Terminally Ill Adults (End of Life) Bill

Kim Leadbeater Excerpts

Friday 13th June 2025 Commons Chamber

[Kim Leadbeater (Spen Valley) (Lab)]

I beg to move, That the clause be read a Second time.

[Mr Speaker]

With this it will be convenient to discuss the following:

Amendment (b) to new clause 13, at end insert—

“(5A) The Secretary of State may only approve a device under subsection (5) if the Medicines and Healthcare products Regulatory Agency has approved the device for that purpose.

(5B) Before making any regulations under this section, the Secretary of State must consult the Medicines and Healthcare products Regulatory Agency.”

This amendment requires that the Medicines and Healthcare products Regulatory Agency be consulted before making regulations and that medical devices can only be approved for self-administration if they have been approved by the MHRA.

Amendment (c) to new clause 13, at end insert—

“(5A) Regulations under subsection (5) must forbid the use of any device used for the self-administration of a gas.”

This requires the Secretary of State to forbid the use of medical devices which cause death by the administration of a gas.

Amendment (a) to new clause 13, leave out subsection (7).

This removes the power to make regulations that may make any provision that could be made by an Act of Parliament (known as Henry VIII power) from this new clause.

New clause 14—Prohibition on advertising—

“(1) The Secretary of State must by regulations make provision prohibiting—

(a) the publication, printing, distribution or designing (anywhere) of advertisements whose purpose or effect is to promote a voluntary assisted dying service;

(b) causing the publication, printing, distribution or designing of such advertisements.

(2) The regulations may contain exceptions (for example, for the provision of certain information to users or providers of services).

(3) Regulations under this section may make any provision that could be made by an Act of Parliament.

(4) But regulations under this section—

(a) may not amend this Act, and

(b) must provide that any offence created by the regulations is punishable with a fine.

(5) In this section “voluntary assisted dying service” means—

(a) any service for or in connection with the provision of assistance to a person to end their own life in accordance with this Act, or

(b) any other service provided for the purposes of any of sections 5 to 27.”

This clause imposes a duty to make regulations prohibiting advertisements to promote services relating to voluntary assisted dying under the Bill.

Amendment (b) to new clause 14, in subsection (2), leave out from “exceptions” to the end of subsection (3) and insert—

“( ) for the following—

communication made in reply to a particular request by an individual for information about a voluntary assisted dying service;

(b) communication which is—

(i) intended for health professionals or providers of voluntary assisted dying services, and

(ii) made in a manner and form unlikely to be seen by potential service users.

(3) Regulations under this section may make provision that could be made by an Act of Parliament, but may not amend this Act or the Suicide Act 1961.”

This amendment would limit the exceptions that can be created to the advertising ban set out in NC14 and also provides that regulations cannot amend the Suicide Act 1961, which includes the offence of assisting and encouraging suicide.

Amendment (a) to new clause 14, leave out subsection (3).

This removes the power to make regulations that may make any provision that could be made by an Act of Parliament (known as Henry VIII power) from this new clause.

New clause 15—Investigation of deaths etc—

“(1) In section 1 of the Coroners and Justice Act 2009 (duty to investigate certain deaths), after subsection (7) insert—

“(7A) In this Chapter a reference to an “unnatural death” does not include a death caused by the self-administration by the deceased of an approved substance, within the meaning of the Terminally Ill Adults (End of Life) Act 2025, that was provided to the deceased in accordance with that Act.”

(2) In section 20 of that Act (medical certificate of cause of death), after subsection (4) insert—

“(4A) Regulations under subsection (1) may make, in respect of cases where assistance was provided or purportedly provided to the deceased under the Terminally Ill Adults (End of Life) Act 2025—

(a) such provision that is similar to, or that corresponds to, provision mentioned in subsection (1) as the Secretary of State considers appropriate;

(b) such further provision as the Secretary of State considers appropriate.

(4B) Regulations under subsection (1) must provide that in cases where the cause of death appears, to the best of the knowledge and belief of the person issuing a certificate under the regulations, to be the self-administration by the deceased of an approved substance (within the meaning of the Terminally Ill Adults (End of Life) Act 2025) that was provided to the deceased in accordance with that Act, the certificate must—

(a) state the cause of death to be “assisted death”, and

(b) contain a record of the illness or disease which caused the person to be terminally ill within the meaning of that Act.”

(3) In Schedule 1 to that Act (suspension of investigations etc), in the definition in paragraph 1(6) of “homicide offence”, after paragraph (d) insert—

“(e) an offence under section 31, 32 or 33 of the Terminally Ill Adults (End of Life) Act 2025;”.”

This new clause provides that references in Chapter 1 of the Coroners and Justice Act 2009 (investigations into deaths) to unnatural deaths do not include deaths caused by self-administration of approved substances provided in accordance with the Bill. It makes offences under clauses 31 to 33 “homicide offences” for the purposes of that Act. It also amends the powers in that Act in respect of medical certificates of cause of death.

Amendment (a) to new clause 15, in subsection (1), leave out from “section” to “(medical” in subsection (2) and insert

“20 of the Coroners and Justice Act 2009”

This amendment ensures that deaths from assisted dying will still fall within the coroner’s duty to investigate deaths under section 1 of the Coroners and Justice Act 2009.

New clause 20—Guidance about operation of Act—

“(1) The Secretary of State must issue guidance relating to the operation of this Act.

(2) The guidance need not (but may) relate to matters about which the Welsh Ministers may issue guidance under subsection (4) (“Welsh devolved matters”).

(3) Before issuing guidance under subsection (1), the Secretary of State must consult—

(a) the Chief Medical Officer for England,

(b) the Chief Medical Officer for Wales,

(c) such persons with learning disabilities and other persons who have protected characteristics as the Secretary of State considers appropriate,

(d) such persons appearing to represent providers of health or care services, including providers of palliative or end of life care, as the Secretary of State considers appropriate,

(e) if any part of the guidance relates to Welsh devolved matters, the Welsh Ministers, and

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

(4) The Welsh Ministers may issue guidance relating to the operation of this Act in Wales, but the guidance must only be about matters within devolved competence.

(5) For this purpose, a matter is “within devolved competence” if provision about it would be within the legislative competence of Senedd Cymru if it were contained in an Act of the Senedd.

(6) Before issuing guidance under subsection (4), the Welsh Ministers must consult—

(a) the Chief Medical Officer for Wales,

(b) the Secretary of State,

(c) such persons with learning disabilities and other persons who have protected characteristics as the Welsh Ministers consider appropriate,

(d) such persons appearing to represent providers of health or care services, including providers of palliative or end of life care, as the Welsh Ministers consider appropriate, and

(e) such other persons as the Welsh Ministers consider appropriate.

(7) When preparing guidance under this section, an appropriate national authority must have regard to the need to provide practical and accessible information, advice and guidance to—

(a) persons (including persons with learning disabilities) requesting or considering requesting assistance to end their own lives;

(b) the next of kin and families of such persons;

(c) the general public.

(8) An appropriate national authority must publish any guidance issued under this section.

(9) In this section—

“appropriate national authority” means the Secretary of State or the Welsh Ministers;

“protected characteristics” has the same meaning as in Part 2 of the Equality Act 2010 (see section 4 of that Act).”

This new clause (which is intended to replace clause 37) makes provision about guidance relating to the operation of the Bill.

New clause 21—Provision about the Welsh language—

“(1) In this section “relevant person” means a person in Wales who wishes to be provided with assistance to end their own life in accordance with this Act.

(2) Subsection (3) applies where the Welsh Ministers make regulations under section 39 (voluntary assisted dying services: Wales).

(3) Regulations under that section must make such provision as the Welsh Ministers consider appropriate for the purpose of ensuring that, where a relevant person indicates that they wish to communicate in Welsh, all reasonable steps are taken to secure that—

(a) communications made by a person providing a voluntary assisted dying service to the relevant person are in Welsh, and

(b) any report about the first or second assessment of the relevant person is in Welsh.

(4) Where a relevant person informs the Commissioner that they wish to communicate in Welsh, the Commissioner must take all reasonable steps to secure that—

(a) communications made by the Commissioner to the relevant person are in Welsh,

(b) each member of the panel to which the relevant person’s case is referred speaks Welsh, and

(c) communications made by that panel to the relevant person are in Welsh,

and any certificate of eligibility issued by that panel must be in Welsh.

(5) Regulations under section 7, 9, 10, 17 or 26 that specify the form of—

(a) a first or second declaration,

(b) a report about the first or second assessment of a person, or

(c) a final statement,

must make provision for the forms to be in Welsh (as well as in English).

(6) Before making regulations in pursuance of subsection (5), the Secretary of State must consult the Welsh Ministers.

(7) In this section—

“panel” and “referred” have the meaning given by paragraph 1 of Schedule 2;

“voluntary assisted dying service” has the meaning given by section 38.”

This new clause (which is intended to replace Clause 47) makes provision about the use of the Welsh language.

New clause 4—Monitoring by Chief Medical Officer—

“(1) The relevant Chief Medical Officer must—

(a) monitor the operation of the Act, including compliance with its provisions and any regulations or code of practice made under it,

(b) investigate, and report to the appropriate national authority on, any matter connected with the operation of the Act which the relevant national authority refers to the relevant Chief Medical Officer, and

(c) submit an annual report to the appropriate national authority on the operation of the Act.

(2) The relevant Chief Medical Officer’s report must include information about the occasions when—

(a) a report about the first assessment of a person does not contain a statement indicating that the coordinating doctor is satisfied as to all of the matters mentioned in section 9(2)(a) to (h),

(b) a report about the second assessment of a person does not contain a statement indicating that the independent doctor is satisfied as to all of the matters mentioned in section 10(2)(a) to (e),

(c) a panel has refused to grant a certificate of eligibility,

(d) the coordinating doctor has refused to make a statement under section 17(6).

(3) An annual report must include information about the application of the Act in relation to—

(a) persons who have protected characteristics, and

(b) any other description of persons specified in regulations made by the Secretary of State.

(4) When preparing an annual report, the relevant Chief Medical Officer must consult—

(a) The Commissioner, and

(b) such persons appearing to the relevant Chief Medical Officer to represent the interests of persons who have protected characteristics as the relevant Chief Medical Officer considers appropriate.

(5) An appropriate national authority must—

(a) publish any report received under this section,

(b) prepare and publish a response to any such report, and

(c) lay before Parliament or Senedd Cymru (as the case may be) a copy of the report and response.

(6) In this section “appropriate national authority” means the Secretary of State or the Welsh Ministers.

(7) In this section “protected characteristics” has the same meaning as in Part 2 of the Equality Act 2010 (see section 4 of that Act).

(8) In this section “relevant Chief Medical Officer” has the meaning given by section 37(5).”

This new clause would require the monitoring, investigation and reporting functions set out in the Bill to be carried out by the Chief Medical Officer instead of the Voluntary Assisted Dying Commissioner.

New clause 5—Implications for civil procedure rules and probate proceedings—

“(1) The Secretary of State must, within six months of the passing of this Act, publish a report setting out the implications of this Act on—

(a) the civil procedure rules, and

(b) probate proceedings.

(2) The report in subsection (1) must include an analysis of likely consequential changes to the civil procedure rules and probate proceedings in consequence of this Act.”

New clause 6—Board to consult communities—

“(1) The Commissioner must, within six months of being appointed under this Act, appoint a consultation board.

(2) The role of the board is to consult communities in order to report to the Commissioner on the impact of the Act on those communities.

(3) The Board must report to the Commissioner and the Secretary of State every 12 months from its appointment on its findings.

(4) The communities that the Board must consult include people from Black, Asian and Minority Ethnic communities.

(5) The Board may consult other groups in addition to those listed in subsection (4) as it considers appropriate.

(6) The Secretary of State must, within 3 months of receiving a report under subsection (3), lay that report before both Houses of Parliament.”

New clause 19—Collection of statistics—

“(1) The Voluntary Assisted Dying Commissioner must ensure that the statistics specified in Schedule (Statistics to be collected) are collected.

(2) The Commissioner must publish a yearly report setting out those statistics.

(3) The Secretary of State may, by regulation, vary the contents of Schedule (Statistics to be collected).”

Amendment 13, in clause 4, page 2, line 22, at end insert—

“(2A) A person may not be appointed under subsection (2) unless the appointment has the consent of the Health and Social Care Select Committee of the House of Commons.

(2B) In this section, references to the Health and Social Care Committee shall—

(a) if the name of that Committee is changed, be taken (subject to paragraph (b)) to be references to the Committee by its new name;

(b) if the functions of that Committee at the passing of this Act with respect to matters relating to the provision of assistance under this Act become functions of a different committee of the House of Commons, be taken to be references to the committee by whom the functions for the time being exercisable.”

Amendment 96, in clause 25, page 21, line 5, at end insert—

“(1A) A drug or other substance may only be approved under this Act if the Secretary of State is reasonably of the opinion that there is a scientific consensus that this drug (or other substance) or combination of drugs (or other substances), is effective at ending someone’s life without causing pain or other significant adverse side effects.”

This amendment ensures that drugs can only be approved if the Secretary of State is reasonably of the opinion that there is a scientific consensus that the drug is effective at ending someone’s life without causing pain or other significant adverse side effects.

Amendment 97, page 21, line 5, at end insert—

“(1A) A drug or other substance may only be approved under this Act if it has been licensed by the Medicines and Healthcare products Regulatory Agency for that purpose.”

This amendment ensures that drugs can only be approved for this purpose if the MHRA has licensed those drugs for that purpose.

Amendment 98, page 21, line 5, at end insert—

“(1A) Nothing in subsection (1) requires the Secretary of State to approve any drugs or other substance if they conclude that there are no appropriate drugs or other substances to approve.”

If the Secretary of State concludes that no drugs or substance is appropriate to be used, then the Secretary of State is not required by subclause 25(1) to approve any.

Amendment 27, page 21, line 7, at end insert—

“(2A) The doses and types of lethal drugs specified in any regulations made under subsection (1) must be licensed by the Medicines and Healthcare products Regulatory Agency.

(2B) The doses and types of lethal drugs to bring about the person’s death must be recommended by the guidelines of either—

(a) the National Institute of Clinical Excellence, or

(b) the All Wales Medicines Strategy Group in Wales, as appropriate, prior to licensing.”

This amendment will require the doses and types of lethal drugs to be licensed by the Medicines and Healthcare products Regulatory Agency and to be recommended by either the National Institute of Clinical Excellence or the All Wales Medicines Strategy Group in Wales as appropriate prior to licensing.

Amendment 99, page 21, line 7, at end insert—

“(2A) The Secretary of State may not lay a draft statutory instrument containing (whether alone or with other provision) regulations under subsection (1) before both Houses of Parliament unless they also lay before both Houses a report setting out all relevant information on the likely time to death, complications (including pain) and likely side effect.”

This amendment requires that a report be provided to Parliament setting out the information available on the proposed drugs, including time to death, complications (including pain) and likely side effects. Such a report is required before Parliament votes to approve the drugs or substance. See consequential Amendment 100.

Amendment 69, page 21, line 8, leave out subsection (3) and insert—

“(3) See section (Regulation of approved substances and devices for self-administration) for powers to make provision about—

(a) approved substances, and

(b) devices for use or used in connection with the self-administration of approved substances.”

This is consequential on NC13.

Amendment 53, line 24, leave out clause 34

This amendment is consequential on NC13.

Amendment 54, line 34, leave out clause 35

This amendment is consequential on NC15.

Amendment 19, in clause 36, page 27, line 17, at end insert—

“(ba) how the provisions of this Act relate to the operation of—

(i) the Government’s strategy on suicide prevention,

(ii) the duties on clinicians and others to secure the right to life, including of those at risk of suicide, under paragraphs 1 and 2 of Article 2 (Right to Life) set out in Schedule 1 of the Human Rights Act 1998,

(iii) the Mental Health Act 1983,

(iv) deprivation of liberty safeguards as set out in Schedule A1 to the Mental Capacity Act 2005, and

(v) liberty protection safeguards as set out in Schedule AA1 to the Mental Capacity Act 2005.”

Amendment 70, page 27, line 20, at end insert—

“(ca) ensuring effective communication in connection with persons seeking assistance under this Act to end their own lives, including the use of interpreters;”

This amendment provides that a code of practice must be issued covering ensuring effective communication in connection with persons seeking assistance under the Bill.

Amendment 108, page 27, line 31, at end insert—

“(h) how the provisions of this Act, including but not limited to section 23, interact with the provisions of the Abortion Act 1967.”

Amendment 71, page 27, line 35, leave out subsection (3).

This amendment is consequential on amendment 70.

Amendment 20, page 28, line 5, leave out subsection (8) and insert—

“(8) If it appears to a court or tribunal conducting any criminal or civil proceedings that—

(a) a provision of a code, or

(b) a failure to comply with a code,

is relevant to a question arising in the proceedings, the provision or failure must be taken into account in deciding the question.”

Amendment 89, page 28, line 7, leave out clause 37.

This amendment is consequential on NC20.

Amendment 34, in clause 37, page 28, line 14, at end insert—

“(ii) persons from Black, Asian and Minority Ethnic communities and advocate groups representing those communities, and

(iii) representatives of the healthcare sector, including persons who work in hospices.”

Amendment 12, clause 38, page 28, line 36, leave out subsections (4) and (5) and insert—

“(4A) Regulations under subsection (1) may not amend, modify or repeal section 1 of the National Health Service Act 2006.”

This amendment would prevent section 1 of the National Health Service Act 2006, which sets out the purposes of the NHS, from being amended by regulations. Its effect would be to require changes to be made by an Act of Parliament instead.

Amendment 105, page 29, line 4, leave out subsection (6).

Amendment 15, page 29, line 5, at end insert—

“(6A) Regulations under this section must provide that, where a body other than a public authority provides voluntary assisted dying services under subsection (1), that body must publish an annual statement that includes information on the following—

(a) the number of persons to whom the body has provided a preliminary discussion under section 5(3);

(b) the number of to persons whom the body has assessed under section 9(1);

(c) the number of persons whom the body has assessed under section 10(1);

(d) the number of persons to whom assistance has been provided under section 23(2);

(e) the cost and revenue associated with providing such assistance; and

(f) any other matter that the Secretary of State may specify.”

This amendment would require private providers of the services permitted under the Act to publish annual statements of the numbers of people to whom they have provided those services. It would also require them to disclose their associated costs and revenue.

Amendment 92, in clause 39, page 29, line 13, leave out from “Wales” to end of line 14.

Amendment 106, page 29, line 16, leave out subsection (2)(a).

Amendment 107, page 29, line 22, leave out subsection (4)(a).

This amendment and amendment 93 ensure that the power under subsection (3) also covers provision securing that arrangements are made for the provision of services, so far as such provision is outside the legislative competence of the Senedd.

Amendment 93, page 29, line 27, at end insert—

“(b) a reference to provision about voluntary assisted dying services includes in particular provision securing that arrangements are made for the provision of such services.”

See the statement for Amendment 92.

Amendment 29, in clause 40, page 30, line 5, at end insert—

“(5) Any notification to the Commissioner made pursuant to regulations under this section must be forwarded by the Commissioner to the relevant Chief Medical Officer.

(6) The relevant Chief Medical Officer may exercise any power granted to the Commissioner under subsection (2).

(7) In this section “relevant Chief Medical Officer” has the meaning given by section 37(5).”

Amendment 21, in clause 43, page 31, line 15, at end insert—

“(4) For the first reporting period referred to under subsection (2) (a) the report must set out an assessment of the state of health services to persons with palliative and end of life care needs and the implications of this Act on those services.

(5) The report under subsection (4) must, in particular, include an assessment of the availability, quality and distribution of appropriate health services to persons with palliative and end of life care needs, including—

(a) pain and symptom management;

(b) psychological support for those persons and their families;

(c) information about palliative care and how to access it.”

This amendment would require the Secretary of State for Health and Social Care to prepare and publish an assessment of the availability, quality and distribution of palliative and end of life care services as part of the first report on implementation of the Act (to be undertaken within 1 year of the Act being passed). This would mirror the assessment already required as part of the 5 year review of the act.

Amendment 28, page 31, line 32, leave out clause 45.

This amendment is linked to NC4.

Amendment 35, clause 45, page 32, line 20, after “characteristics” insert

“, including persons representing Black, Asian and Minority Ethnic communities,”.

Amendment 36, in clause 46, page 33, line 11, after “disabilities” insert

“, and

(ii) persons from Black, Asian and Minority Ethnic communities”.

Amendment 90, page 33, line 18, leave out clause 47.

This amendment is consequential on NC21.

Amendment 39, in clause 47, page 33, line 19, after “provided” insert “in Wales”.

This amendment specifies that this section applies only to services provided in Wales.

Amendment 40, page 33, line 24, at end insert—

“(2A) Any entity providing a service or fulfilling a function under this Act must take all reasonable steps to ensure the particular health professionals providing a service or fulfilling a function under sections 5, 9,10, 12, 15, and 23 have fluent proficiency in the Welsh language, if the services are to be provided to a person in Welsh under subsection (1).

(2B) For the purposes of subsection (2A), “fluent” includes speaking fluent Welsh in order to enable conversations with the person in Welsh.

(2C) The Commissioner must take all reasonable steps to ensure members of Assisted Dying Panels will, if the person to whom the referral relates has asked for services to be provided in Welsh, when hearing from or questioning that person under section 15(4)(b), do so in Welsh.”

Amendment 103, in clause 50, page 34, line 24, leave out from “under” to end of line 29 and insert

“any provision of this Act unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament.”

This amendment would require all statutory instruments in the Act, except commencement orders, to be made by the draft affirmative procedure. It is linked with Amendment 104 which creates the power for the Secretary of State to use the made affirmative procedure in cases of emergency.

Amendment 72, page 34, line 24, after “10(9)”, insert—

“(Regulation of approved substances and devices for self-administration),”.

This amendment provides that regulations under NC13 are subject to the draft affirmative procedure.

Amendment 50, page 34, line 24, after “10(9),” insert “(Doctor independence)”.

This amendment makes regulations under NC7 [Doctor independence] subject to the affirmative procedure.

Amendment 100, page 34, line 24, after “10(9),” insert “25(1)”.

This amendment makes regulations under clause 25(1) subject to the draft affirmative procedure. It is consequential on Amendment 99.

Amendment 73, page 34, line 25, leave out “or 39” and insert—

“39, or (prohibition on advertising)”.

This amendment provides that regulations under NC14 are subject to the draft affirmative procedure.

Amendment 88, page 34, line 25, after “39” insert “or (Collection of statistics)”.

This amendment provides that the changes to NS2 should be made by affirmative regulations, and is consequential to NS2.

Amendment 104, page 34, line 32, at end insert—

“(5A) If they reasonably consider it urgent and necessary for the protection of others, the Secretary of State or the Welsh Ministers may dispense with the requirement to lay a draft statutory instrument.”

This amendment is linked with Amendment 103. It creates the power for the Secretary of State to use the made affirmative procedure in cases of emergency (this means that it would come into effect straight away but there would be a vote afterwards).

Amendment 76, in clause 53, page 36, line 12, at beginning insert “Subject as follows,”.

This amendment is consequential on amendment 77.

Amendment 77, page 36, line 12, at end insert “only.

(2) Sections (Regulation of approved substances and devices for self-administration), (Prohibition on advertising), 50 and 52, this section, and sections 54 and 55 extend to England and Wales, Scotland and Northern Ireland.

(3) Section (No obligation to provide assistance etc)(8) and Schedule (Protection from detriment) extend to England and Wales and Scotland.”

This amendment provides for NC13 (regulation of approved substances etc) and NC14 (prohibition on advertising), and the general provisions of the Bill, to extend to each part of the United Kingdom; and for NC10 (no obligation to provide assistance etc) and NS1 (protection from detriment) to extend to England and Wales and Scotland.

Amendment (a) to amendment 77, in subsection (2), leave out

“(Regulation of approved substances and devices for self-administration),”.

This would provide that NC13 (regulation of approved substances etc…) does not extend to each part of the United Kingdom and only applies, like most of this Bill, to England and Wales.

Amendment (b) to amendment 77, in subsection (3), leave out “and Scotland”.

This amendment would provide that subsection (8) of NC10 (no obligation to provide assistance) and NS1 (protection from detriment) only extend to England and Wales.

Amendment 42, in clause 54, page 36, line 16, leave out subsections (2) to (5) and insert—

“(2) In relation to England, the provisions of this Act not brought into force by subsection (1) come into force on such day or days as the Secretary of State may by regulations appoint.”

This amendment will mean that, except as provided by subsection (1), provisions of the Bill will only commence in England when the Secretary of State makes a commencement order, and not automatically.

Amendment 37, in clause 54, page 36, line 21, leave out subsection (4) and insert—

“(4) Regulations under this section cannot be made unless the Secretary of State has previously—

(a) made a statement to the effect that in their view the provisions of the Act are compatible with the Convention rights; or

(b) made a statement to the effect that although they are unable to make a statement under subsection (4)(a), the Government nevertheless wishes to proceed with commencing provisions of the Act.

(4A) The statement required by subsection (4) must be laid before both Houses of Parliament.

(4B) A statement under subsection (4)(b) must include the steps the Government plans to take to resolve any incompatibility.”

Amendment 3, page 36, line 22, leave out “four” and insert “three”.

Amendment 94, page 36, line 25, leave out “Wales” and insert—

“sections 39(1) and (2) and (Provision about the Welsh language)(2) and (3) which come into force on such day as the Welsh Ministers may by regulations appoint.”

This amendment provides that the Welsh Ministers have power to commence clauses 39(1) and (2) and NC21(2) and (3), and that other provisions of the Bill come into force in accordance with subsections (1) to (4) of this clause.

Amendment 95, page 36, line 26, leave out subsection (6).

This amendment is consequential on Amendment 94.

New schedule 2—Statistics to be collected—

“Characteristics

1 The Voluntary Assisted Dying Commissioner must collect the following information about persons requesting assisted dying—

(a) sex,

(b) age,

(c) self-reported ethnicity,

(d) level of education,

(e) Index of Multiple Deprivation based on postcode,

(f) region of residence,

(g) marital status,

(h) living status (alone, with others, in a care home etc),

(i) main condition leading to “terminal illness” fulfilment,

(j) other medical conditions,

(k) other psychiatric / mental health conditions,

(l) presence of physical disability, and

(m) presence of intellectual disability.

Health and Care Support

2 The Commissioner must collect statistics on the following information about health and care support—

(a) whether the person was, before the request—

(i) under a specialist palliative care team, and

(ii) under a psychiatry team,

(b) whether following the request there has been—

(i) referral to specialist palliative care team, and

(ii) referral to psychiatry team following request.

Information about requests

3 The Commissioner must collect statistics on the following information about the requests for assistance—

(a) the main reason for requesting assisted dying,

(b) any other subsidiary reason for requesting assisted dying,

(c) any previous requests for assisted dying from that patient,

(d) time between first request and subsequent request(s),

(e) number of times a second opinion was requested under section 10, and

(f) number of times the second opinion disagreed with the first.

Information about refused requests

4 The Commissioner must collect statistics following information about requests that are refused—

(a) at what stage of the process was the request refused, and

(b) reasons for refusal.

Information about the process

5 The Commissioner must collect statistics on the following information about the process—

(a) time from initial discussion to first declaration,

(b) time from first declaration to first doctor’s assessment,

(c) time from first doctor’s assessment to second doctor’s assessment,

(d) time from second doctor’s assessment to panel approval,

(e) time from panel approval to second declaration,

(f) time from second declaration to provision of assistance to self-administer lethal drugs,

(g) time from panel approval to death (whether by lethal drug or natural causes),

(h) duration of relationship between patient and coordinating doctor at first request, and

(i) use of a proxy and reason for using proxy.

Information about clinicians and pharmacies

6 The Commissioner must collect statistics on the following information about clinicians and pharmacies—

(a) number of clinicians participating, their speciality, and number of assisted deaths each carries out per year, and

(b) number of participating pharmacies; number of times assisted dying drugs are dispensed.

Information about Assisted Dying Panel processes

7 The Commissioner must collect statistics on the following information about Assisted Dying Panel process—

(a) number of applications made,

(b) number of applications granted and rejected,

(c) reasons for rejection,

(d) whether family members informed of proceedings,

(e) whether family members took part in proceedings,

(f) number of requests for reconsideration made,

(g) number of reconsideration requests granted and rejected, and

(h) reasons for granting requests.

Information on approved substances

8 The Commissioner must collect statistics on the following information about the approved substances—

(a) name of drug(s) used for the assisted death,

(b) whether intravenous or oral self-administration is used,

(c) presence and nature of complications following self-administration of drugs (vomiting, regurgitation, seizures, regained consciousness, other),

(d) time from self-administration to loss of consciousness,

(e) time from self-administration to death,

(f) whether emergency services called at any time following self-administration of drugs,

(g) location of death,

(h) health care professionals present at self-administration,

(i) non-professionals present at self-administration,

(j) health care professionals present at death,

(k) non-professionals present at death.”

Amendment 82, in schedule 2, page 41, line 18, leave out sub-paragraph (1) and insert—

“(1) The Judicial Appointments Commission must make arrangements for the appointments to a list of persons eligible to sit as members of panels.”

This amendment requires that panel members be appointed by the Judicial Appointments Commission. It is linked with Amendments 83, 84, 85 and 86.

Amendment 83, page 41, leave out lines 23 to 26 and insert—

“but has not reached the age specified in section 11 (Tenure of office of judges of Senior Courts) of the Senior Courts Act 1981.”

This amendment requires that the legal member of the Panel is someone who holds high judicial office or has held high judicial office but not yet reached the mandatory retirement age. It is linked with Amendments 83, 84, 85, and 86.

Amendment 41, page 41, line 34, at end insert—

“(2A) In Wales, the Commissioner must take all reasonable steps to ensure each member of a panel has fluent proficiency in the Welsh language if services or functions in the Act are to be provided to an individual in Welsh under section 47(1).

(2B) For the purposes of subsection (2A), “fluent” includes speaking fluent Welsh.”

Amendment 84, page 42, line 2, leave out “or deputy judge”.

This amendment ensures that only High Court judges, and not deputy High Court judges, can chair the panel. It is linked with Amendments 83, 84, 85 and 86.

Amendment 85, page 42, line 2, at end insert—

“(4) All judges of the High Court are automatically on the list and will remain so for the duration of their appointment to the High Court.

(5) If they have not already, all persons on the list (whether as a legal member, psychiatrist member, or social care member) must take the judicial oath.”

This amendment makes all High Court judges automatically eligible to chair panels without needing further application and it requires that the non-legal members take the judicial oath before they can sit. It is linked with Amendments 83, 84, 85 and 86.

Amendment 86, page 43, line 5, at end insert—

“(3) Panels shall have the same powers, privileges and authority as the High Court.”

This amendment gives the panel the same powers as the High Court. It is linked with Amendments 83, 84, 85 and 86.

[Kim Leadbeater]

It is a privilege to open today’s debate and to present to the House the amendments tabled in my name, a number of which relate to issues that I promised to return to when they were raised in Committee. All amendments in my name have been drafted with technical advice and expertise from civil servants from the Department of Health and Social Care and the Ministry of Justice, along with the brilliant Government Legal Department and the Office of the Parliamentary Counsel, in order to make the Bill workable and to give coherence to the statute book, as confirmed by the Minister for Care, my hon. Friend the Member for Aberafan Maesteg (Stephen Kinnock), and the Minister for Courts and Legal Services, my hon. and learned Friend the Member for Finchley and Golders Green (Sarah Sackman), in their recent letter to MPs. Some are technical and drafting amendments, and all are there to strengthen the Bill, so I hope that colleagues will be able to support them, wherever they stand on the principle of assisted dying.

I know that many colleagues wish to speak today, so I will endeavour to speak with brevity. I will speak first to the new clauses that stand in my name, starting with new clause 13. This important new clause and the related amendments would create a regulatory framework and safeguards around the approved substances referred to in the Bill by imposing a duty to make regulations about those substances and a power to make regulations about devices for use in connection with their self-administration.

Amendment 72 provides that the regulations relating to approved substances would be subject to the affirmative procedure, meaning that they must be laid before Parliament and approved by resolution of both Houses, providing important parliamentary oversight. These measures ensure that the substances used in assisted dying are subject to a specific and appropriate regulatory regime.

[Patricia Ferguson (Glasgow West) (Lab)]

I am genuinely looking for clarification. As a former Cabinet Minister in the Scottish Government, I jealously guard the devolution settlement. I wonder how the extension of some of these clauses to include Scotland will be interpreted. What conversations have taken place between my hon. Friend, Scotland’s Lord Advocate and the Scottish Government?

[Kim Leadbeater]

I have taken legal advice from Government officials to ensure that devolution is respected at every stage in proceedings. Where legislation that affects other jurisdictions needs to be amended, those conversations have already started and will continue.

[Jim Shannon (Strangford) (DUP)]

Will the hon. Lady give way?

[Kim Leadbeater]

No, I am going to make some progress, if that is okay.

The substances that would be used would not be new substances. As we know, assisted dying is available in many other jurisdictions, and there are substances that have been used safely and, in some cases, for many years. Their safety and efficacy has been proven around the world, but they do need to be treated differently, which is the purpose of new clause 13.

[Simon Hoare (North Dorset) (Con)]

Will the hon. Lady give way?

[Jim Shannon]

Will the hon. Lady give way?

[Kim Leadbeater]

I am going to make some progress.

However, it is most likely that these products are already licensed for other purposes. They could well be regulated through the Medicines and Healthcare products Regulatory Agency and within the Human Medicines Regulations 2012 for the purposes of the Bill, but it is important that time is given—

[Cat Eccles (Stourbridge) (Lab)]

Will my hon. Friend give way?

[Kim Leadbeater]

I will.

[Cat Eccles]

As an operating department practitioner with more than 20 years of experience, I emphasise that controlling and administering drugs is already a key part of every healthcare professional’s practice. Medicines management is at the front and centre of everything we do when handling drugs. Does my hon. Friend agree that the safeguards added to this Bill, along with the existing frameworks, are more than adequate to deal with this?

[Kim Leadbeater]

I thank my hon. Friend for sharing her expertise, along with other colleagues with medical backgrounds who have worked with me on this amendment.

[Several hon. Members rose—]

[Kim Leadbeater]

Given what you have said, Mr Speaker, I will make some progress. [Interruption.] A lot of Members wish to speak today.

I now turn to new clause 14 and amendment 73. The new clause imposes a duty to make regulations prohibiting advertising of services related to voluntary assisted dying. This issue was discussed in Committee, following an amendment tabled by the hon. Member for West Worcestershire (Dame Harriett Baldwin). It was proposed that there should be no advertising of assisted dying services. I agree, and there was a consensus on that in the Committee. There were some issues with the previous amendment’s workability, so I gave a commitment to return to the matter on Report—hence the inclusion of this new clause. Amendment 73 provides that regulations under new clause 14 would be subject to the affirmative procedure, providing parliamentary oversight.

[Jim Shannon]

On the evidential basis, on page 15 of today’s edition of The Times there is a story about a gentleman who was born in South Africa and lives in Australia. He has come to London this week for this particular Bill in order to give his story. He was diagnosed with pancreatic cancer and told he had only two weeks to live: he lived for three years and one month, and he is still living. There is a growing evidential basis. He said that he was never afraid to die, but he says that he is afraid of the process of dying, and the hon. Lady is the initiator of that. Will she acknowledge the evidential basis and the importance of this subject? Does she realise that the evidential basis against this Bill is growing?

[Kim Leadbeater]

I thank the hon. Gentleman for the intervention, although I am not sure that it is relevant to the banning of advertising for assisted dying services, which I will try to stay focused on.

[Gregory Stafford (Farnham and Bordon) (Con)]

Will the hon. Lady give way?

[Kim Leadbeater]

I am afraid that I am going to have to make some progress, based on the number of Members who wish to speak today.

I thank the hon. Member for West Worcestershire and the hon. Member for Reigate (Rebecca Paul) for working with me on amendment 73, and I am very pleased that they support it.

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

Will the hon. Lady give way?

[Kim Leadbeater]

I will not—sorry.

New clause 15 and amendment 54 make changes to the Coroners and Justice Act 2009 that the Bill would necessitate. They would insert a new clause into the Act to provide that deaths that occur in accordance with the Bill will be certified by an attending practitioner and medical examiner and will not be subject to a coronial investigation.

[Dr Spencer]

Will the hon. Lady give way?

[Kim Leadbeater]

I am afraid not.

Coroners investigate suspicious or violent deaths, or situations in which the cause of death is unknown. Assisted deaths would not fall into these categories, and there would therefore be no need for a default coronial investigation. This will ensure that any unnecessary delays and distress for bereaved families are avoided. These are not unexpected deaths; sadly, they were inevitable.

[Jess Asato (Lowestoft) (Lab)]

Will my hon. Friend give way?

[Kim Leadbeater]

I will not, I am afraid.

It is the manner and timing of their death about which the patient will make a legal, informed choice, having been thoroughly assessed. As Professor Aneez Esmail has said, “I cannot think of any death that would be the subject of greater scrutiny in advance of the person dying than an assisted death. The process far exceeds the level of safeguarding that is in place for many of the deaths that are, at present, routinely reviewed by medical examiners and not referred to a coroner.” Of course, anyone can report a death—including an assisted death—to the coroner, or indeed to the police, if they have any concerns that it was not carried out in accordance with the Act, and if any offences have been committed, they will be investigated.

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[Ms Polly Billington (East Thanet) (Lab)]

Will my hon. Friend give way?

[Kim Leadbeater]

I am going to make some progress, I am afraid.

The Secretary of State must also consult providers of health and care services, including palliative and end-of-life care. I am really pleased that Hospice UK is supporting this amendment—it is very important that those voices are heard. The Secretary of State can also consult anyone else they feel to be appropriate, creating a flexible and holistic approach.

Turning to devolution, this long-overdue reform would apply to England and Wales, which share a criminal justice system. Health is a devolved matter, of course, and I have recognised from the outset that the legislation must respect devolution. I am fully committed to observing the same conventions that the Government would if this were a Government Bill. I have worked with UK Government officials to ensure that the right steps are taken at the right time by the right people. I have engaged with colleagues in the Welsh Government—I met the Welsh Health Minister in Cardiff, and there have been ongoing detailed discussions between the two teams of Government officials to ensure the workability of the legislation in both jurisdictions, in line with the devolution settlement.

Amendments 92 to 95 also ensure that the devolution settlement is respected and adhered to. I thank the right hon. Member for Dwyfor Meirionnydd (Liz Saville Roberts) and the hon. Member for Chesham and Amersham (Sarah Green), not only for their diligent work on the Bill Committee but for working with me on the amendments in relation to Wales, and I thank the Welsh Government for their guidance and support. I hope that colleagues across the House can support these new clauses and amendments.

I now turn to new clause 21, which makes specific provision about the use of the Welsh language. The conversations that happen at the end of a person’s life are extremely personal and should be handled with the utmost sensitivity. It is very important that they are conducted in the best interests of the patient, and a big part of that is using clear communication. In this respect, language matters, so if a patient in Wales has Welsh as their first or preferred language, all efforts should be made to ensure they can communicate with voluntary assisted dying services in Welsh. I committed to this in Committee, and have made good on that commitment.

Turning to amendments 76 and 77, as with any Bill, it is important that the amending legislation secures overall coherence with the statute book. As such, the clauses relating to medicines, advertising and employment protections amend, or confer power to amend, other legislation that currently extends to parts of the UK. Of course, this does not mean the provision of assisted dying, but, for example, they extend the prohibition on advertising to the whole of the UK and apply the employment protections in the Bill to Scotland. That is in line with the guidance I have received from legal experts, and as such I hope all colleagues can support these amendments. If the Bill passes, I will, if necessary, work with other devolved Administrations in the same way as I have worked with the Welsh Government to ensure that devolution is respected.

That concludes the explanations of the amendments tabled in my name. Many colleagues are keen to speak, so I am not going to comment on all the amendments in the group; I will just make two comments about amendments that are not in my name, and allow other people plenty of time to speak.

Amendment 42, tabled by my hon. Friend the Member for Newcastle-under-Lyme (Adam Jogee), would not only try to remove the backstop for the provision of assisted dying in England, but create a number of other issues in relation to commencement. If Parliament chooses to give this choice to terminally ill people, there cannot be a clause in the Bill that would prevent that from being available as soon as it was safe and practicable. But the amendment would remove the four-year backstop. It would also prevent the appointment of the voluntary assisted dying commissioner and create a potential commencement gap between England and Wales. Given that, I have been strongly advised that the amendment would create serious workability issues. I urge colleagues who want an operable Bill to join me in rejecting the amendment.

To finish, I am pleased to support amendment 21, tabled by the hon. Member for Twickenham (Munira Wilson). I thank her for her engagement with the Bill and the amendment, which would require the Secretary of State to prepare and publish an assessment of the availability, quality and distribution of palliative and end-of-life care, as part of the first report on the implementation of the Act, mirroring the assessment already required as part of the five-year review.

Although the Bill seeks to address what in some respects is a very specific issue in terms of the failings of the current law, it has become part of a much-needed broader conversation about death, dying and end-of-life care. We all have our own experiences of death, loss and grief, and we do not talk about them enough. I am really pleased that the Bill has led to many conversations up and down the country; whatever our views, that has to be a positive thing.

[Danny Kruger (East Wiltshire) (Con)]

Will the hon. Lady give way?

[Kim Leadbeater]

I have nearly finished.

I have had many such conversations over recent months with those who support the amendment, including with palliative care doctors, nurses, hospice staff, GPs, Hospice UK and Marie Curie. I thank them all for their constructive engagement with the Bill. I cannot imagine that anyone in this place is not truly grateful for the outstanding work done every day by the wonderful people working in palliative and end-of-life care in every one of our constituencies. Many of us, if not most of us, will have personal experience of the kindness and compassion that those people have shown to our own families and friends.

But this is not an either/or conversation. Palliative and end-of-life care and assisted dying can and do work side by side to give terminally ill patients the care and choice that they deserve in their final days. Just as there should not be an either/or for dying people, there should also not be an either/or for us as legislators in having to choose between supporting assisted dying or other end-of-life choices. That is why I am supporting amendment 21: to ensure that in this place we channel our energies into supporting all options available to terminally ill people—something that I have always committed to do.

[Sarah Olney (Richmond Park) (LD)]

It is a privilege to be called at this stage in the debate. My principal reason for voting against the Bill on Second Reading was my concern that vulnerable people would be put at risk. I agreed to serve on the Bill Committee to do what I could to allay my concerns about that issue and address some of the issues raised by others. I do not think that the revised version of the Bill properly or completely reflects the concerns expressed on a multitude of different occasions. Consequently, it does not fully mitigate the risks to vulnerable groups.

We all recognise that decision making of any kind does not take place in a vacuum and that, in all parts of life, we live in a particular context. The Equality Act 2010 recognises that many people face discrimination or unfair treatment as a result of particular characteristics and that reasonable steps should be taken to eliminate that. It was very clear from the oral evidence sessions that particular care has to be taken to assess the context within which people are making the decision to seek an assisted death: if they suffer from a mental illness or eating disorder, if they are from a low-income or ethnic minority background, if they suffer from a disability or if they are in an abusive relationship. Those factors are likely to lead to an increased risk that someone will seek an assisted death that they would not have sought if those factors were not present.

In Committee, I and others made the point that it would have been desirable to have received an equality impact assessment before the detailed work of Committee scrutiny had begun, so that Committee members had a sense of how the proposed legislation would impact groups that we know can suffer disproportionate levels of disadvantage.

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[Paul Waugh]

I agree with the right hon. Gentleman, and there is a wider point here about the Henry VIII powers in the Bill. This would be the third such power added to the Bill since Second Reading. At that stage, it had none. The Attorney General, Lord Hermer, has said that “excessive reliance” on Henry VIII powers

“upsets the proper balance between Parliament and the executive”,

and he is right.

Away from matters of constitutional principle, I am especially concerned about the practical impact of such a power, which would allow a future Secretary of State to change the law as set out in the Suicide Act 1961. This is the Act that contains the offence of encouraging or assisting a suicide. Ministers have confirmed that the Bill leaves the offence in place in all cases except where a medical practitioner assists a person to die under its provisions. We must surely therefore not hand the power to a future Secretary of State to weaken or even abolish that offence without the need for primary legislation. My amendment specifies that the Suicide Act cannot be amended in that way.

I hope that my hon. Friend the Member for Spen Valley recognises that my amendment does not seek to undo or undermine her new clause, but rather to build on it and to ensure that the ban she intends to deliver does not collapse around the loophole at its heart.

[Kim Leadbeater]

My hon. Friend is making a powerful point, and there is consensus across the House about banning the advertising of assisted dying services. His amendment, though, would be slightly limited in that it makes just two exceptions. There would probably need to be a broader piece of work on that, but I commit to working with him if he is interested.

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[John Glen]

It will not surprise my hon. Friend to hear that I agree wholeheartedly. I recognise that that was a major reason that many colleagues gave at earlier points in our discussions and deliberations.

[Kim Leadbeater]

I thank the right hon. Gentleman for his constructive engagement, but he did not vote for the Bill when it included a High Court judge, and now he is trying to reintroduce a High Court judge. Is there a version of the Bill that he would vote for if it had some sort of judicial oversight other than a commissioner who is a judge or a retired judge, a deputy commissioner who is a judge or a retired judge, and someone on the panel who is a legal expert?

[John Glen]

I have been very clear that I have tabled my amendments in a constructive way to reflect the will that the hon. Lady has expressed, but to recognise the meaningful dilution in the authority of the process and what can reasonably be amended to invigorate it, based on the principles that I think were intended at the outset.

I will revert to the point I was making about the judiciary. They have a commitment to uphold the law, and that should be the standard we are looking for when it comes to matters of life and death. The Judicial Appointments Commission already conducts appointments for all tribunals, including lay members. The Government’s impact assessment compared the panel to the mental health tribunal. All appointments to the mental health tribunal, including the non-legal members, are made by the Judicial Appointments Commission, so this would not be a novel function for it.

Let me move on to amendment 85, which would ensure that all members of the panel have to take the judicial oath if they have not done so already. If other amendments pass, amendment 85 would be necessary only for the non-legal members, and it is crucial for public confidence that the judicial oath is taken.

Amendments 83 and 84 seek to preserve an important element of the Bill as originally presented to the House. They would ensure that the most senior decision-making figure, the chair of the panel, is a High Court judge with all the experience, responsibility and professionalism that that implies. Under these amendments, all High Court judges would be automatically eligible. They would need to be currently serving or at least be below retirement age, and would have to be a judge of the highest authority and not a deputy judge. Members of this House and the public were originally told that this would be a safe Bill precisely because it would have a High Court judge. That was a persuasive promise, and I think there is a way to honour it, even in the new version of the Bill.

I will briefly mention the retirement age, because it is important. It used to be 70, but judges can now continue until they are 75. However, there is no age limit for members of the panel. If we are saying that an 80-year-old retired judge is still with it and is able to decide on matters of life and death, why are they too old to help clear the backlog of criminal cases? That seems to be a meaningful anomaly.

I have been very clear about the purpose of my amendments. I have tabled them in the spirit of trying to strengthen the Bill and return it to what was intended, so that it can meet the expectations of so many Members who supported it at an earlier point.