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

Kim Leadbeater Excerpts

Committee stage
Wednesday 5th March 2025 Public Bill Committees

[The Chair]

I remind the Committee that with this we are discussing amendment 361, in clause 5, page 3, line 28, at end insert—

“(7) Regulations under subsection (3)(e) are subject to the affirmative procedure.”

This is linked to Amendment 360.

[Kim Leadbeater (Spen Valley) (Lab)]

I have nothing further to add in this debate.

[Danny Kruger (East Wiltshire) (Con)]

In the light of the suggestion from the hon. Member for Spen Valley that there will be further amendments later, when we can discuss the shape of the provision and presumably any remuneration, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Amendment proposed: 186, in clause 5, page 3, line 23, at end insert—

“(3A) The Secretary of State must by regulations make provision about the training, qualifications and experience that a registered medical practitioner must have in order to act as the coordinating doctor.

(3B) The regulations must include training about—

(a) assessing capacity;

(b) assessing whether a person has been coerced or pressured by any other person.

(3C) Subject to that, the regulations may in particular provide that the required training, qualifications or experience is to be determined by a person specified in the regulations.”—(Kim Leadbeater.)

See the statement for Amendment 185.

Amendment made to amendment 186: (a), after

“(b) assessing whether a person has been coerced or pressured by any other person.”

insert

“(c) specific and up-to-date training on reasonable adjustments and safeguards for autistic people and people with a learning disability.”—(Daniel Francis.)

Amendment 186, as amended, agreed to.

[Kim Leadbeater]

I beg to move amendment 187, in clause 5, page 3, line 24, leave out subsection (4).

This amendment is consequential on NC8, which contains a single duty to consult before making regulations under various provisions of the Bill.

[The Chair]

With this it will be convenient to discuss the following:

Amendment 188, in clause 5, page 3, line 28, leave out subsection (6).

This amendment is consequential on Amendment 233, which contains a single set of provisions about the procedure for regulations under the Bill.

Amendment 192, in clause 6, page 3, line 36, leave out subsection (4).

See the statement for Amendment 188.

Amendment 199, in clause 8, page 5, line 28, leave out subsection (8).

See the statement for Amendment 187.

Amendment 200, in clause 8, page 5, line 30, leave out subsection (9).

See the statement for Amendment 188.

Amendment 206, in clause 11, page 7, line 24, leave out subsection (3).

See the statement for Amendment 188.

Amendment 211, in clause 19, page 13, line 31, leave out subsection (5).

See the statement for Amendment 187.

Amendment 212, in clause 19, page 13, line 33, leave out subsection (6).

See the statement for Amendment 188.

Amendment 213, in clause 20, page 13, line 39, leave out subsection (3).

See the statement for Amendment 188.

Amendment 215, in clause 28, page 17, line 11, leave out subsection (3).

See the statement for Amendment 188.

Amendment 216, in clause 30, page 18, line 37, leave out subsection (4).

See the statement for Amendment 188.

Amendment 217, in clause 30, page 18, line 38, leave out “that procedure” and insert “section 39”.

See the statement for Amendment 188.

Amendment 218, in clause 32, page 19, line 31, leave out subsection (4).

See the statement for Amendment 188.

Amendment 219, in clause 33, page 20, line 24, leave out subsection (5).

See the statement for Amendment 188.

Amendment 222, in clause 38, page 23, line 1, leave out subsection (2).

See the statement for Amendment 188.

Amendment 233, in clause 39, page 23, line 6, leave out subsections (3) to (5) and insert—

“(5A) The Secretary of State may not make a statutory instrument containing (whether alone or with other provision) regulations under section 5(3A), 8(6A), 30(3) or 32 unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament.

(5B) Any other statutory instrument made by the Secretary of State containing regulations under this Act is subject to annulment in pursuance of a resolution of either House of Parliament.”

This amendment brings together the various provisions about the procedure for regulations and makes regulations under clauses 5 and 8 about training, qualifications and experience subject to the draft affirmative procedure.

Amendment 225, in clause 40, page 23, leave out line 23.

The amendment is consequential on Amendment 233.

Amendment 226, in clause 40, page 23, leave out line 37.

The amendment is consequential on Amendment 233.

New clause 8—Duty to consult before making regulations—

“(1) Before making regulations under section 5, 7, 8, 13, 19 or 21, the Secretary of State must consult—

(a) the Commission for Equality and Human Rights, and

(b) such other persons as the Secretary of State considers appropriate.

(2) The persons to be consulted under subsection (1)(b) must include —

(a) persons appearing to the Secretary of State to have expertise in matters relating to whether persons have capacity, and

(b) persons appearing to the Secretary of State to have expertise in matters relating to whether persons have been coerced,

unless the Secretary of State considers that, having regard to the subject-matter of the proposed regulations, it would not be appropriate to consult such persons.”

This new clause imposes a duty to consult before making regulations under various provisions of the Bill.

[Kim Leadbeater]

This group of amendments is consequential on new clause 8, which would create a single duty for the Secretary of State to consult before making regulations under various provisions of the Bill. It would consolidate the previous requirements to consult in relation to clauses 5, 8 and 19 and expand the duty to cover additional clauses. It would require the Secretary of State to consult the Equality and Human Rights Commission and such other persons as the Secretary of State considers appropriate. The persons to be consulted under subsection (1)(b) must include persons appearing to the Secretary of State to have expertise in matters relating to whether persons have capacity, and persons appearing to the Secretary of State to have expertise in matters relating to whether persons have been coerced.

This is an important strengthening of the Bill. It applies to multiple clauses: clauses 5, 7, 8, 13, 19 and 21. The duty to consult experts, particularly on issues around capacity and assessing for coercion, is an important change that reflects the detailed debate that the Committee has undertaken on those two important issues.

Amendment 233 brings together the various provisions about the procedure for regulations. It would make the regulations to be made under clauses 5 and 8, on training, qualifications and experience, subject to the draft affirmative procedure, so that Parliament has to debate and approve them first. Again, that would strengthen the Bill.

[Danny Kruger]

In a sense, this is a technical set of amendments that consolidate the provisions for secondary legislation. However, it reflects the seriousness of a concern that I and others have raised, which is that so much in this Bill will be left to the discretion of Ministers, often through the negative procedure.

It is important to reflect briefly on the questions that we are considering. The hon. Lady has mentioned quite a few of them, but we are talking about the training of doctors; the High Court procedure, if there is one; the substances that may be used in the administration of assisted death; the prescribing of those substances; the registration of deaths; the codes of practice to be introduced; provision through the NHS; notification to the chief medical officers; changing the schedules in the Bill, and so on.

Those are important matters. I recognise that many of them are complicated and technical, and that it is appropriate to leave them to a degree of professional and ministerial discretion. Nevertheless, my great concern, which relates to the parliamentary procedure—you may have a view on this, Mrs Harris—is that we are having this debate without the benefit of a delegated powers memorandum to explain why each power has been taken, the nature of it, the reason for taking the power and the procedure to be selected.

In a recent report on the Bill, the Hansard Society notes that under the Government’s “Guide To Making Legislation”, a delegated powers memorandum would normally be published prior to Second Reading for a private Member’s Bill on issues of conscience on which the Government are neutral. The report explains that a delegated powers memorandum gives

“details of each power in the bill, including its context, its scope, to whom the power is delegated, and the parliamentary scrutiny procedure…the reasons for taking the power; and…why.”

It points out that

“where the responsible department recommends that the Government should support the Private Member’s Bill or remain neutral then a DPM should be produced for consideration by the relevant Cabinet Committee—the Parliamentary Business and Legislation (PBL) Committee—alongside other key documents such as the explanatory notes, a legal issues memorandum, and an impact assessment”.

We have not yet had an impact assessment either.

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[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your chairship, Mrs Harris. The amendments have been tabled by my hon. Friend the Member for Spen Valley in consultation with the Government. This reflects the Government’s role in ensuring that the Bill is legally robust and workable. The amendments relate to the regulation-making powers and bring together various provisions about procedure and requirements for regulations and consultation.

I will address the amendments in two groups, starting with new clause 8 and its consequential amendments 187, 199 and 211. The new clause contains a duty to consult before making regulations; it is intended to consolidate three subsections that contain duties to consult before making regulations, as set out in the original draft of the Bill under clauses 5, 8 and 19. In addition to retaining the existing duties to consult before making regulations in clauses 5, 8 and 19, the new clause requires the Secretary of State to consult before making regulations under clauses 7, 13 and 21, and brings together these requirements under a single duty.

The new clause would place an additional requirement on the Secretary of State to consult the Equality and Human Rights Commission, as well as such other persons that the Secretary of State considers appropriate. The latter group must include persons with expertise in matters relating to whether persons have capacity or have been coerced, unless it would not be appropriate to consult such persons.

I turn to amendments 233, 188, 192, 215 to 219, 222, 225, 226, 212, 213, 200 and 206. There are provisions throughout the Bill, as it is currently drafted, about the procedure for making regulations. All regulations, except for those made under clause 5(3)(a), clause 8(6)(a), clause 30(3) and clause 32, are required to be made under the negative procedure. Amendment 233 would bring together the various provisions about the procedure for making regulations into a single clause, clause 39, thereby removing repetition in the Bill. The amendment seeks to achieve that by replacing subsections (3) to (5) in clause 39 with the following:

“(5A) The Secretary of State may not make a statutory instrument containing (whether alone or with other provision) regulations under section 5(3A), 8(6A), 30(3) or 32 unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament.

(5B) Any other statutory instrument made by the Secretary of State containing regulations under this Act is subject to annulment in pursuance of a resolution of either House of Parliament.”

The amendment would require that any regulations made under those provisions must be laid before, and approved by, a resolution of both Houses of Parliament. This procedure, the draft affirmative procedure, will apply to regulations setting the training, qualifications and experience of both the co-ordinating and the independent doctors, establishing a code of practice and securing arrangements for the provision of assisted dying under the Act. Any other statutory instrument made under powers within the Bill will remain subject to the negative procedure.

As I have said, the Government have taken a neutral position on the substantive policy questions. These comments relate to the legal and regulatory side of the Bill, and I hope that my observations are useful to the Committee.

[Kim Leadbeater]

I have nothing further to add.

Amendment 187 agreed to.

Amendment made: 20, in clause 5, page 3, line 25, at end insert—

“(4A) Regulations under subsection (3)(a) must specify that training in respect of domestic abuse, including coercive control and financial abuse is mandatory.”—(Daniel Francis.)

This amendment would require the registered medical practitioner acting as the coordinating doctor to have undertaken training on domestic abuse, including coercive control and financial abuse.

Amendment made: 188, in clause 5, page 3, line 28, leave out subsection (6).—(Kim Leadbeater.)

This amendment is consequential on Amendment 233, which contains a single set of provisions about the procedure for regulations under the Bill.

Clause 5, as amended, ordered to stand part of the Bill.

Clause 6

Requirement for proof of identity

[Kim Leadbeater]

I beg to move amendment 189, in clause 6, page 3, line 30, leave out

“where a person makes a first declaration”

and insert

“in relation to the making of a first declaration by a person”.

This amendment adjusts the wording so as not to suggest that a first declaration has been made before it is witnessed.

[The Chair]

With this it will be convenient to discuss the following:

Amendment 190, in clause 6, page 3, line 31, leave out

“at the same time as that declaration is made”

and insert “before signing that declaration”.

This amendment provides that the required two forms of proof of identity must be provided before the person signs the first declaration.

Amendment 291, in clause 6, page 3, line 33, at end insert—

“(2A) At least one of the forms of identity required under subsection (2) must contain photographic proof of identity.

(2B) The person must, at the same time as that declaration is made, provide proof that they have been resident in the UK for at least a year to the coordinating doctor and the witness mentioned in section 5(2)(c)(ii).”.

This would require a person to produce a form of photographic ID and proof they have been resident in the UK when making the first declaration.

Amendment 292, in clause 6, page 3, line 34, leave out “may” and insert “must”.

This places an obligation on the Secretary of State to make regulations on proof of identity.

Amendment 191, in clause 6, page 3, line 35, at end insert—

“(3A) The coordinating doctor may witness the first declaration only if satisfied that the requirements of subsection (2) have been met.”

This amendment provides that the coordinating doctor may witness the first declaration only if satisfied that the requirements of subsection (2) are met.

Amendment 419, in clause 6, page 3, line 35, at end insert—

“(3B) The coordinating doctor may witness the first declaration only if—

(a) the coordinating doctor has conducted a preliminary discussion with the person or is satisfied that another registered medical practitioner has conducted such a discussion, and

(b) the coordinating doctor has made or seen a written record of the preliminary discussion.”

This amendment provides that the coordinating doctor may witness the first declaration only if satisfied that a preliminary discussion of the kind mentioned in clause 4 has taken place and that a written record of it has been made.

Amendment 293, in clause 6, page 3, line 36, leave out “negative” and insert “affirmative”.

This will change the process to the affirmative procedure for statutory instruments specifying acceptable forms of ID for the first declaration.

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[Kim Leadbeater]

Amendment 419 provides that the co-ordinating doctor may witness the first declaration only if satisfied that a preliminary discussion of the kind mentioned in clause 4 has taken place and that a written record of it has been made. The co-ordinating doctor must have made or seen a written record of the preliminary discussion. Amendment 189 adjusts the wording so as not to suggest that a first declaration has been made before it is witnessed to clarify that proof of identity must be provided before the declaration is signed and witnessed.

Amendment 190 provides that the required two forms of proof of identity must be provided before the person signs the first declaration. Amendment 191 provides that the co-ordinating doctor may witness the first declaration only if satisfied that the requirements of clause 6(2) are met; that is to say, that the patient has provided two forms of identity to the co-ordinating doctor. This is a relatively straightforward set of amendments to tidy up the requirements around proof of identity.

[Naz Shah (Bradford West) (Lab)]

I rise to speak to amendments 291, 292 and 293, which were tabled by my hon. Friend the Member for York Central (Rachael Maskell). I do not intend to press them to a vote; they are probing amendments. They all relate to the amendments tabled by my hon. Friend the Member for Spen Valley about the identification required of applicants for assisted dying. They do not change those requirements; they take a more logical and businesslike approach to proving that those requirements are met.

Amendment 291 would change the current requirements on identification and require applicants for assisted dying to produce a piece of photo ID and proof of residence in the UK for the previous year. As currently written, clause 6(2) states:

“The person must, at the same time as that declaration is made, provide two forms of proof of identity to the coordinating doctor and the witness mentioned in section 5(2)(c)(ii).”

Subsection (3) states:

“The Secretary of State may, by regulations, make provision about the forms of proof of identity that are acceptable for the purposes of subsection (2).”

Surely that is not tight enough.

In particular, the Bill as written does not specify that either form of proof of identity should be photo ID. That may be a major omission. For much less significant decisions, the law of England and Wales requires at least one form of photographic ID. For example, there is currently a requirement to have photo identity to work on the parliamentary estate, vote, or have a bus pass or railcard. None of those is as important as applying for an assisted death.

I remind hon. Members that assisted death is a process that would end in a person being issued with and then taking a mixture of lethal drugs. In a hospital setting where drugs are dispensed, rigorous processes are undertaken to verify the patient. Drug errors are not uncommon. The previous Health and Social Care Committee’s report into pharmacy witnessed how clinical practice was being improved to reduce drug errors. Given that a lethal dose is dispensed as part of this process, the identification mechanisms are weak and should be addressed in this preliminary stage through the provisions set out in this amendment. It is possible that the wrong person could be prescribed the medication. That would be an extreme case, but we are talking about creating a wholly new power that would relate to life and death. We are talking about making assisted dying available to people who are, in many cases, extremely distressed. People in extreme circumstances will sometimes do extreme things. We should expect some extreme cases and seek to guard against them.

Amendment 291 would provide such a safeguard. The Bill says that to qualify for assisted dying, applicants must have been resident in the UK for at least a year, but it does not ask them to provide any proof of that residence. In such a serious matter, we surely cannot simply accept someone’s word that they live in the UK. Making that a requirement without a test to establish it de-values the importance of the criteria for qualifying.

Amendment 292 would change clause 6(3), which currently reads,

“The Secretary of State may, by regulations, make provision about the forms of proof of identity that are acceptable for the purposes of subsection (2).”

The amendment would change that “may” to a “must”, as the former treats the identification process with reduced seriousness. If the word “may” stays in legislation, there is no obligation to have rigour in the identification process. As drafted, the Bill is more open for abuse.

Amendment 293 seeks to place the regulations concerning identification under the affirmative procedure, which the hon. Member for East Wiltshire mentioned earlier. Assisted dying is so important that no regulations made under it should be drawn using the negative procedure. As Members will know, if a statutory instrument is made under the affirmative procedure, it must be approved by Parliament within a certain timeframe, which is usually 28 or 40 days. If that does not happen, the change to the law made by the statutory instrument will not take place. In the Bill as drafted, these regulations are covered by the negative procedure, which means that if and when the Secretary of State decides to change them, they could go through on the nod unless Members raised an objection. A statutory instrument laid through the negative procedure becomes law on the day the Minister signs it and automatically remains law unless a motion rejecting it is passed by either House within 40 sitting days.

Placing all changes to regulations under the affirmative procedure would ensure that we have scrutiny by Parliament. We should all approve this. Our responsibility for this legislation will not end when and if it becomes an Act of Parliament. These amendments speak to tighter safeguards and parliamentary scrutiny for all new regulations made by the Secretary of State in relation to identity and residence. All hon. Members should support them.

[Danny Kruger]

I will quickly echo the points well made by the hon. Member for Bradford West in support of the amendments in the name of the hon. Member for York Central. It is important to specify the form of identity that will be presented. The person presenting themselves for an assisted death needs to be who they say they are. At the moment, the power to specify the forms of proof of identity has no minimum requirements. As written, it does not require the Secretary of State to specify what is acceptable.

Two specific aspects we have to pay particular care to are age and residency. The process must be accessible only to over-18s. I am concerned that we rejected amendments yesterday that would have prevented people under 18 having the conversation. In light of that, it is even more important that we make it clear that people who access assisted death must be adults. We need to ensure that the forms of identity are specified and that Parliament can satisfy itself that they are robust.

[Kim Leadbeater]

We did not reject proposals for the preliminary discussion not to be taken by people under 18. We actually put a clause into the Bill that would ensure that the preliminary discussion was not taken with someone under 18.

[Danny Kruger]

That is right. The preliminary discussion will not, but there is nothing to stop the conversation beginning before the person is 18. I know they cannot formally begin the process of an assisted death, but the concern—although I will not revisit the debate—was that the topic should not be raised or discussed with children, and we did not succeed in that.

The proposal is to ensure that we have proper ID—a passport, driving licence or other combined photo ID and proof of age, so a birth certificate must be paired with something if it is to be robust. We think such questions should be reflected more clearly in the Bill. All sorts of ID would not be appropriate, such as student ID, a sworn statement with no underpinning official record and other such things, which we want to avoid.

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[Stephen Kinnock]

I thank my hon. Friend for that intervention. We have the term “ordinarily resident” in the UK in clause 1. Obviously if the Committee sees fit to accept the amendment it would change to “resident”, which is a looser term. This matter would also be one for the Home Office, as the custodian of our rules and regulations on immigration, but my sense would be that if we stick with “ordinarily resident” then someone who is not ordinarily resident in the United Kingdom would not qualify for assisted dying.

As the Bill currently stands, the Secretary of State has the power but not the obligation to set these requirements in regulations. This amendment would remove this discretion and require the Secretary of State to specify what forms of ID must be provided.

Amendment 293 ensures that regulations on acceptable forms of proof of identify must be approved by both Houses of Parliament before coming into force, by requiring these regulations to follow the affirmative rather than the negative procedure. As I said earlier, the Government’s position is neutral, but I hope my observations—

[Kim Leadbeater]

This is a thought based on the comments by the hon. Member for Reigate. The issue of photographic ID is worth giving consideration. Photo ID is used in multiple settings for different reasons. My slight concern is that some of the people we are thinking about with this Bill would be older and I think of some of my own family members who no longer have driving licences, passports or potentially any form of photographic ID. I would be concerned this could be a barrier for terminally ill people. Considering we are making this a robust process, which I totally agree with, I would be concerned that might present an issue.

[The Chair]

Order. I have asked for interventions to be short and not speeches.

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[The Chair]

I call Kim Leadbeater, who now has the opportunity to say anything she likes.

[Kim Leadbeater]

You will be delighted, Chair, that I have nothing further to add.

Amendment 189 agreed to.

Amendments made: 190, in clause 6, page 3, line 31, leave out

“at the same time as that declaration is made”

and insert “before signing that declaration”.

This amendment provides that the required two forms of proof of identity must be provided before the person signs the first declaration.

Amendment 191, in clause 6, page 3, line 35, at end insert—

“(3A) The coordinating doctor may witness the first declaration only if satisfied that the requirements of subsection (2) have been met.”

This amendment provides that the coordinating doctor may witness the first declaration only if satisfied that the requirements of subsection (2) are met.

Amendment 419, in clause 6, page 3, line 35, at end insert—

“(3B) The coordinating doctor may witness the first declaration only if—

(a) the coordinating doctor has conducted a preliminary discussion with the person or is satisfied that another registered medical practitioner has conducted such a discussion, and

(b) the coordinating doctor has made or seen a written record of the preliminary discussion.”

This amendment provides that the coordinating doctor may witness the first declaration only if satisfied that a preliminary discussion of the kind mentioned in clause 4 has taken place and that a written record of it has been made.

Amendment 192, in clause 6, page 3, line 36, leave out subsection (4).—(Kim Leadbeater.)

See the statement for Amendment 188.

Clause 6, as amended, ordered to stand part of the Bill.

Clause 7

First doctor’s assessment (coordinating doctor)

Amendment proposed: 296, in clause 7, page 4, line 2, leave out from “must” to end of line 3, and insert

“after a first declaration is made by a person, arrange a time and which is convenient for both the medical practitioner and the person date that does not jeopardise the care of other patients, to carry out the first assessment.”—(Naz Shah.)

This amendment replaces the requirement that the coordinating doctor to arrange a first assessment as soon as practicable with a requirement to arrange it for a mutually convenient time which doesn’t jeopardise the care of other patients.

[The Chair]

With this it will be convenient to discuss the following:

Amendment 127, in clause 7, page 4, line 2, leave out

“as soon as reasonably practicable”

and insert “within 10 working days”.

The amendment requires the coordinating doctor to carry out an assessment under the Act within ten working days.

Amendment 128, in clause 7, page 4, line 23, leave out “as soon as practicable” and insert “within 10 working days”.

This amendment would require the coordinating doctor to refer a person within 10 working days rather than as soon as practicable to another registered medical practitioner to carry out the second assessment.

Amendment 129, in clause 8, page 4, line 29, leave out

“as soon as reasonably practicable,”

and insert “within 10 working days”.

This amendment would require the independent doctor to carry out the second assessment within 10 working days rather than as soon as practicable to another registered medical practitioner to carry out the second assessment.

Amendment 130, in clause 16, page 11, line 19, leave out “as soon as practicable,” and insert “within 10 working days”.

This amendment would require the coordinating doctor, where they are a practitioner with the person’s GP practice to record the making of the declaration or statement, or the refusal to make the declaration or statement, in the person’s medical records within 10 working days rather than as soon as practicable.

Amendment 131, in clause 16, page 11, line 23, leave out “as soon as practicable,” and insert “within 10 working days”.

This amendment would require the coordinating doctor, where they are not practitioner with the person’s GP practice, to give a registered medical practitioner from that practice notice of the making of the declaration or statement, or the refusal to make the declaration or statement, in the person’s medical records within 10 working days rather than as soon as practicable.

Amendment 132, in clause 16, page 11, line 27, leave out “as soon as practicable,” and insert “within 10 working days”.

This amendment would require the coordinating doctor, where they are not a practitioner with the person’s GP practice to record the making of the declaration or statement, or the refusal to make the declaration or statement, in the person’s medical records within 10 working days rather than as soon as practicable.

Amendment 133, in clause 17, page 11, line 38, leave out “as soon as practicable,” and insert “within 10 working days”.

This amendment would require the coordinating doctor, where they are not a practitioner with the person’s GP practice to record the making of the declaration or statement, or the refusal to make the declaration or statement, in the person’s medical records within 10 working days rather than as soon as practicable.

Amendment 134, in clause 17, page 12, line 2, leave out “as soon as practicable,” and insert “within 10 working days”.

This amendment would require the medical practitioner to whom notice or indication of the cancellation of declaration is given to notify a registered medical professional from the person’s GP practice within 10 working days rather than as soon as practicable.

Amendment 135, in clause 17, page 12, line 5, leave out “as soon as practicable,” and insert “within 10 working days”.

Amendment 136, in clause 21, page 14, line 12, leave out “as soon as practicable,” and insert “within 10 working days”.

Amendment 137, in clause 21, page 14, line 15, leave out “as soon as practicable,” and insert “within 10 working days”.

Amendment 138, in clause 21, page 14, line 18, leave out “as soon as practicable,” and insert “within 10 working days”.

Amendment 139, in clause 22, page 14, line 27, leave out “as soon as practicable,” and insert “within 10 working days”.

Amendment 140, in clause 22, page 14, line 30, leave out “as soon as practicable,” and insert “within 10 working days”.

Amendment 141, in clause 22, page 14, line 33, leave out “as soon as practicable,” and insert “within 10 working days”.

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[Danny Kruger]

Okay. I might address the question at a future point, because the issue of how we reflect on these proceedings outside this place has come up privately.

[Kim Leadbeater]

I do not consider for one second that there is any ill intent behind the amendment, but I am slightly concerned about the language, which is what I think my hon. Friend the Member for Rother Valley meant. The issue is the suggestion that a doctor would, in any circumstances, jeopardise the care of other patients. We are talking about doctors a lot, and we have the utmost respect for medical practitioners, but I imagine that that would be a worrying concept to have in writing from their perspective.

[Danny Kruger]

I respect that point, and it is a fair charge: that doctors would not do this. Nevertheless, as I have been stressing, we are in uncharted territory, and there is a genuine concern about the resource implications of the Bill.

The Bill clarifies and emphasises things in lots of other places—“for the avoidance of doubt” and so on—and the amendment would clarify that the procedure under the Bill would not take precedence in a clinician’s time over other matters that they also consider to be pressing and urgent. That is an appropriate safeguard for doctors.

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[Rebecca Paul]

I think most points have been covered, so I will be brief. The point of the amendment 296 is to recognise the challenges faced by medical practitioners in the NHS. It is really well intended. I suspect that there are different ways to do this, which we could discuss, but the amendment would recognise that medical practitioners will come under a lot of pressure.

The very nature of the assisted dying process means there is pressure to move quickly—for obvious reasons. If someone is in pain and an assisted death is what they have chosen to do, they are going to want to move forward at pace. It cannot be as usual, with however long it can take in the NHS—often for a normal procedure. The point of the amendment is simply to be cognisant of the fact that other patients, too, require healthcare. This comes back to the debate we have had many times about what is healthcare and what is not. It is one of the issues that comes up when we have assisted dying amalgamated with general healthcare in the NHS.

We are hearing concerns from doctors on the frontline. In written evidence, eight doctors, six of them GPs, say that the NHS lacks both the time and the capacity to create the new role of co-ordinating doctor with its grave responsibilities. The statistics bear out their concerns. In a 2024 survey by the Royal College of General Practitioners, over 40% of UK GPs who responded said that they were “unlikely” to be practising still in five years’ time; 40% feel stressed to the point of “not coping” at least once a week; and 79% are concerned about having fewer GPs at their practice and its impact on the quality of care that their practice can deliver. The reality of the matter is that we have to recognise that the introduction of assisted dying places another pressure on our health system, and to try to address that head on.

[Kim Leadbeater]

The hon. Lady is making some interesting points, but would she agree that we are talking about not new patients, but existing patients who are already in their last few months of life? It will not create a whole new pressure on the health service, because they are already receiving treatment.

[Rebecca Paul]

I thank the hon. Member for that point. There will absolutely be some occasions where that is the case, but assisted dying is a different pathway—and we have a whole Bill on it, so there will be other formalities and safeguards. We are all here to make sure that rigour is applied to that pathway. With the best will in the world, there will always be more work and pressure, especially time pressure, on doctors. That time pressure will be critical.

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[Stephen Kinnock]

These amendments introduce requirements on the timing within which the co-ordinating doctor must carry out a first assessment once the first declaration is made by a person. I will turn first to amendment 296. As currently drafted, clause 7(1) requires that the co-ordinating doctor must carry out a first assessment

“as soon as reasonably practicable”

after a person has made a first declaration. Amendment 296 would require that after the first declaration is made, the co-ordinating doctor must arrange a mutually convenient time and date for the first assessment to take place, but it removes the stipulation that the assessment must be carried out as soon as reasonably practicable. The amendment would also require the date and time agreed not to jeopardise the care of other patients. The effect of the amendment may be to lengthen the period between the first declaration and the first assessment, in some cases.

Amendments 127 to 141 seek to ensure that the assessments, declarations and statements made throughout the Bill are finalised and recorded within 10 working days of being started. The amendments achieve this by inserting the term “within 10 working days” in place of

“as soon as reasonably practicable”

in clauses 7, 8, 16, 17, 21 and 22. This would put in place a time-bound limit that the medical practitioner must adhere to when carrying out the first and second assessments, when recording information in medical records at various stages, including the High Court declaration, and when recording other matters in medical records.

Our assessment suggests that in most circumstances, although it would depend on the facts of a particular case, the requirement to do an action as soon as practicable would generally amount to a requirement to do the action sooner than in 10 working days’ time. In terms of the operational effects, having a set timeline may give greater certainty to individuals seeking assistance. However, it may limit doctors’ discretion to set the timeline based around the patient’s wishes. These are matters for the Committee to weigh up and consider.

[Kim Leadbeater]

That has been a very useful discussion. I have nothing to add.

[Naz Shah]

I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

--- Later in debate ---

[Dr Opher]

That is an interesting point, but we are not discussing organ donation, and we are dealing in a different environment here; the patients we are talking about are about to die, and all we are giving them is the right to control the moment and manner of that death. I acknowledge that using a psychiatrist in organ donation has its benefits, but in this service, getting every patient—who, for example, are frail and ill by definition, because they are about to die—to see a psychiatrist is frankly neither applicable nor appropriate.

[Kim Leadbeater]

My hon. Friend makes a powerful point. If we think about some of the people we have met—the families who have lost loved ones to terminal illness and the patients who are terminally ill—they are very clear in their decision. For me, it would be another barrier to those patients, who are dying people, to make them see a psychiatrist for every single case.

[Dr Opher]

I think it would create a barrier. We need to make sure that we deliver legislation that does what we are trying to do, which is to enable someone with a terminal illness, who has full capacity, to make a decision about the end of their life.

--- Later in debate ---

I hope the Committee has found these observations useful.

[Kim Leadbeater]

I will do the easy bits first. As the Minister said, amendment 370 in my name is a drafting change to the definition of a psychiatrist, which is obviously very important. These useful amendments have enabled us to have this discussion, and they all come from a good place in trying to enhance safeguarding within the Bill.

On organ donation, my sister-in-law has had two kidney transplants. On neither occasion, to my understanding, did a psychiatrist speak to either her or the organ donor, who in one instance was her brother—my sister-in-law would be very upset that I have mentioned her in Parliament. My understanding of the law is that someone may be referred to a mental health specialist. I am happy to be corrected if that is not the case, but I do not think a consultation with a psychiatrist is compulsory.

As I said to my hon. Friend the Member for Stroud, it is absolutely right that we support amendment 6. From the start, I have been clear that we should move from “may” to “must” in referring to a psychiatrist where either doctor has any doubt. That is a sensible approach, and it covers most of today’s discussion.

However, introducing a whole new system that would almost sit alongside the Bill, and that would change the process, is unnecessary. Those are my conclusions, based on what has been another very interesting discussion.

[Daniel Francis]

I will not come back on anything but, obviously, I will press some of these amendments in due course.

I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Amendment proposed: 294, in clause 7, page 4, line 5, after “doctor” insert

“based on provided evidence that”.—(Daniel Francis.)

This amendment would require that the doctor bases their assessment on provided evidence.

Question put, That the amendment be made.

--- Later in debate ---

[Sarah Olney]

Although this is not specified in any of the amendments—which are in the name of my good friend, my hon. Friend the Member for Bath (Wera Hobhouse) —they are very much informed by the work she has done over a number of years as the chair of the eating disorders all-party parliamentary group. This is a subject about which she has a great deal of knowledge, and that is what has prompted this group of amendments, which follow on from the debate we had just before the break.

It is important to remember that although amendment 6 —in the name of another good friend, my hon. Friend the Member for St Albans (Daisy Cooper)—talked specifically about people’s capacity, this group of amendments very much returns to a topic I have spoken on at length in previous sittings: how a person’s capacity to request an assisted death might well be impacted if they are suffering from mental health difficulties.

Amendment 363 would require a mental health assessment if there is any indication that a person’s judgment may be impaired by a mental disorder or other conditions. We have debated this topic at length—[Interruption.] I see the right hon. Member for North West Hampshire nodding, but it is worth returning to the issue, because a principal concern of mine is that we have not yet dealt adequately with this risk in the Bill. We have talked about how the Mental Capacity Act might be applied and about psychosocial interventions, but I am keen to see amendment 363 agreed to, because it would deal with many of the objections raised in those other debates. It is an important safeguard that still needs to be included in the Bill.

The Bill has been described as having the strongest safeguards in the world, but it lacks this critical safeguard, which is seen in many similar laws around the world, including Oregon and California, which require that in addition to establishing mental capacity, doctors must ensure that a person’s judgment is not impaired by mental illness. In fact, in the American state of Hawaii, every patient who requests an assisted death is required to see a mental health professional, who can determine whether the patient is capable and appears not to be suffering from under-treatment or non-treatment of depression or other conditions that may interfere with their ability to make an informed decision.

It is provided for specifically and clearly in the legislation that governs assisted dying in other jurisdictions that assessments of the state of people’s mental health—and not just their capacity—must be made properly. The absence of any such safeguard in the Bill represents a clear risk. We know that mental health conditions can impair decision making and lead to suicidal ideation, particularly when a person lacks adequate social support. Without this provision, individuals experiencing a treatable mental health crisis may be given life-ending medication instead of the care and treatment that could alleviate their suffering.

Professor Allan House made the importance of that clear in his written evidence. He wrote:

“Simply checking mental capacity and asking about coercion is not adequate.”

He emphasised that National Institute for Health and Care Excellence guidelines in other areas already require a comprehensive psychosocial assessment that explores

“thoughts about life not being worth living”

and considers

“current and recent personal and social circumstances, recent adversities, psychological state beyond merely assessing mental capacity and the presence of severe mental illness.”

Professor Louis Appleby, the Government’s adviser on suicide prevention—I have referenced him on many occasions in previous sittings—has also raised concerns that the Bill could undermine suicide prevention efforts. Speaking to The Guardian, he said:

“You have a number of potentially remediable risk factors like isolation, for example. Do something about isolation. Depression, treat depression. It should be the offer of supporting people through the remediable elements of a sense of despair.”

That highlights why a safeguard is necessary to ensure that individuals receive proper assessment and treatment, if needed, before making an irreversible decision. If a person qualifies for assisted dying but is also experiencing impaired judgment due to a psychiatric condition, how can we be confident that their decision is truly autonomous?

Amendment 363 would require the co-ordinating doctor to assess whether a person’s request for assisted dying is influenced by a mental health condition. If there is any concern that impaired judgment due to a mental disorder is a factor, the doctor must refer the individual for a psychiatric assessment. The amendment would explicitly protect individuals with mental health disorders, including eating disorders, from accessing assisted dying when their desire to die is a symptom of their illness rather than a rational decision deriving from a terminal illness.

Do not ask me how I know this, but eating disorders really scramble a person’s brain. They leave them entirely incapable of making any kind of rational decision. The lack of nutrition really affects the brain: it has a physical impact that means the brain simply cannot function as it is supposed to. That is a direct cause of a person not ingesting the nutrients they need. When that happens to somebody, their behaviour completely changes: they become anxious, fearful, irrational and aggressive. It is not just that they believe their life is not worth living; the entire span of their life has shrunk down entirely to the question of how they can avoid eating. What is the next meal? What is the next stage in their life when someone is going to try to get them to eat, and how can they avoid that? What tactics can they employ?

When a person is in the grip of that kind of eating disorder, if someone comes along and offers them the possibility of an assisted death, there is every chance that they will choose that as a way of avoiding eating. As I say, do not ask me how I know this, but I have seen it, and for me it is beyond comprehension that we could possibly allow young people, and young women in particular, to put themselves in the position where they are being offered an assisted death and no one is taking those extra steps to treat their eating disorders—and eating disorders are always treatable. That is why I want to press the amendment.

[Kim Leadbeater]

The hon. Lady is making a powerful speech, and I understand that the amendments come from a very good place, and a very strong and experienced one, but she just made the point that eating disorders are treatable. That is the whole point: they would not fall under the criteria in the Bill.

[Sarah Olney]

That is why we need to ensure that people with eating disorders get the treatment they need, instead of being offered an assisted death. That is why we need the amendment.

[Kim Leadbeater]

rose—

[Sarah Olney]

Let me just reply to the hon. Member’s original point. It is so important—and this is why we need the amendment in the Bill—that if there is any doubt at all that someone is suffering from a treatable mental health condition, they are not allowed to proceed with their request for an assisted death until all avenues of treatment for that condition have been explored. Eating disorders are treatable: people can recover and can, in the fullness of time, recover their zest for life. They can move beyond the stage where their decision whether to eat or not is their entire world. They can rediscover their friends, their employment and their education, and they can look forward to a full life again. But it is imperative that while they are in the grip of that eating disorder, they are not offered the option of an assisted death.

[Kim Leadbeater]

I agree with every word the hon. Lady said, and—possibly like her—I have experience of working with people with eating disorders. However, clause 2 defines terminal illness as “an inevitably progressive” illness or disease

“which cannot be reversed by treatment”.

Eating disorders can be reversed by treatment, and therefore I am not willing to support the amendment.

--- Later in debate ---

[Lewis Atkinson]

As I am sure the hon. Lady knows, there are gradients of mental health issues, from low mood to suicidality and so on. We should not prevent anyone from accessing an option merely because of a mild element of, for example, depression, which they have lived with for their entire lives, if they have then been diagnosed with a terminal condition.

The key point, as my hon. Friend the Member for Spen Valley made out, is that the idea that eligibility will be conferred as a result of mental health illnesses is not correct. As we have discussed, the definition of “inevitably progressive” in clause 2, which is at the heart of the Bill, clearly protects against such instances. I also highlight the amendments we have made that help to clarify some of this. Members have pointed out the amendment from the hon. Member for East Wiltshire on removing medical conditions from the Bill, which was very helpful in this regard.

I do not want to fall foul of Standing Order No. 42 on repetition, but I feel like with this issue we are repeating some of our discussions on capacity. In particular, my hon. Friend the Member for Penistone and Stocksbridge highlighted significant elements of the relevant legal framework in her speech at that point. In my view, setting out a test that is separate to the Mental Capacity Act, particularly in respect of the impairment of judgment, which is not then defined in any way, would undermine that Act, which has to be the cornerstone of the Bill.

[Kim Leadbeater]

My hon. Friend is making an important speech. Is he, like me, reassured that it is not just about capacity, but about someone’s clear, settled and informed wish? If someone is suffering from a mental health condition, there is a very strong chance that they will not meet the criteria. Also, my amendment 423 will strengthen the fact that the assessing doctors must speak to somebody else in regard to the patient, including eating disorder specialists.

--- Later in debate ---

[Naz Shah]

Apologies, Mrs Harris: I was late returning to my seat earlier and missed the opening remarks from the hon. Member for Richmond Park on this amendment. I am happy to be corrected, but my understanding is that, as it is, if somebody has anorexia—we are not talking about capacity, which I referred to in the cases of the nine girls I spoke about—that is an accepted mental health condition and the amendment is trying to exclude those people from having an assisted death. In the nine cases I spoke of, the court found that those girls with anorexia had capacity and ruled that they had a terminal illness.

[Kim Leadbeater]

I apologise, but I thought my hon. Friend said that they did not have capacity.

[Naz Shah]

Sorry—they did not have capacity, but the Court of Protection still ruled that they would be taken down the route of palliative care. This is not just a matter of capacity; in this instance, when we talk about mental health—before we even get to the capacity question—the issue is that anorexia is a recognised mental health condition. I beg to differ from my hon. Friend the Member for Sunderland Central on whether we have enough provision. We keep coming back to this issue time and again.

--- Later in debate ---

[Kim Leadbeater]

As I said earlier, I have no doubt that these amendments are coming from a good place and from somebody with huge experience in this particular area. There is absolute consensus on the Committee that the last thing we want is for anybody with a mental health condition and terminal illness to end up going down a path that they did not want, and we have to put as many safeguards as possible in place to ensure that that does not happen.

However, I remain confident that the Bill, with the amendments that we have voted for in Committee and the safeguards that were already there, provides the highest level of safeguards to ensure that people with mental health conditions are protected. Let us look at the fact that there will be two doctors; we have talked at great length about not only their existing skills but the skills that they would gain from the robust training, particularly in assessing capacity, detecting coercion and the specific skills that we might say they would need for the purposes of the Bill.

We can also look at the fact that the doctors can make any referral to any other professional, as they want. Clause 9(2) currently says that they can

“make such other enquiries as the assessing doctor considers appropriate”.

I have strengthened that further with amendment 423, which specifically talks about health and social care professionals, which is again another opportunity to have another professional involved.

Clearly, I would find it untenable for a doctor, presented with a terminally ill patient with an eating disorder, not automatically to speak to a professional involved in that field. That feeds into the broader point, with which I absolutely concur, that we need to do more to support people with eating disorders—that is a very important, separate piece of work. We then add amendment 6, which puts in place the compulsory referral to a psychiatrist. We have talked a lot about the psychiatrist’s role in assessing capacity, but we must remember that this would be a psychiatrist doing the assessment. As my hon. Friend the Member for Sunderland Central mentioned, mental health conditions are referred to in the Mental Capacity Act, and “impairment” is referred to in the Mental Capacity Act.

Many safeguards were there already, and we have added additional ones as a Committee. We also then come on to the multidisciplinary panel, which I hope the Committee will support. It would add extra layers of expertise, with social workers, psychiatrists and legal oversight. I remain confident that there are multiple levels of safeguarding at various stages in the Bill that would address the issues raised by the hon. Member for Bath. Equally, I am very happy to continue speaking to her and meeting her, as I did quite recently, to talk about this issue and look at whether we can do any other things to enhance the Bill going forward.

Question put, That amendment be made.

--- Later in debate ---

[Stephen Kinnock]

The amendments seek to ensure that an individual requesting assistance to die will not be able to do so if there is a real risk that the eligibility criteria have not been met.

The Bill provides in clauses 7, 8, 12, 13 and 18 that where the assessing doctor or court is satisfied that, in their opinion, the eligibility criteria that they are charged with assessing have been satisfied, they must complete the next relevant step required by the Bill. If, however, the assessing doctor or court are not satisfied that the eligibility criteria that they are charged with assessing have been met, they must not take the next steps set out under the Bill.

Our assessment is that, as drafted, this group of amendments could create uncertainty as to what the assessing doctors are required to assess. The amendment would add a separate, potentially overlapping requirement on the assessing doctors and the court to assess whether there were no real risk. That could create uncertainty for the assessing doctors as to what is additionally required. I hope those observations were helpful to the Committee.

[Kim Leadbeater]

I have nothing to add, Mrs Harris.

[Danny Kruger]

I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Amendment proposed: 14, in clause 7, page 4, line 15, at end insert—

“(2A) The coordinating doctor must take the report required under subsection (2B) into account in making an assessment under paragraph (2)(b), (f) and (g).

(2B) One or more qualified persons must have conducted a separate interview with the person and made a report to the coordinating doctor on the matters specified in subsection (2C).

(2C) The matters that must be covered in the report required under subsection (2B) are—

(a) any evidence of duress or coercion affecting the person’s decision to end their life,

(b) any difficulties of communication with the person interviewed and an explanation of how those difficulties were overcome, and

(c) the capacity of the person interviewed to understand the information given to them under paragraph (9)(2), (b), (c) and (d).

(2D) A person shall be taken to be qualified to conduct an interview under subsection (2B) if that person—

(a) is a registered medical practitioner who—

(i) is registered in the specialism of psychiatry in the Specialist Register kept by the General Medical Council, or

(ii) has such training, qualifications and experience as the Secretary of State may by regulations specify,

(b) has not provided treatment or care for the person being assessed in relation to that person’s terminal illness,

(c) is not a relative of the person being assessed,

(d) is not a partner or colleague in the same practice or clinical team as the coordinating doctor,

(e) did not witness the first declaration made by the person being assessed, and

(f) does not know or believe that they—

(i) are a beneficiary under a will of the person, or

(ii) may otherwise benefit financially or in any other material way from the death of the person.

(2E) Before making regulations under subsection (2D)(a), the Secretary of State must consult such persons as they consider appropriate.

(2F) Regulations under subsection (2D)(a) are subject to the negative procedure.”—(Daniel Francis.)

This amendment, and its consequential and linked amendments (15, 16, 17, 18 and 19), would provide for an independent assessment, via an interview conducted by a specialist, of a person’s capacity to make the decision to end their own life, their clear, settled and informed wish to do so, and that they have made the first declaration voluntarily and without coercion.

Question put, That the amendment be made.

--- Later in debate ---

[Sojan Joseph]

I should like to speak to amendment 1 —I am pleased that I was able to table my amendment first. We have already discussed safeguarding many times and how capacity is central to these measures. As we know, clause 1 lists the qualifying criteria that a terminally ill person must meet, which includes having the capacity to make such a decision. Indeed, the qualifying criteria might not be written in any order of importance, but the fact that that appears first underlines its significance.

In many days of sittings the most spoken words have been mental health, capacity, coercion and suicidal thoughts, rather than pain, cancer and suffering. The importance of capacity as a safeguard is again demonstrated when we turn to clauses 7 and 8, which in turn set out what both the co-ordinating doctor and the independent doctor must assess in order for a terminally ill adult to be allowed to end their own life.

In clause 7, the first assessing doctor with responsibility is the co-ordinating doctor. In clause 8, the second doctor is the independent doctor. The doctors are expected to assess mostly the same things. For example, the first doctor will assess whether the person is terminally ill, has capacity to make the decision to end their own life, is aged 18 or over, is ordinarily resident in England, and is registered as a patient with a general medical practice in England. The second doctor does exactly the same and assesses whether the person is terminally ill, has capacity to make the decision to end their own life, is aged 18 years or over and so on.

Before coming to the first assessing doctor, the patient has already been treated by a consultant and been diagnosed as terminally ill, so the three doctors are basically doing the same job. That is important and relevant to my amendment 1, which asks that one of the two assessing doctors should be a qualified psychiatrist or a specialist in psychiatry. As I said earlier, the issues that have been most discussed by Committee members in the last few sittings were capacity, mental health and suicide. In my view, there is a gap that needs to be addressed.

We talked earlier about unconscious bias. There is already a provision in the Bill to refer a patient to a psychiatrist if one of the doctors thinks that there is an issue with their mental health or capacity. We discussed a similar concept when we debated the patient having access to a palliative care consultant. Some of the comments were that needing another person makes it complex, and it should be simplified. Do Members think that if any of the doctors thinks that there is an issue with the patient’s mental health or capacity assessment, making a referral creates that same kind of complexity? Getting access to a psychiatrist could be simplified by having that second doctor be a specialist in mental health. It is to be strongly welcomed that both co-ordinating doctors and independent doctors have to make an assessment that the person wanting to ending their life has the necessary capacity to make such an important decision.

The question came up during the debate about whether, if somebody has mild depression or another mental health disorder, but they still think that they have capacity, they should be allowed to choose this route. We have seen that, in some other countries where this route is already practised, mental health was originally excluded from the criteria but was later added. Are we saying that even if someone has mental ill health, mild depression or some sort of mental illness, if they have capacity, we can allow them to choose assisted dying? Who will make that decision?

In my experience of working in mental health for many years, I have seen many terminally ill people being admitted to mental health wards because of their increasing suicidal thoughts. Many people who have a mental illness for many years, especially chronically mentally ill people, lead a normal life with the support of medication, but when they are diagnosed with a terminal illness, such as cancer, and start chemotherapy or taking medication for that, it can interact with the medication that they were already taking. That can have an impact on their mental health or decision making, so it is important that those patients have access to a psychiatrist.

I am not asking to make the process more complex or for us to draw any more resources from the NHS by adding a psychiatrist into the assessment. All my amendment asks is for one of the two doctors to be a psychiatrist, which in fact makes the process safer and more secure—some of the concerns that we have talked about.

[Kim Leadbeater]

I congratulate my hon. Friend on tabling amendment 1 on the amendment paper—a lot has happened since he tabled that amendment, it is fair to say. I get the impression from the Committee that we will all be voting in favour of making it compulsory to refer to a psychiatrist when one of the doctors feels there is a need to. Is my hon. Friend somewhat reassured by that?

[Sojan Joseph]

I thank my hon. Friend for her timely intervention. I was going to say that having tabled amendment 1 asking for a psychiatrist to be involved, and having now been through many Committee sittings, I wonder whether I influenced an unconscious bias among Members to table more amendments relating to mental health, capacity and suicide. I say to my hon. Friend that although there can be a psychiatry referral, if we are talking about unconscious bias, as soon as the first and second doctor make the decision that the person has capacity, is terminally ill and is eligible for this process, the subsequent assessments can be influenced by the first assessment. That happens quite often in NHS healthcare, and especially mental health.

When the chief medical officer, Sir Chris Whitty, was before the Committee, I asked him about mental capacity assessments. He said:

“I would hope that most doctors are capable of identifying that someone has some degree…of mental health distress, or mental health illness”.

However, he went on to say:

“What not all doctors will feel comfortable doing is actually deciding whether that is sufficient to interfere with someone’s ability to make a decision with full capacity. That is where help from colleagues from psychiatry, and mental health more widely, is going to be useful.”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 38, Q17.]

We have spoken about this many times, but in written evidence the Royal College of Psychiatrists said:

“A person’s capacity can change, and it is decision specific. While we are of the view that a person’s capacity to decide treatment can be reliably assessed, an assessment of a person’s mental capacity to decide to end their own life is an entirely different and more complex determination requiring a higher level of understanding.”

In a previous sitting, we discussed having a panel that is able to do a psychosocial assessment. I know that the new clauses are yet to be discussed, but the relevant new clause does not specify who the members of the panel will be and whether it should include a psychiatrist or a social worker. That is yet to be made clear, so I am not convinced about that.

[Kim Leadbeater]

To clarify, I think it is clear that the panel would include a psychiatrist and a social worker. I hope that reassures my hon. Friend.

[Sojan Joseph]

I thank my hon. Friend for confirming that. That is reassuring but, as I said earlier, I would like to know when the patient will have access to the panel. It is important that they access it early in the process, rather than later, because that is where unconscious bias comes in.

The purpose of my amendment is to save resources, because I know about the pressure on the NHS. Rather than having an additional psychiatrist on top of the two or three doctors, my amendment would simplify the process and save resources.

Although I acknowledge that the evidence I cited referred to the application of the Mental Capacity Act 2005 to the Bill—an issue on which the Committee has already decided—I would argue that it can equally be taken into consideration in this context. After all, in its written evidence, the Royal College of Psychiatrists said:

“Mental disorders, such as depression, are more common in people nearing the end of their life. Delirium is more common… Hopelessness is a common symptom of depression”,

and people’s capacity and consent can be affected when they are going through that condition. I can categorically confirm that I have seen that in my own practice. A person could be absolutely normal, but when they are diagnosed with a terminal illness, that can have an impact on their mental health. We have heard about post-traumatic stress disorder and many other events that can have an impact on people’s mental health and, in turn, on their decision making and capacity.

If the Bill enters the statute book, we should ensure that at least one of the doctors assessing a terminally ill adult who wants to use the legal mechanism to end their life is properly qualified to carry out mental capacity assessments. I know from my own experience that psychiatrists deal with complex mental capacity assessments and other cases every day. For example, psychiatrists who work in accident and emergency departments regularly see people who are intent on ending their life—that is the bread and butter of their work.

--- Later in debate ---

[Naz Shah]

I rise to speak to amendment 21, tabled by my hon. Friend the Member for Lowestoft, which is about the second, independent doctor. We debated amendment 20 earlier, and I am genuinely very pleased that the promoter of the Bill accepted that amendment. Some of what I would like to say now will be repetition, because it is a similar amendment, but I will try to keep my remarks contained and shorter.

I am not sure whether the promoter of the Bill is planning to accept amendment 21 as well as amendment 20 —for both doctors. I will be happy to give way if she wants to clarify that now.

[Kim Leadbeater]

I am indeed happy to accept amendment 21 as well.

[Naz Shah]

Oh, perfect. I am really pleased that my hon. Friend will accept both amendments 20 and 21, tabled by my hon. Friend the Member for Lowestoft. Amendment 21 is about training. Although I welcome the amendments being accepted, my concern is that the amendment for training does not go far enough. We are talking about repeated coercion here, and my hon. Friend’s intention with the amendment was for people to be trained in picking up repeated coercive control. That is very different from domestic abuse, in terms of its manifestation and how it is picked up. From lots of evidence we have received, both written and oral, we know that coercive control is hard to detect. When it is repeated coercive control, it is even harder.

I want the Bill to be strengthened, especially when it comes to minoritised communities and older people. From a safeguarding perspective, the Bill’s impact is very gendered. It is International Women’s Day this week, and this is a very heightened issue. We celebrate women in this place because we do not have equality for women in our systems, across the globe and in this country. From the research and evidence we have had, we know that this Bill would impact more upon women, so it is important that we extend the training. As I suggested earlier, I would be happy to work with my hon. Friend the Member for Spen Valley to look at tabling another amendment and strengthening this safeguard, because I really want to get this one right.

Although I talked about this earlier, there are some statistics on suicide that I did not mention, which is why I want this training. Only this afternoon, I came across some research from the Kent and Medway NHS trust. In addition to research from last year, it has been found that women will kill themselves when they experience domestic abuse. For the first time, the number of women killing themselves as a result of domestic abuse has overtaken the number of women who are killed from domestic violence in intimate partner relationships. Bear with me—I will return to the research from the Kent and Medway trust in a moment, because I cannot seem to locate the statistics I wanted to point out. Either way, I want to support my hon. Friend the Member for Spen Valley to get this Bill right.

--- Later in debate ---

[Stephen Kinnock]

Under amendment 56, the second independent doctor would be required to assess whether the person seeking assisted dying would be liable for detention under the Mental Health Act 1983. If they are liable to be detained, the necessary statement cannot be made for the assisted dying process to continue. Assessment under the Mental Health Act requires consideration of someone’s mental disorder and the risk of harm they present to themselves or others if they are not admitted and/or treated for their mental disorder.

Someone can be detained under the Mental Health Act both with and without capacity. Many people could be considered liable to be detained, but would not actually be detained if, for example, they could receive treatment for their mental disorder in the community. Members should be aware that the Mental Health Bill before Parliament, which will soon leave the Lords and come to this place, includes plans to strengthen and clarify the criteria for detention.

Amendment 57 would require the independent doctor to undertake the second assessment jointly with the co-ordinating doctor. If they are unable to, they would be required to confer before completing the assessment. In the Bill as currently drafted, the second assessment is intended to be conducted independently of the first.

I now turn to the famous amendment 1. As the Bill is currently drafted, the second doctor, known as the independent doctor, must be a “registered medical practitioner” who

“has such training, qualifications and experience as the Secretary of State may by regulations specify”.

The amendment intends to make it a requirement that the second assessment is conducted by

“a registered medical practitioner who is registered in the specialism of psychiatry”.

Operationally, focusing on one medical specialty may have workforce implications that the Government would need to work through, should this Bill pass with that amendment.

Amendment 197, along with amendment 198, place

“a duty on the Secretary of State to make regulations about the training, qualifications and experience required in order to act as the independent doctor.”

The Government have worked with my hon. Friend the Member for Spen Valley on these amendments to ensure that the legislation is robust and workable. Amendment 198 specifies:

“The regulations must include training about…assessing capacity”

and

“assessing whether a person has been coerced or pressured by any other person.”

Under amendment 58, the second independent doctor would have to be an approved medical practitioner under section 12 of the Mental Health Act. A section 12 -approved doctor is

“a practitioner approved for the purposes of this section by the Secretary of State as having special experience in the diagnosis or treatment of mental disorder”.

Their role is to make a medical recommendation, which is part of the process of determining whether someone is liable to be detained under the Act. Section 12-approved doctors are also eligible to carry out mental health assessments as part of the deprivation of liberty safeguards under the Mental Capacity Act. The objective of the mental health assessment is to ensure that the person is medically diagnosed as being “of unsound mind” and so comes within the scope of article 5 of the European convention on human rights, the right to liberty.

The purpose of amendment 428 is to impose an obligation to take all reasonable steps to ensure that the independent doctor is proficient in the Welsh language, if services or functions in the Bill are to be provided to an individual in Welsh in Wales. This mirrors amendment 427, which we have already debated. The amendment does not make clear who is obliged to ensure that these steps are taken or who will assess and enforce whether “fluent proficiency” is met. This may reduce the pool of registered medical practitioners able to carry out the function of an independent doctor under the Bill.

It may be helpful to note again that, regardless of this amendment, under the Welsh Language (Wales) Measure 2011, the NHS in Wales has a statutory duty to deliver its services to the public in both Welsh and English. That legislation gives the Welsh language official status in Wales, and it states that individuals in Wales

“should be able to live their lives through the medium of the Welsh language if they choose to do so.”

The Welsh Government’s active offer for health is intended to support all staff across NHS Wales to provide a service in Welsh for patients without them having to ask for it. Of course, I will add that we have agreed to have further discussions on these points with the right hon. Member for Dwyfor Meirionnydd, and I look forward to them.

Amendment 21 would require that a registered medical practitioner could act as an independent doctor only if they have undertaken training on identifying domestic abuse. Should this amendment be accepted, it would require setting up training mechanisms to equip registered medical practitioners who want to act as independent doctors with the knowledge and skills needed to identify domestic abuse, including coercive control and financial abuse. I hope those observations were helpful for the Committee.

[Kim Leadbeater]

I will not test the patience of the Committee by repeating the Minister’s comments on amendments 197 and 198, but he is absolutely right that they relate to the duty imposed on the Secretary of State to make regulations about the training, qualifications and experience required to act as the independent doctor. I hope that Committee members can support them.

Amendment 21 was tabled by my hon. Friend the Member for Lowestoft, and further to my comments this morning on the very similar amendment 20, I am very pleased to support amendment 21. We have spoken a lot about the training requirements for the provisions of the Bill, and I firmly believe that we have to set ourselves the very high standard of having the best training that we possibly can for medical practitioners involved in the processes set out in the legislation. It is vital because only those medical practitioners who have chosen to undergo such training would be allowed to play the role of assessing doctors.

We have already discussed many of the components that will be required in that training, but it must include assessing capacity and detecting coercion or pressure, which is in line with this amendment, so I am very pleased to support it in that regard. Doctors must have appropriate qualifications and experience to ensure that those seeking assistance under the legislation are in the best possible hands throughout.

I also welcome the comments made by my hon. Friend the Member for Banbury about the wider benefits of such training, which is a really important point to make. It feeds into the wider benefits that there would be for not just the health service but society as a whole. It also feeds into the work that is being done by the Home Office and my hon. Friend the Member for Birmingham Yardley (Jess Phillips), who is the Minister for Safeguarding and Violence Against Women and Girls—I just had to google the fancy title that she goes by nowadays. There is a broader conversation to be had about society and the role of training for coercive control, financial abuse and domestic abuse. I support amendment 21, along with my amendments 197 and 198.

Amendment 56 negatived.

[Naz Shah]

I beg to move amendment 301, in clause 8, page 4, line 39, leave out “7” and insert “14”.

This amendment would increase the period of reflection to 14 days.