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

Debate between Kim Leadbeater and Bambos Charalambous

Committee stage
Tuesday 28th January 2025 Public Bill Committees

[Kim Leadbeater]

Q That is incredibly helpful—thank you. Dr Kaan, do you want to add anything to that, and maybe touch on the training that takes place around identifying these things and the conversations that take place?

Dr Kaan: I echo exactly what Dr Spielvogel has said. As part of our medical training, we are trained to assess capacity in both small and big ways, depending on the size of the decision at hand, as he said. Throughout our medical training, we are trained to do that and to assess with a patient progressively over time, as we are seeing them in subsequent visits as well. This is really no different from that, although obviously the stakes are a bit higher than a blood pressure medication discussion.

We look at whether, for instance, the patient is able to voice a reason for making their decision. Do they have a logic behind it? Do they have a set of values that they can express? Is their decision consistent over time? We are looking at a longitudinal assessment, rather than just one fixed moment in time. Over the course of our assessments, it really does become clear in almost all cases that somebody either does or does not have the capacity to make this decision or any decision. This is really not outside the realm of what physicians are trained to do in any other case of medical decisions, especially large ones.

In the case of coercion, I agree that virtually all the time it is the opposite way: family members and loved ones are well-intentionedly trying to coerce or convince someone not to make this choice or not to proceed with this option, which they may have available, rather than pushing them to do it. I think the way to properly assess that is to ask open-ended questions: as Dr Spielvogel has said, to have them in the room alone, at least for a portion of the assessment, so you can have a one-on-one conversation; to ask the questions in various ways, so you are seeing the consistency of answers over time; and to look for non-verbal cues that may indicate that something else is going on. I have also never come across a case where I felt that a patient was being coerced into this decision by a family member, but rather the opposite.

[Bambos Charalambous (Southgate and Wood Green) (Lab)]

Q My question is about how the legislation is going and how you have implemented it. What changes have you made since it began? What teething problems did you find as you were going along? What adjustments have you made to your process?

Dr Spielvogel: The original version was called the End of Life Option Act. It legalised assisted dying in California when it went into effect in 2016. It was then amended in 2021, I believe; the effect of the main amendment was to shorten the waiting period. There was a 14-day mandatory waiting period between two verbal requests that a patient would give directly to their physician. What we found when we were studying it was that approximately 30% of people died during the waiting period.

There were many conversations with patients. The thought process behind the waiting period is that somebody is making a persistent, well-thought-out and non-capricious decision when they are asking for this, but there is a false premise there—[Interruption.]

Autism and ADHD Assessments

Debate between Kim Leadbeater and Bambos Charalambous

Monday 6th February 2023 Westminster Hall

[Kim Leadbeater]

My hon. Friend makes the valuable point that sadly we still have a lot of work to do to reduce the stigma associated with ADHD and autism. Does he agree that we need an education system and, indeed, a society that celebrate neurodiversity and all the wonderful things it brings with it?

[Bambos Charalambous]

My hon. Friend makes an excellent point. We need education in society, and the acceptance of people with ADHD and autism, to ensure that people with those neurodiverse conditions are able to flourish and live to their full potential.

Nationality and Borders Bill

Debate between Kim Leadbeater and Bambos Charalambous

Report stage
Tuesday 7th December 2021 Commons Chamber

[Bambos Charalambous]

The British Nationality Act has been in law for the last 40 years and that provides the power to strip people of citizenship. What we are talking about here is doing it without notice.

[Kim Leadbeater (Batley and Spen) (Lab)]

Does my hon. Friend agree that to deprive a person of their citizenship without warning or explanation would be a flagrant breach of natural justice and that to do so as an alternative to submitting that person to due process under the law risks undermining our national security, rather than enhancing it?

[Bambos Charalambous]

My hon. Friend makes an excellent point. She is exactly right. How can it be right that somebody is able to be stripped of their citizenship without knowing about it? That is clearly a breach of natural justice.