Terminally Ill Adults (End of Life) Bill (Twenty First sitting)

Debate between Jake Richards and Lewis Atkinson

Committee stage
Tuesday 11th March 2025 Public Bill Committees

[Lewis Atkinson (Sunderland Central) (Lab)]

It is a pleasure to serve under your chairship this afternoon, Ms McVey.

I feel that we are dancing on the head of a pin, but I oppose the amendment. Members across the debate have recognised that, as Dr Sarah Cox from the Association for Palliative Medicine said, it is always for the patient to decide. As my hon. Friend the Member for Rother Valley pointed out, both the original clause and the amendment rightly retain that decision with the patient. They also retain the discretion of the doctor, whether that is on an appropriate test or a best interests test.

I note that in its submission the Royal College of Physicians advocated the removal of the clause, saying that it goes beyond current practice. I support the clause on balance, because of the importance of these conversations and so on, but the physicians who are likely to carry out the conversations think that it is inappropriate to specify these conversations in primary legislation.

There are two phrases in the amendment that I think are entirely inappropriate. First, there is “concluded in good faith”. I am sure it is not the intent of the author and mover of the amendment, but it suggests that in other instances people might be acting other than in good faith. I commend the words from my hon. Friend the Member for Ipswich. We have to start from the point that doctors are operating in good faith. It is dangerous to set up a good faith test, as opposed to an “other faith” test, in primary legislation.

Secondly, I am certainly not trying to reopen the long debates we had about the Mental Capacity Act, but Members will recall that in those debates we were very clear that the “best interests” test should not and does not apply. Introducing language about best interests the first time in the Bill is very dangerous, and totally against the spirit and principle of what we have debated so far. For those reasons, I am against both amendments.

[Jake Richards]

My hon. Friend the Member for Sunderland Central has made many of the points that I planned to, so I will be brief. The primacy of patient autonomy when it comes to familial relationships is a principle that should not be interfered with in the medical sphere, which this is—we can call it treatment or something else, but it is undoubtedly a relationship between a doctor and a person.

I agree with my hon. Friend on the term “good faith”. I do not doubt the motives, but it put forwards the proposition that a doctor would act in bad faith and not tell a family member. It is a rather bizarre drafting, and wholly unhelpful for the intent for which it was put forward.

The most alarming is the second part and the issue of “best interests”. I will not labour the point that my hon. Friend has made, but what is a doctor to do? A doctor is not a social worker. A doctor is not a family support worker. What questions are they to ask? If someone says, “Oh, I don’t really want to tell my next of kin, who is my sister. We fell out last year because of tit for tat,” is the doctor going to make a value judgment as to whether that argument is profound enough to stop the notification?

--- Later in debate ---

[Jake Richards]

Yes.

The other side of the coin is that we must ensure that the process is workable. In Spain, 20% of people die before the panel hears their case. We must be very careful not to create something that is so burdensome as to be completely pointless. I believe that the amendments tabled by my hon. Friend the Member for Spen Valley aim successfully between ensuring flexibility and rigour. Each case will be different—more so than in any other set of proceedings that I can imagine, and I have thought hard. There will no doubt be some that are incredibly complex, in which the panel may require further assessments and hear from relevant experts, but there will be far more that are solemn and serious but straightforward, and that is correct.

Other amendments, such as amendment (d) to new clause 21, in the name of my hon. Friend the Member for Derby North, seek to mandate certain procedural steps. While I have great respect for her as a former colleague, I fundamentally disagree with her amendment, which would require that the panel “must consider” hearing from persons who may be

“interested in the welfare of the person”.

I repeat that this is not a welfare decision. The panel, just like the High Court judge, is not saying, “What do I think is in the best interests of this person?” It is ensuring that the person has made the decision per clause 1, where we started: “settled”, “informed” and “voluntary”. We enter new ground with this law change, and that is why it is a new process, but to my mind it is safer and workable. Colleagues can be reassured, and I urge people to support the change.

[Lewis Atkinson]

I thank my hon. Friend for giving way at the end of an excellent speech. Does he agree that the provision in new schedule 2 that allows the commissioner, who would be a sitting or previous judge, to give guidance and set procedure for the operation of panels would answer some of the concerns raised by those who think that there would not be sufficient judicial input into the procedure of the panels?

[Jake Richards]

That is an important point, because the change, as drafted in the various amendments, provides for real flexibility. That may cause others some concern, but to my mind it is a reassurance, because it will mean that a weighty figure, the commissioner, will be able to set out rules and regulations for the process to make sure that it is rigorous but is not so burdensome as to be pointless.

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

Debate between Jake Richards and Lewis Atkinson

Committee stage
Tuesday 11th March 2025 Public Bill Committees

[Lewis Atkinson (Sunderland Central) (Lab)]

It is a pleasure to serve under your chairship, Sir Roger.

I rise to speak to a couple of the amendments. Amendment 348 is likely unnecessary. I would have been minded to support it had it referred to a registered GP, but the language of “usual or treating doctor” is unconvincing. I am not sure what those terms refer to. The registered GP absolutely should be informed, and both normal practice and the provisions in the Bill about entering information into medical records would mean that that is the case. For me, “usual doctor” is not the right terminology; it does not achieve what I think some of its proponents want. With reluctance, I will vote against that amendment because it does not refer to a registered general practitioner.

On amendments 303 and 458, I believe there must be provision for a second opinion. However, I am persuaded by the points made by the hon. Member for Richmond Park about amendment 459. I slightly disagree with my hon. Friend the Member for Stroud: although the independence of the second opinion is important on matters such as the terminal prognosis, when it comes to the detection of coercion, the more information, the better. It is one thing to be independent in a medical assessment, but the amendment speaks to a psychosocial assessment. We are trying to detect coercion, so it is important that every decision maker gets further information as the process progresses.

The provision for five different touchpoints of assessment is one of the strengths of the Bill. Each assessment should be done in a way that can be progressed with more information. It is not just five different independent points of information; because of the Bill’s record-keeping provisions, the assessment should become increasingly informed throughout the process. I certainly think that the panel, or whatever we get to, should have sight of any negative assessment from an independent doctor, as well as any positive one. The panel will then be able to do its job of scrutinising the two decisions, potentially weighing them up, and calling the different doctors who have given different decisions. I am, then, persuaded by amendment 459.

[Jake Richards (Rother Valley) (Lab)]

It came up in the debates last week that we heard some evidence from medical practitioners on how decisions and assessments were better made when done collaboratively. That means that we need to keep them independent but that, where possible, doctors should be working together in this process. Does my hon. Friend agree that amendment 459, tabled by the hon. Member for Richmond Park, may assist in that?

[Lewis Atkinson]

Yes, I do. I recognise the importance of independent assessment for prognosis and capacity. However, particularly with the issue of coercion, healthcare is a team sport, as anyone who has worked in healthcare knows. The more information and the more viewpoints we can get in those instances, the better. One of the strengths of the Bill is the team sense around it, which we will further in the amendments to clause 12 that we will come on to in due course.

I will finish briefly on amendment 460. I do not see the loophole that has been described. I think we would all want someone to be able to cancel their first declaration, and they are more likely to do so if they feel they have the option of going back and making a future first declaration. My worry with amendment 460 is that, by removing the word “particular”, it suggests that people are only able to make one first declaration in the course of their life. With the periods of reflection built into the Bill, which Members spoke about earlier, if someone changes their mind, they should cancel their first declaration. They are absolutely free to do so and the Bill, as currently drafted, makes good provision for that. To me, amendment 460 would remove the ability for that person to come back to that decision at a later point and go through the assessment process again. While I understand the motivations behind amendment 460, I am cautious about it for those reasons.

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

Debate between Jake Richards and Lewis Atkinson

Committee stage
Wednesday 26th February 2025 Public Bill Committees

[Lewis Atkinson]

Does my hon. Friend agree that clause 8(6), which requires the second doctor to be independent of the first—they must not be

“a partner or colleague in the same practice or clinical team”—

would protect against the situation on which the hon. Member for East Wiltshire speculates?

[Jake Richards]

Yes, there are safeguards and mechanisms in the Bill to ensure that and to protect from a culture that would incentivise this practice.

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

Debate between Jake Richards and Lewis Atkinson

Committee stage
Thursday 30th January 2025 Public Bill Committees

[Lewis Atkinson (Sunderland Central) (Lab)]

Q Mr Greenwich, we are minded that as well as passing really good legislation we want to get public confidence behind this. We have heard a level of concern from disabled people’s representative bodies about the inadvertent implications of this law for disabled people. Were those concerns shared when you took your legislation through, and how it has gone since the implementation of the legislation?

Alex Greenwich: In New South Wales, and across Australia, having a disability or complex mental health issue like anorexia does not make you eligible at all for voluntary assisted dying. The legislation we are dealing with and you are dealing with is not for people with a disability or anorexia nervosa, and not for people who feel they are a burden. It is for people with a terminal illness who may want the choice of a death that is better than what the illness would otherwise provide.

We worked closely with disability groups in New South Wales. Their main concern was that they would be treated equally in terms of access to the law if a person with a disability had a terminal illness. The key point is that this legislation is a safeguard to those concerns. To the point about people who are starving themselves, that is happening today in the UK because people do not have access to voluntary assisted dying. They are starving themselves to death rather than accessing a regulated scheme where they can discuss all their options and choices.

[Jake Richards (Rother Valley) (Lab)]

Q This question is probably best for Alex. Yesterday we heard evidence about the health inequalities in our society and fears that they would be exacerbated by the introduction of assisted dying. What was the experience in Australia?

Alex Greenwich: If I think of our health system and how we adopted voluntary assisted dying, like all health systems we were under pressure following the covid pandemic. By legislating in this space you give your health system the priority of dealing with this, making sure doctors are trained to be able to address it and that there is a good implementation period. I believe the Bill has two years, and I think that is completely appropriate to make sure your health system gets up to speed. When it comes to end-of-life choices and healthcare, voluntary assisted dying provides a great deal of honesty and safeguards.