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

Naz Shah Excerpts

Committee stage
Wednesday 12th February 2025 Public Bill Committees

[Danny Kruger]

I am not sure that we are going to satisfy each other on this point. A lot of the evidence that we have heard conclusively asserts that there is a widespread problem of families applying—and I do use these terms fairly interchangeably—undue influence, encouragement and manipulation. Pressure and coercion form a subset of those terms. They are at the sharp end—the more obvious forms of encouragement and manipulation. Those terms exist in law, and this certainly exists in society, as we have heard from Members and witnesses. It feels to me entirely appropriate and consistent with the principles of the Bill that we are trying to ensure that the new law will only be available to people who are acting entirely autonomously, without having been in any way—however subtly—the victims of any sort of undue influence. That is the purpose of these amendments.

[Naz Shah (Bradford West) (Lab)]

Earlier, the hon. Member gave some examples of subtle encouragement or undue influence. If an elderly person has only one living relative, and they could benefit from their will, the encouragement could be so subtle. They could say to their dad or mum, “This an option available for you,” and not necessarily encourage or talk about palliative care. I know that is a conversation we will come to when we discuss later amendments, but this particular point is about people being driven in a certain direction, and that is so subtle.

As a mother to my children, I encourage them to do certain things, because I want to have that control over their behaviour because they are children. It is a normal thing to do. But when it comes to life or death, as a responsible parent it is my job to get them to think like I do or how I want to shape them. I think it is that subtle. Does the hon. Member agree that it is so subtle that sometimes we have to put it into the letter of the law to make sure it is there consciously, as opposed to expecting people subconsciously to understand the words “under coercion”?

[Danny Kruger]

I emphasise that the basis of the Bill, despite what many campaigners might want, is not one of total autonomy. The Bill requires us to have some responsibility towards the applicant, and not simply to say “Do you want it? You can have it.” There are already provisions in the Bill that put an obligation on the assessing doctors and then the judge not so much to conclude that it is in the person’s best interests—I am afraid it does not have that stipulation—but it does seek to insist that they make their own decision.

As the hon. Lady said, many people make a decision and might not even be fully aware themselves that they are the subject of undue influence. They may be being deceived by their loved ones. Their loved ones might be deceiving themselves about the pressure they are putting on them, but let us just talk about a genuine intent to persuade, which does happen. In answer to the question, “Have you been coerced or pressured?”, the patient may say, “No, of course not.” But if they are asked, “Have you been encouraged?”, they might say, “Actually, yes, I have.” That should raise a very significant red flag, and it is absolutely appropriate and sufficient at that point to say, “I’m sorry, but I don’t conclude that this is an autonomous decision.”

To conclude, I refer back to the debate we have been having since the news broke two days ago that there will be an amendment to scrap the judicial stage that is currently in the Bill. If there were a High Court judge sitting at the end of this process, as we were promised and as was understood by the House when it voted on Second Reading—if there were a judge sitting over each individual case, rather than sitting at the head of a national assisted dying commission, and if there were a judge sitting in court reviewing the case properly—there might arguably be no need for the amendment on undue influence.

It is possible, as the Minister explained, that coercion would sufficiently capture the more insidious undue influence and encouragement we are concerned about. It is possible that we could strengthen the definition of coercion through guidance, or through further definition in the Bill. But if we are going to have a panel, and not a court or a judicial process at all, it is even more necessary that we insist on added protection.

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As with the other amendments in the group, there is a risk in introducing additional or overlapping terminology —the right hon. Member for North West Hampshire referred to “embroidering” the legislation with terms such as “unduly influenced” or “manipulated”. As a general principle, and in order to preserve the integrity of the statute book, where a term is not given a statutory definition, it will be understood that Parliament intended the term to have its ordinary meaning. Indeed, that is how the courts will interpret it.

[Naz Shah]

Many of us on the Committee are first-timers. My understanding is that in a normal Government process we would have gone out to consultation. We are talking about coercion and undue influence, and undue influence in particular is not something that does not appear on the statute books in other legislation, as the Minister may recall I said earlier. We would normally go out and consult and speak to charities, particularly domestic violence charities.

As many Members have said throughout the last few days and this morning, we know that terminology changes. We did not previously have the vocabulary of coercion and the words that we have today. When was the last time, for any Bill—apart from in respect of Domestic Violence Act 2021 under the previous Government—that we actually went out to consult people? Given that there is no impact assessment, which we are so desperately missing and which is a huge chunk of this issue, I want to understand how we can be sure, and how the Government can come here and be absolutely sure, that this will work, given that this is a whole new concept.

This is not domestic violence, with which we have some familiarity. We had one Select Committee inquiry in 2015, and my understanding is that it did not produce anything conclusive either to support or not to support the concept of assisted dying. We have not had the debates to tease this out. Other Members may be much more familiar with these concepts, but will the Minister comment on that?

[Sarah Sackman]

To bring it back to the specific debate about the amendments, the terms “coercive” or “coerce” and “pressure” appear in the criminal law and have broad definitions. That is how they have been interpreted by the courts. Others have referred to section 76 of the Serious Crime Act 2015, which created an offence of controlling or coercive behaviour. In that context and the relevant Bill, Parliament chose not to make a specific legislative definition, but the way in which it has been interpreted, in accordance with its natural meaning, has vindicated the proposition that a broad meaning is given to those terms. For example, that offence could include coercive behaviour such as repeatedly putting somebody down, telling them they are worthless, seeking to control their daily routines or isolating them from friends and family to put pressure on them. As my hon. Friend says, we understand those sorts of behaviours in a much broader way in a changing society.

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[Sarah Sackman]

On the hon. Gentleman’s first point, there is no suggestion that we should somehow accept any weaker form of provision in this Bill to protect other parts of the law. Having said that, he would well expect me, as a Government Minister, to be concerned with the integrity of our statute book as a whole.

It is because the Government take a holistic view of how the criminal law and other areas of our law operate and define these concepts, and how they are read across the piece, that we make our contention in respect of these particular provisions, because the terms “coercion” and “pressure” are given their natural meaning and are expansive. In the Government’s settled view, they would be inclusive of the types of behaviour that are described in the amendments before us—namely manipulation, undue pressure and the sort of encouragement that I think, when he keeps coming back to it, the hon. Gentleman is referring to, which is not encouragement in a benign way as might exist between two perfectly supportive family members in a normal conversation, but the sort of encouragement that is intended to lead to coercive ends.

The hon. Gentleman says that pressure is a subset of encouragement; the Government’s view is that coercion and pressure would cover off the other behaviours that are described in the amendments. It is not necessary to include those additional concepts, because it risks sowing confusion that somehow they are not included in the concepts of coercion and pressure.

[Naz Shah]

I want to understand the Minister’s point about multiple words. We have the Digital Markets, Competition and Consumers Act 2024, referring to both coercion and pressure, and undue influence is also included. Those three terms are used in the same Act. Undue influence is also included in multiple additional statutes—over 10, including the Anatomy Act 1984, which is about people leaving their body to medicine for the purposes of tests and so on. Is the Minister saying that those are bad Acts, because they could confuse people? That is the test we are applying.

[Sarah Sackman]

I am certainly not saying that those are bad Acts, and I do not want anyone to quote me as saying that. We could in theory sit here and come up with a whole set of terms that would be descriptive of types of pressure and coercion. We have come up with a number of those, including “undue influence”, “manipulation” and “unduly pressured”. There are other types of behaviour that we might seek to describe. Indeed, if one refers to the Crown Prosecution Service’s guidance in respect of the offence in section 76 of the Serious Crime Act 2015, there are a whole load of descriptors of different types of behaviour. We could name and enumerate all those different types of behaviours, but, in the Government’s view, that is not the best way to create legislation that is workable.

It is the Government’s settled view that the words “coercion” and “pressure” cover off the types of behaviour that Members suggesting these amendments would wish to include. The risk is that such amendments create more confusion and shed more heat than light, if you like. Indeed, there is then the risk that the definition of coercion is narrower than it in fact is under our law as it is understood in our courts and in the body of common law and case law, which has been developed in construing those sorts of terms.

We are still on clause 1, and we have spoken a little about the interplay between clause 1 and later clauses, particularly clause 26, which engages the criminal offence as drafted in the Bill. I want to stress that while the procedural clauses 1, 7, 8 and 12 may use the same language as the criminal offences in clause 26, they are conceptually distinct, as others have noted. Although it is right that a court could be expected to construe legislation as a whole, case law in relation to one provision will not necessarily flow through directly to a later provision.

It may be helpful to illustrate that with the word “encouragement”, which has been raised. As we know, it is an offence to encourage or assist a person to commit suicide. As the hon. Member for Reigate pointed out earlier, it will continue to be so if the Bill is passed, outside of the specific exemption in the Bill. It is generally also an offence to encourage or assist a person to commit any other offence under the Serious Crime Act 2007. Specifically, it is an offence to do an act capable of encouraging or assisting suicide or another offence. The term “encouraged” is not defined in either statute. While it is true to say that section 2A(3) of the Suicide Act—which was added in 2009—clarified that doing an act that is capable of encouraging suicide includes a reference to a person doing so

“by threatening another person or otherwise putting pressure on another person”,

that was intended to be illustrative of the meaning of “encouraged” in that context; it does not serve as a general definition.

Within the Bill, it is important to keep in mind the difference between the procedural requirements—which is what we are discussing in this group—and the criminal offence requirements. Adding words to one provision because they are found in a criminal offence elsewhere risks, in the Government’s view, unintended consequences. Adding “encouragement” to the procedural clauses is perhaps an example of this.

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Division 5

Question accordingly negatived.

Ayes: 8

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Labour: 5
Conservative: 2
Liberal Democrat: 1

Noes: 15

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Labour: 10
Liberal Democrat: 2
Conservative: 2
Plaid Cymru: 1

[Naz Shah]

I beg to move amendment 94, in clause 1, page 1, line 20, at end insert

“, and

(c) is acting for their own sake rather than for the benefit of others.”

This amendment requires that a person requesting assistance must be acting for their own sake, not the benefit of others. This amendment reflects the proposed changes in Amendments 95 to 104.

[The Chair]

With this it will be convenient to discuss the following:

Amendment 235, in clause 1, page 1, line 20, at end insert

“, and

(c) is acting for the primary purpose of avoiding physical pain.”

This amendment, along with Amendments 236 to 245, seeks to ensure that the primary motivation of the patient is to avoid physical pain.

Amendment 95, in clause 7, page 4, line 15, at end insert

“, and

(h) is acting for their own sake rather than for the benefit of others.”

This amendment is consequential on Amendment 94.

Amendment 236, in clause 7, page 4, line 15, at end insert

“, and

(h) is acting for the primary purpose of avoiding physical pain.”

This amendment is consequential on Amendment 235.

Amendment 96, in clause 8, page 4, line 38, at end insert

“, and

(f) is acting for their own sake rather than for the benefit of others.”

This amendment is consequential on Amendment 94.

Amendment 237, in clause 8, page 4, line 38, at end insert

“, and

(f) is acting for the primary purpose of avoiding physical pain.”

This amendment is consequential on Amendment 235.

Amendment 97, in clause 12, page 8, line 14, at end insert

“, and

(i) is acting for their own sake rather than for the benefit of others.”

This amendment is consequential on Amendment 94.

Amendment 238, in clause 12, page 8, line 14, at end insert

“, and

(i) is acting for the primary purpose of avoiding physical pain.”

This amendment is consequential on Amendment 235.

Amendment 98, in clause 13, page 9, line 34, at end insert

“, and

(e) is acting for their own sake rather than for the benefit of others.”

This amendment is consequential on Amendment 94.

Amendment 239, in clause 13, page 9, line 34, at end insert

“, and

(e) is acting for the primary purpose of avoiding physical pain.”

This amendment is consequential on Amendment 235.

Amendment 99, in clause 18, page 12, line 26, at end insert

“, and

(d) is acting for their own sake rather than for the benefit of others.”

This amendment is consequential on Amendment 94.

Amendment 240, in clause 18, page 12, line 26, at end insert

“, and

(d) is acting for the primary purpose of avoiding physical pain.”

This amendment is consequential on Amendment 235.

Amendment 100, in schedule 1, page 25, line 22, at end insert—

“3A I am doing so for my own sake rather than for the benefit of others.”

This amendment is consequential on Amendment 94.

Amendment 241, in schedule 1, page 25, line 22, at end insert—

“3A I wish to be provided with assistance to end my own life for the primary purpose of avoiding physical pain.”

This amendment is consequential on Amendment 235.

Amendment 101, in schedule 2, page 27, line 12, at end insert

“, and

(c) the patient is acting for their own sake rather than for the benefit of others.”

This amendment is consequential on Amendment 94.

Amendment 242, in schedule 2, page 27, line 12, at end insert

“, and

(c) is acting for the primary purpose of avoiding physical pain.”

This amendment is consequential on Amendment 235.

Amendment 102, in schedule 3, page 28, line 10, at end insert

“, and

(c) the patient is acting for their own sake rather than for the benefit of others.”

This amendment is consequential on Amendment 94.

Amendment 243, in schedule 3, page 28, line 10, at end insert

“, and

(c) is acting for the primary purpose of avoiding physical pain.”

This amendment is consequential on Amendment 235.

Amendment 103, in schedule 4, page 29, line 5, at end insert—

“7A I am doing so for my own sake rather than for the benefit of others.”

This amendment is consequential on Amendment 94.

Amendment 244, in schedule 4, page 29, line 5, at end insert—

“7A I make this second declaration for the primary purpose of avoiding physical pain.”

This amendment is consequential on Amendment 235.

Amendment 104, in schedule 5, page 30, line 22, at end insert

“, and

(d) the patient is acting for their own sake rather than for the benefit of others.”

This amendment is consequential on Amendment 94.

Amendment 245, in schedule 5, page 30, line 22, at end insert

“, and

(d) the patient is acting for the primary purpose of avoiding physical pain.”

This amendment is consequential on Amendment 235.

[Naz Shah]

I rise to speak to support the amendment in the name of the right hon. Member for Braintree (Mr Cleverly), because I believe there is a need to include it in the Bill to ensure real protections against coercion.

Before I get to the substantive nub of the conversation, I want to understand something that I have just experienced. Again, the Chair might want to guide me and I am happy to take guidance. I am trying to understand this because we are all relatively new to the process, as is the Minister who responded earlier, the hon. and learned Member for Finchley and Golders Green. It appeared to me that the Government had a position on the amendments that were tabled. I recognise that my hon. Friend the Member for Rother Valley has set out that that is how debates happen, but actually, that is not my experience of how amendments are tabled in this House. We have notice of amendments. They are not tabled on the day, apart from manuscript amendments. They are tabled before the House rises, which gives us enough time to respond to those amendments, take advice on them and so on.

[The Chair]

Order. That is not in scope of the Bill. Please stick to the amendment.

[Naz Shah]

But in sticking to the amendment—

[The Chair]

Order. I am not having a conversation. Stick to the amendment. It is out of scope; I have been informed by the Clerk.

[Naz Shah]

Thank you, Mrs Harris. Sticking to the amendment, can I ask whether the Government will have already taken a position on it before I get to the end of my speech? Can they not share that before I make my speech? Is that within the scope of the conversation?

[The Chair]

I would suggest that you contact the Minister directly and ask the question, and perhaps she can give you a written response.

[Naz Shah]

Can I not ask for it now while we are in the debate?

[The Chair]

We are debating this amendment, and we are sticking to this amendment. You moved an amendment —can you please continue to speak to that amendment?

[Naz Shah]

I am happy to debate, Mrs Harris, but I am trying to understand because this is new to me. If I speak to the amendment and the Minister already has a position, I would value knowing that position, because otherwise it feels pointless for me to debate it.

[The Chair]

I have already said that you can talk about the amendment and not anything else. Could you speak to the amendment, or we will move on to the next speaker?

[Naz Shah]

Okay, I am happy to turn back to the amendment.

This issue is far too serious for us to overlook. I do not believe that many people, including medical professionals, are properly trained to recognise coercion or undue influence. To illustrate, I will refer back to my own experiences, like I did yesterday. I have had many unfortunate experiences in my life, but they have certainly prepared me for this space. I was forced into a marriage at the age of 15. I was 12 when I went to Pakistan, and although I was not physically bound or coerced in an overtly aggressive way, I was coerced none the less. I made the decision not for my own sake but for the benefit of others. At the time, I did not think for myself but for the benefit of my extended family members. It was clearly not my choice, and I understand that now. The power of influence from people we often trust and rely on in our everyday lives, especially when seeking their advice, can often lead to life-changing consequences. In the case of the Bill, it would be life-ending consequences.

In my forced marriage, and in those of others, because they do happen up and down the country, we can look back and realise what led us to make decisions that were neither in our best interests nor of our own choosing. Although my marriage occurred when I was under age, many people are coerced into forced marriages even in their late 20s and 30s for the benefit of others. The burden of holding family relations together, making other people happy and seeking approval can push a person into a forced marriage—something they never wanted. In my case, it was about keeping relationships between siblings and extended family intact, and the pressure fell on me, as a 15-year-old child. But me being 15 then is beside the point; the fact is that this happens today.

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[Sean Woodcock]

On the point of people feeling that they are a burden, one moment that stood out in the oral evidence was that, although the Western Australian Government’s own statistics show that 35% of people opting for assisted dying cited being a burden as their reason for doing so, the practitioners who offer assisted dying to people were not aware of this fact. I had to clarify it for them. Is that part of my hon. Friend’s motivation for supporting the amendment?

[Naz Shah]

It is very much in support of that, and I want to tease out what my hon. Friend just said, which is important. One conversation we are having is about being a burden—my hon. Friend referred to the evidence that we heard—but another side to that is that when people feel like a burden, somebody benefits from that. That benefit is what the amendment teases out. That is what I want to understand.

[Tom Gordon (Harrogate and Knaresborough) (LD)]

I completely understand where the hon. Lady is coming from, but this is the conflict between someone feeling like a burden because of their own personal choice and autonomy, and how those might impact other people in their surroundings. Does she accept that among the reasons that many people might want to access an assisted death is that they do not want to lose that autonomy? That is not necessarily anything to do with feeling like a burden on other people; it is about their own choice.

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[Naz Shah]

The hon. Member makes a valid point: it could be an absolutely autonomous decision. In an ideal world, that is what we would like to get to, but we are not in an ideal world.

[Sean Woodcock]

I am grateful to my hon. Friend for giving way again, and I am sorry to interrupt her when her speech is in full flow. My response to the hon. Member for Harrogate and Knaresborough, which links to my previous point about Western Australia, is that we have been told throughout this process that clinicians can spot the signs of coercion and whether people feel that they are being manipulated. However, in Western Australia, the people administering assisted dying—who we are trusting, in this Bill, to be able to spot those things—were not aware that 35% of people in the state cited “being a burden” as their reason for going for assisted dying. That is my concern. Does my hon. Friend have a response to that?

[Naz Shah]

My hon. Friend makes a very important point—because if we visit this issue afterwards, that person is dead.

[Dr Opher]

I do believe that what was actually said in evidence was that one of the reasons was that the person felt a burden, but there were other reasons. From the Californian doctors, we heard that feeling a burden is not in itself a reason to approve an assisted dying request.

[Naz Shah]

My hon. Friend is right, but the point I am trying to come back to is to do with those people who feel a burden; wherever they feel a burden, somebody is benefiting from that, because we are taking the burden away—there is ultimately a benefit to somebody.

We have talked a lot about people feeling a burden in terms of potential coercion, potential financial issues and all those things, but we have not discussed this in detail. It is important that we do so if we are to make this Bill, as my hon. Friend the Member for Spen Valley intends, the safest Bill in the world. It is incumbent on us to look at both sides. Just like in the earlier debate about whether we choose assisted dying or choose to take out the plug, ultimately the end is the same—it is death—but they are two different things. The amendment tabled by the right hon. Member for Braintree is very much about the question of who is benefiting from the person taking that decision.

[Dr Shastri-Hurst]

The hon. Lady spoke movingly about her own experiences, which clearly fell into the category of benefiting others, with no benefit for herself. Can she elucidate how she envisages this amendment working in the following scenario? Let us say that in some years to come, this law is enacted and I have a terminal illness—I have six months or less to live—and I do not want to face intolerable pain and suffering in those last moments of life, but I also do not want my son or my wife to watch me suffer. They benefit from that decision, because they do not see me suffering, but I am also doing it for my own sake. How does the amendment fit into that scenario?

[Naz Shah]

The hon. Member makes an important point. That is precisely why we need to have a conversation to ascertain that autonomy, which is what this comes back to—the whole purpose of this Bill is to give people autonomy. It is important that when benefit is being derived, it is not because they are a burden. We need to ascertain that that has been explored and was not about that, but that it is an informed choice and an autonomous decision. That comes back to the conversation around coercion, manipulation or whatever word we want to use; we voted down provisions on the term “undue influence”, but those are the words that apply.

In my understanding, this amendment is about having a conversation to probe what measures will be in place to ascertain what that person is actually saying. I would not wish that experience on the hon. Member, but he could be in that situation, and make that informed choice and be able to demonstrate that—again, we discussed the amendment from my hon. Friend the Member for Broxtowe on the word “demonstrably”. I am very keen to have those conversations, and that is the purpose of this amendment.

[Rachel Hopkins (Luton South and South Bedfordshire) (Lab)]

The point about conversations is really important. I wonder how many conversations my hon. Friend has had with terminally ill people, their family members and children, because I have had quite a few, like the example given by the hon. Member for Solihull West and Shirley, over a number of years now. It is so important to recognise that it is about the individual’s autonomy, but we cannot take away the fact that their loved ones may also derive a benefit in a way that the hon. Gentleman elucidated. Can my hon. Friend see how so many of us here want clarity, but do not want to put at risk an individual’s autonomy with a very subjective decision?

[Naz Shah]

I am sure my hon. Friend did not mean to suggest it in that way, but I feel slightly taken aback by the questioning of whether I understand the importance of this. I remind hon. Members that nobody in this room has had a forced marriage apart from me. That does not mean to say that they do not have empathy when I share my experience. To suggest—

[Rachel Hopkins]

Will my hon. Friend give way?

[Naz Shah]

Let me finish. Perhaps my hon. Friend did not mean to question whether I understand and appreciate it, but it suggests to me, does anybody? Yes, we heard witnesses. We heard evidence. I have heard about it in my own friendship circles. I had a young intern with me not so long ago who had cancer. We talked about this, when I decided to come on to this Bill Committee. A dear friend of mine lost her husband and asked me to support this Bill because of his experiences. I speak to doctors regularly. I have had one parent who died of cancer; the other survived cancer. I have had recent deaths; my own father was in a hospice, and others were in a hospice. To be really clear, I do not think the importance of autonomy is lost on any Member on this Committee or in the House. It is because of that importance that I agreed to take part in this Committee.

[Rachel Hopkins]

I hope that my hon. Friend will accept that I was not questioning her ability to understand the importance of the matter. I wanted only to place on record the importance of having those conversations and to ask whether she recognised that. I am really pleased that she has had so many conversations. That is why so many of us are here and want to see the change in the law, but we do not want to tie it so tightly that it would reduce the autonomy of an individual.

[Naz Shah]

I am grateful that we have been able to have this conversation as we have done. I share my hon. Friend’s concern. Equally, I am also concerned that we may now not have a judge’s oversight on this. There is potentially an amendment seeking to replace that with a panel of experts, which we will not get to debate until we have seen it.

Returning to amendment 94, tabled by the right hon. Member for Braintree, I have already talked about Professor Allan House’s contribution. The importance of the issue is not lost on the House. This includes people who do not want to take up their children’s time. As the hon. Member for Solihull West and Shirley suggested, there is that conversation to be had with families, no doubt. We speak from the privileged position of being able to have those conversations. In an ideal world, we would all be equal, but we are not.

[Daniel Francis]

The one thing that covid taught me was what my hon. Friend is alluding to. Hon. Members heard yesterday a bit about my family situation. I have a child who will never walk, will always be in nappies, will always need to be fed, and will always need to be dressed. During that period, no carer was allowed in the house, and as people know, my wife was also having chemotherapy —thankfully, she successfully recovered. As the carer, who everyone is reliant on, I saw that power imbalance. Everybody in my house was reliant on me during those three months—no one was allowed in the house, my wife was having chemo and my daughter needed round-the-clock care, so to speak. That is the position, which is why I understand this wording. That is the imbalance, whereby somebody could realise that this change in the law now gives them the power to release the burden of their loved one, not for any other reason—that they want their suffering to end—but because they want their loved one to have their life back. I do not know whether my hon. Friend has any comments on that.

[Naz Shah]

I thank my hon. Friend for his valuable intervention. He speaks from his personal experience, and this place and this debate are richer for having those experiences shared. It comes back to the comment made by the hon. Member for Solihull West and Shirley; this is about where there is autonomy. This is about people who make that informed choice without coercion, loss of autonomy, undue influence or encouragement. We are talking about those people; we are not talking about those who do not fall into that category.

Those of us in this House know of inequalities that exist in our communities for disabled people, women, or people with mental health illnesses. We already know that; this is about safeguarding and making sure that we are exploring the reasons why, to safeguard those who do arrive at those conclusions—at that decision of autonomy—so that, should this Bill be passed and become law in two years, we as a Committee will know that we have tried our hardest and our best to support my hon. Friend the Member for Spen Valley to make it the safest Bill in the world.

[Jake Richards]

I am very sympathetic to the amendment, which aims to tackle a mischief that we are all worried about, but there are two fundamental problems. The first, which builds on the intervention from the hon. Member for Solihull West and Shirley, is this issue of deciphering if an action is for your own sake or the sake of others. It is a philosophical question: is there ever really a selfless act? Even if we take an act that may be deemed to be for someone else, it may be because we want that person to receive some pleasure, joy or relief, so in my mind there is a danger that this could become a tautology.

Secondly—I hope that you might be able to comment on this—is there not a danger that we are then putting it on doctors and others in this process to undertake an assessment of welfare? When you are deciding whether something is for an individual’s sake, you are making some determination, are you not, as to what is in their best interests? That directly conflicts with the principles of the Bill, which is all about autonomy and an individual’s choice, rather than others saying what you should and should not do.

[Jake Richards]

Forgive me, Mrs Harris. I apologise profusely.

[Naz Shah]

If we are talking about welfare, I would have thought that this Bill would have included welfare checks, which are absolutely crucial. My definition of welfare encompasses the whole being, with the person at the centre. In this case, welfare would mean putting somebody with a terminal diagnosis at the centre of what service provision looks like, be it for assisted dying or a care pathway through palliative care.

[Jake Richards]

rose—

[Naz Shah]

I am happy to give way if my hon. Friend wants to elaborate.

[The Chair]

Order. Before the hon. Gentleman starts, can I ask for short interventions, please, not speeches?

[Jake Richards]

What I meant by a welfare decision is a paternalistic view, whereby medical practitioners and others say what is in the best interests of an individual, rather than the individual themselves.

[Naz Shah]

I appreciate the clarification and the explanation. I do not feel that having doctors doing this is a contradiction of this Bill at all, because if we go by the letter of the Bill and how it is set out, when a doctor offers those choices, whether it is assisted dying or palliative care, they are giving a choice of welfare options to their patients. That is my understanding, and I am not sure that this is contradicts with the Bill in any way, shape or form.

I have answered my hon. Friend’s first question; can he remind me of his second?

[Jake Richards]

My question was building on the intervention made by the hon. Member for Solihull West and Shirley. It was about whether there can ever be a selfless act.

[Naz Shah]

If we make philosophical and idealistic arguments, we will not be able to legislate on anything. Philosophically, there are people in this House who wear red, blue, green or the colours of smaller parties. We are all different in our positions philosophically. For me, this process is about legislating as well as we can to put safeguards in place that are as strong as possible. I cannot get into that debate because it would not apply to the legal aspect.

[Jack Abbott (Ipswich) (Lab/Co-op)]

To move away from the theoretical, like my hon. Friend the Member for Rother Valley I am sympathetic to what this amendment is trying to do. To give a practical example, let us say that I have been given a terminal diagnosis and say to the doctor, “I personally do not want to go through pain and agony over the next few months, but I am also thinking about my family—I do not want them to suffer alongside me.” I would therefore fall under the definition in this amendment—the hon. Member for Bradford West is shaking her head, but the reality is that I would—because I would also be acting for the benefit of others; I have cited that alongside my own physical pain as a potential reason that I want to do this. As I say, I am sympathetic to what the amendment is trying to do, but I feel that the way it is written would inadvertently include a huge amount of people who are doing it for their own motivations, but clearly the reality of life is that we consider other people as well.

[Naz Shah]

The hon. Member makes a valid point that it would ultimately benefit others. It would—that is a given—but that was not my reading of the way the amendment is drafted. My reading was that “only for your own benefit” means that someone is not being driven by the benefit of others, financial or otherwise. From the point of view of autonomy, if someone chooses to make that decision, of course others will benefit. I take the point that there appears to be a contradiction, but that is not my understanding of how the amendment is written and it is not what I am talking about.

[Jack Abbott]

My hon. Friend mentions the word “only”, but that word does not appear in this amendment. That is the issue: we are opening this up. The amendment says:

“acting for their own sake rather than for the benefit of others.”

In my example, I cited the benefit of others as potential reason that I might seek this.

[Naz Shah]

The hon. Member makes valid point. Maybe the Government would be able to mop this up if this amendment was accepted. That can happen—it is not beyond the scope of Government or the Ministers present.

[Sean Woodcock]

I am grateful for this debate, particularly as lots of people who, on Second Reading, were happy to pass the Bill through to Committee wanted the debate to happen. We should all welcome that, as I know the promoter of the Bill, the hon. Member for Spen Valley, does. I am grateful that we are here.

I will move away from the philosophical debate and return to what I said before lunch: this is about not just the role of the individual—though that is clearly important—but what we see as the role of the state and what we are comfortable with the state allowing. I see this amendment as very much linked to that. Does my hon. Friend the Member for Bradford West think there is something in that—about whether the state is happy for people to cite the benefit of others as a reason for opting for assisted dying?

[Naz Shah]

I thank my hon. Friend for his intervention. That is not something I had spoken to the right hon. Member for Braintree about. Thinking about it, his point is valid: there is always an overlap in terms of whether this is the state interfering or not interfering. In this instance, it is about the state and legislation protecting the individual and ensuring that an autonomous decision, which is what we are trying to get to, was reached, without any coercion, undue influence or subtle manipulation—whatever word we choose to use in these proceedings—and not for the benefit of others.

Too many arguments that I hear in support of the Bill seem to assume that all those who seek assisted dying will do so as a matter of autonomy—as a free choice. Honestly, it would be much easier to support the Bill if that were true, and I sincerely wish it were, because we would not have the issues we have been talking about all today and yesterday. However, we must pay heed to those who do not live their lives in that way. We in this House have a duty to protect those who feel like a burden to those close to them—or who are made to feel like a burden, whichever route that may take, and we have had plenty of conversations about that.

The amendment tabled by the right hon. Member for Braintree would permit doctors to halt an application for assisted dying if they had good reason to believe that an applicant was not acting for their own benefit.

[Sojan Joseph (Ashford) (Lab)]

Would inserting the line in the amendment not also give us another opportunity to assess the patient’s capacity? Under the Mental Capacity Act 2005, a person should be able to “understand” and “weigh” the information, so does having this line not also help us to assess a person’s capacity?

[Naz Shah]

I agree with my hon. Friend’s point. We are not dealing with capacity in this amendment, but I agree that every one of these extra checks and balances would also support the exploration of capacity and would definitely strengthen those conversations with any patient.

The amendment tabled by the right hon. Member for Braintree would not be a perfect safeguard. As we know in this House and across society, nothing, including legislation, is absolutely foolproof. There will be people where, despite the best efforts of the NHS, despite having palliative care and despite having people in these positions, things will be missed. Unfortunately, that happens.

Before I make my closing remarks, I want to come back to where I started—forced marriage. We heard from Dr Jamilla about inequalities and how to spot coercion. There is an added layer to all of this when it comes to women, and also when it comes to people from ethnic minority backgrounds, who already have an inherent distrust, which was magnified during covid.

When it comes to domestic violence, we also know it is harder to spot the coercion, because of the conditioning and the cultural conditioning. My personal conditioning was very different, and it took me until my 30s—years into my adulthood—to recognise it and call it out, despite being an active campaigner against domestic abuse and having access to amazing campaigners in the UK. Going back to Dr Jamilla, some of the conversation she has been having around this issue is about people having that distrust. Coming back to the amendment, we must be able to point out—to draw out—that “benefit of others”. It is harder to spot, so there have to be safeguards.

This amendment, and all the amendments we have talked about today, would benefit the Bill; they would strengthen it. They would in no way, as the Government have suggested, weaken or confuse it or the people applying it.

[Tom Gordon]

Can the hon. Member elaborate on what the amendment would add that previous amendments we have debated would not?

[Naz Shah]

The issue for us in the conversation on this amendment is that we have talked about coercion, undue pressure, undue influence, encouragement and all that, but we have not talked about the benefit to others. It is simply a different conversation; it is about understanding that a person has been coerced and so on, but also for what reason. What is the benefit to others? That is my understanding of the amendment, and that is why I am speaking to and supporting it.

Unfortunately, the Bill as it stands does not have all the necessary safeguards for all those who see themselves as burdens to others, and that is why I support the amendment.

[Kit Malthouse]

I have listened very carefully to the hon. Member, who represents the fine town of Bradford, and to her personal experiences, which have coloured her view. I understand that of which she speaks, and she might be interested to know that I was the author of the first ever violence against women and girls strategy in the country when I was at City Hall. I dealt closely with harmful cultural practices in that strategy, so I do understand the difficulties she elaborated with detecting and combating the influences to which she referred. However, I am going to disappoint her, because I am going to explain why I believe that the amendments make that more difficult and run the risk of making the Bill less safe.

I should mention first, though, that she said that we are dealing with notions of autonomy and trying to achieve a position where people seeking an assisted death do so as a matter of free choice, and she is exactly right: that is what we are all about and trying to achieve. However, as I hope I can illustrate, the amendments may make that more difficult on three levels.

We have talked a lot over the last few hours about precision and novel terms in legality. My first issue with the amendments is the lack of that precision. For example, what does “physical pain” mean? Is it all pain? Is it something as minor as a headache? Is it perceived or actual pain? Is it fear? Does fear become a physical pain, or is it a mental pain?

In the closing stages of bowel cancer, for example, a number of things may happen and a number of things may cause somebody to die. They can have a perforated bowel caused largely by a blockage, as I am sure my hon. Friend the Member for Solihull West and Shirley would say. That would be incredibly painful and lead to peritonitis and organ failure, which eventually leads to death. However, there is a situation where a blockage in the bowel causes a person to vomit effectively semi-digested food and faeces. Is that painful? I do not know whether that is a classification of physical pain. It is certainly uncomfortable and unpleasant, but is it actually painful? I find that the definition of “physical pain”, undefined as it is, and which may be a matter of degree, injects complexity for doctors and lawyers in their assessment of the motivation of a person seeking assisted dying.

Similarly, I do not really know what “benefit” means in the amendments dealing with that. Does it mean financial benefit? Does it mean emotional benefit? Is it perceived or real benefit? Does the doctor have to assess whether a third party is actually getting benefit? Let us assume that it is emotional benefit and that I say—I think it is perfectly legitimate, as my hon. Friend said, for me to say this—“I do not wish my child to witness, know or even learn that the way I died was from the fungating tumours in my neck bursting and,” as we heard on Second Reading, “me drowning in my own bodily fluids. I do not want to get to that stage, and I do not want to burden my child with that.” Do I have to say to the child, who is perhaps an adult child, “How do you feel about it? Are you going to benefit from this or not?” They will respond, “Absolutely not. I want my dad to live as long as possible,” or, “I want my dad to have what he wants to have.”

It is very difficult in these circumstances—do not forget that this will be crawled over by lawyers and doctors—to understand what is actually meant by “benefit”. These are new words—novel concepts—that are being introduced into the law. I did look to see whether there were similar circumstances elsewhere in legislation, and I could not find any. To me, they inject an element of complexity into what we hoped would be, as we discussed earlier, a settled and comprehensible legal framework, in which doctors have previously operated, and should operate into the future. As I say, my first objection is that the amendments inject novel concepts that are largely undefined and that may be actual or perceived, both by the person who is being assessed and by those who are presumably to be in receipt of the benefit.

I am afraid there is also—I am not sure, particularly on the amendments tabled by my right hon. Friend the Member for Braintree—a question in my mind about where my “sake”, whatever that word means, collides with someone else’s “benefit”. As the hon. Member for Ipswich said, if it makes me happy—if part of my dying is me taking satisfaction in the fact that I am not burdening my children with the emotional trauma of watching me die in horrible circumstances—is that for my sake or for their benefit?

[Naz Shah]

The right hon. Gentleman is making a powerful speech. In response to the comment by my hon. Friend the Member for Ipswich, people can have, and will have, an incidental benefit when somebody with autonomy makes a decision. The Government could table tidying-up amendments to clarify that and make this amendment stronger, if it gives an extra safeguard for those who are seeking assisted dying, should the Bill become law.

[Kit Malthouse]

I understand what the hon. Lady is saying, but I am afraid that the amendments do not say that. Even if they did, there would be some difficulty, because you are asking for a further level of complexity in what should be, we hope, a decision made between doctor and patient, in private and confidential circumstances where sensitivity is needed and where we are asking medics to tease out motivations from individuals. I hate to use a pejorative word like “woolly”, but I find the lack of precision in the language troubling. I think it will create yet more complexity and jeopardy for doctors and lawyers.

--- Later in debate ---

[Naz Shah]

That speaks to my earlier point, where I was seeking clarification. I find that I feel very uncomfortable with this process, where the Government are very clearly taking a position, without having an impact assessment in place, on whether the previous amendments and the ones I am talking about would confuse the courts or create uncertainty. Perhaps the Minister can provide clarification, but my interpretation is that the Government are taking a view, not just sharing the position of the Government.

[Stephen Kinnock]

I thank my hon. Friend for that intervention. I will just take us back to the first principles. This is not a Government Bill; it is the Bill of my hon. Friend the Member for Spen Valley, who came top of the ballot for private Members’ Bills. She chose to bring forward this piece of legislation. The Government had absolutely no role whatsoever in drafting the legislation. The Prime Minister then made it clear that the Government will remain neutral in their position on the Bill. However, it is the constitutional duty of the Government to ensure that every Bill that passes through Parliament and secures Royal Assent is workable, deliverable, viable and coherent in terms of the statute.

How does that play into this Bill Committee? Members of the Committee who are not Ministers are here to debate the philosophical, moral, ethical and, in some cases, legal and perhaps clinical aspects of the Bill. Members of the Committee who are Ministers—namely myself and the Justice Minister, my hon. and learned Friend the Member for Finchley and Golders Green—are here to provide observations on the Bill with regard to its legal, practical, technical and operational impact, to ensure that we are doing our constitutional duty to deliver the objectives I just outlined to my hon. Friend the Member for Bradford West.

The answer to the question from my hon. Friend is that when my hon. and learned Friend the Justice Minister and I speak, we focus our remarks exclusively on the legal, practical, technical and operational considerations of the Bill. I assume that the Committee finds it useful to know what the Government’s position is on those matters. We do not opine on the philosophical, ethical or moral considerations that are at the heart of the Bill.

[Naz Shah]

I thank the Minister greatly for his explanation. I am trying to separate the two points. I appreciate the role of both Ministers in providing the Committee with that guidance, as many of us are new to the process. What I am trying to understand, with respect to the amendment from the right hon. Member for Braintree, which I just talked about, is that the Government have asserted a view that the language included would create uncertainty.

[The Chair]

Order. The hon. Member has asked a question and had a response. This Committee is not debating the Government’s stance. It is debating the Bill.

[Naz Shah]

Can I come back to the amendment?

[The Chair]

I am not going to take any more interventions. I will move on to Kim Leadbeater unless the Minister has not finished.

[Kim Leadbeater]

Returning to the amendments before us, I will try to keep my comments brief, as we have had a thorough debate this afternoon. On amendments 95 to 104, I have spoken to the right hon. Member for Braintree and I know that these amendments seek to stimulate discussion, and I am very pleased that they have done that this afternoon. I also know that they come from a good place.

I have already discussed the additional safeguards around training that would be added to the Bill through new clause 8, which states that the Secretary of State must consult

“persons appearing to…have expertise in matters relating to whether persons have been coerced”.

That would consolidate the existing measures in the Bill and, I hope, relate to the concerns expressed in the amendment to some degree.

More broadly, the reasons that someone might choose an assisted death may well include sparing those they love the pain of seeing them suffer, as we have heard this afternoon. That is certainly something that members of my family and people I have spoken to say would matter to them. That should not prevent the provision of assistance. It is surely for that person to decide.

During oral evidence, we heard powerful testimony from Liz Reed about her brother Rob, who had an assisted death in Queensland, Australia. Rob was 39 years old and had a young family when he was diagnosed with stage 4 terminal lung cancer. He was fit, young and healthy, and did not smoke. As well as taking back control at the end of his life, one of his main reasons for choosing an assisted death was so that his young family could remember him as the man and the dad he was. He was not afraid of death, but he was afraid of dying in an undignified and painful way; he was afraid of not getting to say goodbye to his wife and children, or them having to find him after his having had a massive heart attack. Surely we should not decide that that is not acceptable and understandable. It is a perfectly understandable reason for choosing an assisted death.

Liz told us that Rob

“was able to change his mind, which he did, in terms of dates and when it would happen. His views and the views of his family were also taken into account and, through the process, he was treated like a person with autonomy whose choices were being respected.”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 30 January 2025; c. 254, Q328.]

If relatives were implicitly or explicitly coercing or pressuring someone, that would of course be very different—and that is covered by the Bill—but to prevent someone from wanting to consider their loved ones in their final weeks and months of life does not seem at all reasonable to me.

I have talked about training, which is important and feeds into the debate about the assessment of coercion and pressure—here, I refer again to my new clause 8. As we heard during the oral evidence, who is involved in that training is important. We heard from the Association of Palliative Care Social Workers. Its position statement on assisted dying states:

“As social workers we bring a distinctive perspective and skill set. Our focus is on helping people to get practical needs met; to enable them and their families cope with the impact of serious illness and dying and to plan ahead”.

[Naz Shah]

My understanding is that the judges’ views on capacity relate to the fact that there are only 200 qualified palliative care social workers in the country.

[Kim Leadbeater]

This point is about training, and so about hearing from the right people when it comes to the training of professionals. It is important that we ensure that the Secretary of State must consult such people, and I anticipate that organisations such as the Association of Palliative Care Social Workers would be consulted. The statement continues:

“as well as protecting people from abuse, neglect and coercion at a time…when they are most vulnerable…Our expertise includes building trusting relationships, comprehensive knowledge of safeguarding”.

By looking at the training process, people’s motivations for seeking an assisted death would hopefully be considered.

--- Later in debate ---

[Naz Shah]

My hon. Friend has referred a few times now to us not having this framework. We do not have this framework because we do not have this law. Maybe she can help me to understand or correct me if I am wrong, but this framework does not exist because we do not have this law. For this law to exist, we have to have the framework. I am inferring from her a suggestion that she is somehow intervening for people who might be being coerced in a hospital setting or at the end of life in any case, but that is not the case.

[Kim Leadbeater]

I am not quite sure I understand the point. My point is that there is no law that is checking people’s motivations for ending their lives when they are terminally ill, and that is what this law would do.

I will make some progress, and come to amendments 235 to 245. As we have heard from witnesses, choice at the end of life is not just about physical pain, be it current or potential. It can also be about psychological suffering and mental torment as a result of being terminally ill —and it is of course about taking back control, bodily autonomy, dignity and choice. What about patients who are in severe mental torment and fear as a result of their condition, and terminally ill people who want the autonomy and dignity of taking back control at the end of their lives? Who are we to ask them to prove their level of physical pain or desire to avoid physical pain, and to deny them the choice in their final few weeks or months?

--- Later in debate ---

[The Chair]

I call Naz Shah to wind up. It would be helpful if the hon. Member would indicate whether she wishes to push amendment 94 to a vote.

[Naz Shah]

Yes, Mrs Harris, I do want to push the amendment to a vote.

In summary, the reference to “coerced or pressured” in clause 1 relates only to coercion or pressure by another person and does not cover internalised pressure. In written evidence, the Royal College of Psychiatrists said:

“The Bill focuses on external coercion. That is, for example, coercion from family members with personal or financial motivations to hasten death. While this type of coercion may not always be clear, internal and societal pressures that may reach the threshold of coercion can be even more difficult to detect.”

I am not going to rehash that. I appreciate where we are at with this conversation. The royal college says that the Bill does not address

“more subtle forms of coercion, such as where a person may internalise a feeling of being a burden to others. How might such internalised pressure be identified or responded to in this context?”

It is that important question that we are left with. It continues:

“At what level would implicit or internal pressures amount to coercion? At what point would supporting a person to have capacity to make a decision to request assistance to die constitute coercion?”

That coercion may be used for the benefit of others.

That brings me back to the crux of this amendment: it is about the benefit of others. There is nothing to suggest that there would not be an incidental benefit for people; there can absolutely be an incidental benefit. For the avoidance of doubt, this amendment is not about that. We have had votes on adding language to the Bill, which I voted for. We have heard the Government responses, which I struggle with. Ultimately, I want to push this amendment to a vote because I feel that we need to strengthen the Bill. As it is, there are loopholes, and one loophole is one loophole too many.

Question put, That the amendment be made.