Terminally Ill Adults (End of Life) Bill

Caroline Nokes Excerpts

Friday 16th May 2025 Commons Chamber

[Madam Deputy Speaker (Caroline Nokes)]

May I gently suggest to the right hon. and learned Gentleman that he might be bringing his remarks to a close? There are many other Members who wish to contribute this afternoon.

[Sir Jeremy Wright]

I certainly am, Madam Deputy Speaker. I am doing my best, I hope as briefly as I can, to explain these technical amendments in a hugely important Bill, in a part of the Bill that the promoter has advocated for because she believes it is a safeguard. I think it is important, Madam Deputy Speaker, that we establish whether it is such a safeguard, and if it can be improved, how it can be improved—but I entirely take your strictures on board and I will come as quickly as I can to a conclusion.

This is not an equality of arms point—I accept that these are not opposing parties in the traditional sense—but it is really about the presentation of new evidence. Presumably the advice to someone whose application for a certificate has been refused and who has new evidence to present would be to reapply to the commissioner, but what is someone who has new evidence to challenge the basis for an existing certificate to do? Judicial review is no help. That is about the soundness of the decision already taken, which will be assessed using the evidence already presented to the panel that took the original decision.

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[Simon Hoare]

On a point of order, Madam Deputy Speaker. I do not wish to be flippant or to test the patience of the House, but we have just heard an important speech from a former Attorney General on some key legal points. This is still a private Member’s proposal. How can the promoter of the Bill, the hon. Member for Spen Valley (Kim Leadbeater), respond to whether to accept amendments to her proposed legislation if she is not in the Chamber to hear the arguments? Is it not a discourtesy to the House and those who have spent some considerable time working on amendments, on both sides of the argument, for her not to be here to hear what they are advocating?

[Madam Deputy Speaker (Caroline Nokes)]

I thank the hon. Member for his point of order, but he will know that that is not a matter for the Chair.

I remind the House that although there is no formal time limit, many Members wish to contribute in this very important debate and it would be helpful if Members could keep their remarks to within the eight minutes that was suggested.

[Kevin Bonavia (Stevenage) (Lab)]

On Second Reading, I voted in favour of the Bill, partly because I believed in the principle of it—I believe the right to choice, and in the right not to choose—and partly because I believed that we needed to have a way of checking somebody’s clear intention. At the moment, horrible deaths are happening and there are no such checks in place, so I was keen to see how this House could come up with a system that, although it would not be perfect, would be better than the terrible status quo we have now.

At that stage, we had two checks by medical practitioners, and then a third layer: the involvement of a High Court judge. Although I was pleased with a third layer, I was not convinced that it was the right way to deal with the matter. I am therefore pleased that that the Bill Committee proposed a panel of experts to make those checks, and the right hon. and learned Member for Kenilworth and Southam (Sir Jeremy Wright) has rightly addressed some of those points.

For me, having that panel in place is very important, and it is our job to see how we can strengthen it, so I want to speak to amendments 78 and 79. Amendment 78 would improve this provision by ensuring that there is a unanimous decision in favour of a certificate of eligibility—abstentions would not apply. That is better than what was previously drafted and is certainly better than a High Court judge. Amendment 79 would require those reasons to be set out in writing. There will be scrutiny of those decisions and we do need to have the reasons properly set out.

I appreciate that all hon. Members in the Chamber, and all those who have taken part in this process, have approached it with the best of intentions. It is not easy—it is difficult—and we have constituents giving us examples from both sides. We are doing the best we can to alleviate people’s suffering—that, I hope, is our common intention across the House.

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[Kim Leadbeater]

I thank my hon. Friend for her passionate contribution, but this is exactly how we make law. We take evidence and have discussions—[Interruption.]

[Madam Deputy Speaker (Caroline Nokes)]

Order. May I respectfully remind hon. Members that on Report we debate the amendments to the Bill, not the process of how law is made?

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If the safeguards in the Bill fail even once, it will be a young woman like Jessica who dies. It will be parents like Lesley and Neal who lose a child. That is a terrible tragedy that no family should ever have to endure and no one in this House will be able to say truthfully that we did not know or did not see that coming. That is not compassion; it is abandonment. I will not be complicit in that and I hope the House will not be either. That is why we must act now. Amendments 14 and 38 each would close a different and dangerous loophole. One without the other is not enough. If we are serious about protecting vulnerable people, this House must support both amendments.

[Madam Deputy Speaker (Caroline Nokes)]

Order. Members will be aware that there are still many who wish to contribute to the debate. May I ask that contributions are kept to five minutes?

[Kit Malthouse (North West Hampshire) (Con)]

I am grateful to you for that guidance, Madam Deputy Speaker. I am also grateful to the promoter of the Bill, the hon. Member for Spen Valley (Kim Leadbeater), for putting me on the Bill Committee where, in my view, we did some excellent work. Although we have heard an awful lot of claims about the process, I think anybody objective who reads the Bill that is now being reported to the House will recognise that it is a strong piece of work that is measured and seeks to strike a balance in a difficult area of complexity, humanity, compassion and morality.

Before I discuss some of the amendments, I want to bring the House back to what we are trying to deal with: a set of people who have been told that their struggle with disease is over, that they are heading towards an inevitable death and that there is nothing more that medical science can do for them. What we are trying to do is to give them the chance to face death on their own terms. That is the simple mission that the House has been set.

The second thing I want Members to contemplate as they look at this slew of amendments is that although it is easy to look at each amendment individually and see its merits or demerits, we must bear in mind the machine we are building as a whole, and the fact that we are putting those people through this process at a time when they are facing the end of that struggle. They are thinking about what the nature of their death will be like and they are talking to their friends and family, putting their affairs in order, and being concerned about when that awful day is going to come. We have to have some compassion in the process as well as compassion in the purpose.

When Members consider some of the amendments I will highlight, I ask them please to keep in mind that we will have to put these people through a possible two-month process at a moment when their time is severely limited, very often to less than six months. For example, new clause 7 and amendment 50, tabled by my hon. Friend the Member for Meriden and Solihull East (Saqib Bhatti), would restrict the number of patients that doctors can deal with in any 12-month period. That will severely restrict access and may mean that patients who are partway through the process have to change suddenly because their doctor is time limited, pushing them out, notwithstanding the multiple safeguards we already have in the process.



My right hon. and learned Friend the Member for Kenilworth and Southam (Sir Jeremy Wright) gave an interesting speech about amendment 47. Again, in that amendment, he would be creating another step, another delay and another set of problems for the dying person to overcome or issues for them to address. In his amendment—I am sure he is a much better lawyer than me—I found it odd that he would effectively be creating an inexhaustive list of individuals who could be called upon in any circumstances who might be “properly interested” in the welfare of that individual. To me, the person who should be the most interested in their future is the person themselves. Any step we take that cuts across their privacy, their autonomy and the alacrity with which they can seek this solution to their impending or perceived agony seems a step too far. I do not understand how, practically, the commission is supposed to ascertain who those individuals are—are they neighbours, friends or just family? What is the definition of family? We need to put that contemplation and how they want to handle their death squarely in the hands of the dying person.

[Kit Malthouse]

The hon. Lady makes a good point, and it was a compelling point made in Committee and is certainly one that we recognise. That is why the amendments on training that she tabled in Committee were adopted—specifically to ensure that everybody involved in the process is sensitised to detecting those issues and to make clear that any doctor in the process, and indeed the panel, might want to know why family are not being informed. That is specifically why a social worker was put on the panel: to understand the psychosocial environment in which the person is taking that decision. Fundamentally, in the end, if I am facing my death in a matter of weeks and decide in my capacity that I do not want to inform my family, that is my choice. That is my decision. I may have to explain my reasons to the doctors, but—

[Madam Deputy Speaker (Caroline Nokes)]

Order. On that point, I remind Members that we are very short of time.

[Kit Malthouse]

I am grateful, Madam Deputy Speaker; I will be swift.

That is my choice, and this Bill is rooted in the need to give autonomy to those facing death who have capacity. We should take care to tread carefully upon that right.

On the two amendments tabled by my hon. Friend the Member for Reigate (Rebecca Paul), new clause 16 says that somebody cannot be “substantially motivated” by certain considerations. I do not really understand what “substantially motivated” is meant to mean. To me, this misunderstands the complexity of what it must be like to be told that you are dying. The things that might run through your head—the affairs you might have to deal with, the news you have to break to your family, the impact it will have on your small children—form a cocktail of motivations. But the one thing I have learned over the last 10 years from campaigning for and spending lots of time with dying and bereaved people is that towards the end of their life, they have absolute clarity about what they want, because it becomes clear to them towards the end what their death will be like. At the very least, they want to have this card in their back pocket to play if they require it. Remember: these are people who are facing death, who are struggling with death, and we have to give them the power to advance over it.

[Kit Malthouse]

Sorry, but I am conscious of time.

Finally, amendment (a) to new clause 10, which we might divide on this afternoon, is difficult. We debated a similar amendment in Committee. As sponsors of the Bill, we are clear that there should be a conscientious objection clause to allow individuals to opt out, and that is strengthened by new clause 10. But allowing an employer—any employer—to say that any employee in their employment cannot participate if that is what they decide seems to me a step too far, and it could prove to have unintended consequences. First, the board of every healthcare trust in the country will become a battle for control between those who oppose and those who do not. As my right hon. Friend the Member for Gainsborough (Sir Edward Leigh) said, people may suddenly find that they have to uproot themselves, after years of living in a care home, and relocate to get the kind of death that they want. In effect, the amendment prioritises the rights of somebody who is providing accommodation over the rights of the dying. As I said on Second Reading, in my view, as they face their end, we should prioritise the rights of the dying.

[Madam Deputy Speaker (Caroline Nokes)]

It would be unprecedented to put a formal time limit on speeches. Please can Members listen to the stricture that we are very short on time? I call Lizzi Collinge.

[Lizzi Collinge (Morecambe and Lunesdale) (Lab)]

Thank you, Madam Deputy Speaker; I had intended to speak about new clauses 1 and 10, but I will restrict myself to new clause 1 for the sake of time. New clause 1 says:

“No health professional shall raise assisted dying…unless that person has first raised it.”

If the patient does not mention the issue and specifically ask for it, the doctor would be entirely prohibited from even mentioning it. That is problematic for many reasons. It goes against good medical practice, and is actively opposed by the British Medical Association. For me, the new clause would undermine the hard-won rights of people to be fully informed of their medical options, and would make the application of the Bill unfair and unequal, to the detriment of marginalised people in particular.

[Josh Fenton-Glynn (Calder Valley) (Lab)]

Just this week, the Health and Social Care Committee heard from vulnerable service-users who talked about white coat syndrome—that people are more likely to be pushed into options when given them by medical professionals. That is the concern behind the amendment. I do not know how I will vote on the Bill, but I am minded to support the amendment because of what I have heard from people from vulnerable communities.

[Madam Deputy Speaker (Caroline Nokes)]

Order. Interventions also need to be brief.

[Lizzi Collinge]

I thank my hon. Friend for his intervention. I will expand on this, but that is exactly why good medical practice requires all options to be on the table. Patients should not be influenced by the opinions, whether philosophical or medical, of a doctor; they should be able to give full and informed consent. I believe that new clause 1 would chill those discussions, and limit the option of an assisted death to those already in the know, those who are the most medically literate, and those who are often the least marginalised in society. It would result in unequal access to a legal process, and flies in the face of good medical practice, which has moved away from the paternalism that harmed patients and took away their individual control. After many years of fighting, mainly by women and marginalised communities, it is now established that good healthcare practice means patients having full information to make their own decisions.

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[Several hon. Members rose—]

[Madam Deputy Speaker (Caroline Nokes)]

Order. I urge the few remaining Members who will get in to keep their remarks brief, please.

[Carla Lockhart (Upper Bann) (DUP)]

As I thought about today’s debate, I asked myself, “What more can I say than I said in the previous debate?” Yet there is much more, because as the Bill made progress through Committee, its intentions were exposed over and over again. Commitments, safeguards and kind words championed in this place have been set aside. On Second Reading, we were told that the Committee considering the Bill would be balanced and representative, yet its make-up did not reflect that intention: 55% of MPs voted for the Bill on Second Reading, but 61% of the Committee supported it.

The mask has slipped time and again. One of the biggest blows to the Bill, which the public listening today need to know about, relates to the need for approval via High Court judges. On Second Reading, that was laboured as the strongest safeguard, but that safeguard has been removed at a stroke. What is now being legislated for is a panel of psychiatrists—and a voluntary panel, at that. Impartial judges have been replaced by a voluntary panel, which could well be made up of enthusiasts for assisted dying, and the Royal College of Psychiatrists has now said that there are not even sufficient psychiatrists for such panels.

I want to be absolutely clear: this Bill is immoral. If it is passed at a future date, it will create a publicly funded, gold-plated assisted suicide service. That means that the state will have the ability to give a legal drug to end a life. It is immoral, and it goes against my strong Christian faith, and that of many of my constituents in Upper Bann and people across the United Kingdom.

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[Dame Meg Hillier]

On a point of order, Madam Deputy Speaker. Many people have put in to speak today, and we appreciate the huge challenge to you, chairing this debate, and for the Speaker’s Office. It is normal for private Members’ Bills that the debate continues in an orderly and proper fashion so that everyone can have their say. We appreciate that that is much more challenging in these circumstances, but we have heard many times that we are running out of time, Members are not taking interventions because of concerns about time, and the informal time limit has dropped to five minutes. I am aware that the Front Benchers still need to speak. It is in the power of the Chair, of course, to refuse any suggestion of a closure motion. I would like to ask you whether there is any thinking going on about whether this debate can continue. Many of those who have tabled amendments have not yet been called to speak, and I, for one, would like to hear their points of view.

[Madam Deputy Speaker (Caroline Nokes)]

I thank the hon. Lady for her point of order. She would not wish me to anticipate any decision on a closure motion at the current time, I hope. She makes a valid point that many Members who wish to speak this afternoon will be disappointed, but she will also know that there will be further debate on the second group of amendments.

[Dame Meg Hillier]

Further to that point of order, Madam Deputy Speaker. My concern is that this is the last debate on these amendments. It is in the control of the Chair whether to grant a vote on a closure motion. I simply make that point, as I am sure you heard, Madam Deputy Speaker.

[Madam Deputy Speaker]

I reassure the hon. Lady that I have heard her point. I repeat that I will not make a pre-decision on any closure motion that has not yet been moved.

[Dr Opher]

I will be very quick, Madam Deputy Speaker, because I am aware of the need to fit in as many people as possible.

I will address a few issues on the assessment of capacity under new clause 9. One key point about assessing capacity as a doctor is that in most cases it is very clear cut: someone either has capacity or they do not. That is quite easy and quick to establish. With a very small number of patients, it is more difficult. By amendment to the Bill made in Committee, we must now refer such a person to a consultant psychiatrist for an assessment by a specialist. They are then in the best position to assess those very difficult points of capacity. That very much strengthens the Bill.

I will speak very briefly to new clause 1. As doctors, we must, under our ethical obligations, give options to patients. If we are absolutely forbidden to do that—new clause 1 would make it a crime, so we could be convicted for doing so—that totally wrecks the doctor-patient relationship. It is unprecedented and unworkable.

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[Sarah Russell]

I thank my hon. Friend for giving way. On that point, I have particular concerns—

[Madam Deputy Speaker (Caroline Nokes)]

Order. May I just clarify whether the hon. Gentleman was giving way?

[Dr Opher]

Yes, I am happy to give way.