Terminally Ill Adults (End of Life) Bill (Fifth sitting)

Daniel Francis Excerpts

Committee stage
Wednesday 29th January 2025 Public Bill Committees

[Sean Woodcock]

I was merely suggesting that the direct evidence from Oregon is that being a burden is something that might come from a lack of decent social care, and it might be encouraging people to make the decision to seek assisted dying—but fair enough.

[Daniel Francis (Bexleyheath and Crayford) (Lab)]

Q My question is to both Dr Mullock and Professor House. In your written evidence, you both refer to clause 18(9) and issues regarding the obligations of the doctor if the procedure either fails or if there is a long-delayed death. I accept that it is a small number, but we know from elsewhere that there are cases where the death takes some days—three to four days in some cases—or where the procedure fails.

The Bill says that the doctor must stay with the person for the entirety ofthat time. I am trying to understand from your written evidence how you feel that measure should be amended to make it stronger, because at the moment there is no mention what the doctor should do to intervene, and clearly it is not practical for a doctor to stay for three to four days. What are your views on how that could be amended?

[The Chair]

Just before you answer, I bring to the attention of Members that we have about 13 minutes left and five people who want to ask questions. I ask Members keep their questions as tight as they can, and the witnesses to take that into account as well—otherwise I will regrettably end up cutting witnesses off at spot-on 3 o’clock.

Dr Mullock: I will answer very quickly. Informed consent needs to direct what happens if the procedure does not work quickly. There is a very rare risk that the patient might regain consciousness and not die. This is incredibly rare, but nevertheless patients should be informed about that risk. Obviously it is not practical for doctors to remain with people for three or four days. I do not know the risk of this happening, but whatever approach is taken clinically needs to make sure that the risks are minimal and that patients are provided with an informed-consent approach to what might happen if things do not go as planned.

Professor House: It is a striking feature of the Bill that informed consent is not really specified properly. The doctor is required to ask the person what they want to happen in the event of complications without having previously explained to them what all the complications might be. They ask them what they want to happen, but there is no requirement then to discuss what might happen in line with their wishes.

The important element of this comes when you think about the mechanisms that might come into play here, particularly the use of what is called a medical device—a syringe driver. In other jurisdictions where this happens—Victoria and Canada, for example—a doctor steps in with a lethal injection, which is not allowed here. They call it “physician administered” in Victoria. It is not specified what assisting somebody with the use of this medical device might mean, particularly if they are so disabled that they need a proxy to sign the forms for them, or if they are now slightly impaired by having taken some medication.

All that needs much tighter specification. There is no standard informed consent form related to the Bill, for example—of the sort that you would expect to sign if you were having a serious intervention in the NHS. The schedules—the forms that people will sign—do not, for example, say that they have had all the complications explained, and the side effects, or what any subsequent intervention might be. You are putting your finger on something that is very underspecified in the Bill.

--- Later in debate ---

[Sarah Sackman]

We can take that suggestion away. Thank you.

[Daniel Francis]

Q Ms Hadi, we heard evidence this morning that the majority of disabled people support the Bill. I would like to hear your comments on that. What analysis do you have on whether the majority of disabled people support the Bill? Baroness Falkner, based on what we have just heard, if we had had the equality impact assessment before oral evidence was sought and before line-by-line scrutiny, would you have supported the approach more?

Baroness Falkner: My answer will be very brief. Every additional piece of analysis is helpful, because there are gaps in the analysis. The problem is that because we have not had a consultation, and because the process of deliberation was not transparent—it never will be with a private Member’s Bill—there is a sense of not knowing quite enough as to the reasoning behind—