(1 week, 2 days ago)
Lords ChamberMy Lords, can we please take the temperature down and respect the Clock? There are 10 minutes for Back-Bench contributions. Of course, many people want to get in, but please take the temperature down—there is no need to constantly interrupt others. Everyone can speak. We will come to the Cross Benches first and then go to the noble Baroness opposite.
The Parliamentary Under-Secretary of State, Ministry of Justice (Baroness Levitt) (Lab)
My Lords, I will be as brief as I can. I shall start, as I did in Committee, by reiterating that the Government maintain a neutral stance on abortion in England and Wales. Many of the amendments in this group are similar or identical to those tabled in Committee. So, save in a very few cases, I shall not repeat the Government’s assessment of their workability. This means that if I do not explicitly mention an amendment, it is either because there are no workability issues or because I set them out fully in Committee. As a shorthand, I will refer to conduct that comes under Sections 58 and 59 of the Offences Against the Person Act 1861, and under the Infant Life (Preservation) Act, collectively as “abortion offences”.
I begin with Amendment 423ZA tabled by the noble Baroness, Lady Lawlor. It is unclear how this amendment is intended to work in practice—in particular, which party would bear the burden of establishing a lack of mental capacity and what the standard of proof would be. Thus, it is possible that it would create confusion for practitioners. Your Lordships may wish to note that the law already takes account of defendants’ understanding of their actions in various ways. It is unclear how this amendment is intended to interact with well-established criminal law principles.
Amendment 422E, tabled by the noble Baroness, Lady Falkner of Margravine, is similar to that tabled by the noble Lord, Lord Verdirame, in Committee, but it contains an additional requirement that a prosecution could not be brought any later than 12 months from the date of the alleged offence. Your Lordships will be aware that, other than for summary-only offences, there is, almost without exception, no statutory time limit for prosecuting criminal offences in England and Wales. The reason for that is that evidence may emerge over several years, so a limitation period would remove the ability to prosecute in cases where evidence of guilt came to light much later on. The introduction of a limitation period could lead to differences in outcomes depending on when evidence becomes available, the complexity of the case and the resources of investigating and prosecuting authorities.
Amendment 423, in the name of the noble Viscount, Lord Hailsham, is similar to the one he tabled in Committee, but it differs in three respects: it would broaden the scope of the specified defences; it would make provision for who must bear burden of proof in relation to those defences; and it would introduce additional provisions relating to police investigations. In relation to the workability concerns I raised in Committee, for the second and third of these differences there are some further issues. In relation to the burden of proof, the drafting is ambiguous. If the intention is that the defendant should bear the evidential burden, clarification would be needed. In relation to the proposed new provisions for police investigations, your Lordships may wish to note that decisions on whether to initiate, and the scope of such an investigation, are currently operational matters for the police.
Amendment 423A, tabled by the noble Baroness, Lady Barker, is also similar to one tabled in Committee. While the Government remain neutral on changing the criminal law, it is important that investigations into other offences, such as murder, manslaughter or infanticide under the Infanticide Act, are still carried out. Those offences would continue to be investigated and prosecuted by the Crown Prosecution Service if the test for prosecution is met. Your Lordships may wish to note that this amendment would be likely to trigger a review of any live investigations and prosecutions. However, we would not expect this to carry any significant resourcing implications.
Amendment 426C, tabled by the noble Baroness, Lady Wolf of Dulwich, is again similar to an amendment tabled in Committee. It might be helpful to remind your Lordships of the point that I made then, namely that the proposed new offence is not limited to obtaining abortifacient drugs for use in the termination of a pregnancy. Abortifacient drugs are not defined in legislation and are also used for non-abortion-related purposes. In addition, further amendments would be needed to clarify whether the offence was one that is to be triable either way, whether the maximum penalty on conviction on indictment should be the same as that on summary conviction and whether the maximum penalty in the magistrates’ court should align with its general powers, which update automatically should the limits on its sentencing powers change in the future.
I would be grateful for clarification as to whether the Government have considered their own current inquiries into the grooming gangs. There was evidence there that:
“Victims and survivors were also critical about how easy it can be to obtain emergency contraception or abortion services without appropriate questions being asked”.
This evidence has been relied on consistently in Committee and on Report, yet there are concerns. Have the Government looked at that?
Secondly, in relation to the case that I mentioned in Committee, which contradicts much of what has been said, the comments of His Honour Mr Justice Cooke in Leeds Crown Court, in the case of Sarah Catt, very clearly state that this was a “cold calculated” decision that she took for her own convenience and self-interest. She took pills at 39 weeks and gave birth, and it seems she never revealed where the body was. She had a history of deceit and concealment—that is in the judgment of Leeds Crown Court. So have the Government considered, also in relation to other amendments about pardons, that this was conduct not of a victim but of a woman who perpetrated a crime?
Finally—
It was a crime, and she was given eight years in prison for that.
On the question about the offences that the judge also considered—murder, manslaughter and infanticide —I emailed the Minister about the clarification I asked for in Committee on guidance being given to emergency services that may come across a situation such as that outlined in Sarah Catt. What is their obligation to the woman and the child?
(2 weeks ago)
Lords ChamberOn the noble Baroness’s first question, Clause 17(5) says that:
“Where the panel considers it appropriate for medical reasons, it may make provision for the use of pre-recorded audio or video material for the purposes of subsection (4).”
Subsection (4) relates to all of the material that the panel is dealing with. Subsection (5) is saying that the panel can use pre-recorded audio material if it thinks it is appropriate. I think it should be given that direction—I cannot see any reason why the panel should be restricted in relation to that.
Turning to the privacy point, paragraph 6 of Schedule 2 says that:
“Panels are to determine referrals in public”—
so the default is that it is in public, not private—but that
“this is subject to sub-paragraph (2)”,
which says that a panel can sit in private if that is what the person wants. The question from the noble Baroness was, basically, why should everything then be in private. It is because everything is about the patient. The whole thing is about the patient. If I want the circumstances of my illness and why I want an assisted death to be private, I should have that option. It is unrealistic to say that we can chop this up into the bits that are about the patient and the bits that are not.
The noble and learned Lord is correct that the amendment refers to the wrong person at the local authority. However, the substance of what I said two weeks ago about Amendment 462A is this: does not the panel need a power to ensure it can ask a local authority to meet unmet needs of the person in front of it, such as if their care package has fallen apart or there is a problem with their benefits? At the moment, it has no power to do anything other than approve, if the boxes are ticked. I am not saying that poor people should not apply, but I am asking the noble and learned Lord whether the panel should not have a power to ensure those needs are met when it has that evidence in front of it.
The panel has the power. Clause 17(4) says that the panel
“may ask any person appearing to it to have relevant knowledge or experience to report to it on such matters relating to the person to whom the referral relates as it considers appropriate.”
That power would include a power to ask the local authority to provide any information it wants.
Am I right in understanding that the noble Baroness’s amendments are designed to achieve a situation where someone experiences and receives the best palliative care before the discussion takes place? Otherwise, as the most reverend Primate the Archbishop of Canterbury has said, any choice that you exercise could be illusory, unless you are in that situation.
I thank the noble Baroness for her helpful intervention.
There is a further problem. As drafted, there is nothing to prevent any other health professional—a nurse, health visitor or physio—raising assisted dying with a patient. Sometimes, patients form stronger relationships with these people than with doctors because they see more of them. It is essential, therefore, that there is no possibility of a warm-up conversation being initiated by a professional to ease the ground for the doctor when he wants to make his approach. It may be said that this would not happen, but we have seen ample evidence of situations in which cost savings to be secured by freeing up beds and ending treatment are regarded as justification for assisted death. We have, of course, seen situations in which a person who has suffered an amputation or has a terminal cancer seeks a wheelchair and is told the waiting list is two years, but that assisted dying can be provided tomorrow. Any situation in which assisted dying is discussed for the first time must be strictly patient initiated, tightly confined and take place through a clearly defined process.
Amendment 205, to which I put my name, as well as Amendments 207 and 207A and other amendments in the group, would prevent any discussion about assisted suicide with a person who has a learning difficulty or autism without a family member, guardian or independent person present. The effect of this would be to do what all professionals and caring organisations do when dealing with or engaging with people with such disabilities. I also support Amendments 317, 346, 457 and 512 in this group, which seek to protect those who experience feelings of suicidal ideation, which may be transient.
What about the doctors? The MDU, which represents over 200,000 healthcare professionals, is deeply concerned about the proposals in the Bill. The MDU points out that the position whereby doctors are not required to raise this but are still permitted to do so is the worst of both worlds for doctors because they would be liable to complaints in either situation. If the doctor does not raise it, a complaint can be made against them for not having done so; if they do raise it, a complaint can be made against them. As the MDU points out:
“Such proceedings can take a vast toll on doctors. The time taken; the emotional toll; the procedural concerns. This cannot be overstated”.
This is one of the many unintended consequences emanating from this clause as drafted. The clause requires substantial amendment to make it safe.
There seems to me to be a whole range of circumstances that you would want a doctor to be able to talk to the patient about. It is not simply, “We can offer you a way”, and they only talk to you and say, “This is the palliative care available, and only if you have heard that, seen it and chosen from it can we then talk to you about something different, which is assisting your death”. It seems to me—
My Lords, probing Amendment 200C, in my name, would prohibit people from raising with children assistance in taking your own life, and deals with the method by which the issue of assisted dying can be raised with someone under 18. It particularly should not be raised online. The amendment seeks to extend Clause 6.
I first note my support for Amendment 210, just outlined by the noble Lord, Lord Rook, on the consequences for breaching Clause 6. Further, I wish to support Amendments 157 and 164, in the name of my noble friend Lord Ahmad and spoken to by my noble friend Lord Evans. It is entirely sensible to enable people to opt out of being offered such an assisted suicide service.
The Bill seems to have no limit, nor is it probably possible to place a limit, on the number of times assisted suicide could be raised with a patient, so it is surely consistent with autonomy to give the patient the right to opt out. One need think only of a GP surgery, and the number of GPs or nurses you see. If each of those people raises it with you, that could possibly even border on harassment. Conceptually, it is an extension of the freedom of conscience that we give to organisations and clinicians to opt out of the service. I hate to think that even dealing with a GP surgery could perhaps become part of Patchs.
This leads me on to the means by which issues can be raised, which has radically changed, and why my amendment includes online. I am grateful to the noble and learned Lord for filing comprehensive amendments in relation to advertising, but the issue of raising it with someone under the age of 18 is different. I would like assurance from the noble and learned Lord that this use of social media—for instance, someone sending a TikTok or something like that about assisted suicide—is covered by Clause 6.
That example may seem straightforward, but, once again, it brings into focus the analogue nature of the Bill. If ChatGPT, for instance, in response to a question which it mishears, tells someone under the age of 18 all about assisted dying in the Bill, is that covered by the amendments on the prohibition of advertising that the noble and learned Lord has raised? Could a bot or algorithm operate without direct human intervention and raise with a child the issue of assisted dying?
Noble Lords will be aware—the noble Baroness, Lady Berger, has spoken much on this—of the cases that are currently being taken against ChatGPT, in which OpenAI is the litigant. It is being sued for giving suicidal information to young people, who have, incredibly sadly, acted on that information. Has the noble and learned Lord spoken with technology experts about the Bill to ensure that all of these situations have been fully considered? By my reading, I do not believe that they are covered by the prohibition on advertising. As I say, advertising and raising it with someone seem to be two different concepts.
I used the word “person” in the amendment, not just “healthcare professional”, as there are numerous situations and relationships where children might have assisted dying raised with them—obviously that includes at school or college. Does the noble and learned Lord envisage that there will be guidance in this regard, and which one of the many delegated powers would be used under the Bill? What about youth groups, faith groups, sports clubs, carers or school transport? Parents need to know who is allowed to raise this potentially life and death issue with their children.
Assisted dying law will shape how children understand the value placed on life, disability and dependence. Vulnerable children may internalise the message that society is more willing to facilitate their death rather than fund their long-term care and inclusion. The concern of parents and carers around how this issue is raised with children could make the issue of PHSE teaching—namely, sex education—in schools look uncontroversial.
Although the scope of the amendment is wide—as I have said, it is probing—at least it is clear, whereas, alas, Clauses 6 and 56 are not. The phrase “No health professional” is in the title of Clause 6. It then uses the phrase:
“No registered medical practitioner or other health professional”
within the clause. This is a mixture of the definition of health professional in Clause 56. Usually, when you have an interpretation clause stating a definition such as “health professional”, you would then expect that term to appear consistently within the Bill. Nowadays, all you have to do is Ctrl+F to find every example to ensure that there is consistency throughout the legislation. Due to this mix of use of terminology, are physios or OTs included in these definitions and therefore within Clause 6? Although I accept that Clause 6 was added in the Commons, I am disappointed that the noble and learned Lord, the sponsor, has not got ahead of the curve here and laid his own amendment.
Finally, can we have clarification on whether the registered medical practitioner in Clause 5 can be a private GP or healthcare professional? People may have a financial interest as we believe there can be private providers of assisted dying services. It may be that I am correct in that understanding, and I presume the noble and learned Lord, Lord Falconer, will want to ensure that there is no conflict of interest or incentive in the matter. It is possible that the matter has been covered in the developments under the law since the medical devices report. However, due to the lack of pre-legislative scrutiny, it is not clear and I would be grateful if the noble and learned Lord could clarify that.
My Lords, I will speak to my Amendment 155, which is different to the amendments in the name of the noble Lord, Lord Ahmad, on patients who opt out. My amendment ensures that when a person has previously cancelled the process of obtaining assisted dying—having considered it as an option and then rejected it—they can continue to discuss their terminal illness freely with their medical practitioner without being pressed to reconsider assistance to end their life.
As we are hearing, we have had a great deal of evidence on this issue. In its written evidence, the Association for Palliative Medicine of Great Britain and Ireland observed:
“Doctors influence decisions made by their patients in conscious and unconscious ways and are themselves shaped by their personal and professional life experiences … if the patient clearly rejects AD, they may suspect that other treatments suggested by this doctor are driven by an agenda to shorten their lives or may otherwise result in this. This could lead to patients opting not to engage with palliative care or to the loss of trust in a medical practitioner or in the medical profession at a crucial time in people’s lives”.
There is a clear danger here. If a patient has already considered and rejected assisted dying and their doctor raises it again, it may appear as though the doctor is pursuing an agenda to shorten that person’s life. That risk to trust at the very moment when trust is most needed should not be created by the legislation before us.
I also want to refer to evidence given to the Commons by Dr Vicki Ibbett, an NHS specialty doctor in psychiatry with extensive professional and personal experience of suicidal ideation. She expressed serious concerns about the impact of the Bill on suicide prevention work and highlighted that the voices of people with lived experience of suicidal ideation were not heard in oral evidence sessions. Speaking about terminally ill people who may experience thoughts of not wanting to be alive, Dr Ibbett wrote:
“Thoughts of wanting to die have a known association with being given a cancer diagnosis and learning of being terminally ill … Suicidal ideation may have arisen as part of the response to a new diagnosis with a terminal prognosis. It may, therefore, be part of an ‘adjustment reaction’. Adjustment Disorder often settles without professional intervention. If it persists additional support may be beneficial. Assisted suicide should not be facilitated”.
My Amendment 155 therefore seeks to ensure that a doctor may not raise assisted dying with a patient whose medical records show they have previously cancelled a first or second declaration. When somebody has already walked back from that decision, the law should protect them from renewed pressure, intentional or not.
Finally, I will quote from a recent article by Jim McManus, national director of health and wellbeing at Public Health Wales, writing in a personal capacity. He wrote that
“no end-of-life decision happens in a vacuum. Choices are shaped by many things, and sometimes these are inequality, unmet need, patchy palliative care, and the grinding pressures of an overstretched NHS … People expressing a wish to die may be experiencing treatable depression, loneliness, or feelings of being a burden. The Royal College of Psychiatrists has raised concerns that the Bill’s safeguards are insufficient to protect people in exactly these vulnerable states”.
Amendment 155 is a small but vital safeguard, ensuring that when someone has stepped back from assisted dying, their decision is respected. At such a vulnerable moment, no patient should face renewed pressure; our priority must be to protect, trust and uphold compassionate, high-quality care at the end of life.
The point of this part of the Bill is that it is a legitimate option. If the noble Lord is saying that because we have suicide prevention policies in other areas, we should still treat it as something that we should not in any way encourage or help people to access if that is what they want, that is wrong. The true position is that, once it becomes an option, subject to the safeguards being gone through, it is something that people should know about and make their own judgment about.
I do not think we have fully understood these two categories. I was grateful to the noble and learned Lord for the meeting with Professor Ruck Keene. It is clear, particularly when you are talking about the Mental Health Act, when there are two different statutes you can choose from, that we need to be clearer about that for clinicians. So, unfortunately, even at this late stage, I am afraid I will have to lay some amendments so that we can really talk about this in detail, because it is a matter of concern, particularly to psychiatrists.
On the points I have made about children, I accept the point from the Minister that the probing amendment is probably too wide. However, we have not even had the comments on the categories of people who can now raise this with children, such as schools, et cetera. I also raised the point—I am grateful that the noble Lord, Lord Tarassenko, is now in his place—that I believe we also now have this gap with regard to what advertising prohibits. You have medical practitioners unable to raise it with under-18s, but then you have a whole wealth of technology in between that, which can, as we know, even with a mistaken question, raise this issue with under-18s. What does the noble and learned Lord envisage will happen in those scenarios, which are at the moment subject to legal cases in other jurisdictions?
A whole range of issues is covered to a large extent by the Online Safety Act in relation to the promotion of suicide, particularly to young people. That, in a way, is a separate issue from this issue. I fully encourage and support all attempts to try to reduce the risks to young people, but I am afraid that the Bill cannot take that on, on its own.
(1 month ago)
Lords ChamberI am grateful to the noble and learned Lord for his realistic acceptance of the difficulty of judicial review as a remedy for many people. I would be grateful if he could also reflect on the situation with family members: if the panel approves assisted dying, their remedy to challenge that is judicial review. We heard evidence in the Select Committee, particularly from Sir Nick Mostyn, that that is just fine. Many of us, particularly myself, do not feel that it is satisfactory for family members to have to resort to judicial review if they have evidence, for instance, that there has been coercion. Will the noble and learned Lord reflect on that, which may avoid further amendments later down the line?
I will certainly reflect on that, and may I express my gratitude to the noble Baroness, Lady Berridge, for facilitating the meeting with Professor Ruck Keene? It was incredibly helpful, and I genuinely appreciate it. Yes, I will reflect on what the noble Baroness said. I suspect there will be a similar answer to the one I gave to the noble Baroness, Lady O’Loan: we have to be as specific as we possibly can in the Bill, because judicial review is difficult for normal people, particularly in those circumstances. That is why, whether it is a court system or any other system, we must try to make this as clear as possible in the Bill.
Amendment 146, in the name of the noble Baroness, Lady O’Loan, says that the assisted dying commissioner should be able to investigate patterns. In particular, she cites what may happen in relation to care homes. I agree that the assisted dying commissioner should have that ability. He does have that ability under Clause 49(1)(a), (b) and (c); so, for example, if he is concerned about a pattern developing in care homes, he already has the power to monitor that.
The noble Lord, Lord Morrow, asked whether there should be a further Equality Act assessment. I dealt with that last time and said I had looked carefully at what the former commissioner had said and I did not think that a further impact assessment was appropriate, because, if you constantly make particular points that are covered in general, you are never going to get to an end of it. I do not think that the points the commissioner raised were ones that had not already been considered in the impact assessment.
For the accuracy of the record, I am grateful that my noble friend referred to a story that I presented to him at lunchtime because it was relevant to Suffolk. Marie Curie’s overnight nursing service—the part of the service that offers palliative care in Ipswich and Suffolk—will end after the NHS withdrew funding. The service supported 470 patients and delivered 15,385 hours of vital care in the last financial year. It relates to my noble friend’s particular area of the country. I know I was not here at the start of the group but, for the accuracy of the record, I have intervened.
My Lords, I thank the noble Lord, Lord Moylan, and the noble Baroness, Lady Fraser, for these amendments. There is a very serious issue here, evidenced by the nature of the conversation we are having, because it is a conversation about realities. The noble Lord, Lord Empey, said that it was time we started using the language that described exactly what we are doing. I think that is what we are doing now. We are talking about how this is going to be paid for and who should pay for it. How should it be managed?
We have seen the Canadian experience. The noble Baroness, Lady Grey-Thompson, spoke about wheelchair access. In Canada, it is regularly reported that people who cannot get wheelchairs are offered assisted dying instead. I grant you that that would not necessarily apply in this particular Bill, but you can see how, with mission creep and with changes, this could happen. We could end up in a situation in which we are making the kind of decisions that the noble Lord just referred to in this matter.
I must declare that I have an interest, because I am a trustee of a hospice—an unpaid trustee, I would add, and it is not in my register of interests for that reason, but it is relevant to this debate.
The noble Baroness, Lady Finlay, defined the variety of costs attached to the proposals quite clearly. I have to ask, following the noble Lord, Lord Deben, if the estimate of £2,000 is in any way realistic for providing a service which requires for each individual the cost of clinicians, the commissioner, panels, admin staff, communications, monitoring and audit, et cetera. That is to say nothing of maybe a national help service, independent advocates and all sorts of other things. We know that to die at Dignitas and places like that costs an average of £10,000, not £2,000. I would like the noble and learned Lord to ask the Minister if we can have a proper assessment of what is currently planned might cost and where it is to come from.
I have another question for the noble and learned Lord, because it is not the Government who pay; it is us. It is taxpayers who pay. If the noble and learned Lord, Lord Falconer, rejects these proposals or something which approximates to taking the cost away from the National Health Service—as the noble Lord, Lord Deben, says, it is in such a parlous state that palliative care services are being extinguished or diminished very significantly—does he think that the public and the voters will think well of a Government who fund suicide while not funding hospices properly? Does he think it will enhance trust and confidence in the Government?
My Lords, I have two amendments in this group, Amendments 926 and 929, which are related to each other. They are probing amendments related to Schedule 2 and the operation of the panel. It is something that has been niggling away at me and worrying me. I am perfectly prepared, of course, to be told by the noble and learned Lord that there is nothing for me to worry my little head about but let me raise the question none the less.
Schedule 2 makes provision for appointments to the assisted dying review panel. As I understand it— I am sure I will be corrected if I am wrong—the commissioner can create a list of people who are eligible to serve on panels. That is, if one likes, the mega panel at the top. These people can be appointed for a term of five years and reappointed for a term of a further five years. From that large group of people, the commissioner then, in each individual case, will draw and appoint the members of a panel—the three members with the specific skills that we have been discussing—and the decision of those panels needs to be unanimous. Even an abstention would count as a negative vote, so to speak. That is how I understand paragraph 5 of Schedule 2.
That is the background. To work properly, the panel members need to be independent of each other and reach their own view. It seems quite possible that they will have different personal thresholds as to what they regard as the appropriate level of evidence required to persuade them to say yes. In that light, it is more than possible that some of them might turn out to be slightly awkward, in the sense that they tend to say no rather more often than they say yes—which is fatal to the process because one no and the whole thing is over. You have been through the preliminary discussion and the two doctors, and at the panel you are being knocked back because of one rather awkward person. There will be pressure on the system as a whole, essentially, to eliminate those people from it—those who are difficult and who generally are more likely to say no than otherwise.
Amendment 926 says that, when deciding whether or not to reappoint somebody for a further five-year term, no account should be taken of what might be called for this purpose their voting record in panels. Similarly, Amendment 929 would mean the decision of whom to appoint to a panel cannot be taken on the basis of their past voting record. Voting record may be an inappropriate phrase, but I think noble Lords understand exactly what I mean.
As has been mentioned earlier in the course of the day, the background to this is of course the Abortion Act. The principal safeguard in the Abortion Act is that two doctors separately must agree there is a threat to the woman’s health. When the Act was introduced, that was quite possibly a genuine safeguard, and there may have been occasions when doctors said they did not consider there was a threat to the woman’s health that justified an abortion, but it has become entirely routine. There would probably be a flag run up a pole at DHSC headquarters if a doctor were to say no on an abortion application nowadays.
Therefore, I have put these amendments down to prevent something like that from happening—to prevent the panels from becoming routine—and to ensure those people who have the higher threshold of evidence, the more cautious approach, the slightly more sceptical attitude, are not eliminated from the panels, either through having their term not extended or through simply not being appointed when each opportunity comes up. There may be better ways of dealing with the concern I have expressed than the ways contained in my specific amendments. They are, as I say, probing, and I am open to those improvements. But we have to ensure that this does not go the way of the Abortion Act, and that the panels are robust and say no when it is appropriate to say no, which might be quite often. That is what I would like to hear the noble and learned Lord comment on when the time comes.
My Lords, I will speak to Amendment 462A in my name, which outlines that, before approving any application, the panel must be satisfied that the person requesting assistance has had the requisite assistance from the local authority in relation to the delivery of statutory services.
The amendment deals with the problem caused by the basic principles of the Bill, which is based on a very narrow concept of procedural autonomy. If it is only this that matters, then for the panel, as long as they can tick the boxes saying there is no coercion or pressure, and that the person has capacity et cetera, then the application is approved. It is approved under the current drafting of the Bill even if the panel believes and has evidence that the person is applying because, for instance, their housing is inadequate, the care package fell apart, they are actually grieving for other relatives or they are poor.
This amendment would mean that, before any such approval is made by the panel, it must be satisfied that the local authority has received a referral to look at the statutory provision of services for the person. In relation to this, I am grateful that the noble and learned Lord enjoyed his meeting with Professor Alex Ruck Keene, because he has put this a number of times in written and oral evidence about the concept of the panel and its powers, and it is worth quoting:
“You have to think … carefully about what purpose any … of this oversight is actually serving societally, if the oversight panel, whether that be a judge or a panel, cannot decline to approve an application if it considers that the reason the individual is seeking assistance in dying is because of service provision failures by the statutory bodies responsible for meeting their health and social care needs”.—[Official Report, Commons, Terminally Ill Adults (End of Life) Bill Committee, 28/1/25; col. 96.]
I know the noble and learned Lord has answered many questions and commented about the access to this service for the poor. This is a different question. I am not saying that poor people should not be able to apply. I distinguish that from a situation where the panel has concluded on the evidence that, although the person satisfies all the tests under the Act, the evidence is that they are before the panel because they are poor. There are many instances of this from other jurisdictions, for instance, particularly in relation to homelessness. People have come forward for MAID in Canada because they are homeless, which is available because it is not just for terminal illness in Canada.
In relation to the amendment, it may be that the drafting needs to be different; it might be that this needs to be done not just before the provision but can be twin tracked, so that you approve the application but at the same time make sure the local authority deals with the provision of services. I hope the noble and learned Lord will take seriously this additional power for the panel to ensure that people are there for the reason that they are exercising their autonomy in relation to the Act and not pressured because of lack of statutory services.
The noble Baroness refers to it as an additional power but, as I understand the amendment, it says that this is an additional requirement for a certificate of eligibility.
I am grateful to the noble and learned Lord. I accept that drafting changes might be needed between now—
The noble Baroness says, “drafting changes”, but there is a fundamental difference between saying that this is an additional condition that the panel has to be satisfied of and giving it a power. I understand the noble Baroness’s amendment to be saying that an additional requirement needs to be satisfied.
When I mention drafting changes, I mean in relation to the timing of this. As drafted, it would need to be done before the application is granted, and it may be that the requirement to go to the local authority could be at the same time as having approved it, not before. But, yes, this would be an additional requirement on the panel.
I hope the noble and learned Lord the sponsor or the noble Baroness, Lady Finlay, can help with my second point on the principle of the Bill. The noble Baroness, Lady Hayter, referred to the situation based on autonomy: the individual wants to do this and does not want to tell relatives. If we are strict purists about that—we had evidence on this at the Select Committee—then with this Bill there could be a situation where the first time anyone hears about the death is when the medical examiner telephones a relative.
I have tabled amendments in a different group on a requirement to nominate next of kin who are over the age of 18. I think it would be useful for the Committee to know what the situation is if someone acts completely autonomously like this and the body is there. Does the noble and learned Lord the sponsor need to bolt on a provision so that there is a public health burial? That is the continuation of the logic of this that you can do this alone, with no one in your life knowing about it. Therefore, to exercise that autonomy fully, there would need to be a public health burial, with everything done before anyone in the family knows. That is a conceptual difference. The noble and learned Lord and I spoke about this in a meeting in relation to what the law is, and it would be good for him to clarify the situation. Can the medical examiner not call anybody and go forward with a public health burial?
Does the noble Baroness understand that, quite often, people die and their family does not know about it?
Absolutely, and therefore the medical examiner’s evidence is that, when they have the body in that circumstance, they are under an obligation, we think, to locate and find a relative. Sadly, this happens more frequently than we would like to think, and the local authority powers to perform a public health burial then become apparent. So, yes, there are these situations.
It is important to clarify this in relation to this Bill, because we have this evidence from the medical examiner that the first the family might know is when they are called by the medical examiner. We need to be clear about that and about the position of families. Is this personal autonomy—that is the conceptual point—so fully and properly enacted that there would be a public health burial, without any obligation to inform anybody that this is happening?
Baroness Lawlor (Con)
My Lords, I support Amendment 472, tabled by the noble Baroness, Lady Gray of Tottenham, to which I added my name, along with the noble Lord, Lord Goodman of Wycombe. I also support Amendment 941 from the noble Lord, Lord McColl of Dulwich, and I will just say a few words about that.
Amendment 941, to Schedule 2, on the assisted dying panel, would require the social worker to take account of financial dependence, potential financial pressure and potential coercion from someone benefiting financially from a person’s death. My noble friend Lord Deben referred to this apophthegm earlier, but I first heard it from the noble Lord, Lord Grabiner: “Where there is a will, there is a relative”. This is a very important amendment, and I hope the noble and learned Lord the sponsor will consider it seriously.
Amendment 472 from the noble Baroness, Lady Gray of Tottenham, would require that the panel must ask the person seeking an assisted death whether they have discussed the matter with their next of kin. We have been discussing this in different ways today. At the very least, this requirement would prompt reflection about those most affected by this action. It might prompt such a chat simply by virtue of asking.
(2 months ago)
Lords Chamber
Baroness Levitt (Lab)
My Lords, the efforts made to keep children out of the criminal justice system are all going in the right direction. In 2024, only 13% of all children sentenced were aged 10 to 14 and that is a sustained downward trend.
My Lords, the Minister said that children are in the criminal justice system only when it is “absolutely necessary”. But at a meeting in Parliament yesterday about the jury proposals, the heads of the Criminal Bar Association and the Bar Council and the leaders of most of the circuits were clear that there are young people in the criminal justice system who are being treated too harshly and that this has a devastating effect on their lives. May I challenge the Minister to meet with those representatives, because that does not match the “absolutely necessary” wording she used?
(2 months, 2 weeks ago)
Lords ChamberMy Lords, I have added my name to several of my noble friend’s amendments and I would like to congratulate him on finding a solution that could allow the Bill to meet one of the sponsors’ original aspirations. The impact of Amendments 25 and 120 are many. One that may be attractive to the Committee would be that it would considerably shorten the Bill, as several clauses would be removed and hours of debate would probably become unnecessary.
The Bill states that it will
“allow adults who are terminally ill … to request and be provided with assistance to end their own life”
and refers to eligibility for
“lawful assistance to voluntarily end their own life”.
The Oxford Concise Medical Dictionary defines suicide as
“deliberately causing one’s own death”
and assisting suicide as
“the act of helping a patient to commit suicide by giving them the means … to do so”.
The Office for National Statistics similarly defines suicides as
“deaths resulting from intentional self-harm for persons aged 10 and over”.
Clause 32 on the criminal liability for providing assistance explicitly references the Suicide Act 1961, providing that assistance carried out in accordance with this Bill will be exempt from that Act’s offence of assisting suicide. This reinforces that the subject of the legislation under consideration is assisted suicide.
I am aware that many people would prefer the term “assisted dying” because of the stigma associated with the term “suicide”. The Bill rather contradicts itself by adopting the term “assisted dying” while attempting to modify these other statutory provisions that concern assisted suicide. That creates both conceptual and legal ambiguity. If Parliament is being asked to authorise assisted suicide, then it follows that such decisions fall within the proper domain of the courts. For that reason, among others, I support my noble Lord, Lord Carlile’s amendment that would replace the assisted dying review panel with a court-supervised process.
Amendment 120 appropriately moves decision-making from the medical to the legal sphere. Assisted dying is not a medical treatment; it is an act with profound societal implications, and it therefore requires, I suggest, judicial rather than clinical oversight. For that reason, I believe that it does not belong in the National Health Service. Under the proposed model, doctors would continue to provide expert medical evidence confirming diagnosis and prognosis, but the final authorisation would rest with a judge. That judicial scrutiny provides a stronger safeguard against errors, and enhances transparency and public confidence in the system by placing responsibility for these irreversible decisions in the courts, where I believe they properly belong.
Concerns about capacity in the courts, or potential delay and cost, do not outweigh the need for robust safeguards when decisions of life and death are involved. The appropriate response is to streamline court processes, not to lower the level of scrutiny. The same issues of capacity in taking on a new stream of work would, of course, apply in the NHS. A judge would provide a more independent assessment of an individual application than a panel, which is likely to comprise people who have chosen to do that work and have no track record of dealing with issues such as undue influence. It is regrettable that the other place abandoned judicial oversight in favour of an assisted dying review panel and commissioner, thus seriously weakening the safeguards that were originally envisaged. The assisted dying review panel is not, in its current form, fit for purpose. Its composition does not provide sufficient safeguards for vulnerable individuals, and there is insufficient clarity on how it includes expertise in palliative care, safeguarding and decision-making capacity. A court model would be preferable; without it, the panel would need to be substantially strengthened.
I also strongly believe that, without guaranteed access to a comprehensive multi-disciplinary specialist assessment of palliative, psychological and social care needs, neither judicial scrutiny nor an expert panel would be able reliably to identify inappropriate requests for an assisted death. Those preliminary assessments are the most essential safeguards to ensure that treatable sources of distress, or modifiable psychosocial factors, are considered before an informed decision can be made, both by the individual concerned and by the decision-makers. We will debate specialist multi-disciplinary assessments in the next group of amendments, and I look forward to returning to that.
I also support the amendments tabled by my noble friend Lord Carlile that seek to broaden the scope of safeguards referred to in Clause 1. At present, the Bill limits those safeguards to Clauses 8 to 30, which cover only the procedural steps. My noble friend’s amendments would extend the safeguard requirements to the whole of the Bill, ensuring that every substantive provision—not just the procedural elements—must be complied with before assistance to die can be lawfully provided.
I also support my noble friend’s Amendment 69 to strengthen the definition of “a terminal illness”. The amendment clarifies that a terminal illness must be
“an inevitably progressive disease which cannot be halted”.
The inclusion of “halted” is important; it ensures that eligibility is limited to conditions for which the disease trajectory cannot be stabilised or slowed through available interventions.
My Lords, I will speak briefly to two of the amendments in this group. I am grateful to the noble Lord, Lord Carlile, for meeting me in relation to his proposals under Amendment 120.
This group also contains related Amendment 116, which would introduce the capacity test that the noble Lord expects the court to use. Within that amendment, in the clear and settled intention part of that capacity test, is the introduction of the phrase “undue influence or coercion”. That test is different from the rest of the Bill, which uses “dishonesty, coercion or pressure”. I am sure that the noble Lord is aware, as he has outlined, that undue influence has a particular meaning in civil law and is presumed within certain relationships.
The noble Baroness used the phrase “moral pressure”. I mentioned in my speech that this is a fundamental change. If Clause 3 has gone, not by way of clause stand part, then actually, “pressure” has now gone from the test here. We now have “undue influence or coercion”, not “dishonesty, coercion and pressure”. Does she have any view—I mentioned domestic abuse victims—on whether that makes any change to the safety of the Bill for disabled people?
Oh, absolutely: I think pressure is something incredibly important that we have to assess. Certainly, from the huge number of disabled people I have spoken to, pressure comes in many different ways, and it is very difficult to detect. If we do not take that seriously, I think people will be coerced into thinking that this is their only option, rather than that they have a range of options. That is picked up in some of my other amendments, but I thank the noble Baroness for her intervention.
We talked about the equality impact assessment. We need to look at the impacts on the Crown Court, on health and education committees and on children with SEND, and I think we probably need another version of the equality impact assessment to enable us to make the best decision on the way forward for the Bill. I am minded to support my noble friend Lord Carlile, because I think that what he proposes is much better than the panel currently in the Bill.
Mindful of time, I will leave my last comment to the Medical Defence Union, the leading indemnifiers of UK doctors, which gave evidence to the Commons Bill Committee:
“The involvement of the judiciary is essential. Its absence leaves doctors unduly exposed. Media reports suggest that an alternative safeguard is being mooted”—
noble Lords should understand that this was the context when the evidence was given—
“No ‘independent panel’, however so constituted, can replace the legal authority of a course of action sealed and ratified by a judge. Doctors deserve that certainty when relying upon this Bill to provide the very best for their patients at the most delicate moment of their duty of care”.
This is one group we have not really heard a lot from, and we should be minded of its role in the system as well.
Baroness Levitt (Lab)
I am going to repeat the words that were used by my honourable friend the Minister for Courts in the other place. The decision as to the introduction of the panel was made by the sponsor.
Can I outline that it is a matter for a Minister? There is correspondence between the Minister in the other place and Rebecca Paul MP that specifically relates to the issue of “undue influence”, which the noble Lord, Lord Carlile, has now proposed to be added for the first time into the Bill. I would be really grateful if the Minister would look at that correspondence and write and put a letter in the Library, because the Government expressed—if I am remembering correctly—a view on why “undue influence” was not appropriate to add to the Bill.
Baroness Levitt (Lab)
It sounds like an important point. I am sure that the noble Baroness will understand that I do not have the answer to that at my fingertips right now, but I will write to her.
I do not accept that. The position is in relation to the panel. If it wants a report from a doctor, it can get it. I understand the noble Lord, Lord Carlile, to be saying that the court can ask for all these things—which of course it can—and if it thinks they are appropriate, it will do so. I assume it will not ask for them when it does not think they are necessary to the resolution of the issues. The panel can do the same and, if it does not get them, just like the court, it will have to say no.
In relation to the panel, as a non-medic I understand from my time on the Select Committee that “multidisciplinary” has a particular meaning within healthcare that the witness to the Commons was relating to, so it is not quite the same issue. Is the noble and learned Lord not concerned that only two of the three representative bodies of the panel came and gave evidence to the Select Committee, and the British Association of Social Workers and the Royal College of Psychiatrists are not supporting the Bill, regardless of what their view might be on the principle? Although the noble and learned Lord is obviously very well persuaded by the evidence, the professional bodies that would sit on this panel are not yet persuaded.
(10 months, 1 week ago)
Lords ChamberThe noble and learned Lord raised those points a couple of weeks ago and, since then, we have had the letters in the Sunday Times about the appearance of the chief executive in front of the Justice Select Committee. I shall not comment on that, because the CCRC is an independent body, but it has already begun to implement a number of the Henley recommendations—and, of course, we intend to go further on that. On the appointment of the interim chair, as the noble and learned Lord will know the objective is to have an interim chair for 18 months to review the CCRC’s operations. An individual has been identified and is going through the approvals process, so the announcement will be made imminently.
My Lords, at the reverse end of the spectrum, we have a case that has gone before the Criminal Cases Review Commission for preliminary consideration—the Lucy Letby case—with all the uncertainty that must be creating for the families, particularly as they are also having to navigate a public inquiry. Can the Minister satisfy this House that there is adequate resource within the commission to deal with that case expeditiously?
There has actually been an increase in resource for the CCRC over the past five years or so, partly to meet the point on forensics that I made in answer to an earlier question. If there is a disproportionate extra amount of work because of the particular case to which the noble Baroness refers then I will make sure that the authorities within the MoJ are aware of that but, as I say, there has actually been an increase in resource for the CCRC for a number of years now.
(1 year, 1 month ago)
Lords ChamberMy Lords, I too am grateful to the noble Baroness, Lady Deech, for bringing today’s debate and for her tenacity on this issue and the wider issues of family law reform.
With the Law Commission’s recent report, Celebrating Marriage: A New Weddings Law, and its ongoing work on the issue of financial remedies on divorce or dissolution, which includes reviewing its own 2014 report on the matter, it seems we might be on the cusp of much legislative work in this area. So I too would be grateful to know whether His Majesty’s Government’s position, which I agree with, remains that all these issues about financial remedies should be dealt with together. If there is limited legislative time, which is often what the Government say, I reiterate the point I have made at Oral Questions that the greatest injustice to be dealt with in this area is currently those people entering a religious wedding ceremony that, when conducted, turns out not to be valid under UK law.
For participants, especially women, even the current remedies of Section 25 of the MCA are but a dream. Many are left destitute, particularly if they then have adult children, where there is no Schedule 1 claim. I accept that that law is not as well baked, or oven ready, as the noble Baroness, Lady Deech, said. However, I do think that for those women it should have priority.
On the subject of today’s debate, I wonder whether the comment by a previous Minister, my noble and learned friend Lord Bellamy, that prenuptials are the province of a “small and privileged cohort” is correct. As the noble Baroness, Lady Deech, has outlined, and if the Co-op Legal Services statistics are in any way accurate, about a fifth of married couples may have such an arrangement at the moment.
If you google “prenuptial agreement” in the UK, the AI answer is that, as per the case of Radmacher v Granatino, your prenup will be relevant as long as you entered into it freely with full disclosure, you have legal advice, and it is not unfair. I accept the comments made by the noble Baroness, Lady Shackleton, about the breadth of the discretion for “unfair”. That will be comforting to read if, say, your prenup entitles you only to a return plane ticket to the Philippines—only you and not any of your children. Yes, this has been a case. All the reform suggestions outlined would present a remedy for this. I presume it would be prima facie evidence of duress under the proposal outlined by the noble Baroness, Lady Deech. But many people will just look now to AI, so a law change will change that answer when someone looks up a prenuptial agreement.
Can I be assured by His Majesty’s Government that any reforms will have a comprehensive publicity campaign so that the public, particularly vulnerable groups, understand any change? One has only to look at how many people think common-law marriage exists as a legal concept to see how necessary awareness is. I also ask His Majesty’s Government to look at what is covered in the citizenship curriculum. Surely young people need to know and understand an institution, and its legal ramifications, that so many will eventually enter.
Despite much Law Commission work, there remain areas of the prenuptial jurisdiction that have not yet been discovered or considered. It is one of the privileges of being in your Lordships’ House that you are approached to raise issues that the Government may need to consider. Unfortunately for this nation of pet lovers and owners, the law still treats pets as mere chattels. They are treated as property for the purposes of Section 25.
There are currently about 13 million dogs and about 10 million cats as pets, so it is actually not a minority issue. The United Kingdom is becoming something of an outlier legally in relation to this. I am sure the noble Lord, Lord Meston, from his role at the International Academy of Family Lawyers, will be aware of this as well. The recent decision of District Judge Crisp in FI v DO on 20 December last year in the Manchester family court outlined what might become a test for other cases to decide, as in that case, who gets custody of the dog.
But the most interesting part of that judgment was this:
“The dog is a chattel. At times it seemed to me that I was in the realms of a Children Act application which featured the dog when the wife was cross examined about the dog’s welfare and shared care arrangements. I set this out because I have no doubt that if this feature could have been agreed other matters may have been able to be agreed”.
Such, of course, was the emotional attachment that this couple had to the dog that they were in court. A change in the law could avoid some litigation, I would hope.
On 28 January this year, District Judge Hatvany put a blog piece titled Of Dogs and Divorce on the Financial Remedies Journal website, which said:
“Our legal system has a reputation for being the finest on the planet. Yet in court, the legal test for who gets to keep the family dog is the same as that for any other inanimate content of the family home. The roots of this absurdity lie in the common law, which insists that pets are properly no different in principle from furniture even though we all know that this does not reflect reality. This probably stems back to mediaeval times when dogs were kept for hunting and cats for mousing, but in the 21st century it’s laughably outdated. In other jurisdictions, courts are beginning to recognise that pets aren’t just property. There seems to be no effective mechanism in English courts, however, for resolving the issue of who gets the family dog”.
I am informed that this niche professional journal got a large response to this blog piece on pets. When I was weighing up whether to sign up to speak on this Motion in such eminent company, I was reassured that “You and Yours” on Radio 4 this Monday had the subject matter of “pet-nups”. Do His Majesty’s Government have a view on pets in prenuptial agreements and on whether they should continue to be considered chattels? Is the committee that your Lordships established under the Animal Welfare (Sentience) Act 2022 looking at this matter?
This is happening in other jurisdictions. Colombia amended its law in 2016 and its case law recognises that emotional bonds to animals within families do not equate to making animals equivalent to humans. Proposals are apparently afoot to amend the Italian legal code to
“regulate the custody of family pets upon separation or divorce”,
and New York has a best interests test on deciding the custody of a companion animal. In many of these changes, the jurisprudence stems from a recognition of the sentience of animals, so it looks like the Animal Welfare (Sentience) Act 2022 might inadvertently have started us on this journey. These changes also recognise humans’ emotional connection to animals and move away from the division that anything non-human is merely an object. I hope His Majesty’s Government will look at these comparators to see whether they have affected prenuptial arrangements in those jurisdictions.
I thank the working group on pets and divorce, barrister Sarah Lucy Cooper and solicitor Estella Newbold-Brown for their work on this and for drawing this to my attention. This group also has the support of the previously mentioned High Court judge, Sir Nicholas Mostyn, and the Kennel Club. Will His Majesty’s Government agree to meet them to understand the solutions in this area of the law and how often it is an issue in proceedings?
In principle, I share the sentiments of the noble and learned Baroness, Lady Hale, in her vigorous dissenting judgment in Radmacher. I also note the comments of the right reverend Prelate that this is a covenant, not a contract. It reminds me so much of the wisdom we used to receive from the late Lord Sacks in explaining to us the difference between covenants and contracts. I am pleased to learn that there would be an irreducible minimum here: a spouse would not be left so destitute as to be dependent on public funds and an agreement should not be allowed to leave the burden on the taxpayer rather than on the other spouse who has means.
As I conclude, I realise that I may have gone from the sublime to the ridiculous—from women who are left destitute and without remedy as they are not legally married to the custody of family pets—but this reflects the variation and breadth of issues that the breakdown of a marriage or civil partnership can reveal and the issues that the Government need to consider when legislating for a prenuptial, or pet-nuptial, agreement.
(1 year, 1 month ago)
Lords ChamberI thank the noble Lord for his question and the letter he wrote to me recently, which I answered. Complexities were identified in the Law Commission report a number of years ago which are real and need to be taken seriously. The Government are set on doing that, and on giving themselves the time so to do.
My Lords, I have previously raised with the Minister another issue with our marriage law with which he is familiar. There are cases where people—mainly women—go through a religious ceremony thinking that they have got married but they have not actually done so under UK law. They find that out only when things break down. Can the Minister outline the solution to that? Are the Government considering making it an offence to conduct such a ceremony without first having seen a civil certificate of marriage?
I thank the noble Baroness for her question. I do not know the answer, but I will write to her, because she raises a very important point. When she asked a similar question a few weeks ago, I made the point that I regularly came across those types of scenarios when I sat as a family court magistrate. I add that the myth of common-law marriage exists not just in particular sectors of our society but across it. It includes the idea that women—it is usually women—get rights, but that is absolutely not the case. That is why the Government are undertaking to look at how the rights of people who have been in long-standing, cohabiting relationships can be addressed when those couples split up.
(1 year, 3 months ago)
Lords ChamberI am afraid that my noble friend has been unsuccessful in getting a different answer, but I take the point he makes.
My Lords, the Minister said “in due course”, but it has been more than two years since the Law Commission report. There are people still getting married in either domestic premises or religious premises that are not registered. They find out—it is usually the women—that they are not lawfully married only when it comes to their wanting a divorce that they then, of course, cannot get. Can the Minister put this somewhere into citizenship, so that people are aware that, if it is going to be only in due course, this injustice will be dealt with?
The noble Baroness makes an important point. In my time as a family magistrate, I often had people in front of me who were married in religious ceremonies but not married in the eyes of the law, and we had to unpick the arrangements for those separating couples. The noble Baroness has made a very good point.
(2 years ago)
Lords ChamberTo ask His Majesty’s Government what steps they are taking to recognise the work of criminal jurors and, in particular, whether they plan to introduce an ‘appreciation day’ for them.
My Lords, the Government recognise the crucial importance of the role of jurors in delivering justice and the need to secure their well-being. The Government have no current plans to introduce a juror appreciation day, but we continue to commend the hard work of jury panels throughout the year and to explore ways of supporting those who are undertaking this very important civic duty.
My Lords, I am obviously disappointed by my noble and learned friend’s Answer. Other jurisdictions, such as Canada, have introduced such a week—not just a day. There is an increase in jurors speaking out after serving on some of our most notorious trials about the effect that jury service had on them, such as making them unwell. Can my noble and learned friend agree to have a call for evidence to understand what the extent of this issue is? Then there could be analysis of whether it is the type or length of case, or the way in which evidence is presented nowadays, with much more footage, rather than photographs, that is causing these issues that we can then assess.
My Lords, I would like first, if I may, to thank my noble friend for raising this issue and for organising a recent stakeholder conference. The Government are aware of the question that she rightly raises, but are not, at present, planning for a call for evidence as such. We already have regular jury satisfaction surveys, which generally express high levels of jury satisfaction and a willingness to serve again. We do know that a minority of jurors suffer stress, and we are exploring options that we intend to test in the Crown Courts later this year and to issue further guidance to courts on the circumstances in which ad hoc support can be arranged.