who've been receiving a great deal of hate mail because we're known to be specialists in palliative medicine, and because we've been flagging up concerns over this bill. And as for the numbers, perhaps I would ask
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her. If I'm interfering. You can't intervene. Order, order!
**** Possible New Speaker ****
Can I see it? Baroness Finlay. But if you intervene, if you keep it short and the people kind of
**** Possible New Speaker ****
don't intervene on it, people are intervening. Repeatedly intervening on the different points. As for the numbers, the estimates based on the evidence from other countries suggests that the estimates in the impact assessment are very, very low. And actually, the demand for assisted suicide would be much higher. So it would come into the purview of a large number of clinicians. Hence the need for specialisation.
**** Possible New Speaker ****
I'm intervening if I thank you, some diffidence, my Lords. First of some diffidence, my Lords. First of all, to put on the record that this bill is abundantly clear that it is bill is abundantly clear that it is an opt in system. Clause 31 no obligation to provide assistance. No person is under any duty to participate in the provision of assistance in accordance with this act. No registered medical practitioner is any under any duty
10:41
Baroness Andrews (Labour)
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Baroness Andrews (Labour)
to become the coordinating Doctor. The independent doctor? No registered medical practitioner. I registered medical practitioner. I won't read the whole of the clause bylaws, but I do not understand why it is described by noble Lords in the way that the noble Lady does not opt out. Now, coming to the not opt out. Now, coming to the point of the register, we have heard over 13 days how important it heard over 13 days how important it is to listen to and consult medical practitioners at every stage of the Bill.
The proposition in a clause one, amendment 189 is that the register should be put on the face of the bill. It's a privilege to listen to the expertise of our noble friend, Lady Gerard. I would call her our noble friend, and she has expressed some very profound and very intimate reservations. But surely there will be provision, a due course for the discussion of how to register people who are willing to opt in, and to do that with a full consultation of all the medical professions, so that the concerns of the noble Lord Lord Carlile can be addressed.
But surely, my Lords, as with so much of the debate we are having, this is a matter for implementation. Let us get to the point where we can make the decision in principle, but let us make sure that in implementing it, we have it right and that must be done. I think with the full consultation of all the medical professionals. Yeah.
The proposition in a clause one, amendment 189 is that the register should be put on the face of the bill. It's a privilege to listen to the expertise of our noble friend, Lady Gerard. I would call her our noble friend, and she has expressed some very profound and very intimate reservations. But surely there will be provision, a due course for the discussion of how to register people who are willing to opt in, and to do that with a full consultation of all the medical professions, so that the concerns of the noble Lord Lord Carlile can be addressed.
But surely, my Lords, as with so much of the debate we are having, this is a matter for implementation. Let us get to the point where we can make the decision in principle, but let us make sure that in implementing it, we have it right and that must be done. I think with the full consultation of all the medical professionals. Yeah.
10:43
Baroness Cass (Crossbench)
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Baroness Cass (Crossbench)
Yes. my amendment three, eight, three and I so far limited my speeches within this bill to a maximum of 2 or 3 minutes. On this one occasion, I would like to take more time because this may be the only opportunity I have to discuss how we can integrate some of the approaches that have been put forward through the bill. Refraining, my noble friends, Baroness Hollins amendments on Multi-professional assessments up front and Stan part five and Baroness Finlay amendments on parallel care between assisted dying and the continuing care process.
And I believe what I have to say would vastly simplify things. So my amendment focuses on what professionals would be expected to do, who are opted in to work in an assisted dying service, and how it differs from what's expected of those who are not opted in. And specifically, I'd like to talk about two individuals who have completely different roles, a professional who's part of the treating team and so is not opted in, and a professional who is opted in as part of the assisted dying service.
So I just ask you to suspend belief and bear with me while I explain. And I believe we're all agreed on a few points. Firstly, that palliative care provision is inadequate and secondly, that services are often fragmented, with no one professional supporting someone at the end of life and helping them access all the help that they need. So let's walk through the patient journey, which I don't believe we have done in this House so far. And we start with the person who has just been given, rightly or wrongly, a six month prognosis.
There are many things they may wish to discuss and seek help with nursing care, access to financial support, pain management, or just someone to explain again what the consultant said about their terminal illness. Now, if they're lucky, they'll have an excellent general practice team who can help with all these things. But sadly, despite the wonderful primary care described by my noble friend Baroness Gerada, many do not have such a practice and my friend's husband died recently without being able to secure a single visit from anyone in their GP practice in the last nine months of their life.
In that scenario, what they need is a coordinating professional, but not one who is opted in to support their assisted death, but rather what it says on the can and coordinate their care and access to essential help. In this case, the coordinating professional who may be a nurse, a doctor or another healthcare professional would be part of the symptom management team within an ICU network. In fact, they may work across a number of GP practices and it would be their job to organise the Multi-professional assessments and support from relevant professionals, nurses, palliative care specialists, social workers, OTT services or maybe incontinence services.
Ideally, they would have palliative care training to the level of a GP or a nurse with a special interest and access to specialist care consultant, palliative care consultants as needed, and they assure that all the MDT assessments and information were written down or electronically available to the patient. So the patient is the master and owner of their information, and that individual would not need to be opted in because it's not their job to discuss assisted death. It's only their job to signpost the patient to somebody who can.
Now, let us suppose that the patient decides that they do want an assisted death. As I said before, they may talk to their GP, their priest, their partner, their children, but if they actually want concrete information about the practicalities, the best person to talk to will be somebody who knows about it and fully understands the process. And as my noble and learned friend Lord Carlile said, somebody who's specialist and this is where the opted in doctor comes in, who I'm going to call, don't shout at me, the independent doctor, because they're independent of the treating team, but they're part of the specialised assisted death team, and they make up a patient's locality.
Now, like any other patient, any other individual carrying out a specialised role. I agree they would have to be appropriately trained, and their job would then be to do what I set out in amendment 383. First, explain to the patient that this is not a treatment for their terminal illness, but a personal choice, and secondly, to ensure that they have fully understood the diagnosis, prognosis, treatment and palliative care options set out in the documents held by the patient. And I say check understanding, not assess for reasons I will come to.
And because all the patient, all the information would be there in their patient's hand, they would not need to go scurrying around trying to get hold of patient records or treating consultants, except in rare circumstances where something is not clear, and then their key task, the role for which they've been trained, would be to assess capacity, coercion and all the other aspects which we've discussed to ensure the decision is a clear and settled one. The person they may wish to talk to would be the coordinating professional of the GP had taken that role, then the GP, because that person would know the patient well and have information about family and personal circumstances and would be able to alert them to possible coercion.
Now my preference is that they would do this with another independent professional. And I say a professional because that may be a nurse or a social worker, because again, thinking of the patient doing it together and not sequentially would be much less burdensome for the patient. And additionally, when you do things together, I, for example, would often be looking at the face of the patient while the speech therapist was talking to them. The speech therapist would notice body language while I was talking to them.
So you get more information working together than you do sequentially. At that stage, there would be sufficient multidisciplinary involvement for the panel to only have two members, a lawyer of whatever qualification and another person. And then once the panel has signed off, it would be the role of the independent doctor to support the assisted death. If and when the person decides to go ahead. But meanwhile, that marvellous coordinating professional who so far missing from the system, will continue to provide support until such a time arrived.
Now, for the avoidance of doubt, let me explain why having an initial discussion doctor, a coordinating doctor and an independent doctor performing the duties set out in the bill panel work. Firstly, if the initial doctor initial discussion doctor is not the patient's GP because that GP opted out on conscientious grounds, then the Bill does not give any other doctor the right to access the hospital records or speak to the treating clinician, and that would introduce complex delays for the patient.
As far as I can see, the initial discussion adds a whole heap of complications and no real benefit. And that was why I supported Baroness Bull Hollins Part five. Secondly, more importantly, despite the assurance that the noble and learned Lord Alton gave last week that three different doctors would confirm the six month prognosis, the reality is that none of them can do that, and I acknowledge that the noble and learned Lord knows more about the law than I could ever learn in 20 lifetimes, but perhaps a bit less about medicine.
So if the oncology team has examined the patient's scans and determined that the tumour is no longer responding to the recent changes in chemotherapy and no options are left, no other doctor examining the patient with their bare hands is going to be able to confirm or refute that. And if the cardiologist has managed a patient with worsening heart failure over two years and sees that the symptoms are getting worse despite maximum doses of treatment, no other doctor is going to have a better feel for that patient's trajectory.
And unless these three doctors are trained in palliative care, none of them are going to be able to discuss the patient's palliative care options. So in summary, the best approach is for opted out professionals or those who are not opted in involved in the patient's care to advise on prognosis, treatment options and palliative care, and for the opted in professional to check that the patient has understood all this, to assess capacity and coercion and deal with matters related to assisted death.
And finally, by defining the roles and responsibilities as I have described, the process would involve a better use of staff time and, more importantly, be more supportive and less onerous for the patient. I would submit that at least part of the cost of coordinating professionals are already covered within the financial allocation of this bill, and any additional cost savings generated by simplifying the process while also making it safer and more patient centred, could be used to enhance palliative care. And to cheer you all up.
I have now also disposed of 37 amendments also disposed of 37 amendments forming the entirety of Group five.
And I believe what I have to say would vastly simplify things. So my amendment focuses on what professionals would be expected to do, who are opted in to work in an assisted dying service, and how it differs from what's expected of those who are not opted in. And specifically, I'd like to talk about two individuals who have completely different roles, a professional who's part of the treating team and so is not opted in, and a professional who is opted in as part of the assisted dying service.
So I just ask you to suspend belief and bear with me while I explain. And I believe we're all agreed on a few points. Firstly, that palliative care provision is inadequate and secondly, that services are often fragmented, with no one professional supporting someone at the end of life and helping them access all the help that they need. So let's walk through the patient journey, which I don't believe we have done in this House so far. And we start with the person who has just been given, rightly or wrongly, a six month prognosis.
There are many things they may wish to discuss and seek help with nursing care, access to financial support, pain management, or just someone to explain again what the consultant said about their terminal illness. Now, if they're lucky, they'll have an excellent general practice team who can help with all these things. But sadly, despite the wonderful primary care described by my noble friend Baroness Gerada, many do not have such a practice and my friend's husband died recently without being able to secure a single visit from anyone in their GP practice in the last nine months of their life.
In that scenario, what they need is a coordinating professional, but not one who is opted in to support their assisted death, but rather what it says on the can and coordinate their care and access to essential help. In this case, the coordinating professional who may be a nurse, a doctor or another healthcare professional would be part of the symptom management team within an ICU network. In fact, they may work across a number of GP practices and it would be their job to organise the Multi-professional assessments and support from relevant professionals, nurses, palliative care specialists, social workers, OTT services or maybe incontinence services.
Ideally, they would have palliative care training to the level of a GP or a nurse with a special interest and access to specialist care consultant, palliative care consultants as needed, and they assure that all the MDT assessments and information were written down or electronically available to the patient. So the patient is the master and owner of their information, and that individual would not need to be opted in because it's not their job to discuss assisted death. It's only their job to signpost the patient to somebody who can.
Now, let us suppose that the patient decides that they do want an assisted death. As I said before, they may talk to their GP, their priest, their partner, their children, but if they actually want concrete information about the practicalities, the best person to talk to will be somebody who knows about it and fully understands the process. And as my noble and learned friend Lord Carlile said, somebody who's specialist and this is where the opted in doctor comes in, who I'm going to call, don't shout at me, the independent doctor, because they're independent of the treating team, but they're part of the specialised assisted death team, and they make up a patient's locality.
Now, like any other patient, any other individual carrying out a specialised role. I agree they would have to be appropriately trained, and their job would then be to do what I set out in amendment 383. First, explain to the patient that this is not a treatment for their terminal illness, but a personal choice, and secondly, to ensure that they have fully understood the diagnosis, prognosis, treatment and palliative care options set out in the documents held by the patient. And I say check understanding, not assess for reasons I will come to.
And because all the patient, all the information would be there in their patient's hand, they would not need to go scurrying around trying to get hold of patient records or treating consultants, except in rare circumstances where something is not clear, and then their key task, the role for which they've been trained, would be to assess capacity, coercion and all the other aspects which we've discussed to ensure the decision is a clear and settled one. The person they may wish to talk to would be the coordinating professional of the GP had taken that role, then the GP, because that person would know the patient well and have information about family and personal circumstances and would be able to alert them to possible coercion.
Now my preference is that they would do this with another independent professional. And I say a professional because that may be a nurse or a social worker, because again, thinking of the patient doing it together and not sequentially would be much less burdensome for the patient. And additionally, when you do things together, I, for example, would often be looking at the face of the patient while the speech therapist was talking to them. The speech therapist would notice body language while I was talking to them.
So you get more information working together than you do sequentially. At that stage, there would be sufficient multidisciplinary involvement for the panel to only have two members, a lawyer of whatever qualification and another person. And then once the panel has signed off, it would be the role of the independent doctor to support the assisted death. If and when the person decides to go ahead. But meanwhile, that marvellous coordinating professional who so far missing from the system, will continue to provide support until such a time arrived.
Now, for the avoidance of doubt, let me explain why having an initial discussion doctor, a coordinating doctor and an independent doctor performing the duties set out in the bill panel work. Firstly, if the initial doctor initial discussion doctor is not the patient's GP because that GP opted out on conscientious grounds, then the Bill does not give any other doctor the right to access the hospital records or speak to the treating clinician, and that would introduce complex delays for the patient.
As far as I can see, the initial discussion adds a whole heap of complications and no real benefit. And that was why I supported Baroness Bull Hollins Part five. Secondly, more importantly, despite the assurance that the noble and learned Lord Alton gave last week that three different doctors would confirm the six month prognosis, the reality is that none of them can do that, and I acknowledge that the noble and learned Lord knows more about the law than I could ever learn in 20 lifetimes, but perhaps a bit less about medicine.
So if the oncology team has examined the patient's scans and determined that the tumour is no longer responding to the recent changes in chemotherapy and no options are left, no other doctor examining the patient with their bare hands is going to be able to confirm or refute that. And if the cardiologist has managed a patient with worsening heart failure over two years and sees that the symptoms are getting worse despite maximum doses of treatment, no other doctor is going to have a better feel for that patient's trajectory.
And unless these three doctors are trained in palliative care, none of them are going to be able to discuss the patient's palliative care options. So in summary, the best approach is for opted out professionals or those who are not opted in involved in the patient's care to advise on prognosis, treatment options and palliative care, and for the opted in professional to check that the patient has understood all this, to assess capacity and coercion and deal with matters related to assisted death.
And finally, by defining the roles and responsibilities as I have described, the process would involve a better use of staff time and, more importantly, be more supportive and less onerous for the patient. I would submit that at least part of the cost of coordinating professionals are already covered within the financial allocation of this bill, and any additional cost savings generated by simplifying the process while also making it safer and more patient centred, could be used to enhance palliative care. And to cheer you all up.
I have now also disposed of 37 amendments also disposed of 37 amendments forming the entirety of Group five.
10:52
Baroness Fox of Buckley (Non-affiliated)
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Baroness Fox of Buckley (Non-affiliated)
I would like to just thank the >> I would like to just thank the noble Lady Baroness Cass. That was totally compelling, and we're all totally compelling, and we're all going to have to read it and reread it, but I think gave us a real sense of what it would be like. Sometimes we are talking in the abstract anyway. In a more concrete sense, I think of this group of amendments as the workers rights group. And I, I think that we have to take seriously what's being asked of all the workers involved.
If the bill of this kind were to be passed, all sorts of workers associated with health and social care will be expected to deliver it. What happens if that goes against their conscience? That's why I added my name to amendments two, six, eight and 617 in the name of Baroness Finlay of Llandaff to make opt in for a doctor's explicit on the face of the bill, but also because I think it's important to extend any conscience protections to a wider range of workers who might not want to be involved in assisting in the death of others, I added mine.
I wished to have added my name, but. But there wasn't room for me to. Amendments 673 in the name of Baroness Fraser of Craigmaddie. I think it's really important that all workers should be free to refuse to participate without penalty. I've also tabled my own amendment six, five, seven. I'd like to thank Baroness Smith of Newnham and Baroness Eaton for supporting that. That is about proposing that the provision of assisted assisting in someone's death is not regarded as a medical treatment.
Now, we've heard excellent explanations of the problems with that in terms of existentially why it shouldn't be a medical treatment. And there are a range of ethical reasons for that. But the purpose, for the purposes of this group, the amendment is relevant, as if assisted dying is a medical treatment. This could have practical and regulatory pressure add pressure on particularly doctors in terms of their duties. It just seems to me that the aim of this group is quite straightforward, particularly in relation to opt in.
It's to ensure that no medical professional or related staff are forced to participate in assisted dying, or forced to undergo training in assisted dying against their will. And I know that supporters of the bill are keen fans of autonomy. So it seems to me that this group is indispensable because let's make this an autonomous, positive choice for those workers who are happy to take place, take part in the process. The noble Lady Baroness Andrews, has reassured us that in the Bill, there will be no pressure to participate.
Although I think in many workplaces, unless it's made explicit in terms of opt in, she will know that workplaces are not always places where workers rights are given full satisfaction, let us say. But anyway, as it happens, the noble and learned Lord Faulkner actually thinks that opt in should be on the face of the bill, because he emailed us in January to tell us that, saying, following conversation, extensive conversations with the BMA, I believe that explicitly including the words opt in on the face of the bill would provide greater reassurance to medical practitioners.
Well, I agree, I was a bit disappointed those amendments were not tabled more quickly, but they've now emerged. I'm glad to see that there's an explicit opt in provision, but I do think it's too narrow and too exclusively just confined to coordinating doctor, independent doctor and and so on, as explained so well by the noble Lady Baroness Finlay. This leaves out significant parts of the wider medical workforce. And I'm worried that for GPS, nurses and other frontline staff, they could still be mandated to participate in either assistance or training, regardless of their conscientious objection.
These concerns are not only about narrowly focusing on opt in only for the coordinating or independent doctor, but also we have to consider the dangers even of only considering opt in in relation to medical professionals. Baroness Fraser amendments 673 is a reminder not to leave out the plethora of stuff. You might well be asked to play a secondary role in assisted dying, such as those who work in care homes or prisons. Or what about the member of staff? Perhaps a porter who's asked to escort a patient to a room where an assisted death will take place? For goodness sake? Well, a bit of empathy might be helpful anyway.
Well, of course, our main focus is is understandably on doctors, even nurses. But we do need to be careful that we don't assume that those with medical degrees, the professionals, are entitled to a greater respect for their consciences than other relevant workers like porters. I've previously spoken about my qualms about the care sector being sidelined in discussions about the bill. Care England have complained that they've been under consulted, not least in the area of opt out, opt in the.
This matters in terms of the unintended consequences of the bill in care England's survey of its members, 24% of providers have said staffing would be very difficult because of the likelihood of conscientious objection speculating. If forced to comply, care staff will walk out. Imagine what a tragedy, unintended consequence that would be. Only 14% reported the staff would willingly participate in the procedure. 34% reported their staff would not be willing to participate at all. And in terms of what constitutes participation, the Royal College of Nursing has reminded us in written evidence to the Other place the need to consider administrative work.
Quote, protection should extend to indirect involvement, such as administrative tasks or referrals, to ensure that all professionals are supported in line with their personal and professional values. I now just want to reflect very briefly on the whole issue of training, which is so important in relation to these amendments. Practically everyone involved in providing medical or care services has to do manage, particularly medical services, have to do mandatory training units. Obviously they're studying at university, but there is, as we've heard, revalidation, there's CPD and so on.
But if a robust opt in conscience clause doesn't cover all such training, might those who try to opt out get a career limiting black mark against their name? Might those forces do such training fail if they don't endorse assisted dying as a medical treatment of merit, or receive professional sanctions if they give the wrong answers? So I'm looking for a guarantee from the noble and learned Lord, that no workers will face legal or professional repercussions, including indirect penalties of discrimination, for declining to participate in either training or the procedure on my amendment.
Six, five, seven. Despite the insistence when we discussed words last week that this is a change in criminal law, not a health bill, both the fact that the necessity to amend the constitution
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of the NHS and the huge changing expectation of medical ethics. Does not the.
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Does not the. Noble Navy find it very peculiar that people who are very, very keen that people who are very, very keen on employment rights in every other circumstance are not keen on employment rights in these circumstances and put their views circumstances and put their views on assisted suicide ahead of the rights of very ordinary workers. To
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say, I don't want to be part of it. Irony.
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Irony. Irony noted. Anyway. It is. She's making a point which.
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She's making a point which. Contradicts the words. Of the. Bill, as Baroness Andrews has has. Explained.
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Explained. Clause 31. One says in unambiguous terms no
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One says in unambiguous terms no person. I repeat, no person is under any duty, I repeat any duty to participate in the provision of assistance in accordance with this. We all agree with that. We all agree that employees, whatever their status, should be fully
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protected. And trade unions want better
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guarantees. And when we discuss the employment rights bill, sure. What further guarantees the noble Baroness and the noble Lord noble Baroness and the noble Lord have in mind? Because you will know from the bill that schedule three from the bill that schedule three amends the Employment Rights Act, 1996. It incorporates into anybody 1996. It incorporates into anybody who is being prejudiced against because they will not participate in a terminal illness. Things they given every single right under the Employee Employee Rights Act.
So first of all, the idea that they are not being given the same rights that everybody else is wrong. And secondly, I'm not quite sure what point the noble Baroness is making that there should be more rights.
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I sat for many hours through the Employment Rights Bill, and did say that there was a plethora of rights, that there was a plethora of rights, that we were overdoing it, and I was treated with some contempt. was treated with some contempt. Right. I've got to finish. The fear is that once assisted diet. Right, I'm moving on quickly. Once I'm moving on quickly. Once assisted dying is normalised as a medical treatment, health professionals will be obliged to professionals will be obliged to offer it as a medical treatment.
Even worse, under some obligation to explain this therapeutic option as part of their duty of care for eligible patients, they could be held negligent for not offering this treatment against their conscience, and that would seem to be the implications of case law in terms of the Montgomery ruling that ruled all reasonable therapeutic options needed to be presented to and discussed with patients. The
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worry here is that civil liability protections do not cover. The noble Lady to bring her
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remarks to an end. She's well over the ten minutes. This is meant to be a debate.
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This is meant to be a debate. I've taken a lot of opposition points. Let me finish. The worry is here that civil liability protections do not cover where a protections do not cover where a duty is owed to the patients. How can doctors who do not wish to offer or discuss assisted dying be sure they do not face liability for failing to comply with their alleged duty to raise treatments? When I've raised such concerns with supporters of the bill, I've been reassured that now that we have passed the Workers Rights Bill and there are parts in this bill too, there will be lots of protections and they point out that any.
If there are any problems, staff can always use employment tribunals if they feel they've been unfairly treated. Although, as I say, trade unions are quite keen on opt in. But as though those of us who sat through the hours and hours of deliberations. The Employment Rights Bill will know employment tribunals have huge year long, years long waiting lists, and also such tribunals put the burden on the employee to demonstrate and prove detrimental treatment, which seems completely unfair and it seems pertinent to note, as mentioned by the noble Lady Baroness Fraser, that as the remedy in employment cases is damages, not rehiring, this could lead to driving health and care workers out of the understaffed healthcare sector.
Not a good result. Finished to finish as the noble and learned Lord is a member of the party that rightly boasts of its commitment to workplace fairness and workers rights. I'm simply hoping that he'll be sympathetic to those amendments that very much put workers rights guaranteed centre stage in relation to assisted dying.
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It's not too much to ask. My Lord. I'm glad to.
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I'm glad to. Follow the noble Baroness Fox of Buckley because I did add my Buckley because I did add my signature to amendment 673 in the name of the noble Baroness Fraser, name of the noble Baroness Fraser, also signed by Lord Carlile and Lord Hunt of Kings Heath, allowing
If the bill of this kind were to be passed, all sorts of workers associated with health and social care will be expected to deliver it. What happens if that goes against their conscience? That's why I added my name to amendments two, six, eight and 617 in the name of Baroness Finlay of Llandaff to make opt in for a doctor's explicit on the face of the bill, but also because I think it's important to extend any conscience protections to a wider range of workers who might not want to be involved in assisting in the death of others, I added mine.
I wished to have added my name, but. But there wasn't room for me to. Amendments 673 in the name of Baroness Fraser of Craigmaddie. I think it's really important that all workers should be free to refuse to participate without penalty. I've also tabled my own amendment six, five, seven. I'd like to thank Baroness Smith of Newnham and Baroness Eaton for supporting that. That is about proposing that the provision of assisted assisting in someone's death is not regarded as a medical treatment.
Now, we've heard excellent explanations of the problems with that in terms of existentially why it shouldn't be a medical treatment. And there are a range of ethical reasons for that. But the purpose, for the purposes of this group, the amendment is relevant, as if assisted dying is a medical treatment. This could have practical and regulatory pressure add pressure on particularly doctors in terms of their duties. It just seems to me that the aim of this group is quite straightforward, particularly in relation to opt in.
It's to ensure that no medical professional or related staff are forced to participate in assisted dying, or forced to undergo training in assisted dying against their will. And I know that supporters of the bill are keen fans of autonomy. So it seems to me that this group is indispensable because let's make this an autonomous, positive choice for those workers who are happy to take place, take part in the process. The noble Lady Baroness Andrews, has reassured us that in the Bill, there will be no pressure to participate.
Although I think in many workplaces, unless it's made explicit in terms of opt in, she will know that workplaces are not always places where workers rights are given full satisfaction, let us say. But anyway, as it happens, the noble and learned Lord Faulkner actually thinks that opt in should be on the face of the bill, because he emailed us in January to tell us that, saying, following conversation, extensive conversations with the BMA, I believe that explicitly including the words opt in on the face of the bill would provide greater reassurance to medical practitioners.
Well, I agree, I was a bit disappointed those amendments were not tabled more quickly, but they've now emerged. I'm glad to see that there's an explicit opt in provision, but I do think it's too narrow and too exclusively just confined to coordinating doctor, independent doctor and and so on, as explained so well by the noble Lady Baroness Finlay. This leaves out significant parts of the wider medical workforce. And I'm worried that for GPS, nurses and other frontline staff, they could still be mandated to participate in either assistance or training, regardless of their conscientious objection.
These concerns are not only about narrowly focusing on opt in only for the coordinating or independent doctor, but also we have to consider the dangers even of only considering opt in in relation to medical professionals. Baroness Fraser amendments 673 is a reminder not to leave out the plethora of stuff. You might well be asked to play a secondary role in assisted dying, such as those who work in care homes or prisons. Or what about the member of staff? Perhaps a porter who's asked to escort a patient to a room where an assisted death will take place? For goodness sake? Well, a bit of empathy might be helpful anyway.
Well, of course, our main focus is is understandably on doctors, even nurses. But we do need to be careful that we don't assume that those with medical degrees, the professionals, are entitled to a greater respect for their consciences than other relevant workers like porters. I've previously spoken about my qualms about the care sector being sidelined in discussions about the bill. Care England have complained that they've been under consulted, not least in the area of opt out, opt in the.
This matters in terms of the unintended consequences of the bill in care England's survey of its members, 24% of providers have said staffing would be very difficult because of the likelihood of conscientious objection speculating. If forced to comply, care staff will walk out. Imagine what a tragedy, unintended consequence that would be. Only 14% reported the staff would willingly participate in the procedure. 34% reported their staff would not be willing to participate at all. And in terms of what constitutes participation, the Royal College of Nursing has reminded us in written evidence to the Other place the need to consider administrative work.
Quote, protection should extend to indirect involvement, such as administrative tasks or referrals, to ensure that all professionals are supported in line with their personal and professional values. I now just want to reflect very briefly on the whole issue of training, which is so important in relation to these amendments. Practically everyone involved in providing medical or care services has to do manage, particularly medical services, have to do mandatory training units. Obviously they're studying at university, but there is, as we've heard, revalidation, there's CPD and so on.
But if a robust opt in conscience clause doesn't cover all such training, might those who try to opt out get a career limiting black mark against their name? Might those forces do such training fail if they don't endorse assisted dying as a medical treatment of merit, or receive professional sanctions if they give the wrong answers? So I'm looking for a guarantee from the noble and learned Lord, that no workers will face legal or professional repercussions, including indirect penalties of discrimination, for declining to participate in either training or the procedure on my amendment.
Six, five, seven. Despite the insistence when we discussed words last week that this is a change in criminal law, not a health bill, both the fact that the necessity to amend the constitution
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of the NHS and the huge changing expectation of medical ethics. Does not the.
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Does not the. Noble Navy find it very peculiar that people who are very, very keen that people who are very, very keen on employment rights in every other circumstance are not keen on employment rights in these circumstances and put their views circumstances and put their views on assisted suicide ahead of the rights of very ordinary workers. To
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say, I don't want to be part of it. Irony.
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Irony. Irony noted. Anyway. It is. She's making a point which.
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She's making a point which. Contradicts the words. Of the. Bill, as Baroness Andrews has has. Explained.
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Explained. Clause 31. One says in unambiguous terms no
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One says in unambiguous terms no person. I repeat, no person is under any duty, I repeat any duty to participate in the provision of assistance in accordance with this. We all agree with that. We all agree that employees, whatever their status, should be fully
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protected. And trade unions want better
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guarantees. And when we discuss the employment rights bill, sure. What further guarantees the noble Baroness and the noble Lord noble Baroness and the noble Lord have in mind? Because you will know from the bill that schedule three from the bill that schedule three amends the Employment Rights Act, 1996. It incorporates into anybody 1996. It incorporates into anybody who is being prejudiced against because they will not participate in a terminal illness. Things they given every single right under the Employee Employee Rights Act.
So first of all, the idea that they are not being given the same rights that everybody else is wrong. And secondly, I'm not quite sure what point the noble Baroness is making that there should be more rights.
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I sat for many hours through the Employment Rights Bill, and did say that there was a plethora of rights, that there was a plethora of rights, that we were overdoing it, and I was treated with some contempt. was treated with some contempt. Right. I've got to finish. The fear is that once assisted diet. Right, I'm moving on quickly. Once I'm moving on quickly. Once assisted dying is normalised as a medical treatment, health professionals will be obliged to professionals will be obliged to offer it as a medical treatment.
Even worse, under some obligation to explain this therapeutic option as part of their duty of care for eligible patients, they could be held negligent for not offering this treatment against their conscience, and that would seem to be the implications of case law in terms of the Montgomery ruling that ruled all reasonable therapeutic options needed to be presented to and discussed with patients. The
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worry here is that civil liability protections do not cover. The noble Lady to bring her
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remarks to an end. She's well over the ten minutes. This is meant to be a debate.
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This is meant to be a debate. I've taken a lot of opposition points. Let me finish. The worry is here that civil liability protections do not cover where a protections do not cover where a duty is owed to the patients. How can doctors who do not wish to offer or discuss assisted dying be sure they do not face liability for failing to comply with their alleged duty to raise treatments? When I've raised such concerns with supporters of the bill, I've been reassured that now that we have passed the Workers Rights Bill and there are parts in this bill too, there will be lots of protections and they point out that any.
If there are any problems, staff can always use employment tribunals if they feel they've been unfairly treated. Although, as I say, trade unions are quite keen on opt in. But as though those of us who sat through the hours and hours of deliberations. The Employment Rights Bill will know employment tribunals have huge year long, years long waiting lists, and also such tribunals put the burden on the employee to demonstrate and prove detrimental treatment, which seems completely unfair and it seems pertinent to note, as mentioned by the noble Lady Baroness Fraser, that as the remedy in employment cases is damages, not rehiring, this could lead to driving health and care workers out of the understaffed healthcare sector.
Not a good result. Finished to finish as the noble and learned Lord is a member of the party that rightly boasts of its commitment to workplace fairness and workers rights. I'm simply hoping that he'll be sympathetic to those amendments that very much put workers rights guaranteed centre stage in relation to assisted dying.
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It's not too much to ask. My Lord. I'm glad to.
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I'm glad to. Follow the noble Baroness Fox of Buckley because I did add my Buckley because I did add my signature to amendment 673 in the name of the noble Baroness Fraser, name of the noble Baroness Fraser, also signed by Lord Carlile and Lord Hunt of Kings Heath, allowing
11:05
The Lord Bishop of Southwark (Bishops)
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The Lord Bishop of Southwark (Bishops)
Lord Hunt of Kings Heath, allowing for some reticence on the necessity of this amendment, I just wish to make two points. The bill allows an opt out for registered medical practitioners, a health professional, a social care professional or registered pharmacist. Administrative tasks are specifically not excluded. The bill defines health professionals as medical practitioners, pharmacists and nurses, but it does not define care professionals. This is a lacuna which will cause problems should this or any bill on this basis, pass your Lordships House.
Secondly, matters of acute conscience are not ready, are not restricted to the immediate preparation of a lethal dosage or the medical oversight of the procedure. There will be, for reasons of practicality, not least of cost pressure on all sorts of ancillary staff. As anyone in a health and care setting will attest to co-opt them, either directly or indirectly, into what becomes the final procedure. When the conscience of such an ancillary participant tells them they should have nothing to do with such a procedure.
Is it right, my Lords, that they should face sanction inhibition, or their careers of their careers, or even dismissal? I suggest not, and I hope that the House will support this amendment.
Secondly, matters of acute conscience are not ready, are not restricted to the immediate preparation of a lethal dosage or the medical oversight of the procedure. There will be, for reasons of practicality, not least of cost pressure on all sorts of ancillary staff. As anyone in a health and care setting will attest to co-opt them, either directly or indirectly, into what becomes the final procedure. When the conscience of such an ancillary participant tells them they should have nothing to do with such a procedure.
Is it right, my Lords, that they should face sanction inhibition, or their careers of their careers, or even dismissal? I suggest not, and I hope that the House will support this amendment.
11:07
Baroness O'Loan (Crossbench)
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Baroness O'Loan (Crossbench)
She starred in. >> Amendment six, six, eight and 672 and put my name to eight other amendments in this group, and I am amendments in this group, and I am supportive of other amendments, which I will explain. We are talking about how to protect the conscientious objections of doctors and other healthcare practitioners and others through an opt in system, which would allow doctors and others who are willing to engage in assisted suicide to register their position and thereby provide a framework by which their rights are clear and practitioners are not subject to organisational pressure to engage with elements of the process or indeed the whole process.
My Lords, we need to remember that medical practitioners need certainty about their legal and ethical obligations, especially when they're in a situation in which they may find themselves dealing with matters of life and death. In addition to this, my Lords, many of those who work in healthcare have religious beliefs which would preclude their engagement in facilitating others to kill themselves. Catholics, some other Christians, Muslims would be precluded from participation, yet may be prejudiced in their employment opportunities and prospects by this inability to engage.
It is important, therefore, that this factor is considered and any such consideration should surely lead inevitably to the acceptance that the only way that this can actually work is for people to opt in, rather than having to opt out. To that end, my Lord, I have tabled amendments six six, eight, which provides for a comprehensive conscience protection, allowing any person, not just a registered medical practitioner, to opt out of any activity which may facilitate assisted suicide, including any ancillary functions, and 670, which defines what might be might be said to to comprise assistance under the Bill.
Any aspect of assisted dying under or in connection with the provisions of this act, including, but not limited to, administrative and managerial tasks such as the allocation of duties. To carry out these tasks, the supervisors supervision of those to whom tasks are allocated, and accompanying, and monitoring a patient as they receive or after they have received the approved substance, the lethal drug. I also put my name to amendment 665, which states that no health or social care organisation, team or professional is required to or expected to participate in any part of the process of a person's request for an assisted death.
I put my name to amendment 660, which provides that involvement in assistance is wider than only the direct administration of lethal drugs, which clarifies the nature of what can be considered assistance under the. Under the act, I put my name to amendment 679, which is similar but more specific, and states that no company, charity or other organisation is under any duty to participate in, facilitate or permit on its premises. The provision of assistance under the act, no company, charity or other organisation shall be required as a condition of receiving funding or any other benefit from any public body to participate in, facilitate or permit on its premises.
The provision of assistance in accordance with the act. My Lord, this is fundamentally important to ensure that hospices, care homes, nursing homes and other similar organisations do not have to engage at all with the process of assisted suicide and it would also, I think, include prisons. I declare my interest as a trustee of a hospice. My Lords, there is a considerable fear that not providing explicitly to protect hospices in this way could lead to all sorts of difficulties. There's currently an expectation that hospices will provide care and support of many kinds, but.
And that they will not be involved in assisting people to kill themselves. To provide otherwise would change the whole ethos and purpose of a hospice. The amendment would ensure that no financial consequences can ensue from a hospice maintaining its traditional ethos and operations, and not engaging with assisted suicide. Amendment 770, which which we will debate later, would not provide that additional protection. The importance of this cannot be overestimated. Failure to protect hospices in this way may very well lead to closure of hospices.
At a time when there is a huge shortage of expert palliative care. As we've heard so often. My Lords, these amendments are all tabled to ensure absolute clarity for professionals and patients and to further define the nature of the protections which professionals will have under the law, should they not wish to become involved with assisted suicide. My Lords, very significant efficiencies will be created and many potential legal challenges could be avoided if there was absolute clarity about those professionals who wish to engage with assisted suicide and equal clarity that administrative and all other NHS staff cannot be required to engage with any aspect of assisted suicide.
As has been said, the Royal College of Nursing has stated that nursing staff should have should not have to actively choose to be involved, ensuring it's absolutely clear that nurses have the right to say, I want nothing to do with this. That is the language of the Royal College. The solution lies in the. In the establishment of publicly available registers of these professionals who do wish to be involved, and I support the establishment. Therefore, an opt in system and have their.
Put. Therefore, put my name to amendment 189, which requires the Secretary of State to establish and provide for the updating of a public register of registered medical professionals supported by the BMA and the Royal College of GPS, who are willing and able to conduct preliminary discussions. That's the first one. Preliminary discussions under subsection three of clause five and then amendment two, six eight provides that only doctors who have specifically opted in can become coordinating doctors, and only those who positively choose to do so would be able to do the training and participate.
Amendment 359 refers to the independent doctor under clause eight, who must also have explicitly opted in, and amendment 617 amends clause 26 two to provide that. Where a coordinating doctor authorises another doctor to carry out the duties and to provide the lethal drugs to enable a person to end their own life, that doctor must have expressly opted in to do so. I also appoint a support amendment 680, which provides for a specialist register for clinical psychologists who want to participate and to be operated by the Health and Care Professions Council.
And similarly, amendment 681, which requires a specialist register for assisted dying for pharmacists to be kept by the General Pharmaceutical Council. So providing for those who are not registered medical practitioners, etc. I want to go to training. The noble Lord, Lord Faulkner, has limited the statutory opt in language to the bespoke training for coordinating doctors and independent doctors. His amendments do not provide the system wide opt in protection that the Royal Colleges have requested. Consequently, doctors and GPS who do not wish to be coordinating doctors or independent doctors, nurses and other front line staff may be required to participate in basic or tier one training and participate in peripheral aspects of the process.
My Lord, it's important to say that it would not be cost effective to train every member of the National Health Service in the provision of assisted suicide if they're not going to engage with it. And we always have to remember that training. I'm not going to give away. Our noble Lady can come in later. And that training has to be repeated. It's not a one off, and there are huge costs of extractions of staff from the delivery of services when they have to do training.
If the noble and learned Lord is opposed to these amendments, what's his response to the arguments of the BMA and the GP that the Bill does not provide sufficient protections for practitioners? Does the noble and learned Lord think they're wrong if participation is opt out rather than opt in? It will become expected. Amendment 190, which provides for a doctoral only to be able to respond to a specific request from a patient. I also support my Lords. Significant issues would arise were assisted suicide to be regarded as a medical treatment.
For example, in some Canadian provinces, nurses must stay with the patient through all aspects of care except the direct administration of the lethal substance, and there a lot of them have to resign for reasons of conscience to resolve this problem. And we did see this in the abortion context here to resolve this problem. Amendment 657 provides that the provision of assistance under the act is not to be regarded as a medical treatment, at least if this amendment is accepted, doctors will be sure they will not be failing to comply with their duty to raise treatments and discussion with patients, and that no liability could arise from their not doing so.
My Lords, I commend these provisions to the House.
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Thank you. Can I just point out that we've heard it. Several times that the Royal College of GPS are in favour of a College of GPS are in favour of a publicly available register. To the best of my knowledge, and having just checked, the Royal College of just checked, the Royal College of GPS is not in favour of a publicly available register. They are in
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favour of opt in, but not of a publicly available register. I said I think it was an intervention.
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intervention. Intervention. My Lords, I said that there should be a publicly available register. I said that the Royal
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College of GPS were in favour of adopting. Know exactly.
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Know exactly. I just point to clarity. I sat and listened and I thought, should I intervene? You mentioned a should I intervene? You mentioned a number of faiths around the fact that people from those faiths don't believe in assisted dying, but believe in assisted dying, but people from those faiths also believe, don't believe in believe, don't believe in childbirth before marriage. But is there any evidence to suggest that people are opting out of midwifery because of that reason? Or is it just your opinion that people from those fears may not want to take part? Because I'm from one of those faiths, and when noble Lords may have heard that assisted dying might not be for me, but what's.
I'm not here to stop others, and I'm sure others in the medical profession might also share my views. Yeah.
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Sure of the logic of what the noble Lord is saying. And I do apologise to the House. I'm struggling slightly, but I think struggling slightly, but I think what I am saying is that there has to be a conscience clause that people of faith and we're talking about assisted dying here. We're about assisted dying here. We're not talking about anything else that people of faith must have the right. And I don't know, you know, how many faiths may be involved, but they must have the right not to go against their consciences.
It's go against their consciences. It's one of the human rights which we actually have. My Lords, my Lords, thank you very much.
My Lords, we need to remember that medical practitioners need certainty about their legal and ethical obligations, especially when they're in a situation in which they may find themselves dealing with matters of life and death. In addition to this, my Lords, many of those who work in healthcare have religious beliefs which would preclude their engagement in facilitating others to kill themselves. Catholics, some other Christians, Muslims would be precluded from participation, yet may be prejudiced in their employment opportunities and prospects by this inability to engage.
It is important, therefore, that this factor is considered and any such consideration should surely lead inevitably to the acceptance that the only way that this can actually work is for people to opt in, rather than having to opt out. To that end, my Lord, I have tabled amendments six six, eight, which provides for a comprehensive conscience protection, allowing any person, not just a registered medical practitioner, to opt out of any activity which may facilitate assisted suicide, including any ancillary functions, and 670, which defines what might be might be said to to comprise assistance under the Bill.
Any aspect of assisted dying under or in connection with the provisions of this act, including, but not limited to, administrative and managerial tasks such as the allocation of duties. To carry out these tasks, the supervisors supervision of those to whom tasks are allocated, and accompanying, and monitoring a patient as they receive or after they have received the approved substance, the lethal drug. I also put my name to amendment 665, which states that no health or social care organisation, team or professional is required to or expected to participate in any part of the process of a person's request for an assisted death.
I put my name to amendment 660, which provides that involvement in assistance is wider than only the direct administration of lethal drugs, which clarifies the nature of what can be considered assistance under the. Under the act, I put my name to amendment 679, which is similar but more specific, and states that no company, charity or other organisation is under any duty to participate in, facilitate or permit on its premises. The provision of assistance under the act, no company, charity or other organisation shall be required as a condition of receiving funding or any other benefit from any public body to participate in, facilitate or permit on its premises.
The provision of assistance in accordance with the act. My Lord, this is fundamentally important to ensure that hospices, care homes, nursing homes and other similar organisations do not have to engage at all with the process of assisted suicide and it would also, I think, include prisons. I declare my interest as a trustee of a hospice. My Lords, there is a considerable fear that not providing explicitly to protect hospices in this way could lead to all sorts of difficulties. There's currently an expectation that hospices will provide care and support of many kinds, but.
And that they will not be involved in assisting people to kill themselves. To provide otherwise would change the whole ethos and purpose of a hospice. The amendment would ensure that no financial consequences can ensue from a hospice maintaining its traditional ethos and operations, and not engaging with assisted suicide. Amendment 770, which which we will debate later, would not provide that additional protection. The importance of this cannot be overestimated. Failure to protect hospices in this way may very well lead to closure of hospices.
At a time when there is a huge shortage of expert palliative care. As we've heard so often. My Lords, these amendments are all tabled to ensure absolute clarity for professionals and patients and to further define the nature of the protections which professionals will have under the law, should they not wish to become involved with assisted suicide. My Lords, very significant efficiencies will be created and many potential legal challenges could be avoided if there was absolute clarity about those professionals who wish to engage with assisted suicide and equal clarity that administrative and all other NHS staff cannot be required to engage with any aspect of assisted suicide.
As has been said, the Royal College of Nursing has stated that nursing staff should have should not have to actively choose to be involved, ensuring it's absolutely clear that nurses have the right to say, I want nothing to do with this. That is the language of the Royal College. The solution lies in the. In the establishment of publicly available registers of these professionals who do wish to be involved, and I support the establishment. Therefore, an opt in system and have their.
Put. Therefore, put my name to amendment 189, which requires the Secretary of State to establish and provide for the updating of a public register of registered medical professionals supported by the BMA and the Royal College of GPS, who are willing and able to conduct preliminary discussions. That's the first one. Preliminary discussions under subsection three of clause five and then amendment two, six eight provides that only doctors who have specifically opted in can become coordinating doctors, and only those who positively choose to do so would be able to do the training and participate.
Amendment 359 refers to the independent doctor under clause eight, who must also have explicitly opted in, and amendment 617 amends clause 26 two to provide that. Where a coordinating doctor authorises another doctor to carry out the duties and to provide the lethal drugs to enable a person to end their own life, that doctor must have expressly opted in to do so. I also appoint a support amendment 680, which provides for a specialist register for clinical psychologists who want to participate and to be operated by the Health and Care Professions Council.
And similarly, amendment 681, which requires a specialist register for assisted dying for pharmacists to be kept by the General Pharmaceutical Council. So providing for those who are not registered medical practitioners, etc. I want to go to training. The noble Lord, Lord Faulkner, has limited the statutory opt in language to the bespoke training for coordinating doctors and independent doctors. His amendments do not provide the system wide opt in protection that the Royal Colleges have requested. Consequently, doctors and GPS who do not wish to be coordinating doctors or independent doctors, nurses and other front line staff may be required to participate in basic or tier one training and participate in peripheral aspects of the process.
My Lord, it's important to say that it would not be cost effective to train every member of the National Health Service in the provision of assisted suicide if they're not going to engage with it. And we always have to remember that training. I'm not going to give away. Our noble Lady can come in later. And that training has to be repeated. It's not a one off, and there are huge costs of extractions of staff from the delivery of services when they have to do training.
If the noble and learned Lord is opposed to these amendments, what's his response to the arguments of the BMA and the GP that the Bill does not provide sufficient protections for practitioners? Does the noble and learned Lord think they're wrong if participation is opt out rather than opt in? It will become expected. Amendment 190, which provides for a doctoral only to be able to respond to a specific request from a patient. I also support my Lords. Significant issues would arise were assisted suicide to be regarded as a medical treatment.
For example, in some Canadian provinces, nurses must stay with the patient through all aspects of care except the direct administration of the lethal substance, and there a lot of them have to resign for reasons of conscience to resolve this problem. And we did see this in the abortion context here to resolve this problem. Amendment 657 provides that the provision of assistance under the act is not to be regarded as a medical treatment, at least if this amendment is accepted, doctors will be sure they will not be failing to comply with their duty to raise treatments and discussion with patients, and that no liability could arise from their not doing so.
My Lords, I commend these provisions to the House.
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Thank you. Can I just point out that we've heard it. Several times that the Royal College of GPS are in favour of a College of GPS are in favour of a publicly available register. To the best of my knowledge, and having just checked, the Royal College of just checked, the Royal College of GPS is not in favour of a publicly available register. They are in
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favour of opt in, but not of a publicly available register. I said I think it was an intervention.
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intervention. Intervention. My Lords, I said that there should be a publicly available register. I said that the Royal
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College of GPS were in favour of adopting. Know exactly.
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Know exactly. I just point to clarity. I sat and listened and I thought, should I intervene? You mentioned a should I intervene? You mentioned a number of faiths around the fact that people from those faiths don't believe in assisted dying, but believe in assisted dying, but people from those faiths also believe, don't believe in believe, don't believe in childbirth before marriage. But is there any evidence to suggest that people are opting out of midwifery because of that reason? Or is it just your opinion that people from those fears may not want to take part? Because I'm from one of those faiths, and when noble Lords may have heard that assisted dying might not be for me, but what's.
I'm not here to stop others, and I'm sure others in the medical profession might also share my views. Yeah.
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Sure of the logic of what the noble Lord is saying. And I do apologise to the House. I'm struggling slightly, but I think struggling slightly, but I think what I am saying is that there has to be a conscience clause that people of faith and we're talking about assisted dying here. We're about assisted dying here. We're not talking about anything else that people of faith must have the right. And I don't know, you know, how many faiths may be involved, but they must have the right not to go against their consciences.
It's go against their consciences. It's one of the human rights which we actually have. My Lords, my Lords, thank you very much.
11:18
Baroness Watkins of Tavistock (Crossbench)
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Baroness Watkins of Tavistock (Crossbench)
My Lords. >> I just. >> Want to say that I'm broadly supportive of tightening the issue supportive of tightening the issue of ensuring that people's conscience and their beliefs are recognised, and that the people who are prepared to work with patients who, may I remind the House, are terminally ill adults and they are wanting an end of life story that is different to a full, extensive palliative care. And I am completely supportive, as is the Royal College of Nursing.
That full palliative care is what the majority of people will choose. However, I do think that there are a small proportion of people who would choose the the principles of this bill because of the nature of their particular illness or personal choice. I have talked before about the professions, all healthcare professionals responsibility to try and talk with patients about the choice that is available to them. But the thing that upset me most this morning is thinking about patients that I have worked with and done everything together with the multiple the multidisciplinary team to keep alive, who have then taken their own lives because of severe enduring mental illness.
And I really wish that we could stop referring to this as an assisted suicide bill. I think he's just terribly hard on people who have relatives and friends who have died through their own hand, usually in great distress, and the whole purpose of the bill we are talking about today is to reduce stress and distress for the small proportion of people who want this as an option. Yes.
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Lord Stern it's done. May I just ask her? I assume that she's aware ask her? I assume that she's aware that one of the reasons that we need to be absolutely specific about what we're doing is that 42% about what we're doing is that 42% of people think assisted dying is palliative care, and we need to make clear what we're talking about.
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I'm sorry. I do accept that. But I also
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I do accept that. But I also think there was quite a helpful article in one of the newspapers this week talking about using the term assisted death rather than assisted suicide, but I'm pleased that I've had the opportunity to say it in the chamber. My Lords. I will speak to. Well, I want first of all, I'd like to congratulate my noble friend Baroness Cass on her
That full palliative care is what the majority of people will choose. However, I do think that there are a small proportion of people who would choose the the principles of this bill because of the nature of their particular illness or personal choice. I have talked before about the professions, all healthcare professionals responsibility to try and talk with patients about the choice that is available to them. But the thing that upset me most this morning is thinking about patients that I have worked with and done everything together with the multiple the multidisciplinary team to keep alive, who have then taken their own lives because of severe enduring mental illness.
And I really wish that we could stop referring to this as an assisted suicide bill. I think he's just terribly hard on people who have relatives and friends who have died through their own hand, usually in great distress, and the whole purpose of the bill we are talking about today is to reduce stress and distress for the small proportion of people who want this as an option. Yes.
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Lord Stern it's done. May I just ask her? I assume that she's aware ask her? I assume that she's aware that one of the reasons that we need to be absolutely specific about what we're doing is that 42% about what we're doing is that 42% of people think assisted dying is palliative care, and we need to make clear what we're talking about.
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I'm sorry. I do accept that. But I also
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I do accept that. But I also think there was quite a helpful article in one of the newspapers this week talking about using the term assisted death rather than assisted suicide, but I'm pleased that I've had the opportunity to say it in the chamber. My Lords. I will speak to. Well, I want first of all, I'd like to congratulate my noble friend Baroness Cass on her
11:21
Baroness Hollins (Crossbench)
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Baroness Hollins (Crossbench)
excellent speech, but I'm going to speak to my amendment 667680681A and 848C, which seek to ensure that any healthcare professional who any healthcare professional who wishes to participate in assisted dying under this bill may do so only by formally and voluntarily only by formally and voluntarily choosing and training to work in this specialist area. In other words, by opting in and being entered on a register for assisted dying held by their regulatory body, I acknowledge that under the current bill, no person is under any duty to participate.
This is not enough. At the individual level, opting in requires an active and deliberate decision, whereas opting out relies on a pre-set default. The two are not ethically equivalent. Despite appearing similar, and an opt out system assumes that participation is expected unless an individual takes active steps to refuse, which is actually bureaucratically rather burdensome in the context of assisted dying. Making participation the default also risks signalling that it is an endorsed routine practice. Over time, this may shift social norms and create implicit pressure on those involved to participate.
Because of time constraints, I'm going to focus my remarks on amendments six, six, seven and 848C, which deal with doctors, but the principles apply to other healthcare professionals, including pharmacists and psychologists. So some noble Lords have focussed on the matter of conscience. This is important, but I suggest is not the only professional consideration here. If the Bill passes, assisting a person to end their life must not be regarded as part of every doctor's ordinary professional role. The Royal College of General Practitioners has expressed concerns about the Bill as drafted, and has emphasised that any assisted dying service should be separate from core general practice, both in structure and resourcing.
The college made clear that participation should be strictly opt in with no expectation placed on GPS or other healthcare professionals to take part, and one reason for their position is to ensure that core general practice and palliative care are not deprioritised, and that no additional demands are placed on already overstretched services. However, my amendments seek to ensure that if Parliament decides that doctors will be involved in implementing the bill, then doctors must choose to work in the service just as they choose other areas of medicine in which they wish to practice.
It follows that they must be adequately trained and registered to practice. OPT out systems are often justified on the basis that they increase participation. They work by setting a default position where individuals are included unless they take active steps to withdraw. And in practice, many people remain with that default, and it reflects a well-established behavioural tendency that people are more likely to stick with the preset option than to change it, even when there are alternatives. So as a result, uptake increases not because everyone has actively chosen to participate, but because fewer people opt out than would have opted in.
So making participation the default may increase uptake because it's expected. And in centralised healthcare systems such as the NHS, declining participation may carry subtle penalties. I want to illustrate this with the example of the Mental Health Act in principle. A clinician may object to compulsory detention or treatment of individuals who retain decision making capacity about their care. However, in practice, such a position may carry consequences for training and career progression. The Mental Health Act in England and Wales sets out the legal framework for compulsory detention, but does not impose a duty on individual doctors to participate.
For detection and treatment, a medical recommendation is required from an approved doctor. The approval framework defines which doctors are eligible to give such recommendations, but does not oblige them to do so in strict legal terms. There is no statutory duty compelling any psychiatrist to work within the Mental Health Act framework. Instead, the act requires that certain professionals are involved if detention occurs, but it does not compel any specific individual to act effectively. Participation operates as an opt in system.
A psychiatrist must apply for and maintain approval status to undertake this work. However, there's a clear distinction between legal obligation and professional and contractual expectations within the NHS. Many consultant psychiatrist roles include mental health act work in the job plan, and those taking up such posts are expected to hold relevant approval. If a psychiatrist accepts such a role, participation then becomes a contractual duty system. Therefore it's not. It's not coercive in a legal sense, but it becomes structurally coercive in a professional sense without any statutory compulsion.
The training pathway and the labour market strongly shape participation. This is even within an opt in system, and it raises the question of how much stronger these pressures may become under an opt out model proposed under the bill. Although I accept that it's been slightly modified potentially by the noble and learned Lords amendment, which I don't think goes far enough. My Lords, my amendments in this group also address the regulation of doctors who choose to participate. Just as every recognised medical speciality is regulated by the GMC, I believe assisted dying should be treated no differently.
It's a completely new area of practice, requiring its own defined set of skills, competencies and training standards that fall outside the remit of any existing speciality. So accordingly, my amendments and the amendment of the noble Lady Baroness Fraser propose the creation of a specialist register for assisted death, which would be publicly available. As with other speciality registers. Participating doctors would, of course, be required to hold both their primary speciality registration and this additional registration and dual speciality registration is well established within NHS practice.
It reflects a recognised training model in which clinicians develop advanced expertise across complementary domains to deliver specific, specific and often more complex interventions. Dual accreditation is typically used where clinical practice spans more than one domain, as is the case in assisted dying, where unmet palliative care needs must be addressed before death is considered. Therefore, this approach is entirely consistent with existing professional standards, and no clinician should take part in any aspect of the assisted dying process unless they are appropriately registered and regulated, requiring clinicians to specialise further reinforces that participation is genuinely opt in.
It would be difficult to argue that an individual was compelled to undertake specific training and accreditation, so this provides an additional safeguard. That involvement reflects a clear and deliberate professional choice. So, in conclusion, any involvement should be strictly opt in and sit outside. Routine professional responsibility. And registered with their respective regulatory bodies as providers of assisted death. And it supports a standalone, separately regulated system with participation limited to those who have actively chosen to be involved, have received appropriate training and are properly regulated.
Finally, personally, I hope that Parliament does not require doctors to participate in any way, and I support amendments to that effect as well.
This is not enough. At the individual level, opting in requires an active and deliberate decision, whereas opting out relies on a pre-set default. The two are not ethically equivalent. Despite appearing similar, and an opt out system assumes that participation is expected unless an individual takes active steps to refuse, which is actually bureaucratically rather burdensome in the context of assisted dying. Making participation the default also risks signalling that it is an endorsed routine practice. Over time, this may shift social norms and create implicit pressure on those involved to participate.
Because of time constraints, I'm going to focus my remarks on amendments six, six, seven and 848C, which deal with doctors, but the principles apply to other healthcare professionals, including pharmacists and psychologists. So some noble Lords have focussed on the matter of conscience. This is important, but I suggest is not the only professional consideration here. If the Bill passes, assisting a person to end their life must not be regarded as part of every doctor's ordinary professional role. The Royal College of General Practitioners has expressed concerns about the Bill as drafted, and has emphasised that any assisted dying service should be separate from core general practice, both in structure and resourcing.
The college made clear that participation should be strictly opt in with no expectation placed on GPS or other healthcare professionals to take part, and one reason for their position is to ensure that core general practice and palliative care are not deprioritised, and that no additional demands are placed on already overstretched services. However, my amendments seek to ensure that if Parliament decides that doctors will be involved in implementing the bill, then doctors must choose to work in the service just as they choose other areas of medicine in which they wish to practice.
It follows that they must be adequately trained and registered to practice. OPT out systems are often justified on the basis that they increase participation. They work by setting a default position where individuals are included unless they take active steps to withdraw. And in practice, many people remain with that default, and it reflects a well-established behavioural tendency that people are more likely to stick with the preset option than to change it, even when there are alternatives. So as a result, uptake increases not because everyone has actively chosen to participate, but because fewer people opt out than would have opted in.
So making participation the default may increase uptake because it's expected. And in centralised healthcare systems such as the NHS, declining participation may carry subtle penalties. I want to illustrate this with the example of the Mental Health Act in principle. A clinician may object to compulsory detention or treatment of individuals who retain decision making capacity about their care. However, in practice, such a position may carry consequences for training and career progression. The Mental Health Act in England and Wales sets out the legal framework for compulsory detention, but does not impose a duty on individual doctors to participate.
For detection and treatment, a medical recommendation is required from an approved doctor. The approval framework defines which doctors are eligible to give such recommendations, but does not oblige them to do so in strict legal terms. There is no statutory duty compelling any psychiatrist to work within the Mental Health Act framework. Instead, the act requires that certain professionals are involved if detention occurs, but it does not compel any specific individual to act effectively. Participation operates as an opt in system.
A psychiatrist must apply for and maintain approval status to undertake this work. However, there's a clear distinction between legal obligation and professional and contractual expectations within the NHS. Many consultant psychiatrist roles include mental health act work in the job plan, and those taking up such posts are expected to hold relevant approval. If a psychiatrist accepts such a role, participation then becomes a contractual duty system. Therefore it's not. It's not coercive in a legal sense, but it becomes structurally coercive in a professional sense without any statutory compulsion.
The training pathway and the labour market strongly shape participation. This is even within an opt in system, and it raises the question of how much stronger these pressures may become under an opt out model proposed under the bill. Although I accept that it's been slightly modified potentially by the noble and learned Lords amendment, which I don't think goes far enough. My Lords, my amendments in this group also address the regulation of doctors who choose to participate. Just as every recognised medical speciality is regulated by the GMC, I believe assisted dying should be treated no differently.
It's a completely new area of practice, requiring its own defined set of skills, competencies and training standards that fall outside the remit of any existing speciality. So accordingly, my amendments and the amendment of the noble Lady Baroness Fraser propose the creation of a specialist register for assisted death, which would be publicly available. As with other speciality registers. Participating doctors would, of course, be required to hold both their primary speciality registration and this additional registration and dual speciality registration is well established within NHS practice.
It reflects a recognised training model in which clinicians develop advanced expertise across complementary domains to deliver specific, specific and often more complex interventions. Dual accreditation is typically used where clinical practice spans more than one domain, as is the case in assisted dying, where unmet palliative care needs must be addressed before death is considered. Therefore, this approach is entirely consistent with existing professional standards, and no clinician should take part in any aspect of the assisted dying process unless they are appropriately registered and regulated, requiring clinicians to specialise further reinforces that participation is genuinely opt in.
It would be difficult to argue that an individual was compelled to undertake specific training and accreditation, so this provides an additional safeguard. That involvement reflects a clear and deliberate professional choice. So, in conclusion, any involvement should be strictly opt in and sit outside. Routine professional responsibility. And registered with their respective regulatory bodies as providers of assisted death. And it supports a standalone, separately regulated system with participation limited to those who have actively chosen to be involved, have received appropriate training and are properly regulated.
Finally, personally, I hope that Parliament does not require doctors to participate in any way, and I support amendments to that effect as well.
11:29
Baroness Blackstone (Labour)
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Baroness Blackstone (Labour)
Just ask the. >> Just ask the. >> Noble Lady Baroness Hollins why she has identified this small group she has identified this small group of specialists, and only then would she accept that the causes of dime. The causes of death are very wide, and many different specialists may have been involved in the treatment of a patient who wishes to end their death as. Bring on their deaths as soon as possible because of their huge suffering. So why why would we confine this, this form of treatment or the provision of this option for patients who are close to death, to only the small groups that she has identified here? Why would not general practitioners be included? Why would not neurologists be included? Why would not gastroenterologists be included? This seems to me to be an amendment that has been put in to narrow the number of medical practitioners who are able to support dying people in the way that those dying people wish, because they don't want to go on living any longer with the torment that they are suffering.
So I hope that the noble Lady will think again about this particular amendment, which seems to me unbelievably restrictive as far as
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the the inclusion of the medical profession is concerned. Lady may have misunderstood
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Lady may have misunderstood because I spoke about dual accreditation, which could apply to accreditation, which could apply to any doctor from any speciality who wished to obtain the necessary wished to obtain the necessary training and accreditation to be able to to to contribute in this particular in this particular issue.
So I hope that the noble Lady will think again about this particular amendment, which seems to me unbelievably restrictive as far as
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the the inclusion of the medical profession is concerned. Lady may have misunderstood
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Lady may have misunderstood because I spoke about dual accreditation, which could apply to accreditation, which could apply to any doctor from any speciality who wished to obtain the necessary wished to obtain the necessary training and accreditation to be able to to to contribute in this particular in this particular issue.
11:31
Baroness Berridge (Conservative)
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Baroness Berridge (Conservative)
Thank you. >> Thank you. >> Thank you. I'm grateful to the noble Lord. I've added my amendment, noble Lord. I've added my amendment, my name to amendments 359660665 and 681. As I believe these ensure the widest possible protection for those people who, due to issues of conscience, are not able to participate in assisted dying and I specifically use not able. This is a different concept to that underlying the bill of autonomy and choice. Not able in matters of conscience is something we haven't really considered in our law for a long time.
But if one casts one's mind to conscientious objection to war, to being involved in war, it is an important part of the rights of people to be able to say, I am not able to participate in that. Which is why, particularly when there was some comment about the role of the porter. Everybody has that right of conscience, not a choice, a conscience, and one only has to watch 24 hours in A&E to actually see that brief encounter with the porter, as an example, is such an important part of healthcare, and I think we need to remember that everyone has freedom of conscience, not choice.
Of course, if the bill provided the opt in system on the face of the bill, as my noble friend Lady Fraser mentioned, then the protections in these specific amendments would not be needed. And I'm afraid I address the noble and learned Lord Deben about pre-legislative scrutiny. I do admire the confidence with which he assures us, with Bill in hand, that this is all sorted out. But until I am satisfied that royal colleges, who are the people who are going to deliver this, are satisfied that the Bill.
Is that clear, then? I'm afraid these amendments do need to be considered. There are other jurisdictions where there are tighter protections for practitioners in Oregon. Even the medical practitioner does not have to participate, does not have to document requests or provide information. But the language in this bill is just unwilling or unable, which is a wider definition. And the noble Lady lady alone has mentioned the case from Scotland, where they considered the conscientious objection clause in the abortion Bill, which was found to actually only apply to direct participation, not the ancillary services which these various amendments are trying to secure for individuals and organisations.
And I note that I do anticipate that there will be GP surgeries who will opt out, because patients will just want to know that whoever they get at the surgery doesn't support this. But these amendments would cover the situations I have been concerned about, namely the Secretary of State, the Commissioners of Services for assisted dying. If this is going to be an NHS, NHS service and civil servants, I would be grateful to know from the noble Lady, the Minister, that she could confirm to us either today or on our final day of committee.
That's currently scheduled, that the civil servants in all government departments who have had to work on this bill have not been pressurised or or required to work on this bill. The bill may not yet be law, but I do think that it is a very best good employment practice to have not put any pressure or the other examples noble Lords have made that can be given to staff to make sure they participate. And finally, my Lords, in relation to the noble Lady, Lady Watkins point coroners still record verdicts of suicide.
The government still has a suicide prevention strategy. The bill in which we are amending is the criminal law, called the Suicide Act, 1961, and I. I do agree that we should act with compassion, but we do have to be legally correct about what we are doing. And there's potentially a wider issue there for the government to take away. If you want to change the name of legislation and change the name of strategy. But that's not for today. My Lords, my.
But if one casts one's mind to conscientious objection to war, to being involved in war, it is an important part of the rights of people to be able to say, I am not able to participate in that. Which is why, particularly when there was some comment about the role of the porter. Everybody has that right of conscience, not a choice, a conscience, and one only has to watch 24 hours in A&E to actually see that brief encounter with the porter, as an example, is such an important part of healthcare, and I think we need to remember that everyone has freedom of conscience, not choice.
Of course, if the bill provided the opt in system on the face of the bill, as my noble friend Lady Fraser mentioned, then the protections in these specific amendments would not be needed. And I'm afraid I address the noble and learned Lord Deben about pre-legislative scrutiny. I do admire the confidence with which he assures us, with Bill in hand, that this is all sorted out. But until I am satisfied that royal colleges, who are the people who are going to deliver this, are satisfied that the Bill.
Is that clear, then? I'm afraid these amendments do need to be considered. There are other jurisdictions where there are tighter protections for practitioners in Oregon. Even the medical practitioner does not have to participate, does not have to document requests or provide information. But the language in this bill is just unwilling or unable, which is a wider definition. And the noble Lady lady alone has mentioned the case from Scotland, where they considered the conscientious objection clause in the abortion Bill, which was found to actually only apply to direct participation, not the ancillary services which these various amendments are trying to secure for individuals and organisations.
And I note that I do anticipate that there will be GP surgeries who will opt out, because patients will just want to know that whoever they get at the surgery doesn't support this. But these amendments would cover the situations I have been concerned about, namely the Secretary of State, the Commissioners of Services for assisted dying. If this is going to be an NHS, NHS service and civil servants, I would be grateful to know from the noble Lady, the Minister, that she could confirm to us either today or on our final day of committee.
That's currently scheduled, that the civil servants in all government departments who have had to work on this bill have not been pressurised or or required to work on this bill. The bill may not yet be law, but I do think that it is a very best good employment practice to have not put any pressure or the other examples noble Lords have made that can be given to staff to make sure they participate. And finally, my Lords, in relation to the noble Lady, Lady Watkins point coroners still record verdicts of suicide.
The government still has a suicide prevention strategy. The bill in which we are amending is the criminal law, called the Suicide Act, 1961, and I. I do agree that we should act with compassion, but we do have to be legally correct about what we are doing. And there's potentially a wider issue there for the government to take away. If you want to change the name of legislation and change the name of strategy. But that's not for today. My Lords, my.
11:35
Lord Harries of Pentregarth (Crossbench)
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Lord Harries of Pentregarth (Crossbench)
Amendment for a. >> Little, because it's been such a privilege to listen and learn and try to clarify mind on the various amendments that we have had before amendments that we have had before us. And I do wish that some of our critics in the press would have been able to hear this morning, because the amendments this morning go to the very heart of the bill, and we've had the opportunity of hearing from people of different sides, of real expertise, expertise from Baroness Gerada, Baroness Hollins, Baroness O'Loan, Baroness Finlay and and so on.
It's been a huge privilege for those of us who are not medical in order to be able to clarify our minds on this issue. And I do hope that the noble and learned Lord Doyle will be able to address Baroness Cass point in particular, because she made points that I'd not heard before, and I don't know whether he'd heard them before, but she was claiming the bill, as we have it at the moment is not actually workable, and I very much hope that he will be able to address that point.
I just want to say three things very, very briefly. First of all, in relation to the noble Baroness Baroness Andrews, who suggested that actually the things we're talking about this morning should be left to the medical professions to actually regulate. But what we've been debating this morning as to whether we should have a public register or whether we should simply have an opt out clause, which everybody agrees with, of course, is not just simply a detailed regulation. With due respect, it actually goes to the very heart of the bill, which is something which actually Parliament has to make its mind about.
Secondly, in relation to the noble Baroness Prentis Grady, if I might say so, we listen to with great respect, towards the end of her speech, she mentioned the well known fact that a number of doctors, when patients come to the end of their life, are given very, very large doses of painkiller, which has the effect of shortening their life. This is, of course, very well known, but from an ethical point of view, there is a fundamental difference between depending on whether one is a utilitarian or a consequentialist on the one hand, or whether one believes that actually certain things are fundamentally wrong.
This has been mentioned 2 or 3 times in the debates over recent years. And for for the ethical tradition on which of this country is based in particularly the medical profession, there is a fundamental difference between administering a poison to kill someone and actually administering a large dose of painkilling drugs, which has the foreseen effect of also shortening their lives, which from a moral point of view is entirely legitimate. And finally, my Lords, in relation to the noble Baroness Baroness Watkins, on the question of language again, which has been mentioned another time, many of us don't like to confuse what we're debating with assisted dying.
We don't like that, but we do also respect what you say, that the language of suicide, of course, is is unpleasant and really not appropriate. So personally, I'd like just to use neutral language as possible and talk about people taking their own life, which seems to me that there's neutral language as we can get on this.
It's been a huge privilege for those of us who are not medical in order to be able to clarify our minds on this issue. And I do hope that the noble and learned Lord Doyle will be able to address Baroness Cass point in particular, because she made points that I'd not heard before, and I don't know whether he'd heard them before, but she was claiming the bill, as we have it at the moment is not actually workable, and I very much hope that he will be able to address that point.
I just want to say three things very, very briefly. First of all, in relation to the noble Baroness Baroness Andrews, who suggested that actually the things we're talking about this morning should be left to the medical professions to actually regulate. But what we've been debating this morning as to whether we should have a public register or whether we should simply have an opt out clause, which everybody agrees with, of course, is not just simply a detailed regulation. With due respect, it actually goes to the very heart of the bill, which is something which actually Parliament has to make its mind about.
Secondly, in relation to the noble Baroness Prentis Grady, if I might say so, we listen to with great respect, towards the end of her speech, she mentioned the well known fact that a number of doctors, when patients come to the end of their life, are given very, very large doses of painkiller, which has the effect of shortening their life. This is, of course, very well known, but from an ethical point of view, there is a fundamental difference between depending on whether one is a utilitarian or a consequentialist on the one hand, or whether one believes that actually certain things are fundamentally wrong.
This has been mentioned 2 or 3 times in the debates over recent years. And for for the ethical tradition on which of this country is based in particularly the medical profession, there is a fundamental difference between administering a poison to kill someone and actually administering a large dose of painkilling drugs, which has the foreseen effect of also shortening their lives, which from a moral point of view is entirely legitimate. And finally, my Lords, in relation to the noble Baroness Baroness Watkins, on the question of language again, which has been mentioned another time, many of us don't like to confuse what we're debating with assisted dying.
We don't like that, but we do also respect what you say, that the language of suicide, of course, is is unpleasant and really not appropriate. So personally, I'd like just to use neutral language as possible and talk about people taking their own life, which seems to me that there's neutral language as we can get on this.
11:38
Baroness Lawlor (Conservative)
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Baroness Lawlor (Conservative)
Introduce my amendment six six for it is designed not only to for it is designed not only to ensure that no medical professional is obliged to participate in training, but that in order to participate in training, a medical professional must give written consent. Professional training aims not only to show students how to apply their academic knowledge in practice, but how to approach their role in their chosen profession. The second element is two levels. There is the day to day one, as summed up by the Cambridge Clinical Course under the labels Communication Skills and Patient management.
How, for instance, to deal with a patient who insists, contrary to the evidence, that they have cancer. But there is a second higher level, an induction into the ethos of the profession. This level is of vital importance in training medical professionals because they are dealing with human beings. Throughout this Committee stage, one of the most powerful messages has been that each each individual is different, and that one of the most precious skills of doctors, nurses and other medical professionals is to be sensitive to these differences when applying medical science.
In a particular case, there is no simple blueprint or checklist to guide them. Rather, they need to be guided by other by the ethos of the profession into which their training has induced. Their. This is therefore a strong reason why this amendment seeks to ensure the training of health professionals related to an assisted suicide needs explicit consent from participants. It implies that training is treated as a separate activity. Training for. For this purposes of. This bill is treated as a separate activity within the course as a whole, requiring consent from the participants, and that there is neither compulsion nor pressure to participate it.
If assisting, assisting suicide or assisted death under this bill is presented in training as just another element, amongst others, of what health professionals do, the ethos will be drastically changed instead of one based on supporting the ill, the frail and the elderly, of seeing in every life one worth living and improving health, a new ethos will grow. At first, it will be one of moral equivalence between encouragement and help to live and encouragement and help to die, one in which there is no ethical basis for the profession.
But everything depends on the apparent preferences of the patient. But soon I fear it will develop into something more sinister, an ethos in which medical professionals are servants of the state, deciding for the common good as they believe who is to live and who is to die. A second reason for this amendment is the freedom of conscience, of medical and other healthcare professionals. To many, as has been mentioned, not just in this house. Baroness Sater.
I'm just finishing. I won't take interventions. Thank you. And a second reason for this amendment for written opt in for training for medical and other health and care professionals. Is that too many? Not just in this house but in society as a whole? Assisting suicide is deeply immoral, and it would be obnoxious to be training a have to train in practising it.
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My Lord, my Lord. I'll just. Check that I have understood her
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Check that I have understood her correctly when she said that the patient's preference should not prevail if they want an assisted prevail if they want an assisted death, but the doctor should decide. Does she mean that the doctor knows Does she mean that the doctor knows best? Is that what she meant?
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best? Is that what she meant? I thank the noble Lady for this. I'm talking about medical professionals and I'm also talking about the moral equivalence. Can you remind me where I exactly said
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that? I rise very briefly to speak to
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I rise very briefly to speak to amendment six, five seven in the name of the noble Lady Baroness Fox, name of the noble Lady Baroness Fox, to which I have added my name, and to support the amendments in the name of my noble friend Baroness name of my noble friend Baroness Finlay or the amendments 268359617
How, for instance, to deal with a patient who insists, contrary to the evidence, that they have cancer. But there is a second higher level, an induction into the ethos of the profession. This level is of vital importance in training medical professionals because they are dealing with human beings. Throughout this Committee stage, one of the most powerful messages has been that each each individual is different, and that one of the most precious skills of doctors, nurses and other medical professionals is to be sensitive to these differences when applying medical science.
In a particular case, there is no simple blueprint or checklist to guide them. Rather, they need to be guided by other by the ethos of the profession into which their training has induced. Their. This is therefore a strong reason why this amendment seeks to ensure the training of health professionals related to an assisted suicide needs explicit consent from participants. It implies that training is treated as a separate activity. Training for. For this purposes of. This bill is treated as a separate activity within the course as a whole, requiring consent from the participants, and that there is neither compulsion nor pressure to participate it.
If assisting, assisting suicide or assisted death under this bill is presented in training as just another element, amongst others, of what health professionals do, the ethos will be drastically changed instead of one based on supporting the ill, the frail and the elderly, of seeing in every life one worth living and improving health, a new ethos will grow. At first, it will be one of moral equivalence between encouragement and help to live and encouragement and help to die, one in which there is no ethical basis for the profession.
But everything depends on the apparent preferences of the patient. But soon I fear it will develop into something more sinister, an ethos in which medical professionals are servants of the state, deciding for the common good as they believe who is to live and who is to die. A second reason for this amendment is the freedom of conscience, of medical and other healthcare professionals. To many, as has been mentioned, not just in this house. Baroness Sater.
I'm just finishing. I won't take interventions. Thank you. And a second reason for this amendment for written opt in for training for medical and other health and care professionals. Is that too many? Not just in this house but in society as a whole? Assisting suicide is deeply immoral, and it would be obnoxious to be training a have to train in practising it.
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My Lord, my Lord. I'll just. Check that I have understood her
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Check that I have understood her correctly when she said that the patient's preference should not prevail if they want an assisted prevail if they want an assisted death, but the doctor should decide. Does she mean that the doctor knows Does she mean that the doctor knows best? Is that what she meant?
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best? Is that what she meant? I thank the noble Lady for this. I'm talking about medical professionals and I'm also talking about the moral equivalence. Can you remind me where I exactly said
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that? I rise very briefly to speak to
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I rise very briefly to speak to amendment six, five seven in the name of the noble Lady Baroness Fox, name of the noble Lady Baroness Fox, to which I have added my name, and to support the amendments in the name of my noble friend Baroness name of my noble friend Baroness Finlay or the amendments 268359617
11:44
Baroness Smith of Newnham (Liberal Democrat)
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Baroness Smith of Newnham (Liberal Democrat)
Finlay or the amendments 268359617 and the amendment in the noble. In the name of the noble Lady Baroness Cass and in particular, I think that the amendment from the noble Lady Baroness Cass in many ways picks up on the issue that's highlighted in six, five, seven to make explicit that an assisted death should not be seen as a form of treatment. And I think that was implicit in what the right reverend the Lord Harris was saying, that actually we have a situation where there is a difference between taking somebody off life support, giving them significant doses of pain relief at the end of life, and administering a dose of medicine that is intended to be fatal.
They are all slightly different, but I think the the wording in Roman numerals two of Baroness Cass amendment perhaps would also help us find a way across the aisles to deal with the concerns that Baroness Watkins raised, that those who are opposed to assisted dying tend to, say, assisted suicide. Many who are in favour say assisted dying. But the wording that Baroness Cass is used is to say that it's a personal choice to end their life, and I think that might be a way that we could at least think about finding a way forward.
But I have a few questions to ask the Minister and also the noble Lord, the sponsor of the bill, in intervening on the noble Lady Baroness Fox. Lord Faulkner rightly said that clause 31 already says there is no obligation to provide assistance, etc. and that picks up on the amendments of Lady O'loan as well, that to say no person is under any duty to participate in the provision of assistance. What I would be interested to understand is, in these circumstances, what should assistance be taken to mean? And that fits follows on from the points of noble Lady Baroness Berridge, who was asking about the roles of politicians and also civil servants, because most of the debate has been about what the medical profession, health workers, maybe even porters are being asked to do.
But clause four of the bill requires the Prime Minister to appoint a voluntary, voluntary assisted dying commissioner, and many of the clauses give sweeping powers to the Secretary of State. Does that mean that the Prime Minister and the Secretary of State, presumably for health, but possibly also the Justice Secretary and junior Ministers would be expected to engage with this legislation if passed, and that there wouldn't be a conscience clause for politicians and perhaps even civil servants, because that would seem to go against the norms of saying that there can be conscience clause clauses.
And I think it would be and I say this as a practising Catholic, unfortunate if Catholics and others of faith or people for whatever reason which may not be religious, felt that they couldn't support an assisted dying service.
They are all slightly different, but I think the the wording in Roman numerals two of Baroness Cass amendment perhaps would also help us find a way across the aisles to deal with the concerns that Baroness Watkins raised, that those who are opposed to assisted dying tend to, say, assisted suicide. Many who are in favour say assisted dying. But the wording that Baroness Cass is used is to say that it's a personal choice to end their life, and I think that might be a way that we could at least think about finding a way forward.
But I have a few questions to ask the Minister and also the noble Lord, the sponsor of the bill, in intervening on the noble Lady Baroness Fox. Lord Faulkner rightly said that clause 31 already says there is no obligation to provide assistance, etc. and that picks up on the amendments of Lady O'loan as well, that to say no person is under any duty to participate in the provision of assistance. What I would be interested to understand is, in these circumstances, what should assistance be taken to mean? And that fits follows on from the points of noble Lady Baroness Berridge, who was asking about the roles of politicians and also civil servants, because most of the debate has been about what the medical profession, health workers, maybe even porters are being asked to do.
But clause four of the bill requires the Prime Minister to appoint a voluntary, voluntary assisted dying commissioner, and many of the clauses give sweeping powers to the Secretary of State. Does that mean that the Prime Minister and the Secretary of State, presumably for health, but possibly also the Justice Secretary and junior Ministers would be expected to engage with this legislation if passed, and that there wouldn't be a conscience clause for politicians and perhaps even civil servants, because that would seem to go against the norms of saying that there can be conscience clause clauses.
And I think it would be and I say this as a practising Catholic, unfortunate if Catholics and others of faith or people for whatever reason which may not be religious, felt that they couldn't support an assisted dying service.
11:48
Lord Pannick (Crossbench)
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Lord Pannick (Crossbench)
Lord Roe I just want to respond, if I may, to Baroness Berridge on if I may, to Baroness Berridge on the importance of conscientious objection, because the strength of objection, because the strength of clause 31 and schedule three is that they are not confined to those who can show that they have a conscientious objection to assisted suicide. Any doctor, any other person who does not wish to assist has a legal right not to do so for any reason. Indeed, they don't have to give any reason.
This is the broadest possible protection and it is broader, let us not forget than the protection which Parliament included in the Abortion Act 1967, because under section four of the Abortion Act, the doctor or other person who does not wish to participate must not only have a conscientious objection, they must be able to prove that they have a conscientious objection if there's any issue about it. So Lord Falconer's bill includes the broadest possible protection, and my reaction to many of these amendments is the reaction I have had over 13 days to the amendments to this bill, which we have debated, whatever their intention, and I make no allegations about intentions, their effect will inevitably be unnecessarily to impede the ability of persons who are dying to receive the assistance
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that they so desperately want. After.
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After. I would like to thank. My Lord Sassoon. It was an intervention, but
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It was an intervention, but after another speech, I'm grateful for the clarity, but I. I draw for the clarity, but I. I draw attention to the fact that if that was a position that could have been put. If and can now still be put in put. If and can now still be put in a meeting with the various Royal colleges to assure them that the Bill does what the noble and learned Lord and the noble Lord Pannick says that it does, because we are faced with a situation where the practitioners are not satisfied and do not have the confidence that the noble Lord alludes, that the
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bill will give them the protection that they want. Don't. Of course, what we're not
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Don't. Of course, what we're not going to get to is any vote, any conclusion on on this bill which conclusion on on this bill which will enable Parliament to implement what is the view of the vast
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what is the view of the vast majority of people in this country. We could get to the front benches. Yes.
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Yes. Here, here. My Lords, I'm very. Except the spirit of the noble Lady, Baroness Butler-sloss. I shall be very brief.
This is the broadest possible protection and it is broader, let us not forget than the protection which Parliament included in the Abortion Act 1967, because under section four of the Abortion Act, the doctor or other person who does not wish to participate must not only have a conscientious objection, they must be able to prove that they have a conscientious objection if there's any issue about it. So Lord Falconer's bill includes the broadest possible protection, and my reaction to many of these amendments is the reaction I have had over 13 days to the amendments to this bill, which we have debated, whatever their intention, and I make no allegations about intentions, their effect will inevitably be unnecessarily to impede the ability of persons who are dying to receive the assistance
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that they so desperately want. After.
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After. I would like to thank. My Lord Sassoon. It was an intervention, but
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It was an intervention, but after another speech, I'm grateful for the clarity, but I. I draw for the clarity, but I. I draw attention to the fact that if that was a position that could have been put. If and can now still be put in put. If and can now still be put in a meeting with the various Royal colleges to assure them that the Bill does what the noble and learned Lord and the noble Lord Pannick says that it does, because we are faced with a situation where the practitioners are not satisfied and do not have the confidence that the noble Lord alludes, that the
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bill will give them the protection that they want. Don't. Of course, what we're not
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Don't. Of course, what we're not going to get to is any vote, any conclusion on on this bill which conclusion on on this bill which will enable Parliament to implement what is the view of the vast
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what is the view of the vast majority of people in this country. We could get to the front benches. Yes.
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Yes. Here, here. My Lords, I'm very. Except the spirit of the noble Lady, Baroness Butler-sloss. I shall be very brief.
11:50
Lord Moore of Etchingham (Non-affiliated)
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Lord Moore of Etchingham (Non-affiliated)
The. I just want to come back to the. In support of the Baroness, noble Baroness Lady Fraser of noble Baroness Lady Fraser of Craigmaddie, in her amendment about the register, and I do understand we're trying. One of the things we're trying. One of the things we're trying to do is, of course, protect professionals in this grouping. And therefore many of us will be very sympathetic to what will be very sympathetic to what the noble Baroness Gerada said about receiving hate mail if there about receiving hate mail if there were a register.
But I'm afraid that I think in modern times, everyone in public positions has to face the disagreeable fact of hate mail. It's a feature of social media, and we cannot prevent. We cannot, therefore close down the openness that we want to have in many aspects. And I'm thinking about this in relation to the patient here of the benefit to the patient of this register. It's very important that for the medical profession as well, but it's also very important for the patient, I think, for a wider reason.
First of all, the reason, obviously, is that you want to find someone who who will do this for you, who will assist in your taking your own life. But also, as these debates so often show, there is a big moral gulf, unfortunately, between those who support and those who oppose this bill. And if you think of a patient, particularly perhaps an elderly patient, someone with a serious illness and therefore eligible for the bill, they it's important that they do know what type of a doctor they are dealing with in a wider field of care.
I. I think, for example, suppose I had to find a doctor for my aged mother who is absolutely determined to live to be 100 and is in fact the only woman woman I know who lies about her age upwards. She. I know that she would not want to go to a doctor who was a doctor who provided assisted dying, so it seems pretty. And I think that's a understandable thing, because behind all of this is a very different view about what life and death is.
And therefore a patient would need to know that. And I think that's a very good reason for supporting the amendment of the noble Baroness.
But I'm afraid that I think in modern times, everyone in public positions has to face the disagreeable fact of hate mail. It's a feature of social media, and we cannot prevent. We cannot, therefore close down the openness that we want to have in many aspects. And I'm thinking about this in relation to the patient here of the benefit to the patient of this register. It's very important that for the medical profession as well, but it's also very important for the patient, I think, for a wider reason.
First of all, the reason, obviously, is that you want to find someone who who will do this for you, who will assist in your taking your own life. But also, as these debates so often show, there is a big moral gulf, unfortunately, between those who support and those who oppose this bill. And if you think of a patient, particularly perhaps an elderly patient, someone with a serious illness and therefore eligible for the bill, they it's important that they do know what type of a doctor they are dealing with in a wider field of care.
I. I think, for example, suppose I had to find a doctor for my aged mother who is absolutely determined to live to be 100 and is in fact the only woman woman I know who lies about her age upwards. She. I know that she would not want to go to a doctor who was a doctor who provided assisted dying, so it seems pretty. And I think that's a understandable thing, because behind all of this is a very different view about what life and death is.
And therefore a patient would need to know that. And I think that's a very good reason for supporting the amendment of the noble Baroness.
11:53
Lord Stevens of Birmingham (Crossbench)
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Lord Stevens of Birmingham (Crossbench)
Yeah. >> Being equivalently. concise. >> I do think.
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It's important to connect amendment 657, which specifies that assisted dying would not be regarded as a medical treatment. regarded as a medical treatment. With the debate we've had on the broader conscience protections that the bill needs to include. And the reason for that is not just that regarding assisted dying as a treatment is a conceptual error. As Wittgenstein pointed out, death is not an event in life. Instead, what we're talking about is a personal existential choice. It is in no sense a treatment.
But the bill is silent on that question and the reason why, in the real world, that matters, as Baroness Fox and others have pointed out, is because notwithstanding the employment protections that are based in the
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It's important to connect amendment 657, which specifies that assisted dying would not be regarded as a medical treatment. regarded as a medical treatment. With the debate we've had on the broader conscience protections that the bill needs to include. And the reason for that is not just that regarding assisted dying as a treatment is a conceptual error. As Wittgenstein pointed out, death is not an event in life. Instead, what we're talking about is a personal existential choice. It is in no sense a treatment.
But the bill is silent on that question and the reason why, in the real world, that matters, as Baroness Fox and others have pointed out, is because notwithstanding the employment protections that are based in the