Terminally Ill Adults (End of Life) Bill (Twenty First sitting)

Sarah Green Excerpts

Committee stage
Tuesday 11th March 2025 Public Bill Committees

[Danny Kruger]

I want to speak briefly in support of the hon. Lady’s amendment and also in support of amendment 310, tabled by the hon. Member for York Central. The hon. Member for Richmond Park is absolutely right. I will not rehearse her argument, which is very straightforward. The question is: what other reason could there be to justify a co-ordinating doctor transferring the case? The Committee might reject that amendment, in which case I hope they will accept the amendment tabled by the hon. Member for York Central, which specifies that whatever the reason, particularly if it is other than death or illness, it is important for the High Court or the panel to be notified of the substitution and the reason why.

[Sarah Green (Chesham and Amersham) (LD)]

Maternity leave is one reason and retirement might be another.

[Danny Kruger]

Those might be appropriate reasons; I hope that can be specified. The crucial thing is that if there is an unwillingness—not an incapacity but an unwillingness—to proceed, that is of some concern. It is not that they are no longer able to do it—possibly for the reasons that the hon. Lady suggested—but if there is an actual unwillingness to proceed, what is the reason?

On amendment 309, if the first doctor is replaced for whatever reason, surely it is imperative that the new doctor conduct their own assessment, rather than taking the previous doctor’s word for it. A doctor is legally responsible, obliged under all medical regulation and law for their actions, and they cannot rely on a previous assessment. If the first doctor gave up the case because of some kind of incapacity—an illness, or, indeed, their demise—it might be that their own judgment was impaired at the time. I would have thought it was obvious that the new doctor should take responsibility for conducting an assessment and proceeding with full responsibility for the case.

--- Later in debate ---

[Sean Woodcock]

May I say what a privilege it is to have you in the Chair, Mrs Harris? [Laughter.] Clearly, I know how to win and lose an audience.

I rise to speak to amendment (d) to new clause 21, which has been tabled by my hon. Friend the Member for Derby North. I will start by saying how glad I am that the promoter of the Bill, my hon. Friend the Member for Spen Valley, has recognised some of the concerns regarding the multidisciplinary panel, and I welcome the improvements that she has made in the new clause.

I am pleased that the panel “must” now hear from the person to whom the referral relates, whereas previously it was the case that the panel “may” hear from them. That is a partial concession, but an important one. It will allow the commissioner to have greater scrutiny over the application and better assess the person’s eligibility for assisted dying.

Amendment (d) is a technical amendment. We have discussed a number of such amendments before in this Committee, many of which have fallen for reasons that I understand, even if I do not agree with them, including on the basis that doctors are already having these conversations and we do not want to police them. The panel stage is brand new; given that and given the level of public scrutiny of the Bill, I make no apology for supporting putting something into primary legislation to say what is expected of this process. It is very important that we make sure from the off that we get things right.

I am deeply concerned about some of the potential oversights in the panel model. The purpose of the panel is to provide meaningful scrutiny of a person’s application. The panel draws on a wider range of experts to assess the complex aspects of the application, such as assessing for coercion and capacity. However, the panel’s ability to fulfil this scrutinising role is in many ways quite limited.

Amendment (d), which was tabled by my hon. Friend the Member for Derby North, would address the significant oversights in new clause 21. It would introduce a far more comprehensive set of requirements for the panel in its review. Those changes are not barriers to access; rather, the amendment would ensure that the panel has a far wider range of information—a theme to which I referred earlier—on which to review the application for an assisted death. Fundamentally, the amendment would give the panel more tools to conduct meaningful scrutiny.

However, let me list what the panel is not required to do under new clause 21. It does not have to hear from one of the two registered medical practitioners. It will hear from the other registered medical practitioner, perhaps via audio link, but it does not have to question them. Likewise, it will hear from the person, perhaps via audio link, but it does not have to question them. The person may have a proxy to sign their declarations, but the panel does not have to hear from or question the proxy. The panel does not have to hear from or question any other person. Let us be clear who that includes: the panel could assess the person’s application without any information from the person’s relatives, family members, friends, social workers or care workers.

New clause 21 states only that the panel

“may ask any person appearing to it to have relevant knowledge or experience to report to it on such matters relating to the person to whom the referral relates as it considers appropriate.”

Subsection (4) makes it clear that, whereas paragraphs (a) to (c) require the panel to hear by live audio from the person seeking assisted dying, the evidence that the panel chooses to take from anybody else could be in written form.

Let me draw out with an example what that might mean in practice. A person is diagnosed with a terminal illness—in this case, heart failure arising from coronary heart disease. Both doctors approve the person’s application for assisted dying, on the balance of probability. The person has a physical disability and asks a proxy—a neighbour, say—to sign off the application. The first doctor speaks to the panel via video link restating the schedule forms and providing no new information. The panel then hears from the person, also via video link. It cannot see the person, but after hearing their statement it decides that it is satisfied that the conditions are met and approves the person’s assisted death.

The panel has not spoken to the second doctor and has not put any questions to the second doctor or to the person applying for an assisted death. Incredibly, the panel has not spoken to the proxy, who may just be someone of good standing in the community. Nor has it spoken to the person’s relatives, to anyone standing to benefit from the person’s death or to anyone in the person’s care. Any one of those people could have concerns that the person is being coerced into an assisted death. They may even have evidence of coercive behaviour. However, at no point is the panel required to consider speaking to any of those people.

Time and again, the Committee has heard from experts that coercion and controlling behaviour can be extremely difficult to detect. Often, the person will not reveal that they are suffering from that form of coercion, yet it is often those who are closest to the sufferer—a close relative, a member of the family or a social worker—who pick up the signals. Any of them could be looking out for the person’s welfare and noticing them becoming more isolated and emotionally manipulated by another. At no point, however, does the panel have to consider hearing from that person. If this Bill is going to do everything to safeguard against the risk of coercion, as everybody on this Committee believes it should, that should change.

The panel must consider listening to the people closest to the person. Amendment (d) to new clause 21, in the name of my hon. Friend the Member for Derby North, would address those flaws by giving the panel a higher standard of scrutiny. The panel would have to hear from and question both doctors. It would have to question the person, not simply hear from them. If the person has a proxy, as under clause 15, the panel would have to hear from and question that proxy. Crucially, the panel would have to consider hearing from and questioning persons properly interested, and any other person who has provided treatment or care for the person being assessed in relation to that person’s terminal illness. It would also be able to hear from and question any other person whom new clause 21 states can be asked to report to the panel.

The changes in the amendment would significantly improve the scrutiny provided by the multidisciplinary panel. It would provider a broader range and greater detail of evidence for the panel to base its review on. Ultimately, it would make the multidisciplinary review far more meaningful. Why is this greater scrutiny necessary? This is about protecting the vulnerable people who are easily forgotten. The amendment seeks to provide the strongest possible protection for them. This robust and comprehensive scrutiny is necessary to have a better chance of preventing the worst abuses.

I foresee one possible criticism from some hon. Members, which is that the amendment would slow down the decision-making process for people who are at no risk of coercion. That may well be true, but if the amendment is accepted, the panel would have to question both doctors, not just hear from one, and it would have to determine whether to hear from and question other people. In straightforward cases, in which the panel discovers no initial evidence that disquiets it, a small amount of time might be added to the hearing; in cases in which the panel finds evidence that means it may need to dig deeper, there could be a greater delay to the decision.

Personally, I do not see how we can avoid that. If we are serious about having safeguards to protect the most vulnerable, we should and must accept it. The process of vetting applications will take more time on average, and a lot more time in some cases, but the alternative is a simpler and faster system in which it will be much harder for the panel to detect coercion and other disqualifying factors. In that case, the chances will be higher that some coercive or abusive people will find it possible to push people towards an assisted death. Such a system is what we see in new clause 21, as drafted. We face an inescapable trade-off. We cannot lift protection for those who are most vulnerable to coercion because it would make the process easier for people who do not face that risk. I urge hon. Members seriously to consider supporting the amendment.

[Sarah Green]

I rise to speak to two aspects of this group of amendments. The first is the inclusion of social workers. When we first started receiving written evidence, I found the submissions from social workers the most compelling. I agreed with them that their profession has a key role to play in the process. I am pleased that they will feature on the panel: I believe that that will strengthen the safeguards in the Bill.

My second point relates to amendment (a) to new schedule 2, in the name of the right hon. Member for Dwyfor Meirionnydd. I was fortunate to grow up in a Welsh-speaking part of rural north Wales. I am a Welsh speaker, and Welsh is the first language of some of my friends, my neighbours and my family members. It is the language that they dream in, the language they count in and the language that they are most comfortable using, so when it comes to end-of-life conversations it is important that they can use the language in which they are most proficient and fluent.

Should an individual choose to access an assisted death through the medium of Welsh, they should be able to do so without the use of an interpreter. Crucially for the panel, that means that where an individual has chosen that route, the panel will need Welsh proficiency. Welsh speakers have had the right to ask for services in Welsh for years now, so assisted dying should be no different. That is why services in Welsh need to be on the face of the Bill. I wholeheartedly support the amendment and will vote for it if the right hon. Member chooses to press it.

[Sojan Joseph]

I will not talk for long, because most of my points have already been raised. I welcome the provisions in new schedule 2 on membership of the panel. I was concerned about all patients having access to a psychiatrist and a social worker, so the measures proposed are welcome and reassuring. My reservation, which other hon. Members have raised, is that it would be even better for people to have earlier access to the panel. I am also concerned about whether the panel would have the power to overturn the decisions taken by the two doctors and whether it might be influenced by them.

In addition, will the Health Minister clarify his response to amendment 1? He said that specifying one category of doctor, a registered psychiatrist, would create capacity issues. I hope that that will not be an issue when we have a psychiatrist on the panel. Otherwise, I welcome the proposals.