Terminally Ill Adults (End of Life) Bill (Twenty-seventh sitting)

Naz Shah Excerpts

Committee stage
Wednesday 19th March 2025 Public Bill Committees

We cannot risk an innovation in the law of murder with the unintended consequence that some murders go unprosecuted and unpunished. We must pass quality law that solves rather than creates problems. I do not intend to oppose the amendments, except amendment 509, as I do not see why the consent of the DPP should be required in the case of dishonesty, coercion or pressure. It is good that there is clarity on what people are prohibited from doing, but I am anxious that the Government discharge their duty to the statute book and that they do so in an even-handed manner.

[Naz Shah (Bradford West) (Lab)]

I thank the hon. Member for East Wiltshire, who has raised some concerns for me. I rise to speak in support of the amendments, but also to raise some points. I share the hon. Gentleman’s concerns, but let me begin by speaking about the bits that I feel pleased with and able to support.

My hon. Friend the Member for Spen Valley has already explained the amendments and may explain them more later. I am pleased that they tidy up errors in the original construction of the Bill. In its original form, subsection (2) rightly states:

“A person who, by dishonesty, coercion or pressure, induces another person to self-administer an approved substance provided in accordance with this Act commits an offence.”

Unfortunately, in the Bill as drafted, the penalty for such an act is only a prison sentence of 14 years. It is quite right for that to be the penalty for the offence detailed in subsection (1), namely when someone,

“by dishonesty, coercion or pressure, induces another person to make a first or second declaration”,

but does not actually succeed in getting them to the end of the assisted dying process. However, it is easy to agree that 14 years is an inadequate penalty for successfully coercing or pressurising somebody into an assisted death. I am glad that my hon. Friend the Member for Spen Valley has recognised that problem and has tabled an amendment that would impose a maximum penalty of life imprisonment for such an offence.

My hon. Friend the Member for Sunderland Central made a powerful speech in this Committee the other day, in which he said that abusive or coercive people are already likely to be forcing their victims to starve themselves or refuse treatment. That is true, and I thank him for raising that important point. I will welcome all measures to make it harder for abusers to do so and will gladly work with hon. Members to do so. However, I want to sound a strong note of caution.

Creating an offence and giving it a strong maximum penalty is only one of the ways to deter abuse and coercion, and perhaps the easiest. As I have mentioned before, the conviction rate for coercion is only about 4%. There are other things that we need to do to deter and prevent abuse. We need the people who may come into contact with it to be aware of what could happen; we need them to be able to spot the signs that it may be happening; we need ways to investigate those signs carefully. Only when we have done those things can we move on to the CPS potentially prosecuting somebody for an offence and, if they are found guilty by the court, to sentencing that person. Those are matters that this clause deals with, and they come at the end of a process.

I welcome the amendment tabled by my hon. Friend the Member for Lowestoft (Jess Asato), which makes training in domestic abuse and coercion mandatory for professionals working on assisted dying cases, and which my hon. Friend the Member for Spen Valley has accepted. However, new training on its own will not be enough to make it near-impossible for abusers to succeed. Having unfortunately had lots of experience in the area—having seen it in my own life, the lives of people close to me and the lives of constituents—I know that sometimes abusers are not subtle. Even so, they can be hard to catch, because their victims cannot recognise that they are being abused. The classic—I wish I had a pound for every time I heard it—is “He’s changed.” There are hundreds of justifications and some are very subtle indeed. These people can be very hard to catch, or they may never be caught at all.

I have heard hon. Members say—I think my hon. Friend the Member for Spen Valley said it earlier—that the Bill strengthens the safeguards around people who are terminally ill, because those are not there in the first place. I appreciate that idea, but that is just for those people who are terminally ill. I want to strengthen safeguards more generally. In some ways, the Bill offers people a new opportunity to be coercive, controlling and dishonest. That is why I have been banging on about safeguards so much in this Committee; perhaps people find it a bit much, but I do it because abusers are very persistent and clever people and we have to be clever and persistent in how we devise our safeguards against them.

Although I welcome the clause and the amendments tabled by my hon. Friend the Member for Spen Valley, I am disappointed that other safeguards have been rejected. I still say that the panel procedure could and should be much tougher. That would not guarantee that abusers would be caught, but it would make it more likely.

[The Chair]

Order. Members cannot continue to talk about the substance of amendments that have already been rejected, and we are now going into that territory. I am not going to stop the hon. Lady talking, but rehashing debates about amendments that we have already had is not in order.

[Naz Shah]

I apologise, Mr Dowd. I will not refer to them.

I come back to the point made by the hon. Member for East Wiltshire about DPP consent. I will be grateful if the Minister picks up some of these queries. In this place, we make laws. My experience of the law on forced marriage—I was a victim of forced marriage—was that we made a law but never got any convictions. Very little moved on it, because we already had laws in place to prosecute that offence. I am not saying that the same is happening here, but I draw the Committee’s attention to the fact that we may be making a law that already exists. If it already exists in the Suicide Act, are we just making a law for the sake of putting something on the statute book or on the face of the Bill?

We have talked a lot about how we should not complicate things. The word “complication” has been used quite a lot in this Committee. Are we adding another layer of complication by putting this measure in the Bill, when we are not prepared to do so for other things that people feel strongly about? This is also something that already exists.

My understanding is that if we were prosecuting coercion, for which unfortunately the prosecution rate is only 4%, that would not need DPP consent. It would be needed, potentially, for assisting suicide, but not for coercion. Do we need some clarity about the application of the law in this regard? Suppose we had a scenario in which somebody was murdered: it was premeditated, and somebody had thought through how to use this process as an avenue to kill that person. I do not want us to make a law that would allow somebody to literally get away with murder. More thought needs to be given to that. I am not an expert or an eminent lawyer like the Minister, but I am concerned by the comments of the hon. Member for East Wiltshire, having looked more closely at the issue. I would welcome the Minister’s comments.

[Jake Richards]

You intimated, Mr Dowd, that we can speak for as long as we want, but I will not speak for long on this clause, partly because I fear that we are making a mountain out of a molehill. The clause creates new criminal offences; I am not a criminal lawyer, but that is my reading of the clause and the amendments tabled to it by my hon. Friend the Member for Spen Valley. There are an array of reasons why criminal offences are legislated for. One good reason is to provide deterrence against committing such an offence. If the Bill receives Royal Assent, we are entering new ground. We are developing a new process in our healthcare system that will affect how our society and culture works, and creating a new legal process, which we had lengthy discussions about when discussing the provisions that will replace clause 12, in the debate over the panel.

In my mind, it is wholly appropriate to have an offence specifically in this very new area. I cannot see any weight to the argument that it undermines the law of homicide in our country and jurisdiction. Respectfully, I cannot see how Members who have been, understandably, worried about the Bill cannot see that this only strengthens it. I would gently say that the arguments that this somehow undermines the law of murder or homicide are slightly disingenuous. I had hoped that debate on this clause would be straightforward, with the Committee seeing that it clearly strengthens the safeguards around assisted dying.

[Naz Shah]

I have taken your advice, Mr Dowd, because my points would have made for a long intervention. First, I gently remind my hon. Friend the Member for Rother Valley that we have not used the word “disingenuous” in this Committee, so I sincerely wish that he reflects on that. Regardless of the debate we are having, everyone on the Committee is very committed to what we are doing here.

Secondly, my hon. Friend said that we were making a mountain out of a molehill. I refer again to the issue of forced marriage, legislation on which went through the House when police forces already had legislation to prosecute for it. As legislators, we should have ensured that we raised awareness and trained our police officers and communities to apply that—

[The Chair]

Order. We are dealing with clause 26 and the amendments to it, specifically in relation to these offences. Can the hon. Lady please speak to the clause and the amendments?

[Naz Shah]

I am speaking to the clause, Mr Dowd. I apologise—I will try to be clearer. Clause 25 creates a new offence, and I am trying to give an example of past legislation that speaks to the same principle. If we are creating a new offence that the DPP needs to consent to, and we already have an offence, then are we complicating it for the CPS or our police forces?

Take the issue of coercion, because that is what the clause refers to. We only have a 4% conviction rate for coercion. My hon. Friend the Member for Spen Valley referred to a horrific case of a lady who was investigated, and talked about her husband’s death. We need to be clearer about what the new offence would lead to. What would it actually protect? Are we protecting cases such as that referred to by my hon. Friend, or we making it more complicated for our law enforcement to police this? Ultimately, if passed, that is what the amendments and the legislation will mean—real-time legislative changes and potential cases to prosecute. That is my point.

--- Later in debate ---

I turn to amendment 444. As the Bill currently stands, the Secretary of State may by regulations make provisions relating to the prescribing, dispensing, disposal and transporting of approved substances. If the amendment were accepted, regulations made by the Secretary of State relating to the transportation, storage, handling and disposal of approved substances would need to specify that those substances must at no time be left unsupervised by a medical practitioner. The operational impact of the amendment would be to place a duty on a medical practitioner to ensure that approved substances must at no time be left unsupervised. That would increase the obligations on the co-ordinating doctor, and potentially any medical practitioners with access to approved substances. It is unclear when the duty on the medical practitioner would apply. For example, would it apply when the approved substance is in transit, or only once it has been provided to the person?

[Naz Shah]

Would the Government’s intention not be to sign this duty over to a regulator?

[Stephen Kinnock]

My understanding is that the amendment would place the duty on a medical practitioner. I am speaking to the purpose and effect of the amendment, which is not about a regulator; it is about a medical practitioner. Does that answer my hon. Friend’s question?

[Naz Shah]

I am not sure, but I will give it more thought.

--- Later in debate ---

[Naz Shah]

I was not intending to speak to this group, but I am now trying to find amendment 500.

[Kit Malthouse]

Amendment 500 was to clause 21 and we have agreed it already.

[Naz Shah]

In responding to my hon. Friend the Member for Sunderland Central, I appreciate that we do not want to put too much detail in the Bill, but with some of the commitments that we have made as a Government on collecting data we need to go further. That is for the simple reason that our equality laws are not right when we look at other issues, such as the gender pay gap.

[The Chair]

Order. Can we stick to the amendment that we are debating?

[Naz Shah]

Amendment 273 would strengthen our position to collect that data, which is really important if we are serious about potentially reviewing the legislation by looking at the loopholes and at which communities are taking up assisted dying. The data in other jurisdictions says that it would be people from affluent backgrounds, but the hon. Member for Richmond Park powerfully raised concerns about the risks, as we heard in evidence from people such as Dr Jamilla and others. I strongly support the amendment, but I will also look at the Equality and Human Rights Commission issues that my hon. Friend the Member for Sunderland Central raised; I thank him for raising them.

[Lewis Atkinson]

Does my hon. Friend agree that to keep the list of characteristics on which we have to collect information up to date, we need a level of flexibility—not in primary legislation? Would she comment on the fact that no information regarding sexuality or other protected characteristics is included in the Bill?

[Naz Shah]

My hon. Friend makes a valid point; that is an issue. If we are going to do this right, are we going to be looking at all six characteristics? That is important, so I agree with him.

--- Later in debate ---

[Danny Kruger]

I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 29, as amended, ordered to stand part of the Bill.

Clause 30

Codes of practice

[Naz Shah]

I beg to move amendment 447, in clause 30, page 18, line 12, leave out “may” and insert “must”.

This amendment requires the Secretary of State to issue Codes of Conduct.

[The Chair]

With this it will be convenient to discuss the following:

Amendment 394, in clause 30, page 18, line 24, at end insert—

“(ba) the provision of information and support to persons with learning disabilities who are eligible to request assistance to end their own life under this Act, including the role of advocates for such persons;”

Amendment 448, in clause 30, page 18, line 27, after “of” insert “registered and qualified”.

This amendment requires a code of practice on the use of interpreters to be, instead, on the use of “registered and qualified” interpreters.

Amendment 534, in clause 30, page 18, line 30, at end insert—

“(da) the forms of proof of identity that are acceptable for the purposes of section 6.”

Amendment 523, in clause 30, page 18, line 31, leave out paragraph (e) and insert—

“(1A) The Secretary of State may issue one or more codes of codes of practice in connection with any matters relating to the operation of this Act not required under subsection (1) as the Secretary of State considers appropriate.”

This amendment, which works together with Amendment 447, would clarify that the Secretary of State is not required to issue a code of practice under subsection (1)(e) but instead has the discretionary power to issue further codes of practice as the Secretary of State considers appropriate.

[Naz Shah]

Amendment 447 was tabled by my hon. Friend the Member for York Central; I also speak in support of amendment 523, which was tabled by the hon. Member for East Wiltshire and helpfully clarifies amendment 447. My understanding was that the Bill’s promoter indicated that this was something she would support; I am happy to give way so she can clarify.

[Kim Leadbeater]

I confirm that I am happy to support amendment 447.

[Naz Shah]

Perfect. I thank my hon. Friend—I like it when we get to amendments that are supported.

Amendment 447 would literally change the word “may” to “must” in clause 30. The first four matters that the clause lists are so important that issuing codes of practice cannot be left just as a choice for the Secretary of State; it must be something that the Secretary of State has to do. It is worth pointing out, as I am learning about this new process, that when we leave it to the Secretary of State, that means a Secretary of State under any Government, depending on how long it takes. It is not necessarily just our Government; it could be another Government. I am just pointing that out, because somebody pointed it out very clearly to me, and I was shocked by that detail.

The Bill sets out five areas of responsibility that the codes could cover. They include some of the most consequential matters that this Committee is considering, as set out in clause 30. The first four are doctor’s assessments of

“whether a person has a clear and settled intention to end their own life,”

and whether that person has capacity to do so, accounting for the effect of depression and other mental disorders on decision making; the

“treatment or palliative, hospice or other care available to the person”;

the provisions for effectively communicating with them; and

“the arrangements for providing approved substances to the person… and the assistance which such a person may be given”.

They are all vital and I am pleased that this amendment would ensure that the Secretary of State has to issue codes of conduct, rather than being able to decide that they may not do so.

If these matters were not covered by codes of practice, they could be left to individual doctors to interpret, which would mean that doctors would face having to make unfamiliar and complex decisions without the clear guidance that a code of practice would give. That could have created—indeed, it would have created—dangers for both doctors and for people seeking assisted dying.

The fifth area of responsibility for the Secretary of State, as set out in clause 30, is codes of practice on:

“such other matters relating to the operation of this Act as the Secretary of State considers appropriate.”

It seems clear to me that, because the Secretary of State will issue codes of practice for the first four areas of responsibility, they must also issue codes for other matters if they see a need for them. I am confident that we all agree on that.

Amendment 523 would make it clear that the Secretary of State can issue codes of practice on any other matters as they see appropriate, but they would not have to do so if they thought there were no other matters that needed such codes. That is a sensible clarification that preserves what the Bill drafters were doing when they wrote the clause. If the Bill passes, we will be authorising doctors to depart from centuries of previous practice. They will face decisions that they have not previously had to take. I am pleased that, if the Bill passes, the Government will be able to set out the clearest possible guidelines for medical professionals in accordance with the many provisions in this clause.

Doctors in England and Wales have never previously had to assess whether someone has a clear and settled intention, and it is surely unfair to ask them to work out how to make that judgment without clear guidance from a code of practice. A code of practice also mitigates the risk that different doctors will approach this task in widely differing ways. The truth is that the use of the Mental Capacity Act 2005 is untested in relation to assisted death, where a person will take lethal drugs to end their life.

Codes of practice will address important and difficult questions of interpretation. Again, that will give us much-needed clarity, including in the area of the provision of palliative care to people considering assisted dying and how doctors advise them. The independent commission on palliative and end of life care found that knowledge of palliative care among doctors is often limited, so the Secretary of State’s intervention will be much appreciated, and the codes will give a settled direction.

I am grateful that my hon. Friend the Member for Spen Valley has accepted amendment 447. I look forward to working through the rest of the Bill and getting some more amendments passed.

[Daniel Francis]

I will speak to amendment 394 in my name, which provides that codes of practice may be issued on

“the provision of information and support to persons with learning disabilities who are eligible to request assistance to end their own life under this Act, including the role of advocates for such persons”.

I am aware that my hon. Friend the Member for Spen Valley may speak to amendment 517 and new clause 25, which we will discuss shortly.

I tabled a number of amendments, one of which was accepted, following conversations with Mencap. Dan Scorer from Mencap gave us oral evidence on advocacy support, the discussions and the role of families and said:

“Individuals should be able to choose who supports them with those discussions, whether it is friends or family members or an independent advocate—that would probably be our preference—who is specifically trained to support people with a learning disability who are considering their end-of-life options.”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 30 January 2025; c. 273, Q355.]

I will not go on at great length—hon. Members have heard my views on support for people with learning disabilities, and I am conscious that we will come to other amendments on this issue—but I will move my amendment when we get to the relevant stage, in a manner consistent with the approach that I have taken in Committee so far.