Terminally Ill Adults (End of Life) Bill

Edward Leigh Excerpts

Friday 16th May 2025 Commons Chamber

[Madam Deputy Speaker (Judith Cummins)]

I call the Father of the House.

[Sir Edward Leigh (Gainsborough) (Con)]

I wish to speak to new clauses 16 and 17. Rather than giving my own views, I think that powerful testimony on behalf of someone who actually runs a care home should be heard by the House. I want to quote, as briefly as possible, Dan Hayes, who runs the Orders of St John Care Trust, which runs care homes in Lincoln generally and in my constituency:

“we believe that the Bill as drafted is flawed, and the risks to older, vulnerable people, residing within social care environments are substantial.

We believe that any assumption by those drafting the final legislation that it is not intended for use by those living with conditions regarded as part of the ageing process, would be mistaken. Any legislation would be immediately tested and assumed to be accessible to such a cohort of people.

To that end we believe that in order to provide the necessary protections to such a vulnerable part of our society, the Bill must be explicit in its reference to older people living in residential services.”

That is why these new clauses are so important. He continues:

“The Bill must take account of the current unfairness and instability at the heart of our social care system, and question whether such legislation can be introduced whilst such problems exist.

The Bill must recognise that an individual health/social care professional’s ability to remove themselves from the process of Assisted Dying is so difficult, that specific exclusion of the care home sector should be a feature of the Bill. In any case, organisations, and sites, should be given the ability to exclude themselves from the act of an assisted death without prejudice to their approval as providers of services to the state.”

We have experience of that, with regard to Catholic adoption agencies. There is a real risk that some care homes may feel they have to withdraw from this sector. I will carry on quoting:

“Those that fund their own care pay substantial sums, often saved for over a lifetime—including property wealth. These savings will have been set aside for retirement and to pass on to loved ones. Instead, they are used to fund the costs of their own residential care, and to substantially subsidise the state.

We see the real prospect that those that might fit the criteria for assisted dying under the Bill, but have no wish to accelerate their death, would feel an immediate dilemma between prolonging their own lives, and the future quality of life of their loved ones. For illustrative purposes, the six-month period stated within the current Bill would equate to between £25,000 and £40,000 of expense borne by an individual paying for their own residential care in the current system.

Failings in the system mean that older people who should not be in hospital are held there, causing a burden to the NHS, and Local Authorities face an ever-growing proportion of funding needed to support social care, without a proportionate increase in funding from central government.”

[Lola McEvoy]

Will the right hon. Gentleman give way?

[Sir Edward Leigh]

I wish to be mindful of other people, so I will proceed and make this one simple point on behalf of care homes. Mr Hayes continues:

“During the pandemic, we saw the appalling attempts at a widespread use of ‘Do Not Attempt Resuscitation’ arrangements for older people. This is a clear demonstration that an existing broken system places a lower value upon the lives of older people than of others.”

This is the important point:

“Relationships within residential care for older people are both professional and intimate. Carers, Care Leaders, and Service Managers are all competent health and social care professionals, but they are also friends and confidantes of those that live within social care services. The relationships are familial in the sense of contact for hours each day and the extension of support to ordinary, everyday issues outside the scope of normal healthcare professionals.

Our employees deliver loving care and build relationships in a way that residents come to depend upon and take comfort from. Such relationships are key to excellent care provision, and these important relationships enhance and prolong lives by providing a sense of purpose and place to older people.”

I have been around these care homes. They are fantastic places, with such love and such care for the most vulnerable in society. My Hayes then continues:

“In such a setting, it renders the ability for an individual to refuse to partake…as useless.

In an environment such as a care home, there is no way in which a professional could be fully ‘separated’ from assisted dying, should a resident they work with closely seek to enquire about or make a request.

Imagine a scenario where an individual living in social care is at the point where they will be provided with the approved substance to bring about their own death: In a care home, this is likely to be in their own room, which will be in close proximity to many other older people who live within that setting. It will be commonplace and understandable that the magnitude of the event will mean that the individual will wish to have company and comfort up to and immediately before/during the period in which the substance is taken.

A request for the company of a care professional will create a substantial moral dilemma for that person, profoundly so if they are individually opposed to Assisted Dying.”

That is the choice that these loving care workers will have to make—that would be the pressure on them. He goes on to say:

“Even where they are not, it will mean that they will intimately witness the death of someone with whom they have a strong bond, with that death having come about through facilitation, rather than naturally.”

Imagine the pressure on the workers in that care home.

--- Later in debate ---

[Stephen Kinnock]

I will just make a little progress.

Amendment 60 may similarly prevent access to an assisted death for those residing within a care home or hospice, if that care home or hospice decided it would not allow such assistance on its premises.

[Sir Edward Leigh]

The Minister is making a very important point, and this is what I dealt with in my few short remarks. If, according to the Minister, care homes run by religious orders will have to provide this service, those orders will have to get out of care homes altogether.

[Stephen Kinnock]

I thank the right hon. Gentleman for that intervention. As I say, the Government do not take a position on the policy intent that my hon. Friend the Member for Spen Valley has set out. I would simply observe that if somebody has been in a home for a considerable period of time, that home is then considered to be their home. As such, any action to take them out of that home could engage article 8 of the ECHR, on the right to family life.

I now turn to the procedure for receiving assistance under the Bill, including safeguards and protections. First, I will speak to the amendments that have been tabled by my hon. Friend the Member for Spen Valley with technical workability and drafting advice from the Government.

Amendment 58 clarifies the duty on the Secretary of State to make through regulations provisions for training about reasonable adjustments and safeguards for autistic people and those with a learning disability. That remedies previously unclear wording in the Bill. Amendment 60 is required to make provision for circumstances where the independent doctor dies or, through illness, is unable or unwilling to act as the independent doctor. Amendments 67 and 68, tabled by my hon. Friend the Member for Spen Valley, clarify that an approved substance can be self-administered using a device should the individual be unable to self-administer without one. Amendment 91 gives effect to amendment 273, which was accepted in Committee, by ensuring that data will be recorded in the final statement to ensure coherence within the Bill.

I turn now to the amendments tabled by other Members on the subject of procedure, safeguards and protections that the Government have assessed may create workability issues if voted into the Bill. New clause 7 would limit the number of times two doctors can be jointly involved in the assessment of a person seeking assisted dying to three times within a 12-month period. In situations where there is a limited pool of doctors in any geographical location or area of medicine, that could limit access to assisted dying and create inequalities in access. New clause 9 would require the co-ordinating doctor, independent doctor and assisted dying review panels to apply the criminal standard of proof that requires them to be satisfied beyond reasonable doubt. Cases considered by the panel are civil matters, and as such it would not be usual practice for the criminal standard of proof to be applied to their decision making—and it is a very high bar. The provision would also impose additional standards on the assessing doctor that fall outside the usual framework for medical decision making.