Terminally Ill Adults (End of Life) Bill

Caroline Johnson Excerpts

Friday 16th May 2025 Commons Chamber

[Kim Leadbeater]

I will make some progress, if I may.

This is essentially about providing flexibility for doctors while ensuring continuity of care for patients, and I hope colleagues can support new clause 11.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

Will the hon. Lady give way?

[Kim Leadbeater]

I will make a little more progress, if I may, because a lot of people want to speak.

New clause 12 ensures that there is thorough reporting of instances where the co-ordinating doctor concludes that the patient does not meet the strict eligibility criteria set out in the Bill. It is very important that this data is recorded, but at present there is no requirement for the co-ordinating doctor to produce a report when they are not satisfied about all matters set out in clause 23(5) and will not provide the person with the approved substance. That lack of a reporting obligation does not align with the rest of the Bill—hence new clause 12, which I am sure colleagues will feel it is important to support.

[Kim Leadbeater]

That would not be an issue, because copies of the report would be given to the patent, the co-ordinating doctor if they are not in the patient’s GP’s practice, and the commissioner, so that information would be recorded, and it is very important that it is. The report must set out the reasons—

[Dr Caroline Johnson]

Will the hon. Lady give way?

[Kim Leadbeater]

I will make some progress, if I may. I am trying to be very open to interventions, but I do need to crack on.

The report must set out why the co-ordinating doctor is not satisfied and must contain an explanation of why the patient cannot proceed with the assisted dying process. The co-ordinating doctor must give a copy of the report to the person, to the person’s GP practice if they are not a practitioner within that practice, and to the voluntary assisted dying commissioner. That reflects the thorough and robust reporting and monitoring mechanisms throughout the Bill.

I turn to the other amendments in my name. I will try to keep my comments succinct, as many colleagues wish to speak. Amendment 56 ensures that the co-ordinating doctor gives the commissioner a copy of the patient’s first declaration. That enables the commissioner to carry out their monitoring responsibilities under clause 45. Amendments 57 and 61—

[Dr Caroline Johnson]

Will the hon. Lady give way?

[Kim Leadbeater]

I will.

[Dr Johnson]

Persistence pays off. When considering the Bill, I had presumed that the doctor concerned would be a senior clinician—a senior doctor—but page 63 of the impact assessment refers to pre-registration doctors, who have just completed medical school and are on a provisional registration. Will the hon. Lady confirm that it is her intention that the provisions in the Bill may be carried out by the most junior doctors, as well as by more senior consultants and general practitioners?

[Kim Leadbeater]

I thank the hon. Lady for her intervention. Given her background, she knows what she is talking about. Regulations will set out the level of expertise required by the doctor, but there will also be training for every single doctor taking part in the assisted dying process. That is done well around the world, so there is work we can build on in that regard.

Amendments 57 and 61 are essentially tidying-up amendments that modify the wording of the Secretary of State’s duty to set out training requirements in clauses 7 and 10. That fits with the intervention from the hon. Member for Sleaford and North Hykeham (Dr Johnson). Training is of paramount importance within the assisted dying process, and there will be a period of years in which anyone who opts in to be part of this process will have thorough and robust training.

Due to amendments made in Committee, with very good intention, the current wording suggests that the regulations themselves must include details about training. That obviously does not make sense and would be unworkable, as it would have to be done separately. Similarly, amendment 58 removes unclear drafting as a result of changes made in Committee that could have the effect that the regulations have to contain training about training, which obviously does not make sense.

Amendments 59, 52, 74 and 62 are also tidying-up amendments that are necessary as a result of the introduction of compulsory training for all doctors and panel members in domestic abuse and coercive control, following amendments tabled by my hon. Friend the Member for Lowestoft (Jess Asato), which the Bill Committee voted unanimously to accept.

Amendment 74 ensures that the term “domestic abuse” in the Bill has the same meaning as in the Domestic Abuse Act 2021. It clarifies the definition of “domestic abuse” and ensures that the term is consistent with existing legislation. It provides for a very broad definition to capture the full range of behaviours, including physical or sexual abuse, violent or threatening behaviour, controlling or coercive behaviour, economic abuse, and psychological, emotional or other abuse. It does not matter whether the behaviour consists of a single incident or a course of conduct. These really important amendments address concerns about coercion and provide additional layers of safeguarding within the Bill. As such, I hope colleagues support them.

Amendment 60 makes provision, corresponding to the provision in clause 12 about the death or illness of a doctor from whom a second opinion is sought, for a further referral to be made where, before reporting, the independent doctor dies through illness, or is unwilling or unable to act. The amendment once again ensures continuity of care and is an important detail to add to the Bill.

Amendments 67 and 68 clarify the provision of clause 23 in cases where an approved substance requires administration via a medical device. The current drafting of the clause is not clear about whether it is allowable to administer the approved substance via a device, which it is. The amendment provides clarity for clinicians.

--- Later in debate ---

[Rebecca Paul]

My hon. Friend makes a good point, and I agree. In the interests of time, I will make some progress.

The current situation, whereby fully funded palliative and end-of-life care is not available in certain postcodes, means that those unfortunate patients do not have a real choice. We know that 25% of people who die in this country do not get the palliative care they need—that is more than 100,000 people a year—and if the Bill goes through, they will be offered a fully funded assisted death as the only reliable way to end their pain. That is no choice. I urge Members who want to see improvements in palliative and end-of-life care to vote for my amendment 80, and for amendments 30 and 31, tabled by my hon. Friend the Member for Runnymede and Weybridge, if they are pushed to a vote.

[Dr Johnson]

Will my hon. Friend give way?

[Rebecca Paul]

I will not because I do not have much time.

I will move on to the lack of a best interests test in the Bill, which my new clause 16 seeks to remedy. Patient autonomy is of course important, but it must be balanced against what is in someone’s best interests. In certain situations, when it is in their best interests, treatment can be given against a patient’s will—for example, force-feeding a young girl with anorexia. It is not an easy balance to get right, but in the absence of any best interests test in the Bill, following the process rigidly would lead to devastating results in some cases.

The Bill currently prioritises autonomy of the patient in a specific moment of time, rather than what might be in their best interests in the long run. It makes no allowance for the fact that someone may feel a certain way temporarily due to other considerations. For example, when someone has just received a terminal diagnosis, it can understandably cause a depressive state and suicidal feelings, but those feelings do not necessarily last, so it may be in the best interests of the patient to allow a little time to pass, to give them a little breathing space before considering the assisted death route.

New clause 16 essentially tries to provide a best interests test by excluding certain reasons, other than the alleviation of pain, that might be driving a patient’s decision. For example, we have heard a great deal about the internal pressure from patients themselves that is driven by their concern not to be a burden, and we heard clearly in Committee that a patient could tell a doctor that they are want an assisted death only for financial reasons, and that would still be approved. We know from the experience of overseas territories that patients will often opt for an assisted death because of social and welfare issues, such as being homeless.

--- Later in debate ---

[Dame Meg Hillier]

I thank my right hon. Friend for that intervention. Given her many years as a constituency MP in the same borough as me, we both know many such vulnerable people. Dr Rachel Clarke, a hospital palliative care doctor, said:

‘If, for instance, you say to a vulnerable patient who has just been told they have a diagnosis of terminal cancer, “Have you thought about assisted dying?”, I would suggest that stating it broadly like that is a form of pressure and that you are potentially unintentionally coercing that patient.’––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 75, Q93.]

So we are in a very difficult space, as my hon. Friend the Member for Stroud (Dr Opher) highlighted, with his background as a practising GP. We recognise that. As I have said, this is an imperfect process to deal with that challenge, but it is a very different set of circumstances compared with the other advice that doctors give.

[Dr Johnson]

rose—

[Dame Meg Hillier]

Speaking of doctors, I give way to the hon. Lady.

[Dr Johnson]

I rise to support the hon. Lady’s new clause 1. As a doctor, I am very aware of the trust that the public place in doctors and the seriousness with which they take what we say. If a doctor gives somebody information about assisted dying, it is quite reasonable for that person to think that the doctor is suggesting that they should take part in that process, or is hinting that their death will be dreadful and trying to be kind. If doctors are allowed to say, “This is a good process,” more people will take it up than would otherwise have wanted to.

[Dame Meg Hillier]

I thank the hon. Lady.

Oral Answers to Questions

Caroline Johnson Excerpts

Tuesday 17th March 2020 Commons Chamber

[Andy Carter (Warrington South) (Con)]

1. What diplomatic steps he is taking with his international counterparts to tackle the spread of covid-19.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

11. What diplomatic steps he is taking with his international counterparts to tackle the spread of covid-19.

[Michael Fabricant (Lichfield) (Con)]

12. What steps he is taking with his international counterparts to ban wet markets and butcheries in (a) China and (b) south-east Asia where viruses have crossed the animal-human interface; and if he will make a statement.

--- Later in debate ---

[Dominic Raab]

We are working with £241 million of aid funding and investing £65 million in research to support vulnerable countries’ capacity to tackle this. The Foreign Office is regularly reviewing our travel advice, and consular staff are working with British nationals right across the world to give them the support and advice that they need. I will be making a further statement after oral questions.

[Dr Caroline Johnson]

What discussions is my right hon. Friend having with his counterparts in countries such as the United States, Australia and Israel, which are working actively on a vaccine for covid-19, so that we can share information from our research and develop a vaccine more quickly together?

[Dominic Raab]

I thank my hon. Friend for that question —I know how expert she is in this field. We are, of course, emphasising the importance of vaccine research and encouraging the scientific community to co-ordinate. In particular, we want to prioritise collaboration on vaccine research, including with financing and co-ordination through the Coalition for Epidemic Preparedness Innovations fund.

Antarctica: Science and Diplomacy

Caroline Johnson Excerpts

Tuesday 28th January 2020 Westminster Hall

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

It is a pleasure to speak under your chairmanship, Mr Robertson. I thank my hon. Friend the Member for North Wiltshire (James Gray) for securing this debate on an extremely important issue. He is a great advocate for the polar regions and of the need to protect our oceans. I am pleased to be a member of the APPG for the polar regions, which he chairs. My interest in the polar regions came about when I went on holiday with my husband to the Arctic region in 2015. I found the place both beautiful and fascinating and have been pleased to be able to go back since.

As has been said, 2020 is a historic year because we are marking the 200th anniversary of the first sighting of Antarctica by the Royal Navy Captain Edward Bransfield in 1820. In the 200 years since, Antarctica has had a very special place in people’s minds, but it has never been at greater risk than it is now—from two things: intrusive foreign powers and climate change.

The first threat is the more diplomatic issue. Many countries are interested in the potential of as yet unexplored and untapped mineral wealth in the region. The Antarctic treaty, which my hon. Friend mentioned, has stood the test of time—indeed, it celebrated its 60th anniversary last year—but it bans exploration for natural resources only until 2048. Obviously, when the treaty was written, that seemed like a long time ahead; it is now just 18 years away, so I am interested to know what my hon. Friend the Minister is doing to ensure that there is no exploration after that date. The possibility of unexplored oil and gas fields, coupled with the world’s largest supply of freshwater, means that the Antarctic is potentially a very attractive place to foreign actors interested in exploiting rather than preserving it. It is particularly concerning that China has stated that its objective is to “understand, protect and use” Antarctica. Concerns have been raised about what it means by the word “use”.

The second issue is climate change.

[James Gray]

I am sorry to interrupt my hon. Friend so soon; she is making an excellent speech. If it is any reassurance, the Chinese were at the Antarctic parliamentarians assembly before Christmas and they signed up to the statement and showed no inclination of any kind whatever to breach the Antarctic treaty now or in the future, so I think we can be assured that the Chinese are firmly on side.

[Dr Johnson]

That is fantastic news. I am pleased to know that all countries will work together to preserve that fantastic continent and I am therefore hopeful that we will be able to sign another Antarctic treaty lasting for another 75 years.

It seems ironic that it is the fossil fuels and the possibility of finding them that make Antarctica alluring to foreign powers but are also the thing that is causing its demise. I was interested to read a BBC report from Justin Rowlatt today. He had a very exciting visit, by the sound of it, to Antarctica and has talked about the challenges that he faced just in getting to the ice sheet and being able to stay there and see what was happening, because of the storms. The report describes the east Antarctic ice sheet as being on land and about a mile thick, being relatively stable and not really sinking into the sea, and being relatively unchanged, but it describes the west of Antarctica as being ice largely floating rather than on land. That is a smaller proportion of Antarctica—only 20%—but it is much more vulnerable to the effects of climate change, of global warming, and therefore to melting into the sea.

The Thwaites glacier, which my hon. Friend the Member for North Wiltshire described, is about the size of Britain, but is melting. Unfortunately, there seems to be a bit of a vicious circle, in that the more it melts, the faster it starts to melt. That glacier alone, although only a small part of Antarctica as a whole, could, if it melted completely, cause sea levels to rise by more than half a metre. The effect of that, particularly on low-lying areas of the world and the populations that live there, would be almost immeasurable.

The Antarctic serves as a bellwether for the changing climate. Some data recently produced by Antarctic scientists suggest that there is now an onset of irreversible ice sheet instability—the cycle going so far that we will not be able to reverse it. That would lead to sea levels rising by several metres, which would have catastrophic effects.

I congratulate the Government on what they have done to protect those bits of the marine environment that they can down near the south of the world, particularly in the 4 million sq km of marine protected area, including around South Georgia and the South Sandwich Islands. That was described by my hon. Friend earlier, but I will stress again what he said. We need to have the Weddell sea as a marine protected area and to work with countries around the world to make that happen. I understand that there is a little bit of resistance, but the hope is that we will be able to overcome that. We have opportunities, particularly as we host the international climate change conference this year, to bring that issue right to the fore. I am interested in what the Government are doing to try to stop the potentially irreversible depletion of ice sheets before it is too late.

Finally, I want briefly to talk about science. Much of the knowledge about climate change has been gathered by brilliant British scientists. They have made a brilliant contribution to polar and climate science. In fact, in the period from 2011 to 2015, the UK produced the second greatest number of scientific papers in relation to Antarctica. It is crucial that we inspire a new generation of polar scientists. I was pleased to hear the hon. Member for Bristol West (Thangam Debbonaire) say that her mother and her niece are engaged in this field, suggesting multi-generational interest in Antarctica. It is great that they are both women. As a Conservative party vice chairman, I am interested in how to encourage more girls to study science, technology, engineering and maths. I am interested in projects such as Homeward Bound, which took 100 women from 33 countries on a three-week expedition at the end of last year, visiting 10 bases and research stations over three weeks, with the aim of getting women interested in Antarctica, giving confidence to female scientists and inspiring younger girls to consider this field of science. That kind of programme will help to bridge the gender equality gap in science. Currently, 72% of those researching globally are men; we need to get women in there too.

It is vital that the UK continues to lead the other signatories to the Antarctic treaty in fulfilling its objective to preserve the continent for peace and science, and ensures that another treaty is in place when this one runs out in 2048.

Foreign and Commonwealth Office

Caroline Johnson Excerpts

Monday 12th November 2018 Ministerial Corrections

The following is an extract from Foreign and Commonwealth Affairs questions on 30 October 2018.

[Dr Caroline Johnson]

Given that the recent UN taskforce report highlighted appalling examples of sexual violence against Rohingya Muslims in Burma, I welcome the announcement that the Secretary of State made on his recent visit to Rakhine of increased support to victims of this terrible crime, but what can be done to increase the resources available to other conflict regions?

[Harriett Baldwin]

I thank my hon. Friend for welcoming the announcement and highlighting the work of that team of experts, who have now been deployed, I think, to 26 countries on a wide range of cases, have helped to train 17,000 people to make sure that evidence is secured and have worked extensively on this important issue in a range of situations around the world.

[Official Report, 30 October 2018, Vol. 648, c. 759.]

Letter of correction from the Minister for Africa:

An error has been identified in the response I gave to my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson).

The correct response should have been:

Oral Answers to Questions

Caroline Johnson Excerpts

Tuesday 30th October 2018 Commons Chamber

The Secretary of State was asked—

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

1. What diplomatic steps he is taking to tackle sexual violence in conflict throughout the world.

[The Minister for Africa (Harriett Baldwin)]

The UK Government continue to lead global efforts to end the horror of sexual violence in conflict. We have developed tools to improve the chances of justice for survivors and in June secured sanctions against seven Burmese military officials. We will host an international conference in 2019 to galvanise the world into further action.

[Dr Johnson]

Given that the recent UN taskforce report highlighted appalling examples of sexual violence against Rohingya Muslims in Burma, I welcome the announcement that the Secretary of State made on his recent visit to Rakhine of increased support to victims of this terrible crime, but what can be done to increase the resources available to other conflict regions?

[Harriett Baldwin]

I thank my hon. Friend for welcoming the announcement and highlighting the work of that team of experts, who have now been deployed, I think, to 26 countries on a wide range of cases, have helped to train 17,000 people to make sure that evidence is secured and have worked extensively on this important issue in a range of situations around the world.[Official Report, 12 November 2018, Vol. 649, c. 2MC.]

Oral Answers to Questions

Caroline Johnson Excerpts

Tuesday 17th October 2017 Commons Chamber

[Boris Johnson]

The hon. Gentleman is completely in error when he says that. In point of fact, both the French and the Dutch appealed to us at various times for help with their own needs, and, of course, we were very glad to supply that. We are now working with them and the Americans to make sure that we have a joined-up plan to react in the event of any future hurricanes.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

19. I should like to recognise the significant effort that our servicemen and women and others are putting into the momentous task of the relief effort. After the emergency response is over, it is crucial that there is sustained support. What will the Secretary of State’s Department be doing to ensure that crucial infrastructure such as health and education get fully back up to speed?

[Boris Johnson]

As I have said, there is a long-term plan to restore those overseas territories to full economic health, and it will take a long-term commitment from this country. I want all those British nationals there to realise that this Government are absolutely determined to vindicate their rights and to give them the support that they need.