Police, Crime, Sentencing and Courts Bill

Baroness Meacher Excerpts

Report stage
Wednesday 12th January 2022 Lords Chamber

Moved by

[Baroness Meacher]

103: After Clause 172, insert the following new Clause—
“Restorative justice
The Secretary of State must, every five years— (a) prepare an action plan on restorative justice for the purpose of improving access, awareness and capacity of restorative justice within the criminal justice system,(b) publish a copy of the action plan, and(c) publish a report on progress in implementing the previous action plan.”

[Baroness Meacher (CB)]

My Lords, Amendment 103 seeks to ensure that the regular action plans on restorative justice provided by the Ministry of Justice until 2008 be restored and also that they should be published and a report produced on progress on the previous action plan as well. It is a more modest amendment than the one I moved in Committee. At that point, we wanted the Government to produce action plans every three years; we are now talking about every five years, which at least reduces the pressure on the department. The amendment would be an enormous improvement on the complete absence of national leadership on this issue since 2018.

But, first, what is restorative justice? It is an interpersonal approach that enables people who have been a victim of criminal or other harmful behaviour to meet the perpetrator, generally face to face, and others closely involved in the case to ask questions of that perpetrator and express how the incident affected them personally. It also enables perpetrators to express what was going on for them when they committed their crime or whatever they did and also to listen and understand the personal impact of that action, so that something that was a very impersonal action turns into something very personal. That is in fact a very important point.

Restorative justice is very much a voluntary process. No one is forced into it—both the victim and the perpetrator have to want to go through it. It can also go alongside other criminal justice activities or procedures. It is highly cost effective; for every pound spent on it, £8 are saved for the criminal justice system. That seems a very good reason for the Minister to take this amendment very seriously, as I hope he will, albeit I will not press it to a vote.

Why do we need the amendment included in this legislation? Every PCC area in England and Wales has a local restorative justice provider which takes referrals for restorative justice. Youth offending teams have a member of staff who leads on it. The victims’ code of practice from 2020 entitles every victim of crime to be informed about restorative justice and have access to it. However, this is simply not happening. The Office for National Statistics data showed, I think in 2020, that only 5% of victims are aware of being told anything about restorative justice at all. I hope the Minister will agree that that really is not satisfactory when these victims have a right to that information.

This problem seems to be driven by a lack of strategic direction from the centre. That is the whole point of this amendment. Also, the Ministry of Justice ceased to provide any funding to PCCs to support these important services. Before introducing the PCSC Bill, the Government published a White Paper highlighting the importance of restorative justice:

“We believe restorative justice is an important part of the justice system and has significant benefits both for the victim and for the rehabilitation of offenders.”


That is absolutely right. We know that reoffending drops by 14% if people have been involved in restorative justice. That is where the £8 saving for every £1 spent comes from. The White Paper went on to refer to opportunities to increase the use of restorative justice by using deferred sentencing and setting restorative conditions as part of out-of-court disposals.

Despite all this, restorative justice has been absent from the Bill. Can the Minister explain why it was promoted in the White Paper but does not feature in the Bill? I hope he will want to put this right. The amendment is relatively minor in its impact on the Ministry of Justice, yet it could have really far-reaching impacts, both for victims and for perpetrators. I hope the Minister will look favourably on Amendment 103.

[Lord Cormack (Con)]

My Lords, I made a very brief reference to restorative justice in one of our debates on Monday. I am glad to have an opportunity to comment briefly on the amendment just moved by the noble Baroness, Lady Meacher. I agree with her wholeheartedly. We should always do everything we can to keep people out of prison; to repeat myself from Monday, although sending people to prison is the punishment and the aim is rehabilitation, it does not always work like that. I know that from experience in my former constituency, which had a very large prison—Featherstone—and a young offender institution at Brinsford just a mile or so away. I believe a lot of the young people in Brinsford would have benefited enormously by not going to prison and would have benefited from restorative justice.

I became totally convinced in this view when I had the privilege to be the chairman of the Northern Ireland Affairs Committee for the last of my Parliaments in the other place, 2005 to 2010. I saw at first hand the effect of restorative justice in Northern Ireland, and a lot of young people who would perhaps have gone on to a long life of crime were rehabilitated and came to terms with their victims. As the noble Baroness said, there has to be agreement from both sides, as it were, but it was wholly beneficial in a vast number of cases.

Following the White Paper to which the noble Baroness, Lady Meacher, referred, it seems very strange indeed that there is no provision or recognition in the fairly massive Bill before us. One of my criticisms of the Bill is that it is too long. It should be three Bills rather than one—but that is another story and we have touched on that in the past. But although the noble Baroness, Lady Meacher, said that she will not press this to a Division—I do not dissent from her on that—I hope nevertheless that my noble friend the Minister will be able to make some favourable and encouraging comments about the importance of restorative justice and its place in the criminal justice system.

--- Later in debate ---

[Lord Wolfson of Tredegar (Con)]

I was saying absolutely the opposite and, if it came out wrong, it came out wrong. The whole point of restorative justice is that the offender and the victim have to consent. That is the point which I was making about crimes of sexual violence. The victim there should not feel under any compulsion or pressure to engage in restorative justice if they do not want to. Victim choice and free-will participation is at the heart of restorative justice. I hope that I have made that very clear.

[Baroness Meacher (CB)]

My Lords, I thank the Minister for the warm and encouraging words that we were asking for. Unfortunately, they do not give us any reassurance that there will be a restoration of some sort of national leadership on this issue. As I explained in my brief comments, this is what is missing and why restorative justice is languishing. He said that victims should have access to restorative justice, which is very difficult when only 5% of them are aware of being told about it. There is a major issue of lack of information, lack of understanding and lack of national leadership. This was a small suggestion to put these things right and I very much regret that the Government will not take it on. Having said that, of course I will withdraw my amendment.

Amendment 103 withdrawn.

Assisted Dying Bill [HL]

Baroness Meacher Excerpts

2nd reading
Friday 22nd October 2021 Lords Chamber

Moved by

[Baroness Meacher]

That the Bill be now read a second time.

Relevant document: 9th Report from the Delegated Powers Committee

[Baroness Meacher (CB)]

My Lords, I declare my interest as the unpaid chair of Dignity in Dying. My Bill has three informal co-sponsors: the noble Baroness, Lady Davidson of Lundin Links, who will make her maiden speech today; the noble and learned Lord, Lord Falconer of Thoroton; and the noble Baroness, Lady Brinton. I thank them for their support. Indeed, I thank every noble Lord in the Chamber.

Today, in England and Wales, assisted dying is prohibited by the Suicide Act 1961. Anyone who assists a person to end their life is liable to prosecution and imprisonment for up to 14 years. It turns compassionate friends and family into criminals and causes thousands of dying people to attempt to take their own lives alone in order to safeguard their relatives.

How many of us fear that we may be one of the unlucky small minority—I emphasise “small minority” —of people who suffer a traumatic dying process in which our precious palliative care services cannot relieve our suffering and cannot enable us to have a dignified death? Some 52% of the population report that they have witnessed a loved one suffer unbearably at the end of their life. Assisted dying will reduce those fears of dying so that we can live better. Then, when we are given a terminal diagnosis, the legal right to an assisted death will give us and our families great comfort and reassurance, knowing that we will have a choice and some control over how long we can tolerate our suffering.

The benefits of the Bill to dying people and their families will be huge, yet this is a truly modest Bill based on tried-and-tested laws from overseas. It is an overwhelmingly popular Bill in society. We know that 84% of the population at large support assisted dying, including 80% of people who declare themselves religious and 86% of disabled people. That is not surprising, because the sole aim of this Bill is to reduce unnecessary and unbearable suffering.

What do I mean by intolerable or unbearable suffering? There are forms of suffering that even the best palliative care cannot alleviate. A small but significant minority of dying people will experience intolerable symptoms. Let me give some examples. One is constant nausea and vomiting, night and day, which, because of an allergy to antiemetics, cannot be alleviated by palliative care services. Another is fungating wounds from a cancer protruding through the skin, perhaps in the cheek; I have a friend who suffered that recently. Such wounds exude pungent and deeply unpleasant odours described by doctors as “ward-clearing” because all the other patients have to leave due to the odour. However, the dying person can never leave, can they? That is, unless they are given the opportunity to take their own life.

Motor neurone disease is totally different but, day by day, week by week, it eventually deprives the person of every possibility of moving a muscle anywhere in their body. Some of those people will end up unable to speak, to swallow, to eat or to drink. How many of us want to go through that? Should we not have the right to avoid the very end of all that suffering? Often the loved ones of these people go through years and years of nightmares and panic attacks, thinking back and remembering the pain and suffering that their nearest and dearest went through. This Bill could end that suffering.

What can the dying person do under the current law to avoid such suffering? The options are grim. We can starve ourselves to death—a horrible way to die. We can refuse treatment, with more uncertainty about how much suffering that will cause. We can take our own lives—thousands of people try to do that every year and nine-tenths of them fail with the most appalling consequences. We can poison ourselves with stored up pills and alcohol, alone, to protect our loved ones. I had an aunt who had terminal liver cancer. The tumour was the size of a football. In the middle of the night, all alone, she took all her pills and whisky and the next morning her husband, who knew nothing about it, found her dead. That death left an indelible mark on me and probably explains why I am here today. The law leads dying people who desperately want medical assistance to die to travel to another country, long before they are ready to die. Imagine going to take your life before you really feel that that is what you want to do.

Now I will tell you something that you will find a little surprising. Our colleague, the noble Lord, Lord Field of Birkenhead, who is dying, asked me to read out a short statement:

“I’ve just spent a period in a hospice and am not well enough to participate in today’s debate. If I had been I’d have spoken strongly in favour of the Second Reading. I changed my mind on assisted dying when an MP friend was dying of cancer and wanted to die early before the full horror effects set in, but was denied this opportunity … A major argument against the Bill is unfounded. It is thought by some the culture would change and that people will be pressurised into ending their lives. The number of assisted deaths in the US and Australia remains very low—under 1%—and a former Supreme Court judge in Victoria has concluded about pressure from relatives that ‘it just hasn’t been an issue’. I hope the House will today vote for the Assisted Dying Bill.”


Why are we bringing another Assisted Dying Bill before Parliament? Those who oppose this Bill will remind us that over six years ago such a Bill was defeated overwhelmingly in the House of Commons, but a great deal has changed since then. We have seen a radical shift in the views of doctors. In 2019, the Royal College of Physicians ended its opposition to assisted dying. Last month, the BMA did the same thing following a survey that showed that 50% of its members supported assisted dying and 39% were against. My belief is that, about 10 years ago, maybe 5% of doctors supported assisted dying. The change has been extraordinary. I had a meeting with the Royal College of Surgeons the other day. It is considering reviewing its position. If it does, all the royal colleges will have moved from opposition to neutrality.

In this same period, seven more US states have legalised assisted dying. Now 11 US states have it, as well as five states in Australia. New Zealand is introducing assisted dying; it will be available for people from next month. All those jurisdictions have an Act of Parliament very similar to the Bill that we are discussing today. Other countries have broader models of assisted dying. Canada and Spain are among the latest countries to legalise euthanasia in the past few years, in which a doctor administers a lethal medication. Italy will have a referendum next year. When a country has a referendum, it will introduce a law, because this is an incredibly popular measure. Debates are under way in Portugal, Austria, Germany and Ireland. Perhaps most important is the likelihood that within a few years the Scottish Parliament will legalise assisted dying—there is a majority for it in the Parliament. My challenge to our Prime Minister is: “Boris, do you really want to be upstaged by Scotland on this issue, an issue of such historic proportions?”

This Bill is an attempt to drag our assisted dying legislation out of the 1960s and into the present day. It is not a euthanasia Bill; it would read very differently if it were. What are the main provisions of the Bill? It would give terminally ill, mentally competent people over the age of 18 the right to choose the manner and timing of their death. To be eligible for an assisted death, two independent doctors would have to confirm that the person requesting assistance had a life expectancy of no more than six months. Prognoses are a little unreliable but, in the countries that have this law, people take the medicine only in the last week to two weeks of life and, at that point, the prognosis is much more certain. People must have mental capacity and have reached a clear and settled decision to have an assisted death without pressure or coercion from any person. If at any stage there were doubts over their capacity, either doctor could refer the person to a specialist. The patient’s nearest relatives would be interviewed to check their motivation. Having seen this evidence, the entire process would need to be approved by a judge of the family division of the High Court.

How does this Bill relate to palliative care? All of us who support the Bill—and I mean all of us—are passionate about achieving the best possible palliative care across the country. While we are unable, in this Bill, to include additional financial provision for palliative care, we urge the Government to follow the example of Victoria, in Australia, and elsewhere, where the legalisation for assisted dying has been accompanied by a significant investment in palliative care services. The principles of patient choice are rightly paramount in modern medicine but are drastically curtailed when it comes to the end of life. Patient choice means nothing for the dying unless it includes the patient’s right to decide when they can take no more suffering.

The right to an assisted death, where and when the patient chooses, surrounded by loved ones, is an essential and complementary part of high-quality palliative care. The Oregon Hospice & Palliative Care Association was against assisted dying before legislation was introduced there. Today, it is very much in favour. Why? Because it has improved palliative care; now, their doctors and nurses can have honest, expansive conversations about the wishes and fears of dying people. Palliative care has improved in Oregon over those 22 years, and it would do the same here.

I will touch on the report of the Delegated Powers and Regulatory Reform Committee, of which I am a member, although I should say that I did not attend the meeting to discuss this Bill. The report raises valid points about having the affirmative rather than negative procedure, and I will be talking to doctors and lawyers about some adjustments to the Bill to reflect those recommendations.

In my closing remarks, I will briefly scotch some arguments that are likely to be heard today. Might there be a slippery slope, our opponents suggest—I have just had that debate with a doctor on BBC television news. No, there would not be. Our opponents know that not a single jurisdiction in the world that has legalised assisted dying for people who are terminally ill and mentally competent has expanded it beyond those strict criteria, except Canada. The reform there was led by a Supreme Court judgment that, if somebody is not terminally ill but is suffering unbearably, it is contrary to their human rights to be denied an assisted death. The Parliament decided to have a narrow Bill initially, not dissimilar to ours, and, if that worked, to extend the scope of that Bill. Canada is a very exceptional case because of that. The reform was led by a Supreme Court judgment and the Parliament was a bit nervous about doing it, so people today should not refer to Canada as an example of a slippery slope. The laws in Belgium, the Netherlands, Switzerland, Canada, Spain, Colombia and elsewhere may be raised today. I hope they will not be, as they have always been more broadly based. References to those laws are irrelevant to our debate.

We will also hear much today about vulnerable people, which is absolutely right, but there are no legal safeguards for dying people who decide to end their lives early, whether by starving or, on occasion, shooting themselves. We propose a rigorously safeguarded system that would end these barbarous deaths and protect vulnerable people.

Some say that pain can always be controlled; cancer specialists know better. Some have written to me referring to the terrible suffering of terminally ill cancer patients from physical pain—a small minority, but each and every one of them is important, nevertheless. The Association of Cancer Physicians, in its excellent and balanced book End of Life Choices for Cancer Patients—it is careful not to come down on one side or the other—concludes that

“we do not see the comprehensive provision of high quality palliative care and the introduction of assisted dying as alternatives in competition with each other.”

In other words, they work well together when they exist together. The current law is unsafe and results in untold suffering. No civilised society should tolerate such a law. I beg to move.

--- Later in debate ---

[Baroness Meacher (CB)]

My Lords, I thank every single one of your Lordships who has spoken here today. I want to say a special thank you to the Minister. I should think he was pretty depressed when he found out that he had to reply to an extremely lengthy debate on a Friday, but I thank him for his courtesy and comments; they are most welcome. I also thank the noble Baroness, Lady Davidson of Lundin Links, for her formidable maiden speech. I tell you, my maiden speech was nothing like as good as that; it was really quite superb.

We have heard many moving and powerful speeches. Of course, I could respond to lots of the comments made by people on the other side of the argument. It would not be difficult but it would certainly take time. I am absolutely sure that your Lordships do not want me to do that this afternoon—am I right?

[Noble Lords]

Hear, hear.

[Baroness Meacher (CB)]

I do want to respond to the noble Lord, Lord Carlile, because I can do it quickly. The High Court has been consulted. He said that it had not; I think it is important to put that right.

This has been a remarkably courteous debate, despite the incredible depth of feeling, including my own, on the issues on both sides of the House. I know how strongly people feel about this issue. I am grateful for the courteousness with which everybody—I think I can say that—has expressed their opinions.

All I want to do is say thank you again to noble Lords.

Domestic Abuse Bill

Baroness Meacher Excerpts

Wednesday 21st April 2021 Lords Chamber

Moved by

[Baroness Meacher]

At end insert “and do propose Amendments 40B and 40C in lieu of Amendment 40—

40B: After Clause 72, insert the following new Clause—
“Victims of domestic abuse: data-sharing for immigration purposes
(1) The Secretary of State must make arrangements to ensure that personal data of a victim of domestic abuse in the United Kingdom that is processed for the purpose of that person requesting or receiving support or assistance related to domestic abuse is not used for any immigration control purpose.
(2) The Secretary of State must make arrangements to ensure that the personal data of a witness to domestic abuse in the United Kingdom that is processed for the purpose of that person giving information or evidence to assist the investigation or prosecution of that abuse, or to assist the victim of that abuse in any legal proceedings, is not used for any immigration control purpose.
(3) Paragraph 4 of Schedule 2 to the Data Protection Act 2018 shall not apply to the personal data to which subsection (1) or (2) applies.
(4) For the purposes of this section, the Secretary of State must issue guidance to—
(a) persons from whom support or assistance may be requested or received by a victim of domestic abuse in the United Kingdom;
(b) persons exercising any function of the Secretary of State in relation to immigration, asylum or nationality; and
(c) persons exercising any function conferred by or by virtue of the Immigration Acts on an immigration officer.
(5) For the purposes of this section—
“immigration control purpose” means any purpose of the functions to which subsection (4)(b) and (c) refers;
“support or assistance” includes the provision of accommodation, banking services, education, employment, financial or social assistance, healthcare and policing services; and any function of a court or prosecuting authority;
“victim” includes any dependent of a person, at whom the domestic abuse is directed, where that dependent is affected by that abuse.”

40C: In Clause 79, after subsection (7) insert—
“(7A) Regulations under this section bringing section (Victims of domestic abuse: data-sharing for immigration purposes) into force may not be made until both Houses of Parliament have approved a resolution to the effect that it should be brought into force, moved either after debate in that House of any publication of the outcome of a review by the Secretary of State of existing data-sharing procedures in relation to victims of domestic abuse for purposes of immigration control, or after 1 July 2021, whichever is the sooner.””

[Baroness Meacher (CB) [V]]

My Lords, I rise to move Amendments 40B and 40C, which need to be taken together. Again, I thank supporters across the House, including the right reverend Prelate the Bishop of London, for their support and I thank the Minister for our very helpful meeting yesterday. I was very grateful for a very open discussion about the issues.

The purpose of our original Amendment 40 was to protect victims of domestic abuse whose migration status is uncertain. About half of these victims are too afraid to report the crimes committed against them. Their perpetrators threaten that the victim will be detained or deported if they report the abuse. Irrespective of what their immigration status is, it is a very useful threat for perpetrators to use. The victims have good reason to be afraid because, at present, if the victim reports a crime of domestic abuse to the police, there is every reason the police may pass that information along to the immigration authorities. This is at a moment of crisis for the victim, when they have quite likely been made homeless, they may have been thrown out of their home and are completely vulnerable. The idea that the immigration authorities begin to look for them at that point is utterly inappropriate.

To make clear what we were trying to achieve: our amendment was intended to prevent information about the victim, or any witnesses, being passed from the police to the immigration services. I understand the reasons for the Commons’ rejection of the amendment. They argue that the Government have committed to the review that the Minister has referred to about the processing of migrant victims’ personal data for the purposes of immigration control and that the amendment would pre-empt the outcome of that review. I totally understand that.

Incidentally, the Minister referred to the need for information to be passed to the NHS. We agree with that and we are not talking about blocking the sharing of information with the NHS; we are simply talking about the police passing information to the immigration services, which is a completely different issue.

Our compromise amendment fully respects the Government’s position and takes account of it. The only reason given by the Commons for rejecting the amendment was the fact that the review is ongoing. Amendment 40C, linked with Amendment 40B, makes clear that regulations under this section will not come into force

“until both Houses of Parliament have approved a resolution to the effect … after … any publication of the outcome of a review … or after 1 July 2021, whichever is the sooner.”

As the Minister has explained, it is expected that the review will be published in June. Therefore, the review will need to be completed, and it will need resolutions from both Houses before these protections could be introduced. So we are allowing time for the review to be completed and also putting quite an onerous block in the way of this reform by saying “we need a resolution from both Houses.”

The Minister referred to the National Police Chiefs’ Council guidance, but I am told that the guidance is implemented very unevenly across the country. If we simply enhance the guidance, that is no guarantee that these victims of domestic abuse will be protected. It simply is not sufficient or strong enough.

The Minister explained to me that, if protection of domestic abuse victims is needed, there may be a Bill in the next Session. However, these things are very uncertain, and all we are doing is leaving open the option of resolutions of both Houses. If there is an alternative Bill, then clearly this matter could be picked up in that Bill. The Government rightly said that the original amendment was not acceptable because it pre-empted the review, so we have taken that on board fully.

One of the issues is that the review will need to illustrate that there is a problem with these victims of domestic abuse having such fear that they do not report the crimes committed against them. I worry that the review sounds as though it will be focusing on the positive experiences of some domestic abuse victims whose immigration status is settled or quite straight- forward.

In our meeting the Minister referred, as he did today, to the 128 domestic abuse victims who are in touch with immigration officials. About 60% of them have settled status and the remaining 30%-plus have not been detained or deported. This is welcome information, but we have no idea whether those 128 represent 1% or 10% of these migrant women who are victims of domestic abuse. It would be extremely helpful if the review tried to identify this cohort of about half of domestic abuse victims who have an immigration status issue to find out exactly what is happening to them. I ask the Minister to make sure that the review adequately covers that half of the cohort about which we are talking.

--- Later in debate ---

We have asked the elected House to consider this matter again; it has done so and has disagreed with your Lordships’ Amendment 40 by a substantial majority. I submit that we should not now send it back to the other place in the same form, even if it is accompanied by an additional amendment which provides for delayed commencement. The Government are committed to completing their review of the current data-sharing arrangements in a little over two months’ time. Noble Lords do not have long to wait for that. We should allow the super-complaints process to take its proper course. We will soon publish and then implement the findings of the review. I know that your Lordships’ House will scrutinise the Government’s actions closely, as indeed it should. I urge the noble Baroness not to press her Motion, and noble Lords to agree Motion E.

[Baroness Meacher (CB) [V]]

My Lords, I express my sincere and deep thanks to those who have spoken so powerfully and eloquently in support of this amendment—my heartfelt thanks to all of them. I know that those who represent these very vulnerable women will also be extremely grateful.

I also want to thank the Minister for his response, but my greatest disappointment is that he misrepresents our amendment. He talked about a “deferred commencement”. The whole point about this revised, compromised amendment is that it provides very clear provisions which leave it to the Government, first, to complete their review but, secondly, to decide whether they want this to go through both Houses of Parliament. The Government have a huge majority in the Commons and can certainly prevent a resolution going through. This is not a deferred commencement, it is a conditional commencement: conditional on the outcome of the review and on support from the Government, to be perfectly frank about it. It is not exactly a wild amendment at all; it is very, very modest.

I welcome that the review will be talking to the relevant organisations to try to understand the appalling consequences of this sharing of information with the Immigration Service. I hope they get at that information and publish it in the review, because it is there, we know it is—I have heard lots of information about these appalling cases. We depend on the review being thorough—we do not know whether it will be—and on the Government supporting the protections this amendment seeks to provide. On that basis, I want to test the opinion of the House.

Domestic Abuse Bill

Baroness Meacher Excerpts

Report stage
Wednesday 10th March 2021 Lords Chamber

[Lord Blunkett (Lab) [V]]

My Lords, in view of the pressure of time, I shall be brief, but I could not allow this amendment to pass without congratulating all those who have played such a significant part. The noble Baroness, Lady Newlove, has shown enormous tenacity. There are times in all our parliamentary, public and political lives when we suddenly realise that we can make a real difference to the well-being, and in this case the lives, of others. I congratulate her from the bottom of my heart. I pay tribute to those whom she generously paid tribute in her speech, and also to her co-signatories, my noble friend Lady Wilcox and the noble Baroness, Lady Meacher, who have stuck with this all along.

Unusually for these Benches, I congratulate, as my noble friend Lord Hunt did, the two Ministers, who have been assiduous in their preparedness to listen, respond and be flexible. This is the House of Lords at its best. Parliament is at its best when people listen to each other, where divides are narrowed and overcome, and where people of good will are prepared to find a way forward in the interests of the people whom we seek to serve in the country as a whole.

I have played a very small part in this, but I like to think that the Minister, as I said to him on another occasion, would not wish to put his parliamentary colleagues in the House of Commons in the invidious position of voting down such an important and critical measure. He certainly listened, as have the Government. Will we be able to do so on other issues?

Today there will be many votes. It should not diminish the importance of the Bill that we have continuing issues to raise, because this is a really important piece of legislation. I have one thing to put on the record on the statistics that the noble Baroness, Lady Newlove, gave us this afternoon. This is about power and domination, never about love. It is about people who are prepared to use their manhood for ill, not for good. It is about inadequates who then inflict their inadequacy on the people they claim to love. If we can put that message out to young men in particular, we will have done a very proud job of work this afternoon.

I thank the noble Baroness, Lady Newlove, for what she has done. Many people will have cause to thank her in years to come.

[Baroness Meacher (CB) [V]]

My Lords, this Bill will be remembered in years to come for the many important changes and reforms that will be introduced through it, but without doubt one of the most welcome changes will be the recognition of non-fatal strangulation in law and, we hope, the effective response by the criminal justice system. I say “welcome”; this particular amendment will be most welcomed by the most severely abused women who suffer this particularly horrible crime. As others have said, the noble Baroness, Lady Newlove, has done a superb job, supported by some pretty superb people, in steering the amendment to this point. She has said pretty well all that I would have said, and therefore I will be extremely brief.

The only point that has not been mentioned is that if we really want the amendment to achieve what it should achieve, which is the appropriate response by the police, the courts and so on, then training police officers so that they are aware of this stand-alone offence will be very important, and maybe a little training for doctors, although they should certainly be aware of what a strangulation looks like. Can the Minister say anything about that?

Like others, I say a tremendously sincere thank you to our Ministers, who have really listened. The noble Baroness, Lady Williams, has been a marvellous Minister in this House for a long time now, and we now have the benefit of the noble Lord, Lord Wolfson, as well as the noble Lord, Lord Parkinson. We are very lucky to have those Ministers in this House and I pay credit to them.

[Baroness Burt of Solihull (LD)]

My Lords, like others who have spoken, I am absolutely delighted at this outcome and grateful to the noble Baroness, Lady Newlove, and the two Ministers for addressing this gap in the legislation by giving this cruel and dangerous offence its rightful place as a crime in its own right. I congratulate all outside and inside this place who have campaigned for years to bring non-fatal strangulation on to the statue book. This will make a huge difference, as others have said, to the police, who will be given the confidence to arrest perpetrators. Judges will be able to bring the full force of the law on these sadistic, controlling criminals, who threaten, hurt, maim and kill their terrified victims.

Nothing that I can say can add to the cogent, clear contribution of the noble Baroness, Lady Newlove. As my noble friend Lord Marks said, this is a victory not only for her, but for all those victims from the past and the future who will now get justice, as well as greater awareness that this is not okay, and, as the noble Lord, Lord Blunkett, says, is nothing about love.

Domestic Abuse Bill

Baroness Meacher Excerpts

Committee stage & Committee: 4th sitting (Hansard) & Committee: 4th sitting (Hansard): House of Lords
Wednesday 3rd February 2021 Lords Chamber

[Baroness Gardner of Parkes (Con) [V]]

My Lords, I am very supportive of the Bill. The mental and physical damage of domestic abuse goes far beyond the pain and anguish caused at the time it occurs and stays with victims and their families for many years, if not for the rest of their lives. It is important that we do all we can in this legislation to help victims to get out of abusive relationships and rebuild their lives.

I will speak on Amendments 130 and 130A and propose to add parental alienation to the definition of abusive behaviour and, therefore, every provision of the Bill. I fear that the amendments may undo much of the work which the Bill seeks to do to protect victims of domestic abuse and swing the pendulum of control back to the perpetrator of that abuse, rather than the victim, if they make counter-allegations.

Without meaning to sound flippant I say that, at the extreme, any parent going through a break-up or divorce could find themselves accused of domestic abuse under this Act. That is not what the Bill is intended for. I wonder if the concerns of noble Lords on these amendments are already covered by the combination of Clause 1(3)(e) and (5). Alternatively, if they had a specific instance in mind, they should look at where that can be catered for in specific clauses, not by a wholesale change to the entire Act in this way.

The noble Lord, Lord Marks, has made it clear that direct cross-examination can cause great distress. It is important to help all people in vulnerable situations. I can see these amendments having massive unintended consequences if they are included. I urge the House not to accept either of these changes, so as to maintain the integrity of the Act.

[Baroness Meacher (CB) [V]]

My Lords, I will speak principally to Amendment 130 in the name of the noble Lord, Lord Rosser. Parental contact is, of course, enormously important. Continued contact can be very dangerous both mentally and physically, but it can be beneficial. To make the right decision for each family is of the utmost importance, and sometimes people get it wrong. However, my support for the amendment is nuanced. I support proposed new subsection (4) but I add that a parent of either sex who has been found to exercise controlling or coercive behaviour should probably not have continued contact with the children. Such contact is likely to be used to continue controlling the partner. The child becomes a pawn in the fight with the partner.

I know an appalling example of this. Years after a divorce between an American dad and a British mum, the mother is required to pay to fly to the US five or six times a year to take her child to the father for contact. Because she cannot trust the father to allow the child to come back, the mother keeps the passport. This means that, after the week’s contact, she has to fly to the US and pick up the child. Even Covid was not accepted as a reason not to go, and the mother caught it on the plane back to the UK over Christmas. The child does not want to go to see her father but is being used as a pawn.

I accept that anecdotal evidence is of limited value; I am a great believer in research. However, I ask that, before Report, the presumption of parental contact be considered in the context of controlling or coercive behaviour and the results of relevant research on the issue.

The first part of the amendment assumes that the presumption of parental contact should not apply in relation to a parent where domestic abuse has affected the child or other parent. I support the implication that parental contact should be very carefully assessed in these circumstances, but the wording of the amendment could be nuanced before Report. I fully accept that it should not be presumed that parental contact would apply in these circumstances.

In my experience, even when domestic abuse against children as well as a partner has occurred, this should not necessarily rule out parental contact. This depends on the nature of the abuse, the ages and level of understanding of the children, the presence or absence of controlling behaviour—a key factor in the situation—and an overall assessment of the potential harms and benefits involved. I also broadly support the amendment in the name of the noble Baroness, Lady Jones, but I would qualify it on Report.

While again recognising the limited value of individual cases, I will illustrate with a personal experience my point that very serious domestic abuse and continued parental contact may be compatible and, indeed, helpful. The case I will cite involves abuse of children by a mother. As with abuse by a father, abuse by a mother can be extraordinarily damaging, and it can take the authorities a very long time to recognise it.

A male member of my family and his children suffered what can be described only as severe trauma over several years. It took Cafcass and the judicial system two and a half years to recognise that the person who was lying about her abuse of her children, and making up allegations, was in fact the mother. The authorities assumed at that time that mothers did not abuse their children. The very little eight year-old girl climbed up on a chair and unbolted the front door—she was always locked into her mother’s house—ran to the bus stop, managed to get on the right bus and get off at the right stop, and ran one mile through Tottenham to her dad’s house. Only then did the matter go back to court and the judge recognised that he and everyone else involved had made an appalling mistake. Having required the children to live with their mother for two and a half years, the lead social worker in the case finally made it clear that the children should only visit her but certainly not live with her.

The children have lived with their father ever since, but all have suffered from various levels of PTSD. They have had years of therapy, paid for the father, not by the state. Despite the abuse of the children and the damage to them, this father has encouraged contact with the mother. Once the children were safely placed with their father, he felt it was important for them to accept that their mum could not provide parenting but that she was, nevertheless, herself a victim. Her behaviour very much reflected her own experiences as a child. The children know that they cannot expect normal parenting, but they understand her mental state and therefore see her as a person with her own problems. In my view, they have benefited very much from the fact that they are not left with only the horrendous memories of their abuse as small children.

My personal experience, while only anecdotal, explains why I feel so strongly about the issue of parental contact. It is very complex yet hugely important. In conclusion, I support both these amendments but would like to see them adjusted before Report.

[Lord Marks of Henley-on-Thames (LD) [V]]

My Lords, throughout the preparation for proceedings on this Bill, I have been extremely impressed, and greatly assisted, by the work of Women’s Aid, the Victims’ Commissioner for London, the Victims’ Commissioner and many others who have worked tirelessly, with the grain of this Bill, to improve the response of us all, and the courts, to the scourge that is domestic abuse. However, with this amendment and the amendment to it, which many of them support, I have a number of concerns.

The amendment, as we have heard, seeks to disapply the presumption in Section 1(2A) of the Children Act 1989. I turn for a moment to two provisions of that widely admired legislation. As is well known, Section 1 provides:

“When a court determines any question with respect to … the upbringing of a child … the child’s welfare shall be the court’s paramount consideration.”


That overriding requirement lies at the heart of the Act, and judges and lawyers have long regarded it as the central canon of our law relating to children. The presumption under Section 1(2A) requires courts hearing proceedings, which include making orders about where children are to live and orders for contact between a child and their parents, to presume that

“unless the contrary is shown, that involvement of that parent in the life of the child concerned will further the child's welfare.”

That presumption reflects a wealth of evidence not mentioned so far in this debate, but it is generally in a child’s interest to have a relationship with each of their parents. However, that presumption is rebuttable, hence the words

“unless the contrary is shown.”

It is often the case that judges will make a decision, which generally they do not like to make but do, that given a history of domestic abuse by one parent of the other and the effect upon the child, contact with one parent will be withheld. The noble Lord, Lord Rosser, confirmed that the statutory guidance for judges ensures that they carefully consider whether contact is justified or should be withheld.

I do not suggest for a moment that all contact is safe. As many have said, cases of abuse and very serious abuse can arise during and around occasions on which contact takes place, as it can on other occasions. But I disagree with the noble Baroness, Lady Jones of Moulsecoomb, which I rarely do on these issues, that the presumption is treated by the courts as overriding. I agree with the point made by the noble Baroness, Lady Meacher, that different solutions may be right for different families. The question for the House is where that leaves us. My concern is that there will be cases where this amendment runs the risk of putting the interests of children behind the interests of parents.

However, the removal of the presumption in this subsection is not the only reason I am concerned about this amendment and the amendment to it. Subsection (4) of the proposed new clause would forbid the court from making any order for unsupervised access with a parent who is

“awaiting trial, or on bail for, a domestic abuse offence, or … involved in ongoing criminal proceedings for a domestic abuse offence.”

That prohibition would be absolute, and I think it would be wrong. It would forbid a child from having unsupervised contact with a parent which may, in particular circumstances, work against the best interests of the child, contravening the paramountcy principle I mentioned. It should be for the judges to determine what the circumstances in each case demand. The noble Baroness, Lady Meacher, pointed out that circumstances differ and the extent to which they do.

Furthermore, the amendment is not limited to cases involving domestic abuse against a parent of the child concerned. Section 9(8) of the Children Act referred to in subsection (4) of the proposed new clause is concerned with allegations of “a domestic abuse offence.” The subsection would prohibit, for example, a court making an order for unsupervised contact between a father and his older child because the father had been accused of a domestic abuse offence committed against a new partner who was not the child’s mother, irrespective of any relationship between the new partner and the child. Such a prohibition would be grossly unjust, depriving the child of his or her relationship with the father. It would again run entirely counter to the paramountcy principle.

What is more, this amendment only requires, before unsupervised contact is prohibited, that allegations have been made. They need not have been established; they might be wrong or malicious. The noble Baroness, Lady Meacher, mentioned a case where they were indeed wrong. The noble Baroness, Lady Gardner of Parkes, mentioned a case where allegations might be malicious. This provision runs the risk of inviting unwarranted allegations of abuse calculated to destroy a child’s relationship with a parent against whom nothing has been found, on the basis of allegations that may be irrelevant to the welfare of the child. A family judge would determine whether such allegations of abuse were made out and would do so on the basis of evidence adduced before the court, not on the basis of unproved allegations. This amendment involves, to that extent, a denial of justice and a denial of justice to children.

I firmly believe that judicial discretion should not be withdrawn in this sensitive area of family life. There are many cases where abusive behaviour by one parent towards another entirely justifies the withdrawal of contact between the abusive parent and the child. But there are other cases, as the noble Baroness, Lady Meacher, recognised, where withdrawing contact is inimical to the welfare of the child.

Improving the way in which family courts understand and respond to domestic abuse of all sorts is of the greatest importance, but this amendment is too prescriptive in its statement and its outcome. Removing the power of judges to act in the best interests of the child, on whose behalf they daily make very difficult decisions, is not the way to achieve the aims of this Bill.

--- Later in debate ---

[Baroness Wilcox of Newport (Lab) [V]]

My Lords, the important issue of non-fatal strangulation has been introduced comprehensively and powerfully by the noble Baroness, Lady Newlove. I commend her on her tremendous work in campaigning and lobbying to bring this issue to public attention. We support these vital amendments and our stated preference is Amendment 137 as opposed to the wider Amendment 138. However, both of the amendments would make non-fatal strangulation or suffocation a standalone offence on the statute book and should be located within this Bill.

A separate offence of non-fatal strangulation would help the police to spot domestic abuse and coercive control. This is our opportunity to help those women who have suffered this dreadful form of abuse and forced control at the hands of their perpetrator. At its heart, the Bill must be about providing services for people who have become the victims of abuse, and indeed torture, in their own home. The importance of the Bill and these measures has only grown during the coronavirus crisis as perpetrators have exploited lockdown to intensify their control and abuse. Calls to helplines and concerns have increased greatly across all the four nations of the United Kingdom.

My good friend Rachel Williams, who is from Newport, is a leading campaigner. She has set up her own charity, Stand up to Domestic Abuse. I am proud to wear the organisation’s badge through every day of these proceedings. Rachel’s abuse story is well chronicled and her support charity for survivors is simply outstanding. On the issue of non-fatal strangulation, Rachel has set up a petition to ask the Prime Minister to support its inclusion as a stand-alone offence. When I looked at it about an hour ago, the petition had secured 202,288 signatures. These are Rachel’s words:

“Strangulation is a very symbolic act of control which leaves its victim in no doubt that there is a real and visceral threat to their life. If you put your hands on someone’s throat and squeeze, the message and terror for the victim is clear. As a survivor of domestic violence, I know the impact it has.”


When Rachel knocked at my door at the civic centre asking for help and support for victims, I said that we would do our very best within the limited financial framework of a local authority in such austere times. But what I could never have foreseen a couple of years ago is that I would be in a position in your Lordships’ House where I have the privilege of speaking to improve and amend the laws of our lands so that survivors such as Rachel and support organisations will have the very best protection that can be afforded by the most appropriate legal framework.

We have such an opportunity before us today. Non-fatal strangulation or suffocation must finally become a stand-alone offence for the perpetrators of this most repugnant of crimes. I support the amendments.

[Baroness Meacher (CB) [V]]

My Lords, I give my strong support to Amendment 137 in the name of the noble Baroness, Lady Newlove, and I want to congratulate her on her comprehensive and extremely powerful presentation of the arguments in favour of these amendments. Of course, I wholeheartedly agree with every word that she spoke. I also want to thank our Ministers for their support for this amendment, and indeed thank the Home Secretary and Justice Secretary, both of whom, I understand, support the amendment. I thank too all those who have provided briefings for us, in particular Julia Drown, who has been absolute stalwart in support of our work on this issue.

I understand that the Government have accepted the principle of the amendment and agree that it should have general application rather than be limited to cases of domestic abuse; that is, between couples who are personally connected, albeit that the amendment should stand within the Domestic Abuse Bill. That is what I understand, and no doubt the Minister will update us on developments in the work of the Government’s lawyers, who I believe are drafting an amendment that would work in practice. It would be helpful if he could confirm that the Government support the broader amendment but also that it must be included in this Bill for the reasons already given. I do not want to repeat them.

In the circumstances, I want to keep my remarks extremely brief and will just spell out the key reasons why I feel so strongly that the amendment should be agreed. First, women who are victims of non-fatal strangulation are seven times more likely to be killed subsequently. If there is anything that we should do, surely it is to prevent murder.

Secondly, the fact is that these very serious crimes are not being dealt with effectively by our criminal justice system simply because of the peculiarity that there might not be much to observe in the way of immediate symptoms, while the medium or long-term consequences, both mental and physical, of this heinous and horrendous crime are extremely serious. Again, all that has been outlined by other speakers, so I will not repeat it.

I have a lot of sympathy for the police, who do not—of course, they cannot—handle this very well. There needs to be a very specific, stand-alone offence that they can grapple with and understand. The police are overloaded—they are very busy, as I know well from my work with the Police Complaints Authority some years ago—so all my sympathies go to them. For the police, as well as for the victims, we need to get this amendment on the statute book.

Thirdly, this is a particularly horrible way to be assaulted. The idea that it is not dealt with effectively and that people are not punished for doing it is completely unacceptable, so I say again that I very strongly support the noble Baroness, Lady Newlove, and her amendments.

[The Lord Bishop of London [V]]

My Lords, I thank noble Lords who have preceded me and those who will follow. I also thank the steady campaigners, researchers and wider members of civil society for their tenacity in bringing the issue of non-fatal strangulation to the forefront of the Bill. It is something so nuanced that, if addressed, it has the potential to change the trajectory of women’s lives post strangulation.

Researchers, lobbyists and specialist organisations alike have spent significant proportions of their lives trying to highlight the one thing that we all know to be true: that there is almost always more than meets the eye. That said, I am delighted to have heard that the Government are committed to addressing this issue, and it is good to have heard so many noble Lords speak in favour of the amendment at Second Reading and today.

We have heard powerful contributions from the noble Baronesses, Lady Newlove and Lady Wilcox, and many noble Lords will have received briefings and accounts of the impacts of this crime on victims. I add my voice in support of the amendment, which calls for non-fatal strangulation to be included in the Bill as a stand-alone offence.

International research by Glass showed that non-fatal strangulation by a woman’s partner was associated with a 700% increase in the likelihood that he would attempt to kill her and an 800% increase in the likelihood of him actually killing her. Data collected by organisations such as Stand up to Domestic Abuse suggests that non-fatal strangulation is not a single, spontaneous assault but a pattern used by some perpetrators.

I am sure that noble Lords have read the details of what it is like to face this type of assault. We have heard them today and previously in your Lordships’ House, so I will not repeat them. The reality is that the effect of putting this amendment in the Bill really will be a reduction in the number of cases whose details we might have to share on this matter in the future.

At present, the police too often deal with non-fatal strangulation as a tick-box exercise on a risk assessment form, rather than as a crime. Furthermore, the current law leads to perpetual undercharging or no charging at all. Work from organisations such as the Centre for Women’s Justice highlights how serial perpetrators of domestic abuse and coercive control should have an official history that reflects their potential risk to others.

Right to Die

Baroness Meacher Excerpts

Thursday 14th July 2016 Lords Chamber

Asked by

[Baroness Meacher]

To ask Her Majesty’s Government what assessment they have made of the constitutional implications of the Supreme Court’s 2014 judgment in the case of R (Nicklinson) v Ministry of Justice [2014] UKSC 38.

[The Minister of State, Ministry of Justice (Lord Faulks) (Con)]

My Lords, the Government do not agree that this case raises constitutional issues. The issue in this case was whether the prohibition on assisted suicide in the Suicide Act 1961 was incompatible with the appellant’s right to respect for private and family life. Dismissing the appeal, the Supreme Court held that our courts could decide the question of compatibility but that it was not appropriate to do so then. The court encouraged Parliament to consider the issue further. Both Houses have since had the opportunity to do so.

[Baroness Meacher (CB)]

I thank the Minister for his reply, but he will know that a majority of the Supreme Court justices in the Nicklinson case took the view that the current law is in breach of Article 8 of the human rights convention. They deferred making a declaration of incompatibility only to allow time for Parliament to pass a law to change the situation. Does the Minister accept that a Private Member’s Bill debated on Friday immediately after the Summer Recess was not an adequate response to the Supreme Court justices, and that it is now time for the Government, with Parliament, to pass legislation to allow help to be given to mentally competent terminally ill people who have a consistent wish to avoid unbearable suffering at the very end of their lives?

[Lord Faulks]

The Government recognise that strong views are held on this subject on both sides. It remains the Government’s view that any change in the law is an area for individual conscience and a matter for Parliament to decide rather than for government policy. The noble Baroness and the House will remember the lengthy, thorough and extremely illuminating debates we had last year or the year before in relation to the Private Member’s Bill proposed by the noble and learned Lord, Lord Falconer. Since then, there has been a Bill in the House of Commons which was defeated at Second Reading.

Humanist Marriages

Baroness Meacher Excerpts

Tuesday 2nd June 2015 Lords Chamber

[Lord Faulks]

The quarrel, as I understand it—if the noble Baroness will allow me to continue—is that it is felt that both those ceremonies should take place at the same time. There having been a consultation, there was no consensus across the key stakeholders. The consultation raises a number of significant issues of a broader nature; in particular, the National Panel for Registration was concerned about the risk of forced and sham marriages. That is also a concern, incidentally, in Scotland, where there is a different system, based on the celebrant rather than the registration buildings and where there is also concern and a consultation about that very issue.

[Baroness Meacher (CB)]

During the 10 years of humanist marriages in Scotland, some 20,000 such marriages have taken place, which is more than the number of Catholic marriages and, by the end of the year, will number more than Church of Scotland marriages. Will the Minister agree to look into the popular demand for such marriages in England and Wales with a view to implementing the legislation that the previous Government passed, on the assumption of a recommendation to implement by the Law Commission?

[Lord Faulks]

I can assure the noble Baroness that the Law Commission will talk to officials in Scotland on the issue as part of its scoping work on marriage law reform in England and Wales. In Scotland, Ministers were concerned about the qualifying requirements for a celebrant; they are concerned about the reputation, dignity and solemnity of marriage as well as combating sham marriages and civil partnerships. Although, of course, it must be immensely frustrating for those who want a humanist marriage at the same time as the celebration, this is part of an overall consideration by the Government as to the way forward.

Assisted Dying Bill [HL]

Baroness Meacher Excerpts

Friday 16th January 2015 Lords Chamber

[Lord Brennan (Lab)]

My Lords, I rise to support the amendment for the following reasons. Parliament should speak the truth in legislation. In so doing, whatever degree of sentiment we strongly hold for or against an issue, when it comes to the very content of a statute there is no room for emotion and definitely no place for euphemism. The right words should be used in their right meaning. An Assisted Dying Bill could easily be understood to refer to a palliative care Bill. An assisted suicide Bill tells the truth, and the Bill should say that on its face.

It is a legislative irony that in Switzerland, which gave rise to Dignitas, the legislation specifically refers to suicide. At present, the word “suicide” appears only once in this Bill, in Clause 6(2), and that occurs because of statutory necessity. For the Bill to pass, the medical participant must be given an exemption from prosecution under that Act, otherwise the law will be broken. In the Bill’s present content the word is used once to amend a previous law, but not again.

It is necessary to use the word “suicide” because, first, death is normally a passive process. Medical participation in producing another person’s death is an active process. It involves the person wishing it, the doctor being satisfied and thus able to certify that it is reasonable, a process for use of the drugs that are to be given, and then the prospect of statutory provision. All of that surely requires clarity of expression. Secondly, it is necessary to better inform both our debate and public debate. In a Gallup poll conducted in 2013, 70% of the participants agreed with the proposition to:

“End the patient’s life by some painless means”,

but only 51% were ready to agree to:

“Assist the patient to commit suicide”.

The more bland and emollient the language used, the more acceptable the proposition becomes. The clearer the language, the more we are in touch with reality, and the better the decision to be made.

The Committee benefits from Members such as the noble Baroness, Lady O’Neill, with her clarity of thinking, accuracy of expression and modesty in presentation. I commend the amendment. Returning to my first point, there should be truth in legislation and, using her advice, we should pass this amendment because it is commensurate with the gravity of the issue with which we are dealing: life, or death, committed at the hands of a third party.

[Baroness Meacher (CB)]

My Lords, I want to make one brief point. I agree with the speakers who have contributed so far that we need clarity and truth. The issue here is the decision to be made. If someone wants to commit suicide, they are deciding whether or not they wish to die. This Bill is not about that at all. It is about people who are dying, and the only question for them is how they die and whether they can die with dignity. That is an entirely different question, and it is extremely important that the Bill is absolutely clear about that distinction.

[Lord Cormack (Con)]

My Lords, I hate to cross swords with the noble Baroness, for whom I have enormous respect, but frankly she is wrong. This is about accelerating a death by wilful means, and there is no case for ambiguity here. The noble Lord, Lord Brennan, has made a powerful speech and I endorse all that he said. There is no case for ambiguity. We are talking about terminally ill people who have decided— often, I imagine, after long and careful thought and in consideration of their families—that they want to bring forward the termination. That is suicide, and they are going to be assisted. It would be in the interests not only of clarity but of honesty to make the Bill the “assisted suicide Bill”, because then we would know what we are talking about and people in the country would know what we are talking about. There is a powerful case for the Bill and a powerful case against it, but there is no case at all for fudging it.

--- Later in debate ---

[Baroness Finlay of Llandaff]

I am grateful to the noble Lord for that illustration, which is very clear and well known to all Members of the House. It is for that type of reason that I have proposed the removal of the word “reasonably” from Clause 2(1)(b) of the noble and learned Lord’s Bill.

A number of clinicians have tried to predict prognosis—for instance, whether to take the risk of a heart or lung transplant, and when to introduce palliative care in non-cancer services for the frail elderly. However, they have found that they just cannot determine time. Prognostication is reasonably accurate on the population level but, as the noble Lord, Lord Winston, has just illustrated, it is not accurate at an individual level at all. It is no better than tossing a coin. Indeed, different studies have shown that a prognostication expecting someone to live for more than a year is not too awfully wrong. Similarly, expecting somebody to die within a month is more likely to be accurate than inaccurate. However, in the interval in between you honestly could toss a coin on it. It is for that reason that I suggested that, if the prognosis in the Bill really is to deal with those people who are distressed during their dying phase, the prognosis section should be shortened to six weeks.

There are other aspects to prognostication that I will point out to the noble and learned Lord, Lord Falconer. The national clinical director for end-of-life care told the commission that he chaired that predicting the course of a terminal illness is “fraught with difficulty”. In 2004 the RCGP made the same point to the Select Committee chaired by the noble and learned Lord, Lord Mackay:

“It is possible to give reasonably accurate prognoses of death within minutes, hours or a few days. When this stretches to months then the scope for error can extend into years”.

The Royal College of Physicians, giving similar evidence, said that,

“prognosticating may be better when somebody is within the last two or three weeks of their life … when they are six or eight months away from it, it is actually pretty desperately hopeless as an accurate factor”.

More recently, we have seen in the report from the inquiry into the Liverpool care pathway, chaired by the noble Baroness, Lady Neuberger, how prognoses of death within 48 hours have sometimes turned out to be wrong. The report called for further research into improving the accuracy of prognosis within the last weeks to days of life.

Yet, in the face of all this evidence, we are being asked to consider legalising assisted suicide or assisted dying for people with a prognosis of six months. The only conceivable explanation is that that is what Oregon’s assisted suicide law says. However, Oregon’s law has been shown to be fallible in the matter of prognosis. Oregon’s own data show that the time from the first request to death by whatever cause, whether through physician-assisted suicide or natural causes, ranges from 15 to 1,009 days, which is two years and nine months. Washington’s data show that, among those being given a prescription for lethal drugs and therefore expected to die within six months, the range was three to 150 weeks. I note that, in every year of that legislation since it has been passed, patients have lived well beyond 24 weeks or six months. The percentage ranges from 5% to 20% of a request for death.

The plain fact is that prognosis of “terminally ill” is highly unreliable over a range of six months. The DS 1500 has been used as a way to allow patients to access benefits rapidly, without having to go through assessment hoops. However, as those who have filled them out know only too often, it is only a guesstimate. Very often, patients vastly outlive the prognosis. We have had to have difficult conversations about how they should now go through the complete assessments. I tabled a Question to ask whether the Department for Work and Pensions collected data on the DS 1500. Unfortunately, it does not. It would be interesting to know for how many months that benefit had been drawn.

The plain fact is that this is unreliable. As a practitioner in the field, I can count the number of terminally ill people whom I have treated. I have not tallied them up among the thousands that I have looked after, but I could bore this House for weeks with the number of clinical stories of people who were expected to die within six months and who stayed alive for much longer. Those are the reasons behind these amendments. I hope that those who are arguing sincerely that the Bill aims to try to improve the dying process in those last days and weeks of life will seriously consider that they are asking people to make a prediction on which there really is not a scientifically accurate basis.

[Baroness Meacher]

The noble Baroness placed a great deal of emphasis on accuracy. Those points completely fail to take account of the fact that we all have a great will to live. Just because the individual finally has control and some autonomy does not mean that they will rush out to try to take some pills. I feel that this is a completely misguided set of arguments. The most important thing about the Oregon law, which has been in place for 17 years and works extremely effectively, is precisely that some people live for three years. They do not take their lives; they live for three years until life becomes unbearable. It is only at that point that they take the pills or whatever it is. We have to be very careful not to be misled, albeit one can come back with arguments that most doctors exaggerate the length of time that they expect people to live. Even that is not the point.

[Baroness Finlay of Llandaff]

When we legislate we need to know that there is accuracy attached to the terms. If we are asking doctors to make a declaration or statement of prognosis, they must at least know that there is some scientific basis behind it. In making a decision, there are three fundamental issues; first, the person must have accurate information; secondly, they must have the mental capacity to make that decision; and, thirdly, it should be voluntary and free of coercion. If you make the decision to end your life because you believe that what lies ahead in the next weeks and months is so terrible but, in reality, you might have improved dramatically and lived for years if you had had the care you needed, then I would say that you are not being supplied with accurate information and that it is therefore not a valid decision.

--- Later in debate ---

[Lord McColl of Dulwich]

I have been trying to intervene for some time. I strongly support the amendment on terminal illness tabled by the noble Baroness, Lady Finlay, but noble Lords will be pleased to know that most of what I was going to say has already been said so I will not repeat it. It was said very ably by the noble Baroness, Lady Campbell of Surbiton, for whom I have the greatest admiration and with whom I have worked for many years.

There is an aspect of the definition of terminal illness that I should like to deal with. Under the benefit rules, an attendance allowance or a personal independence payment can be made under special rules if somebody has a terminal illness. The definition is therefore important. My understanding is that, for the purposes of receiving one of those benefits under the special rules, someone is defined as being terminally ill if they have,

“a progressive disease and his death in consequence of that disease can reasonably be expected within 6 months”.

This definition is set out in Section 66 of the Social Security Contributions and Benefits Act 1992. Are we going to say that anyone who receives one of these benefits would be eligible for assisted suicide on the basis of their physical health? I raise this as a genuine question because the Personal Independence Payment Handbook, issued in August 2014, also states:

“Awards made under the special rules for terminal illness will be for 3 years”.

This seems to be rather at odds with the expectation that the person is reasonably expected to die within six months.

To get this benefit, individuals have to get a completed DS 1500 form from their doctor, as has been mentioned. In a forum discussion on the internet, many of the individuals who got the benefit as a result of this form were definitely of the view that they would be living for more than six months. I am concerned that in future they might be encouraged to consider assisted suicide because they would fall within the definition of the Bill. The form was also referred to in the House of Lords report on the Bill of the noble Lord, Lord Joffe. I quote one doctor, who said:

“A simple bit of practical evidence is one of the benefit forms that are filled in for patients assigned to the doctor thinking that the patient has six months to live. I would not like to count how many of those forms I have signed in my life for patients still living after a year, eighteen months or even longer”.

Another doctor giving evidence to that committee about decisions on who had a terminal illness said that,

“doctors make arbitrary decisions about when a patient has reached a terminal stage. This can be when the patient is discharged from specialist care, when the patient moves from a curative state to a palliative state; some just use the position when what is known as the DS 1500 Form is actually prescribed, or some just use the point where patients have become bed-ridden or immobile”.

Surely we need something far more rigorous than someone being “reasonably expected” to die within six months when the consequence is that their life is actually ended. I fully support Amendment 20 of the noble Baroness, Lady Finlay, to remove the word “reasonably”.

[Baroness Meacher]

Perhaps I may pick up the point about a six-month prognosis. The point there is that one’s life is ended. The whole point of the Bill is that one’s life is not ended simply because one starts the process at the point when one receives the six-month prognosis. It is all about having autonomy and a sense of control over one’s own situation, so that when life becomes unbearable one can then take that control.

[Lord McColl of Dulwich]

I thank the noble Baroness for that clarification. I note that in August 2011, 13,400 individuals receiving attendance allowance in England and Wales were considered terminally ill under the benefits definition. That would be a substantial group of people who might reasonably be eligible to have their death hastened by assisted suicide. We need to be very clear what we are talking about in relation to a terminal illness and, at the moment, there is a lot of room for ambiguity. Ambiguity does not lead to safeguards.

Criminal Justice and Courts Bill

Baroness Meacher Excerpts

Monday 20th October 2014 Lords Chamber

Moved by

[Baroness Meacher]

42: Clause 19, page 18, line 3, leave out “It is an offence for”

[Baroness Meacher (CB)]

My Lords, I shall speak also to Amendment 43A, which takes the place of Amendment 43 on the Marshalled List. The intention was to have withdrawn Amendments 45 and 46, so I shall not refer to those two amendments today.

I must apologise to the Minister and your Lordships for coming into this debate rather late in the day. The noble Baroness, Lady Finlay, who I was going to say is not in her place but who now is, is the person who has raised the concerns about Clause 19 at earlier stages and had a very helpful meeting with the Minister.

Clause 19 introduces a new offence of ill-treatment or wilful neglect by care workers, including doctors and nurses. A similar offence for care providers is introduced in Clause 20. I have less of a problem with an offence of ill-treatment—it seems to me that that is a proactive act which is a little bit clearer—but I have no doubt that an offence of wilful neglect of an individual would lead to criminal investigations of good clinicians simply because patients may believe that they should have had medications or treatments which were not appropriate at the time or may have been judged not appropriate by the relevant clinician.

Our amendments would raise the bar for such offences for individual doctors and nurses by introducing the requirement that the care worker commits an offence only if their activities amount to a gross breach of a relevant duty of care owed to the individual who is allegedly ill-treated or neglected. Of course, I understand the history behind Clause 19 and the fact that offences already exist for ill-treatment and wilful neglect of children in certain circumstances and of adults who lack capacity. I suggest that such situations are rather different from those of competent adults in, for example, an acute hospital or GP surgery. My concern is that we have lost sight of proportionality here, and the consequences will be disastrous, both for good, conscientious clinicians and for the NHS, with its impending £30 billion funding gap.

Of course, none of us can accept ill-treatment or wilful neglect of patients—and I will come back to that in a while. I wonder whether those in the Government who designed this new offence for individual clinicians have really appreciated the devastating effect on conscientious care workers if they find themselves under criminal investigation when it is clear that they have used their clinical judgment in good faith or done their very best with the resources available to them.

The Government have stated that the offences are intended to deal only with the most serious incidents—that has to be right. However, the offence is broadly drafted and the police will have an obligation to investigate cases of alleged neglect unless it is absolutely clear at the outset that there is no case to answer. Almost any decision could potentially be investigated for wilful neglect, even though, later, the vast majority and probably the whole lot would not go all the way to prosecution and a guilty verdict. The question of proportionality is therefore highly relevant.

Criminal investigations are incredibly disruptive, time-consuming and costly. The potential cost to the NHS of disproportionate criminal investigations is impossible to estimate accurately, but my main concern is the unwarranted distress and catastrophic nightmare that such investigations would cause for the conscientious worker—and the vast majority facing investigation probably would be conscientious workers. It is not acceptable for the Government to say that it would be up to prosecutors not to prosecute other than in serious cases. It would be far too late at that stage to prevent the damage. Doctors and nurses are likely to find themselves suspended during a criminal investigation—it is very different from a disciplinary investigation. Their self-respect, and professional and public respect, will be in ruins. Huge damage will have been done before the matter comes anywhere near prosecutors. Does the Minister agree that the problem with Clause 19 is the investigations rather than, later down the line, the prosecutions?

I am aware of the Government’s consultation in March this year on the proposed formulation of the new offence. They claim, and I do not doubt it, that the 130 responses indicated broad support for the proposals. On the face of it, they sound eminently reasonable—how could one disagree with them that we need to deal with these problems—but I question the clarity of the consultation documents on the consequences of Clause 19 and those investigations. I do not believe that the British people would support the cost, disruption to services, and devastation caused to good workers, doctors and nurses that criminal investigations would create under these provisions.

I understand that the appalling consequences for doctors in hospital settings have been debated at earlier stages of the Bill. I agree with others that Clause 19 will be entirely disproportionate in its consequences for those hospital staff. I will focus on GPs because they are incredibly vulnerable to malicious complaints.

As things stand, we know that GPs daily experience fear of complaints. We know, and the Minister knows, that GPs regularly have to see 60-plus patients in a day. Many of those patients will have relatively minor ailments, but in that list will undoubtedly be patients with life-threatening illnesses. This means 10 hours of stressful, direct patient contact. Any one of those patients may leave the surgery dissatisfied, rightly or wrongly, with the outcome of the consultation. The patient may want an antibiotic and the doctor may know that it is not the right thing. The issue then is whether the doctor really has the time to explain the whole business about why an antibiotic may not be a good idea. That is their vulnerability: if they had all the time in the day slowly to explain to patients, or to people with learning difficulties or language problems or whatever it is, there would be no problems, but doctors do not have that luxury, and GPs certainly do not. Any angry patient could regard this as wilful neglect. Of course, it is not, and ultimately there would not be a prosecution, but the investigation will nevertheless have to take place.

The point then is not about the prosecution. Does the Minister really believe it appropriate for the threat of a criminal investigation to hang over GPs, nurses and doctors every time they go to work? I could not cope with work if every day—and every 10 minutes—I was worried that I might face a criminal prosecution for the judgment I was making. I say it again: we will not tolerate ill treatment or wilful neglect of patients. The question is whether Clause 19 and criminal investigations are the best way of dealing with these issues.

Have the Government assessed the likely impact of this new offence on the willingness of doctors to become GPs and on their early retirement plans? In this country we already have a shortage of doctors willing to train as GPs. Large numbers of doctors—six in 10, we understand—are planning early retirement. What will happen to the supply of GPs if Clause 19 comes into effect? The BMA describes the situation already as having reached crisis point. GPs are moving abroad as the pressures in this country become more and more unpleasant.

Applicants for GP training are at their lowest level for five years. Advertisements for GP partners that we know five or 10 years ago would have had 30 responses now receive maybe none. Nobody wants to be a GP partner these days even in quite desirable areas—and I happen to know a few. At the same time the pressure to transfer more care into the community rises year on year. I appeal to the Minister to think again before Third Reading. The Minister can quote from the ambitious figures for the number of GP training places to be made available, but will there be any trainees to fill those places? There is also the expectation—I would say a wish—that the number of trainee doctors becoming GPs will increase from 40% to 50%. Well, I doubt it if this clause becomes law.

Amendments 42 and 43A seek to raise the threshold for a criminal investigation of a professional care worker. I read the Minister’s letter to the noble Baroness, Lady Finlay, but I have to confess that I was not persuaded by the arguments. As I said, none of us can condone ill treatment or wilful neglect of patients. I have repeated that again and again because that is not the point here. The point is how we deal with these things not whether we do so. The Government have strengthened the Care Quality Commission and I applaud them for doing that. The Care Quality Commission needs to be able to deal with these things effectively, and much better they be dealt with through the Care Quality Commission than in this way. I hope the Minister can assure us that further thought will be give to this damaging clause before Third Reading. I beg to move.

[Baroness Finlay of Llandaff (CB)]

My Lords, I apologise for coming in just after my noble friend Lady Meacher had started speaking, due to traffic congestion. I am most grateful to her for having put the amendment so clearly. I endorse the point that nobody, but nobody, thinks that wilful neglect is all right. It is not all right. It is not to be allowed to even happen let alone condoned. The problem is that the burden of proof on the individual and on the organisation that employs them has been set at different levels as the clauses are currently drafted. The requirement is to prove gross neglect for an organisation but that had not appeared in relation to the offence committed by the individual. The difficulty is proving intent.

I had a meeting with the Minister at which he spent a great deal of time—I am very grateful to him—and he replied fulsomely with a long letter following that conversation. I remain unconvinced that the Bill will not effectively result in healthcare professionals being hung out to dry—that was a phrase I used before and I use it again—by an organisation that does not support its clinical staff adequately when serious complaints come in. At the end of the day, it is not wilful neglect but it is interpreted and viewed by understandably distressed relatives as neglect of their relative who may have suffered serious harm within the system or become extremely ill because of the progress of the disease. Although the work conditions for the staff have made it extremely difficult for them to function well, they have not been guilty of wilful neglect.

I stress that I do not think this applies only to nurses and doctors. If a physiotherapist or an occupational therapist declines to comply with a request from a patient or their family, that could be interpreted by the family or patient as wilfully withholding something that they feel they need. There is then some unintended adverse incident further down the line that was not predicted and the complaint goes against that healthcare professional. No one should underestimate how damaging it is to a healthcare professional to have a complaint made against them, and how most extremely conscientious healthcare professionals can feel quite destroyed by a complaint. However, an accusation of wilful neglect that goes to the police would certainly destroy somebody’s professional reputation. Even if it proceeds no further, they will find it very difficult to shed the trauma of that experience of being referred to and investigated by the police.

I hope the Minister can clarify exactly how intent will be interpreted and implemented, and how it will be proven that an organisation has intent to neglect patients. I suggest that the organisation can prove that it did not directly intend to but, actually, if it is really badly managed and is not supporting its front-line workers, it is neglecting patients because it is not allowing its staff to do their duty properly. However, I can see that such an offence would be very difficult to stick anyway. Certainly, if the burden of proof is higher for the organisation than for the individual, as I said before, I foresee that people will be hung out to dry.

--- Later in debate ---

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, I thank all noble Lords for their contributions to the debate on these important new offences. I have listened carefully to all four speeches. If I may, I shall start with government Amendments 47, 48, 49 and 50. These are minor and technical amendments, which add additional types of excluded care provider to those already identified in Clause 21, for the purposes of the care provider ill treatment or wilful neglect offence in Clause 20.

The Clause 21 exclusion currently applies to local authorities when exercising their functions in respect of the provision of education and other children’s services and other organisations when exercising social work functions relating to children on behalf of a local authority. It has come to light that a small number of third-party providers might also exercise education or other children’s services functions on behalf of the local authority or instead of the local authority, following a formal direction from the Secretary of State, or, as the case may be, from Welsh Ministers. Clearly, it would be unfair for such provider organisations not to be excluded from the care provider offence to the same extent that the local authority would be if it were exercising the relevant functions itself. Amendments 47 and 48 therefore remove these organisations, to the extent that they are providing those services, from the meaning of a “care provider” for the purposes of Clause 20 in England and Wales.

Amendment 49 makes similar provision in relation to independent agencies that provide adoption support. Those providers that are run by local authorities will already be covered by the exclusion in Clause 21. However, as currently drafted, independent agencies with which a local authority has made arrangements for the provision of adoption support, will not. Amendment 49 corrects this small inconsistency. I hope that that is helpful to the noble Baroness, Lady Thornton. The organisations in question are “registered adoption societies” and “registered adoption support agencies”. Amendment 50 places definitions of these phrases in the Bill. I am sure that noble Lords will agree that it is important to make these changes, to ensure that there is consistency and equity in the application of the care provider offence across organisations. To answer the express question of the noble Baroness, Lady Thornton, who asked whether the exemptions included private adoption agencies, free schools and academies, the answer—as I hope she has gathered from my remarks—is yes.

Amendments 42 and 43A, in the name of the noble Baroness, Lady Meacher, seek to achieve two particular purposes, and try to put the individual care worker offence on a par with the care provider offence. They restructure Clause 19(1) so that the care worker offence is dependent on there having been a gross breach of a duty of care owed by the care worker to the victim of the alleged ill treatment or wilful neglect. I understand the point that the amendments seek to make—that there should be some kind of a threshold in order for the offence to bite.

However, there are real problems with the noble Baroness’s approach. We have approached the issue in a different and, I suggest, a better way. The “wilful” element of neglect, and the intent to cause harm required for someone to be found guilty of ill treatment, means that the threshold for this offence as drafted in the Bill is very high and, by its very nature, captures only the worst types of behaviours. Our view is that should a care worker ill treat or wilfully neglect someone in their care, that would always represent a gross breach of a duty of care. It seems to us that a care worker who is being paid to provide healthcare or adult social care services will always owe a duty of care to the individual to whom those services were being provided. That ill treatment or wilful neglect of the individual, which would involve some form of deliberate act or omission, would amount to a gross breach of that duty.

Regretfully, accepting the noble Baroness’s amendments would cause significant unnecessary confusion and complexity and it would risk diverting attention away from the central issue of what has been done by that individual care worker in respect of a person in their care. It would be unhelpful to introduce the concept of a duty of care explicitly. Moreover, specifying that there must be a gross breach of the duty of care in effect raises the threshold before the offence could come into play. There would be a very real risk that behaviour which anyone would recognise as ill treatment or wilful neglect could go unpunished. Any ill treatment or wilful neglect is totally unacceptable, and the care worker offence is drafted very carefully to reflect that. The Government could not accept any amendments that might undermine that and make it harder in practice to prosecute an individual care worker. The approach that we have taken is simpler, clearer and more logical.

The noble Baroness, Lady Meacher, expressed her fear that our proposals might lead to an avalanche of cases and to innocent professionals being “hung out to dry”, as it was put. To address that point, it is important to note that employees of a hospital or a care organisation are already subject to other statutory duties in relation to the care of patients, for example with regard to negligence and to health and safety. The offence that we are proposing would only bite if someone behaves in a way that meets the criteria of the offence—the very worst cases where their behaviour amounts to ill treatment or wilful neglect. We do not share the pessimistic view of the attitudes of health and social care staff that—

[Baroness Meacher]

Can the noble Earl explain what he means by “will not bite”? He seems to be saying that the doctor or nurse will not be found guilty if they have not indulged in a gross breach of duty, but does the noble Earl accept that these doctors and nurses could easily find themselves under criminal investigation even if they have acted utterly properly and with good faith? That is the issue, rather than the issue of where it bites.

--- Later in debate ---

[Earl Howe]

My Lords, this is Report stage so I shall be brief, but I am grateful to my noble friend for the point she has made. I understood from the noble Baroness, Lady Meacher, that she was not proposing to speak to Amendments 45 and 46. Nevertheless, the noble Baroness, Lady Finlay, raised a point about the unevenness between the two offences. However, I agree with my noble friend Lady Barker. If we interfere with the wording as drafted in the Bill, we are in serious danger of doing the very opposite of what the noble Baroness, Lady Finlay, seeks, which is to have the two offences broadly on a par with each other.

[Baroness Meacher]

I thank the Minister for his response. I do not believe that offences for GPs and other doctors involving competent adults are comparable with offences for front-line staff dealing with incapacitated adults or children. The noble Earl indicated that they are somehow comparable, and that because there has not been a swathe of complaints in relation to the earlier offences, we would not get them here. I think we would and that has not been fully dealt with. I recognise what the noble Earl has said—and certainly recognise what Paul Burstow has said—and do not have concerns about Clause 20 in particular, but there are concerns about this. We have not been able fully to deal with matters today and I hope that we can have a further discussion with the Minister before Third Reading. I understand the purpose of Third Reading but it is very difficult to feel that we can just leave this here when there are so many ends not tied up at this stage.

[Earl Howe]

I am sorry to disappoint the noble Baroness but I cannot undertake to agree that the Government’s position will change on this matter.

[Baroness Meacher]

I understand what the noble Earl is saying but we need to discuss how we take this forward and what we do at Third Reading. With that, I beg leave to withdraw the amendment.

Amendment 42 withdrawn.

Assisted Dying Bill [HL]

Baroness Meacher Excerpts

Friday 18th July 2014 Lords Chamber

[Baroness Meacher (CB)]

My Lords, I support the Bill of the noble and learned Lord, Lord Falconer, and I will respond to a few of the concerns expressed by the Bill’s opponents. I am very saddened to find a number of people who I greatly respect on the other side of this argument.

Several Peers have told me that their main concern about the Bill was that it might change our attitude to death, but we must change that attitude and end the taboo which has prevented terminally ill people talking about their plight. People often go to their graves lonely and in fear and misery, feeling unable to talk to anyone about what they face.

Former Archbishop Desmond Tutu is surely right; he called for a mind shift in the right-to-die debate. That shift has, of course, happened in a very safe way in Oregon, the example followed closely by the Bill. We know that more than one-third of terminally ill people in Oregon have in fact talked about their forthcoming death. Many choose to discuss their options and have had their fears allayed and wishes met. The result is that only 752 people have finally taken the pills or whatever out of nearly 500,000 deaths since the introduction of the law 17 years ago. I must add that there has been no move to abolish the law—or indeed to extend it to other groups, a fear that many have mentioned. Everyone in Oregon benefits from knowing that they can end their suffering if it becomes unbearable. We all know that any suffering is more bearable if we can do something about it.

Our opponents say that they fear unscrupulous relatives. In Oregon, concern about being a burden to the family is not a significant factor in choosing an assisted suicide. The former chief executive of the Oregon Hospice Association, no less, told us that concerns about being a burden are commonly voiced by terminally ill people, whether or not they seek an assisted death—that is a common feeling when you are terminally ill. Our opponents need not fear abuse by relatives; the safeguards have been shown in Oregon to deal with this relatively small problem very well.

In their literature, our opponents have taken a quote from Keir Starmer, the former DPP, out of context to imply that he is content with the law as it stands. I spoke to Keir Starmer last week. This was not his meaning, but his guidance has resulted in the investigation of 84 cases of assisted dying. In every one, the relatives have been deeply compassionate and none has been prosecuted. I hope that the misleading quote from the former DPP will be removed from our opponents’ literature.

Our opponents have suggested that people who are depressed and may not have capacity have had an assisted death in Oregon. The former CEO of the Oregon Hospice Association, a convert to the Assisted Dying Act since it was introduced, made it clear that only those whose judgment is sound will have an assisted death. Many people with depressive feelings have those feelings because of their terminal illness, and their judgment is perfectly sound.

Lastly, a medical Peer said that, as a doctor, she could not face both ways. My noble friend does not need to. The guiding principles for every doctor in all their work are, of course, to follow the best interests of the patient and to respect a competent patient’s autonomy, wherever that takes them. These principles provide a clear direction of travel for any patient wanting help to end their intolerable suffering.