Allied Health Professionals

Sarah Olney Excerpts

Thursday 23rd April 2026 Commons Chamber

[Sarah Olney (Richmond Park) (LD)]

I thank the hon. Members for Thurrock (Jen Craft) and for Dudley (Sonia Kumar) for bringing this important debate to the House. I echo the sentiments of other Members who have underlined the important work that allied health professionals undertake and recognised the role that these clinicians play in saving lives, providing care and keeping our NHS running. At a time when some patients experience corridor care, the service of allied health professionals is even more pivotal as their work helps to keep people out of A&E. These clinicians lend their expertise to help treat and care for people or to diagnose illnesses before they require urgent attention.

These practitioners have also volunteered to take even more strain off of emergency services, writing to the Secretary of State for Health and Social Care last month to request additional responsibilities. In the letter, the allied health professionals asked for the Department of Health and Social Care to consider extending additional independent prescribing powers to their sectors. Currently, they are provided with negligible independent prescribing responsibilities despite many of these clinicians having undertaken the exact same training as other medical professionals. For example, podiatrists can prescribe medicine for their patients, but dietitians have only supplementary prescribing rights and have to be overseen by a doctor.

This issue was raised with me by one of my constituents who is a dietitian and who supported the allied health professionals’ request for additional prescribing responsibilities. She states that this change would not only reduce GP waiting list times, but recognise the studies that allied health professionals have undertaken and the expertise they possess. My constituent highlights the bureaucracy and farce of an allied health professional who runs their own clinic having to go and find a consultant to sign off their prescribing, even though they will have had all their prescribing permissions checked and signed off by the chief pharmacist in the hospital. That creates duplication of work at a time when we desperately need to make the NHS more efficient.

The Government’s Pharmacy First initiative has had success in encouraging patients away from GPs and towards pharmacists, who can prescribe medicine for common ailments. My constituent merely asks that the Government build on their own good work in this area and extend prescription powers to all allied health professionals equally. I would be grateful if the Minister considered my constituent’s request and responded to the letter sent to the Department for Health and Social Care last month.

Domestic Abuse-related Deaths: NHS Prevention

Sarah Olney Excerpts

Tuesday 20th January 2026 Westminster Hall

[Sarah Olney (Richmond Park) (LD)]

It is a pleasure to serve under your chairmanship, Sir John. I congratulate the hon. Member for Stroud (Dr Opher) on securing this important debate. He is a real champion for the NHS, and it is a benefit to all of us that he brings his former experience as a GP to bear in this debate.

The NHS has more contact with people experiencing domestic abuse than any other service and, therefore, it is vitally important that staff feel adequately equipped to comfort and reassure victims who take that brave step of reaching out for support, often for the first time. In turn, it is essential that victims can feel confident that when they confide in the NHS, the staff that they speak to have the knowledge to properly support them.

While NHS staff do receive the statutory general safeguarding training, it can be easy, as the hon. Member for Stroud has detailed, to miss the signs of abuse and the cries for help, especially when staff are tired from working extensive and difficult hours. As a country, we have so much to thank our NHS for—whether it be for the sacrifices that staff made during the pandemic, or for working additional hours to take care of our loved ones—so my speech is intended to ensure that staff have the tools they need at their disposal to help the most vulnerable, rather than critique their best intentions.

Victims are often hesitant to ask for support; they feel trapped by their abuser and fear the repercussions. The extent to which domestic abuse and sexual assault is known to the authorities is somewhat unknown. It is estimated that only 16% of people report their experiences to the police. One reason is mistrust of the authorities, which emphasises the importance of ensuring that those who treat victims’ injuries are prepared to provide them with the help and support they need. Of the 16% of people who do report an assault, only 2.6% of alleged offenders are charged or receive a summons. Even in cases where the offence takes place in public, the percentage of reported sexual assault offences that receive a charge is disproportionately low; fewer than 5% of reports on public transport resulted in a charge in 2025.

While death is tragically the end result of too many domestic abuse cases, there will have been a point in almost every single case where a step could have been taken to better support the victim. A report commissioned by Standing Together Against Domestic Abuse underscored that fact; of the 47 reviews of deaths related to domestic abuse published in 2024, 89% contained reports of an instance in which our health service had the opportunity to step in and do more to help. While domestic abuse training is mandatory in the social care system, the same training is not always made available to other NHS frontline services. That is clearly something that could be rectified, so I will be interested to hear what the Minister has to say about how the Government might ensure that domestic abuse training is stepped up. Will they release the funds to ensure that every NHS frontline member of staff has access to mandatory domestic abuse training?

Therapeutic Play and Children’s Healthcare

Sarah Olney Excerpts

Tuesday 6th January 2026 Westminster Hall

[Mr Bailey]

I thank my hon. Friend for her powerful intervention. I know that she is fighting for her constituent and that she is lobbying the DWP, in support of the Department of Health and Social Care, to make sure that the challenges her constituents face are addressed.

[Sarah Olney (Richmond Park) (LD)]

I thank the hon. Member for securing this important debate. Last year, two important reports were produced: “Mental health inpatient settings: overarching report of investigations directed by the Secretary of State for Health and Social Care” and “Improving support for people with complex mental health difficulties”. They found that therapeutic input improves patient outcomes and results for adults with mental health difficulties. My constituency is home to the Cassel hospital, a tier 4 therapeutic community for adults with complex multiple-diagnosis presentations. Patients there tell me that the treatment is lifesaving and life-changing, but it is currently under a tier 4 review. Does the hon. Member agree that that review should consider the reports I mentioned? I would be grateful if the Minister could make reference to the tier 4 review in her summing up.

[Mr Bailey]

I thank the hon. Member for her powerful intervention; she is a massive advocate for her constituency. Her plea has been heard and I hope it will be answered.

Overall, the estimated financial benefit of the greater use of therapeutic play resources in NHS care is £3.2 million a year, at a cost of less than £700,000 a year. Surely, if we want the NHS to become more preventive, including through a higher uptake of childhood vaccinations and outreach programmes about exercise and health lifestyles, this is an opportunity we cannot miss.

I will close by asking the Minister a few questions. First, how is the Department working to ensure that the Play Well toolkit is implemented across every part of the NHS, including through delivering on training? How will the need for health play specialists be incorporated, as we have heard, into the NHS workforce plan? How will play specialists be included in the modelling of multidisciplinary teams for the new neighbourhood health service?

I was planning to ask whether the Minister would agree to meet with Starlight, but I am very pleased that she has already agreed to do so. I look forward to hearing the outcome of that meeting, which I know will be very valuable and will help us to deliver a more effective system that addresses the problems that we have raised today.

I want to close by thanking Hari and his mum Sarah for their determination to use their experiences to create better policy and help thousands of others. I look forward to our next Huddlestone street party and to hearing how Sarah and Starlight have moved this issue forward. It is a great pleasure to be able to use my position as their MP to highlight this issue.

Oral Answers to Questions

Sarah Olney Excerpts

Tuesday 25th November 2025 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

I thank the hon. Lady for that question and for her work on this issue. She makes a really important point about consistency of care. We understand that services are different in different parts of the country—sometimes the needs are different—but we want to ensure that, where there is good practice and proven evidence, care is rolled out. As we say, bring the best of the NHS to the rest of the NHS. I am sure that the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for West Lancashire (Ashley Dalton), will take note of that point.

[Sarah Olney (Richmond Park) (LD)]

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health and Social Care (Wes Streeting)]

Obesity robs children of the best possible start in life, hits the poorest hardest, sets them up for a lifetime of health problems and costs the NHS billions, so I can announce to the House that we are expanding the soft drinks industry levy to include bottles and cartons of milkshakes, flavoured milk and milk substitute drinks. [Interruption.] We are also reducing the threshold to 4.5 grams of sugar per 100 ml. This Government will not look away as children get unhealthier and our political opponents urge us to leave them behind.

[Mr Speaker]

The only thing I will say is that at least we are hearing it first in this House and not on Sky.

[Sarah Olney]

I congratulate the Secretary of State and the Department of Health and Social Care on the launch last week of the men’s health strategy. My constituent Philip Pirie, who sadly lost his son to suicide, has been calling on the Government to launch a public health campaign to reduce the stigma of suicide. Nearly 75% of those who lose their lives to suicide have not been in contact with mental health services, and that is why we need to reach out. Will the Secretary of State meet me and my constituent to discuss such a campaign?

[Wes Streeting]

I am sure that my hon. Friend the Minister for Care would be delighted to meet. The men’s health strategy sets out precisely the challenge in those terms. Through the partnerships that we have already announced, such as with the Premier League, as well as the people who have been knocking on our doors to get involved in such a campaign, I am absolutely confident that together, collectively across the House and across the country, we can tackle this terrible stigma.

Suicide: Reducing the Stigma

Sarah Olney Excerpts

Wednesday 19th November 2025 Westminster Hall

[Sarah Olney (Richmond Park) (LD)]

I beg to move,

That this House has considered the matter of reducing the stigma associated with suicide. 

It is a pleasure to serve under your chairmanship, Mr Mundell, in this very important debate; I am grateful that time has been found for it. Suicide can be an extremely difficult topic for people to discuss, whether that means talking about suicidal thoughts, opening up about an intent to commit suicide, or for the families and friends of loved ones who have taken their own lives and who need someone to talk to. That is why I would like to dedicate my speech to my constituent Philip Pirie, who is sitting in the Gallery, and to his son Tom, who tragically lost his life to suicide just over five years ago. I cannot imagine the pain that Philip has been through, which makes his work on suicide prevention in the following years even more commendable.

Just this year, Philip co-chaired work on the NHS guidance “Staying safe from suicide”, which developed best practice for medical professionals to help identify and support those who may be considered at risk of suicide, and I am pleased that the Premier League will be promoting this work. The guidance sought to support those who are in contact with mental health services; however, nearly three quarters of people who take their life are not receiving professional help. Philip has since been engaging with Members of Parliament, mental health workers and charities to discuss his proposal for a national public health campaign to encourage people to talk about the topic. Tackling the stigma of talking about suicide is critical to ensuring that people do not suffer in silence, and it is vital that those who are struggling feel comfortable in reaching out for support.

Today marks International Men’s Day, and perhaps the greatest issue impacting men in today’s society is their mental wellbeing. Suicide is the leading cause of death for men under the age of 50. Each death—of a son, a father, a brother or a friend to someone—is a tragedy. Members in this room will have experienced this close to home. We all know the shocking statistics associated with male suicide, but it is important to think about the individuals who lose their life, and the severe emotional impact that that will have on their loved ones, which cannot be quantified or understood by quoting statistics alone. Talking openly about suicide is the first step to reducing the stigma towards it, and I am so pleased to see MPs from all parties in attendance at, and wanting to speak in, this debate.

According to the charity Campaign Against Living Miserably, one in four people living in the UK will experience suicidal thoughts in their lives, while 200,000 people attempt to commit suicide each year. Suicide will impact almost everyone in this room, and across the country, in one way or another. We will all have been confronted with moments in our life when we know that a person close to us is struggling. But when we reached out to check on them, were we doing so just at surface level, or did we really try to tackle the thoughts that we suspected they might have been experiencing? With suicide such a prevalent issue in our society, why is it so difficult for us to talk about it frankly? Why do we try to dance around the issue, even when we know we should not?

[Steve Darling (Torbay) (LD)]

On 30 September, I had the privilege of participating in the Baton of Hope relay across Torbay, which is an initiative that propagates conversations around suicide. The impact that it had across our communities in Torbay was amazing. Does my hon. Friend agree that the more conversations we have about suicide, the more we will prevent it?

[Sarah Olney]

I am grateful to my hon. Friend for that encouraging example of how taking steps to reduce the stigma around suicide can have a positive impact, and how we need a community approach to help reach out to all those people who might be struggling.

Although talking about mental health is becoming more socially acceptable, to what extent are we asking the challenging questions? To what extent do we really want to know how other people are getting on, and to what extent do people who are suffering feel comfortable in talking honestly about how serious their struggles are? For those reasons, I want to echo my constituent Philip Pirie’s calls for the Government to launch a public health campaign to truly tackle the stigma associated with suicide.

As we have seen today, the Secretary of State for Health and Social Care has launched his men’s health strategy. He promised the Samaritans that

“mental health and suicide prevention”

would be at the “heart of it”. Everyone in the House will welcome these words and the recognition that the men’s mental health crisis needs serious attention. I would like the Secretary of State to go one step further and consider a public health campaign with posters and adverts on TV and radio, and to hold regular open discussions with the public on the topic of suicide.

[John Milne (Horsham) (LD)]

As chair of the all-party parliamentary group for rural business and the rural powerhouse, all too often I hear devastating stories of suicide in the farming community. Campaigns such as the Farm Safety Foundation’s Mind Your Head play an important role in encouraging frank and honest conversations. We know that 95% of young farmers say that mental health is the biggest hidden danger in the sector. I fully support my hon. Friend’s call for a national awareness campaign; does she also agree that cuts to the rural England prosperity fund should be reconsidered, given the vital support it provides to rural-focused services, including those for mental health?

[Sarah Olney]

My hon. Friend makes an important point about how specific groups and particular sectors can be impacted. Just under an hour ago I was having a conversation with my friend Diana Chrouch, who is the adviser to the APPG for ethnic minority business owners, of which I have been a co-chair for many years. She pointed out that there is a high risk of suicide for people working in the construction sector. I think it would be valuable to identify particular risk areas, and design a strategy that could reach out to them, but I also fully support my hon. Friend’s call on the subject of the rural England prosperity fund.

In the late 1980s, the UK launched a public health crisis to raise awareness of the AIDS epidemic. That was hugely successful: it not only raised awareness of safe sex practices, but served to reduce the stigma and falsehoods associated with the illness. At the peak of the AIDS epidemic in the UK in 1994, just over 1,500 people died from the illness. In the UK last year, more than 7,000 people died from suicide. That figure is growing, and the suicide rate for young women under 24 saw the steepest increase since records began.

As the Secretary of State identified in his men’s health strategy, underlying addictions, such as gambling and drug addiction, often cause or exacerbate mental health conditions. Those addictions can cause isolation and financial difficulties and destroy relationships. As the Government strategy identifies, 12% of participants in the gambling survey for Great Britain reported that they had thought about, or attempted, taking their own life. Many betting stores are positioned on high streets of deprived areas in the UK. We must acknowledge the link between gambling addiction, poverty and suicide.

The statutory levy imposed on gambling firms is a positive step, and I am pleased that the funds raised will be directly invested into gambling harm prevention, research and treatment, but what steps are the Government taking to engage those who treat, or provide support to, people with a gambling addiction to directly address the risk of suicide among their patients? What more can be done to integrate the identification of suicide risk into our approach to treating addictions of all sorts? What more can the gambling industry in particular do to mitigate the impact that its activities have on vulnerable people, particularly in the light of the enormous profits that it makes as a result?

Exercise can be a positive outlet for many people who are struggling with mental health difficulties, enabling them to set targets, grow their confidence and involve themselves in sociable activities. However, there can be a reductive narrative about the relationship between exercise and mental health, and that can be dangerous. Some influential, outspoken figures have dismissed the real and serious issues that people are struggling with by instructing people that going to the gym is the simple answer. For most people, a workout in the gym will encourage body positivity and self-confidence, but for some, the constant need to achieve a perfect body can lead to obsessions and eating disorders.

I support the Government’s recently announced work with the Premier League. Conversations about mental health also need to start in gyms and sports clubs, so I encourage the Government to target local sporting hubs to widen awareness of mental health, and to encourage those struggling to speak with friends, families or mental health professionals. Can the Minister tell me whether the engagement of sports bodies and mental health initiatives includes a specific recognition of suicide risk, and the ways in which sports clubs and coaches can assist in identifying and responding to suicidal intentions among the young men, in particular, with whom they work?

More also needs to be done to encourage support for employees in the workplace. Whether they are a new or experienced member of staff, reaching out to their line manager or boss to let them know about the difficulties they are facing, and to request additional consideration—whether that means an adjustment to working hours or time off to see a mental health professional, or just letting them know the stress that they are experiencing at work or in everyday life—can be daunting. I encourage the Minister to increase awareness of best practices to support employees’ mental health in the workplace, and ensure that those who are struggling receive the support that they need. What more can be done to assist employers with training on how to respond if they recognise that one of their employees is struggling with a mental health issue? How can workplaces support some of those difficult conversations that might make all the difference in saving a young life from suicide?

[Helen Grant (Maidstone and Malling) (Con)]

I congratulate the hon. Lady on securing this important debate. Over the past 10 years in England and Wales, one student has died every four days as a result of suicide. Ben West, a young man from my former constituency, set up a project called Walk to Talk when he was 17 and still at school. He did this following the death to suicide of his 15-year-old brother Sam. Does the hon. Lady agree that talking and asking questions directly about suicide can help to remove the stigma around it and save lives?

[Sarah Olney]

I thank the hon. Member for that intervention, and I am so sad to hear Sam’s story. It is very encouraging to hear about the steps that Ben has taken to raise awareness of the issue. The hon. Member makes an important point about academia at schools and universities; that is another big risk factor for young people. They feel the real pressure of academic studies and exam results, so schools and universities also have a role to play in reducing stigma and encouraging those conversations, which could be lifesaving.

We urgently need to tackle the stigma around suicide, and a public health campaign would be a significant step in the right direction. Many lives could be saved if more people understood the difference that the right conversation, at the right time, could have on the young people in their lives. We would not just save the lives of young people who are deterred from suicide, but save their friends and family from the burdensome legacy of grief, guilt and heartache that affects all of those who are affected by the suicide of a loved one.

In closing, I ask the Minister if he would meet me and my constituent Philip Pirie to discuss the details of a campaign such as that I have laid out today, as well as the impact that suicide can have, its increasing prevalence in our society, the impact it has on young men, in particular, and what this Government can do to take action.

--- Later in debate ---

[Sarah Olney]

May I say what a privilege it has been to have this debate today, not least because it has given me an opportunity to highlight the work of my friend and constituent Philip Pirie? It has been a wonderful tribute both to his hard work and to the memory of his son, Tom.

It has also been a privilege to hear the contributions from hon. Members across the Chamber. I particularly want to thank the hon. Members for Caerphilly (Chris Evans), for Harlow (Chris Vince) and for Cannock Chase (Josh Newbury) for sharing their personal experiences, which provided a moving context to the debate.

It was great to hear about various initiatives from the Minister, not least because Mr Pirie has directly contributed to some of them, but I reiterate my call for a public health campaign. Particular groups are at risk. The farming community has been mentioned a number of times, not least by my hon. Friends the Members for Winchester (Dr Chambers), for West Dorset (Edward Morello) and for Horsham (John Milne). The hon. Member for Maidstone and Malling (Helen Grant) mentioned young people in schools and universities, and other hon. Members mentioned gambling and drug addiction. The hon. Member for Upper Bann (Carla Lockhart) mentioned social media, and we know that veterans and carers are also at risk. Many hon. Members made the point that so many people are not in touch with mental health services when they commit suicide. That is why we need a public health campaign to reach much more widely.

I thank all the hon. Members who contributed today with examples of successful community initiatives, which the Minister might want to look to when he is planning a public health campaign. My hon. Friends the Members for Torbay (Steve Darling) and for Harrogate and Knaresborough (Tom Gordon), and the hon. Members for Maidstone and Malling, for Strangford (Jim Shannon), for Sherwood Forest (Michelle Welsh), for Caerphilly, for Rugby (John Slinger) and for Harlow all talked about amazing things going on in their communities.

Finally, I want quickly to mention the hon. Member for York Outer (Mr Charters), among other hon. Members. MPs are such great advocates for mental health in their communities, and we should all take that forward.

Motion lapsed (Standing Order No. 10(6)).

Terminally Ill Adults (End of Life) Bill

Sarah Olney Excerpts

Report stage
Friday 13th June 2025 Commons Chamber

[Kim Leadbeater]

I have nearly finished.

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

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

[Sarah Olney (Richmond Park) (LD)]

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

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

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

[Sir John Hayes (South Holland and The Deepings) (Con)]

Will the hon. Lady give way?

[Sarah Olney]

I will not, if that is okay.

We were told that it was not practical to produce such an assessment until after Committee stage, as it would be necessary to assess the impact of amendments made in Committee.

The equality impact assessment was finally published five weeks ago. I have to say that I was pretty astounded. It does not recognise that certain groups in this country may have their lives prematurely shortened as a result of this legislation; instead, it concerns itself with the barriers that vulnerable people may face when trying to access assisted dying. I find that astonishing. Did the people who drafted the assessment not hear the speech of the hon. Member for Vauxhall and Camberwell Green (Florence Eshalomi) on Second Reading? She spoke with passion about how the underlying inequalities in access to healthcare experienced by those from black and minority ethnic backgrounds would be exacerbated if the Bill passed unamended. Did they not listen to the oral evidence that Dr Jamilla Hussain gave to the Bill Committee? She talked about her experience of working with racialised communities in Bradford and their fears of being pushed disproportionately towards an assisted dying pathway. Did they not listen to the testimony of Dr Miro Griffiths on the experience and concerns of disabled people—testimony that has been echoed by Baroness Tanni Grey-Thompson and the actress Liz Carr?

I find it inexplicable that the framing of the impact on vulnerable people should be the removal of barriers to accessing assisted dying and not, as it should be, the increased risk to their health and wellbeing that the Bill presents. I am concerned that we are thinking about the impact on vulnerable people solely with reference to those who are suffering a terminal illness with less than six months to live. We are not thinking about the impact on wider society of introducing a concept of lives not being worth living and how that might disproportionately affect our more vulnerable communities.

My new clause 19 and consequential new schedule 2 and amendment 88 seek to ensure that a comprehensive range of statistics are collected about those who seek and receive an assisted death, so that proper and complete monitoring of requests can be carried out. It is imperative that we get the most detailed possible picture of who is requesting an assisted death so that any patterns of disproportionality can be properly detected and addressed.

[Jim Shannon]

What assurances does the Bill give to the families of people with a disability, or those with mental health issues and those who are anorexic? I do not see any. Does the hon. Lady see any assurances for those who want to end their lives but suffer from those ailments?

[Sarah Olney]

I welcome that intervention. I spoke extensively about the Bill’s impact on anorexic people, and I am not satisfied that those concerns have been addressed.

I am pleased to support amendment 21 tabled by my good friend, colleague and constituency neighbour, my hon. Friend the Member for Twickenham (Munira Wilson), which has attracted support from across the House. It would require the Secretary of State to report on the impact that the Act has had on the healthcare available to those with palliative and end-of-life care needs. I am really pleased that the hon. Member for Spen Valley (Kim Leadbeater) has agreed to accept the amendment.

I am also pleased to support amendments 103 and 104 in the name of my other constituency neighbour, my hon. Friend the Member for Wimbledon (Mr Kohler). They seek to make all statutory instruments made under the Act subject to the affirmative procedure rather than the negative procedure. As it stands, the Act will come into force in four years’ time with no further scrutiny by MPs, yet a whole host of issues that have been delegated to the Secretary of State or have not even been considered will need to be legislated for after Royal Assent. As the Bill stands, the only way for Parliament to scrutinise those powers will be to call for a 90-minute debate on a motion that cannot be amended and will be voted on only if the Leader of the Opposition calls for a vote. Making statutory instruments subject to the affirmative procedure rather than the negative procedure would mean that the Secretary of State, whoever that is, can exercise the powers delegated to them only with the approval of Parliament. For an issue as sensitive and profound as assisted dying, I believe that to be an appropriate level of scrutiny.

[Paula Barker (Liverpool Wavertree) (Lab)]

Will the hon. Lady give way?

[Sarah Olney]

I am sorry, but I will make some progress.

In a similar vein, I plan to support the amendments in the name of the right hon. Member for Tonbridge (Tom Tugendhat), which seek to remove all Henry VIII powers from the Bill and from the amendments introduced by the hon. Member for Spen Valley. I will support the right hon. Member’s amendments if they are selected for a vote, as I do not believe that the use of Henry VIII powers is appropriate or necessary.

I want to speak against amendment 94 in the name of the hon. Member for Spen Valley. It appears to be innocuous, but in reality it would reverse the effect of an amendment that I had accepted in Committee. The Bill as originally drafted would create an enormous constitutional minefield. It seeks to amend the criminal law of England and Wales, which is a reserved matter for the UK Parliament, and simultaneously to make provision for healthcare, which is a matter devolved to the Senedd in Wales. The Senedd debated a motion calling on the Welsh Government to support the principles of assisted dying, but it was defeated by 19 votes to 26. The motion was non-binding, but the Bill gives the UK Parliament the power to impose on the Senedd in Wales a measure that it has expressly said it does not want. The Bill as amended in Committee would give the Senedd the power to decide for itself when it is ready to bring the Bill into force.

Amendment 94 would reverse that provision and deprive the Senedd of the right to exercise its legitimate powers. It is not just that the amendment would restore the constitutional loophole that the Committee had closed; it threatens to create real problems and risks for Welsh citizens if the Senedd is forced to implement the Bill before its devolved healthcare system is ready. I urge fellow Members to have regard to the Committee’s decision and vote against amendment 94.

--- Later in debate ---

[Dr Sandher]

My hon. Friend makes a powerful point, and other hon. Members have also spoken powerfully about the impact that the Bill could have on ethnic minorities. Does any hon. Member know how many ethnic minorities access assisted dying in other nations? I will give way on this point; the hon. Member for Richmond Park (Sarah Olney) raised it earlier.

[Sarah Olney]

The hon. Member calls me to speak. If we do not know, it is probably because those other nations are not collecting the data. My position is that we should be collecting the data, which is why hon. Members should vote for my new clause 19.

[Dr Sandher]

We do know. Ethnic minorities are less likely to access assisted dying in jurisdictions where it is in place. In Oregon, 10% of those accessing assisted dying are ethnic minorities, but they make up 40% of the population. In California, ethnic minorities make up 15% of people accessing the option, but 30% of the population. However, that is not the point. The point of the Bill is to give people the choice to end their life regardless of the colour of their skin. There is no special quality about the colour of my skin that affects my access or the need for a special representative in this case, which is covered by the ECHR and by the Secretary of State.

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

Sarah Olney Excerpts

Committee stage
Tuesday 25th March 2025 Public Bill Committees

On resuming—

[Sarah Olney (Richmond Park) (LD)]

It is a pleasure to serve under your chairmanship, Sir Roger. I rise to speak in support of new clause 33 and new schedule 3.

I am concerned that amendment 455 will be inadequate to maintain trust in the system. Collecting comprehensive data, such as the detailed statistics outlined, in an assisted dying regime serves several critical purposes that revolve around ensuring transparency, accountability, safety, equity and continuous improvement of the system. It is about ensuring from the very start that there is good data and learning from the paucity or the blanks in other regimes and from where they have been criticised.

The Secretary of State would have the power to amend the new schedule, but Parliament’s intent and our expectation that the system will be scrutinised would be crystal clear. We need to collect data for monitoring and oversight and gather detailed information about individuals who request assisted dying, and about the process itself. That would allow regulators to monitor how the system is functioning, which would help to ensure that the law is being applied consistently and fairly, preventing misuse or abuse.

We need to safeguard our vulnerable population. Data on characteristics such as age, ethnicity, disability and mental health conditions and on deprivation indices can reveal whether certain groups are disproportionately seeking or being denied assisted dying. That helps to identify potential coercion, discrimination or gaps in care that might drive requests, ensuring that the system protects vulnerable individuals.

For the purpose of improving healthcare and support services, information about the prior involvement of palliative care or psychiatry teams, and about referrals made after requests, highlights whether patients are receiving adequate support before opting for assisted dying. If data shows low referral rates or unmet needs, it could prompt improvements in healthcare, access or quality, potentially reducing the number of requests driven by untreated suffering.

For the purpose of evaluating the process, tracking timelines—that is to say, from initial discussion to death—and procedural steps such as second opinions and panel decisions ensures that the process is efficient yet thorough. It can reveal bottlenecks, delays or inconsistencies, allowing policymakers to refine the system for both patients and clinicians.

For the purpose of understanding motivations and outcomes, collecting the reasons for requests, refusals and complications such as drug efficacy or adverse reactions provides insight into why people seek assisted dying and how the process unfolds. That can inform public policy, clinician training and patient counselling, ensuring that decisions are well informed and voluntary.

For the purpose of ensuring accountability, data on clinicians, pharmacies and panel decisions creates a transparent record of who is involved and how often. That helps to prevent overreliance on a small group of professionals, ensures that ethical standards are upheld and allows for audits if concerns arise.

For the purpose of public trust and ethical debate, detailed statistics foster transparency, which is essential for maintaining public confidence in a sensitive and controversial practice. They also provide evidence for ongoing ethical and legal debates, enabling society to assess whether assisted dying aligns with its values and goals, and for the purpose of learning and adaptation. By analysing complications, drug effectiveness and reconsideration requests, authorities can refine protocols, such as by adjusting approved substances or dosages, to make the process safer and more humane. Long-term data collection supports evidence-based adjustments to the regime.

Almost all jurisdictions around the world have systems for reporting on people requesting and having assisted deaths. However, there is a high degree of variability in the data reported around the world; very few data items are published consistently in all jurisdictions. We have an opportunity to learn from monitoring and reporting systems elsewhere, and to put the most robust possible system in place.

Research published in BMJ Supportive & Palliative Care in 2022 examined in depth the data reported in jurisdictions around the world. It identified official data reports from 16 jurisdictions in which assisted suicide or euthanasia is legal. It found that although most jurisdictions report the number of patients who die by assisted dying, only three—New Zealand, Canada and the state of Victoria in Australia—document the number of patients who make a request to die by assisted dying. The research is from 2022, so it is possible that there are now a few more jurisdictions.

Unless we know about the applications that are assessed as ineligible, we will not have adequate insight into the functioning of patient safeguards and eligibility criteria. That is a point that Dr Annabel Price made in oral evidence and in an editorial in The BMJ in 2015. We need to understand not just who has an assisted death, but who is ineligible and why, to understand how the safeguards are functioning.

The 2022 paper identified Colorado, Hawaii and Maine as reporting the number of patients who received assisted suicide prescriptions, but not the number of persons who actually die by their ingestion. In these jurisdictions, there is no record of how many of the patients ingested the prescribed drugs. This is stipulated in the 2021 data summary for the Colorado End-of-life Options Act, which states that the Act

“does not authorize or require the Colorado Department of Public Health and Environment to follow up with physicians who prescribe aid-in-dying medication, patients, or their families to obtain information about the use of aid-in-dying medication.”

The official statistics reported therefore

“reflect all deaths identified among individuals by prescribed aid-in-dying medication…irrespective of whether their death was caused by ingestion of medication, the underlying terminal illness or condition, or some other cause.”

These states do not appear to have a mechanism to ascertain the amount of unused assisted suicide drugs circulating within the community. The fate of many therapeutic drugs with the potential for abuse or use for fatal overdose, such as diazepam or morphine, is not monitored, but the doses and combinations of lethal drugs used in assisted suicide and euthanasia may present a heightened risk, so monitoring the fate of those drugs should be considered.

Concern about pressure on vulnerable groups warrants the detailed reporting of patient demographics. It is needed to ensure patient safety because it allows researchers and monitoring organisations to monitor trends to determine whether there is disproportionate participation among vulnerable or minority groups and, if so, why.

Even basic patient characteristics, including gender, age and ethnicity, are not universally reported in other jurisdictions. Although marital status could be an indicator of at-home support, fewer than half of reports include it. The level of education can be an indicator of socioeconomic position, but is not routinely reported by many jurisdictions.

Although we have been told that studies that have analysed routine statistics did not indicate a disproportionate use by lower socioeconomic groups, socioeconomic trends have changed over time and new evidence has emerged. For example, in Oregon, the proportion of assisted dying patients on state health aid has doubled in the past decade; it reached 79% in 2021. That indicates an increase in use over time by those in a lower socioeconomic position.

Similarly, an in-depth review by Ontario’s coroner last year showed that those dying by their assisted death legislation, both track 1 and track 2, were more likely to be those with longer prognoses. Given the impossibility of prognostication and the pressure being brought to bear by some campaign groups for the Bill to be wider, socioeconomic data will be very important to ascertain whether there is equity of access to assisted dying and whether financial pressures, including access to benefits, are involved in areas of higher or lower uptake.

Knowing whether patients have received care from hospice or palliative care services provides an understanding of whether patients have been provided with alternative end of life care options. That information is included in fewer than one half of the reports from jurisdictions around the world, with none providing information on the duration or scope of hospice or palliative care involvement. For example, while official reports indicate that 80% to 90% of Canadian patients who have assisted deaths receive palliative care, other studies have shown that fewer than half of such patients had seen a specialist palliative care team.

It is also essential to have information about the clinicians who participate in assisted dying, because the clinical demand of assisted suicide and euthanasia is highly time-consuming, with evidence from other jurisdictions, such as an Australian study of those participating clinicians, showing that it takes 60-plus hours of work per assisted death. Understanding the number of clinicians participating in assisted dying and their speciality is important in understanding the willingness of clinicians to participate, and how the clinical demand for assisted dying is distributed across specialities and practitioners.

Information on the drugs used in assisted deaths is critical to understanding the safety and efficacy of different drugs and drug combinations. The 2022 paper found that just six jurisdictions report the drugs used to bring about patient death. There is no one drug or drug combination that has been shown to be most effective and safe for ending patients’ lives. If that research existed, we would not see such variation in the drugs used. Data on complications following drug ingestion or administration is needed to understand the safety of different drug combinations, but it is rarely reported.

Even in jurisdictions where information on safety is included, missing data can be high. For example, in Oregon, data on complications is unknown in up to 70% of cases annually. Reporting the drugs used to bring about patient death, as well as information about the assisted dying process, including the time from drug ingestion or administration to patient unconsciousness and death, and the presence of complications, would enable the safety and efficacy of these drugs to be assessed.

As in many jurisdictions around the world, what I am proposing relies on retrospective reporting of data, after the patient has died. I suggest that this is the minimum standard that must be achieved. Ideally, we would also build in processes for prospective scrutiny, before the person has died, as well as formal review processes that scrutinise individual cases in more detail. Analyses from Belgium and the Netherlands, where review processes are established, have shown that 48% of assisted deaths in Belgium, and one in five of such deaths in the Netherlands, are not reported via the official reporting system. In some cases, legal requirements are not followed.

Setting up a post-event review panel, such as happens in the Netherlands and Ontario, would improve understanding and safety. In the Netherlands, every case is reviewed by a panel, and many cases, especially the controversial ones, are published to promote education and debate. Controversial or worrying cases will occur in England and Wales if this Bill passes, and it is essential for ongoing patient safety that these are not swept under the carpet, but that there are transparent processes to understand and learn from them.

We have heard frequently in Committee that there is no evidence of harm from other jurisdictions, but we have also heard it powerfully argued that other jurisdictions do not collect the data we would need to determine that. In Oregon, information on complications following ingestion of lethal substances is missing in around 70% of cases. Robert Clark, the former Attorney-General for Victoria, has written:

“The Victorian oversight and accountability structure can best be described as one of ‘hear no evil, see no evil, speak no evil’. In other words, it appears designed for the regulator to find out nothing, investigate nothing and report nothing that could suggest that assisted dying has been anything other than an unblemished success.”

Let us not repeat those mistakes. We can lead the way in rigorous, comprehensive data collection and transparent monitoring.

Amendments tabled by the hon. Member for Spen Valley change responsibility for oversight from the Secretary of State and chief medical officers to the commissioner. This brings a danger of bias in reporting, as there could be an element of marking one’s own homework. This means that there is even more reason for complete data reporting and transparency. Ensuring that data collected is comprehensive and reporting is transparent may go some way to assuage that concern. Importantly, strengthening data collection reporting and monitoring will not make the process harder or more lengthy for the person requesting an assisted death. It just makes the system safer and stronger.

In this amendment, I am not proposing doing anything new or radical. We are simply taking the strongest aspects of what is done in other jurisdictions and bringing them together to enable the best and most comprehensive reporting in the world. All new laws have risks as well as benefit. We must identify and be open about those risks in order to learn from harms and improve onward safety. New schedule 3 will help us to achieve that.

[Naz Shah]

I rise to speak to amendments 455 and 456, tabled by my hon. Friend the Member for Spen Valley. Under the Bill as drafted, an annual report would be issued by the chief medical officers for England and Wales. If the other amendments pass, that report will be issued by the voluntary assisted dying commissioner.

Amendment 455 will do two things, broadly speaking. Proposed new subsection (2A) states that the commissioner’s report

“must include information about the application of the Act in relation to…persons who have protected characteristics”.

Amendment 456 clarifies that the definition of “protected characteristics” is the same as that used in the Equality Act 2010. Proposed new subsection (2A) also provides that the commissioner must report on any other description of persons specified in regulations made by the Secretary of State.

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[Sarah Sackman]

I suggest that those are ultimately policy choices, first for the promoter, my hon. Friend the Member for Spen Valley, and then—if the regime is voted on and passed—for the commissioner. In reality, a lot of the data that one will collect when one has due regard to the differential impact on these protected groups will in practice have a large degree of overlap with other aspects of socioeconomic disadvantage, as is so often the case in equality impact assessments.

[Sarah Olney]

I had an interesting exchange with the hon. Member for Penistone and Stocksbridge last week about socioeconomic indicators. They are in the Equality Act but have not yet been implemented. I understand that it was in the Labour Government’s manifesto to bring forward the implementation of the socioeconomic factors in the Equality Act. Given that, as I understand it, the implementation of the Bill will probably take us up to the next general election, does the Minister not think that, at some point before it is fully implemented, there will be a way of collecting the relevant socioeconomic statistics?

[Sarah Sackman]

The hon. Member is right. Section 1 of the Equality Act 2010 refers to taking into account the impact of public administration decisions on socioeconomic disadvantage. The previous Labour Government brought that provision in under that landmark Act, but it was never brought into force. She is right that the Government are looking to do that. The question is: what is appropriate for the Bill that we are considering right here, right now? From the Government’s point of view, the voluntary assisted dying commission will be subject to the Equality Act, as it stands, and it is right that there is no need to specify the carrying out of an equality impact assessment in the Bill. That assessment will, at the appropriate time, contain whatever the Equality Act requires of that public decision maker. I do not think that we need to pre-empt, through this vehicle, things that have not yet happened in other areas of legislation.

The other point is that, leaving over for the regulations and guidance that the voluntary assisted dying commission is anticipated to produce, to take into account what needs to be taken into account in order to fully understand the regime and how it is operating, can all be developed by what will ultimately be an expert body in this field, should Parliament decide to vote for it. The question in the context of the amendments is: what do the Committee and Parliament say needs to go in the Bill right now? The Government’s position is that the amendments are neither necessary nor workable in our current legal regime.

Amendment 451 seeks to further specify what is included in the commissioner’s annual report under the promoter’s amendments to clause 34. Under amendment 451, the report must contain information on where there have been complications in the procedure, and we assume that to mean the procedure relating to the self-administration of the approved substance, as I think was clarified earlier by my hon. Friend the Member for Bradford West, who referred to clause 9 in that regard. The commissioner’s report would also be required to include analysis of a specified list of matters, including the diagnosis and prognosis of persons seeking assistance, concerns raised by family members or the multidisciplinary panel, and demographic data, including socioeconomic data and information on protected characteristics.

The Government have worked with the promoter on her amendments 455 and 456. Under amendment 455, the commissioner’s annual report would be required to include information about the application of the Bill to persons with protected characteristics and any other descriptions of persons specified in regulations made by the Secretary of State. That is the point: the regime can evolve as appropriate when we know what it looks like and how it is operating. It can even go further than some of the categories that Members have described. That may include persons from different demographics and socioeconomic backgrounds, as proposed by the amendment. The amendment would also require the commissioner to consult, when preparing an annual report, with the chief medical officers for England and Wales and others who appear to the commissioner to represent the interests of persons who have protected characteristics and who the commissioner deems appropriate.

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[Kim Leadbeater]

This is a standard power for regulations to include the power to make incidental, consequential, transitional or saving provision. This is a minor amendment, and it is a standard but vital measure to ensure the legislation works effectively and cohesively.

[Sarah Olney]

The clause, when amended by amendment 545, which we will vote on shortly, brings into stark relief how much of the Bill is to be left to regulations and how little say MPs will eventually get over it. When it comes to voting on Third Reading, MPs will have little certainty on how the Bill will actually operate—so much is to be taken on trust. If, through the gaps and grey areas, people come to harm, that will be on Parliament for failing to address these issues while we had the chance.

Let us consider all the powers that the Bill creates. Clause 5 creates a power to determine what goes into the first declaration, subject to the requirements of amendment 418. Clauses 5, 8 and 19 create powers to determine the training, qualifications and experience of the medical practitioners, with no minimum floor, and we do not even know who will ultimately decide the training—that, too, is to be left to regulations under amendment 186. Clause 6 creates powers to determine the forms of proof of identity, with no requirement for those to be photographic or to prove residency.

Clauses 7, 13 and 21 create powers to determine the statements, declarations and reports required from the doctors and the applicant. Clause 11 creates powers to make regulations for the replacement of the co-ordinating doctor if they have died, are ill or are otherwise unable or unwilling. Clause 15 creates a new power to determine who can be a proxy. Clause 20 creates a power for the approval of drugs and substances to end people’s lives. Clause 28 creates a power to determine the prescribing, dispensing and transporting of approved lethal substances —the right hon. Member for North West Hampshire has called this purely administrative. Clause 29 creates a power to make regulations relating to the registration, certification and recording of deaths. Clause 30 creates a power to issue codes of practice that practitioners must simply “have regard to”.

Clause 32 will create an extraordinarily broad Henry VIII power, as we are completely in the dark as to how the assistance will actually be provided. Clause 33 creates a power to determine which events should be notified to the commissioner and how to enable the exchange of information. That is all to be decided by the Secretary of State, with the detail removed from the Bill.

All those things are to be subject to the negative procedure, except the training and qualification requirement for the first and second doctor, the codes of conduct, and the power for the Secretary of State to arrange for delivery of assisted dying. When a statutory instrument is made through the negative procedure, there is no need for a vote. The only exception, by convention, is when the Leader of the Opposition asks for one, but they understandably would not do so on a conscience issue. In practice, Parliament will never get a say on these matters. Is the Committee content with that?

Even on affirmative statutory instruments, Parliament’s say is limited to a 90-minute debate on a motion that cannot be amended. Suppose that the Secretary of State published a code of practice on the assessment of capacity that MPs felt did not take sufficient account of mental health conditions. They would be faced with the option to vote for it despite its inadequacy, or to vote against it and risk creating a position where there are no codes of practice at all. That is an impossible position to place parliamentarians in, yet that is what the Bill does. It is a massive blank cheque to the Executive.

I say to Government Members, who I know have great faith in the Health Secretary, that according to the Interpretation Act 1978, “Secretary of State” means any Secretary of State. The powers will not necessarily be exercised by the Health Secretary; they could be exercised by another Secretary of State. Indeed, under the doctrine of ministerial delegation, they could be delegated to another Minister who is not a Secretary of State.

I make these points to illustrate that there is an issue of principle that cannot be waved away on the basis that we think someone sensible will exercise the powers. Parliamentary scrutiny matters, and I very much regret that the Bill avoids it through these wide regulation-making powers.

[Stephen Kinnock]

The Government have worked with my hon. Friend the Member for Spen Valley on amendment 223, which would broaden the regulation-making power using standard legal wording so that any regulations made under the Bill can ensure that it works effectively with other legislation.

Amendment 223 agreed to.

Amendment proposed: 545, in clause 39, page 23, line 6, leave out subsections (3) to (5) and insert—

“(3) The Secretary of State may not make a statutory instrument containing (whether alone or with other provision) regulations under section 5(3A), 8(6A),30(3), (Voluntary assisted dying services: England) or (Voluntary assisted dying services: Wales) unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament.

(4) Any other statutory instrument made by the Secretary of State containing regulations under this Act is subject to annulment in pursuance of a resolution of either House of Parliament.

(5) The Welsh Ministers may not make a statutory instrument containing regulations under section (Voluntary assisted dying services: Wales) unless a draft of the instrument has been laid before, and approved by a resolution of, Senedd Cymru.”—(Kim Leadbeater.)

This amendment brings together the various provisions about the procedure for regulations. It also makes regulations under clauses 5 and 8 about training, qualifications and experience, and regulations under NC36 and NC37, subject to the draft affirmative procedure.

Question put, That the amendment be made.

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[Sarah Olney]

I rise to speak to my amendments 531 and 535 and to amendment 490 in the name of my constituency neighbour, my hon. Friend the Member for Twickenham (Munira Wilson).

I welcome what the hon. Member for Spen Valley has just said about needing more time to get this right. As I said earlier, there is still so much that has been left to secondary legislation. I regard that as unsatisfactory in itself, but the fact that we are going to take time to get it right will surely go some way to mitigating some concerns.

I have heard raised around the estate on a number of occasions today the concern that the four-year gap between passing the legislation and implementing it will take us right up to the next general election. I have to say that I share those reservations, even though I am not a member of the party of government, about how the general election campaign will intersect with the implementation of this legislation. I share people’s fears that this whole process will get enmeshed in party politics, which we have hitherto been able to avoid in the Committee, but nevertheless could create a real danger for successful implementation.

I did think that the auto-commencement of this Bill after two years was a little bit reckless. The extension to four years at least permits some potential improvement in palliative care—to re-ignite the spirit of consensus, as that is something that we all want to see—but an NHS already grappling with long waiting lists and staffing shortages could buckle under the added burden of implementing a complex new framework leading to rushed or inconsistent application. An automatic commencement of the new laws, regardless of the situation in the NHS, could leave patients and healthcare workers unsupported.

It is important is that, before the moment comes—whenever that is—Parliament should be fully informed as to how the service will be provided and the strength of other provisions, so that MPs can be confident that those choosing to end their lives through this service are given a fair choice and are not being pushed down a single pathway. We must also have confidence that the medical professionals and panels involved have received adequate training.

Amendment 531 would ensure that at least we go into this with our eyes open and that shortcomings are flagged if not addressed. It would provide that the critical provisions of the Bill, without which assisted dying cannot lawfully operate, do not come into force until a report is made setting out the readiness of services to be provided under the legislation and that the training has been provided. Similarly, amendment 488, in the name of the hon. Member for York Central, mandates a statement from both Houses that all necessary regulations are in place. This would prevent a premature roll-out without clear rules. These steps would not halt progress; they would ensure we are ready to proceed.

Amendment 490, in the name of my hon. Friend the Member for Twickenham, does two important things. First, it requires that if the Secretary of State wants to commence before the auto-commencement deadline, they must publish a report covering the same matters covered by the report under clause 35. This would not be a new requirement, but would instead bring it forward. Crucially, that report would include details about the provision and availability of palliative care services in England and Wales.

Secondly, amendment 490—this is it goes further than my amendment 531 and amendment 488—requires that regulations bringing the Act into force prior to the auto-commencement deadline use the affirmative procedure: in other words, that there will be a vote in Parliament. It stands to reason that if the Secretary of State wants to go quicker than the four-year deadline, then Parliament ought to be able to consider whether all necessary preparations have been done and to refuse early commencement if that is not the case.

Amendments 488, 490 and 531 would not interfere with the auto-commencement point in four years’ time: when four years is reached the whole scheme will come into force. Those amendments would not prevent that, but they would achieve greater oversight and accountability if the Secretary of State decided to commence early. I hope that even if the hon. Member for Spen Valley is not minded to accept striking out the auto-commencement provisions, she will still accept these amendments.

[Kim Leadbeater]

The hon. Member makes some very fair points, but I think they will be covered by my new clause 40.

[Sarah Olney]

I am grateful for that intervention, but the crucial point is the vote in Parliament, so that MPs get not only an opportunity to consider whether sufficient progress has been made—as per new clause 40—but a vote to confirm that they are content for the legislation to proceed.

[Kit Malthouse]

I am sure the hon. Lady understands that a vote of that nature would not necessarily be binding, or compel the Government to do anything, but there would be other opportunities for the House to consider the legislation in debate and vote on it. She knows that there are a number of ways to do that, including via a Backbench motion or an Opposition day.

[Sarah Olney]

I refer to my earlier comments: there are few enough opportunities for MPs to have any further control over how this legislation is going to be implemented. I do not think that it is asking too much to want a further opportunity to be mandated, and not left—dare I say it—to the vagaries of the Backbench Business Committee. There are Opposition days, but this is cross-party, conscience issue. I can speak only for my own party, but I think there are a number of other issues that the Opposition would want to use those debates to address. Taken together, these amendments would ensure that Parliament is properly informed if the Secretary of State decided to commence the scheme before the four-year auto-commencement deadline.

I want to address how the Bill will be implemented in Wales. On 23 October 2024, in anticipation of the Bill being published, Senedd Cymru debated a motion calling on the Welsh Government to

“a) support the principles of assisted dying; and

b) support Westminster parliament to introduce a compassionate assisted dying law in England and Wales.”

The motion was defeated 19 to 26. Among those who voted against were a number of Welsh Government Ministers, including First Minister Eluned Morgan, and I believe that in three political parties—Labour, Plaid and the Conservatives—there was a majority against. In that context—as Professor Emyr Lewis, who gave evidence to the Committee, has stated—it would be constitutionally wrong to pass the Bill without the consent of the Welsh Senedd. He believes that this is different from other instances where legislation has been passed by Westminster against the will of Wales:

“This is not the equivalent, for instance, of trying to re-base the UK’s internal markets following the chaos of Brexit. When the UK Parliament passed Acts ignoring refusal of consent from Cardiff or Edinburgh, it did so in what were considered to be the interests of the economic coherence of the UK. This Bill, however, is a different sort of creature. It is a Bill which would bring about a profound change in the law relating to life and death, where there are strongly held (and expressed) moral, religious and cultural views against as well as in favour. How can it be constitutionally appropriate for the UK Parliament to pass such a Bill for Wales, when the Senedd has indicated its opposition by democratic vote after a thorough debate?”

[Kim Leadbeater]

I hope the hon. Member can acknowledge that the motion voted on in the Senedd was very different from the legislation before this Parliament. I hope that I can reassure her, as I have previously, that I am in contact with the Senedd and will be meeting Welsh Ministers. New clause 37 will hopefully also provide some reassurance on issues around devolution.

[Sarah Olney]

I again refer to what I said earlier: I fear this is another example where, instead of debating and agreeing these points in Committee or elsewhere in Parliament, we are delegating these matters to be decided elsewhere by some other people, not in the legislation that we are debating and voting on.

I reiterate that the Senedd has already made its view clear. It may not have been a binding vote. It may not have been voting on this specific piece of legislation. However, I think the will of the Senedd is clear: they do not want an assisted dying Bill imposed upon them, and that is what the evidence of Professor Emyr Lewis told us.

[Kim Leadbeater]

I think that is a very inaccurate representation of the vote that took place in the Senedd.

[Sarah Olney]

I am sorry that the hon. Lady feels that.

The complicating factor here is that the criminal law is not devolved to Wales, but health is, as is safeguarding. One possibility is to seek to respect devolution strictly, by either changing the law or giving the power to the Secretary of State to change the law in respect of what is reserved, while giving to the Welsh Ministers the powers in respect of what is devolved. The problem is that the Bill does not quite do that, even with the amendments that have been tabled by the hon. Member for Spen Valley. Those amendments fail to properly identify what is and what is not devolved; instead, they kick the can down the road.

Future litigation might be required to figure out the precise boundaries. For example, regulation of health professionals is a reserved matter, but adult safeguarding is a devolved matter, so is the training of those health professionals on spotting coercive control a reserved or a devolved matter? The Bill does not answer that question. The solution therefore carries a real risk. If Wales decides that it does not want assisted dying and therefore does not provide it on its NHS, and the Welsh Ministers decide not to set up proper training and regulatory programmes in respect of the safeguarding issues raised, the position in Wales will be that it is decriminalised, so the service can be provided by private providers charging a fee and not necessarily properly trained in safeguarding. That is not a sustainable middle ground, so it would naturally pressure Wales to move towards commissioning such services itself.

In other words, the Bill either respects devolution at the risk of creating a legal limbo, or it puts pressure on Wales to catch up with England, neither of which are desirable. Another alternative is to take away any choice that Wales might have on the matter entirely, and have the law apply in Wales in exactly the same way it does in England, including when it comes to the actual delivery of services. That would avoid the legal limbo problem, but at the cost of acting in a way that is constitutionally quite wrong.

That brings us to the solution that Professor Lewis proposed in his blog:

“How then might the Bill be amended to respect the Senedd’s vote on the matter of principle? One straightforward way would be to provide for different commencement provisions in the Bill. As things stand, under clause 42 of the Bill, most of the Bill will not come into force until the Secretary of State has brought it into force, with the approval of the UK Parliament. Why not provide that the Bill will only come into force in Wales when and if the Welsh Ministers bring it into force with the approval of the Senedd?”

That is what I seek to do through my amendment.

I can foresee three objections. First, it might be said that the criminal law is a reserved matter and therefore Parliament ought not to refrain from legislating for Wales or have different commencement arrangements for the criminal law in England compared with Wales, but Parliament is sovereign and can do what it wants. By the same reasoning, Parliament should never grant a temporary power to a devolved legislature to legislate on matters that are normally reserved, yet Parliament does do that.

The second objection might be that England and Wales are a single jurisdiction, and that there should not be a difference in the criminal law between them, but this misunderstands that, as a result of the devolution settlement, there are already differences in the criminal law of England and Wales. For example, in our law there is a defence of reasonable chastisement, which means that parents smacking their children would not be committing a criminal offence. Although the criminal law is not devolved to Wales, child welfare is and, using those powers on child welfare, the Senedd voted to abolish the defence of reasonable chastisement in Wales. That means that there is a difference in the criminal law of England and Wales. A position whereby assisting suicide was partially decriminalised in England but fully criminalised in Wales would not be an oddity. There is no principle of our constitution that says that the criminal law must be the same on both sides of the border.

The key issue is that the decriminalisation of assisted suicide, which the Bill will bring about, is not a stand-alone measure. What we are introducing is not something like the Swiss criminal code, for example, which does not criminalise assisted suicide when the person acted for non-selfish motives. Rather, it is a decriminalisation of assisted suicide that is contingent with complying with a detailed healthcare regulatory scheme, which is an issue that is devolved to Wales.

Finally, it might be objected that this might create difficult cross-border issues. As Professor Lewis put it in his blog,

“that would be true also if, for instance, the Scottish Bill did not become law. Far more difficult cross-border issues were successfully accommodated in the context of legislation, also involving profound ethical considerations, when the National Assembly for Wales (as the Senedd was then called) changed the law on organ donations.”

I accept that such a situation might require constitutional amendments at subsequent stages, but these could easily be made by the Government on Report.

Ultimately, when one looks at it in detail, having a different commencement provision for Wales is the only practical way of respecting the vote of the Senedd while not running the risk of creating a legal limbo. Finally, I draw the Committee’s attention to the supplementary written evidence of Professor Lewis, in which he commends my amendment 535.

Regardless of where we stand on assisted dying, we should respect democracy. The people of Wales, through their elected representatives—acting as they should, as representatives—have voted against assisted dying. We should respect that choice and not impose it on them, in whole or in part, without their consent.

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

Sarah Olney Excerpts

Committee stage
Tuesday 18th March 2025 Public Bill Committees

[Kim Leadbeater (Spen Valley) (Lab)]

It is a pleasure to serve under you this morning, Ms McVey. My amendments 374 and 471 serve to clarify that the second declaration must be made before it is witnessed—it is a drafting amendment—and to bring clause 13 in line with the reporting requirements elsewhere in the Bill. For the functions of the commissioner to be carried out effectively, including supervising the assisted dying panels and making annual reports on the legislation’s operation, it is essential that all relevant details and reports are made available.

I am unable to support amendment 457, in the name of the hon. Member for Richmond Park. As I said when we started discussing the amendment, I do not fully understand why it has been positioned at this stage in the process. The shorter period of reflection is a recognition that a person’s death is expected within a month, so they literally have a few weeks left of life.

[Sarah Olney (Richmond Park) (LD)]

That was the hon. Member’s response when I made my speech on the amendment in the previous sitting. I have reflected on that over the weekend. I still think that the issue of the voluntary stopping of eating and drinking is a very serious one that ought to be reflected somewhere in the legislation, but she is correct that, at this particular point, we are talking about the second period of reflection already being at an end, so it cannot be hastened in any way by such a measure. Therefore, I will be withdrawing the amendment.

[Kim Leadbeater]

I appreciate that; that is helpful and I thank the hon. Member. As the Minister said, a person whose death is approaching may have stopped eating and drinking for a number of reasons. They may simply be too ill. They may be unable to digest food. It may be that they have lost their appetite, or that they will be even more ill if they eat and drink, so it would seem particularly cruel to intervene on that basis at that point, but I appreciate her comments.

Amendment 316 in the name of my hon. Friend the Member for York Central seeks to mandate the action a doctor must take if a patient is likely to die within one month. Like other amendments, it goes against the basic principles that underlie the Bill—that the wishes of the person seeking assistance should be respected. Surely that is even more important than ever as they face their final weeks. As the right hon. Member for North West Hampshire said, palliative care will have been discussed at length throughout the assisted dying process. It is also worth noting, as the hon. Member for East Wiltshire said, that evidence from other jurisdictions with similar laws—Australia and America—shows that between 80% and 90% of people who have gone through the assisted dying process are already receiving palliative care, so I am not minded to support the amendment.

[Sarah Olney]

I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Amendments made: 207, in clause 13, page 9, line 20, leave out “Schedule 4” and insert

“regulations made by the Secretary of State”.

This amendment provides that the form of a second declaration is to be set out in regulations (rather than in Schedule 4).

Amendment 470, in clause 13, page 9, line 26, at end insert—

“(3A) Regulations under subsection (3)(a) must provide that a second declaration contains—

(a) the following information—

(i) the person’s full name and address;

(ii) the person’s NHS number;

(iii) contact details for the person’s GP practice;

(iv) specified information about the certificate of eligibility;

(b) the following further declarations by the person—

(i) a declaration that they have made a first declaration and have not cancelled it;

(ii) a declaration that they understand that they must make a second declaration in order for assistance to be provided under this Act;

(iii) a declaration that they are making the second declaration voluntarily and have not been coerced or pressured by any other person into making it;

(iv) a declaration that they understand that they may cancel the second declaration at any time.

In this subsection “specified” means specified in the regulations.”

This amendment provides that regulations about the form of a second declaration must make the provision mentioned in paragraphs (a) and (b).

Amendment 471, in clause 13, page 9, line 27, leave out from “if” to “that” in line 28 and insert

“the coordinating doctor is satisfied (immediately before witnessing it)”.

This amendment removes wording which would suggest that a second declaration is made before it is witnessed.

Amendment 208, in clause 13, page 9, line 38, leave out “Schedule 5” and insert

“regulations made by the Secretary of State”.

This amendment provides that the form of a statement by the coordinating doctor following the making of the second declaration is to be set out in regulations (rather than in Schedule 5).

Amendment 472, in clause 13, page 9, line 41, at end insert—

“(6A) Regulations under subsection (6)(a) must provide that a statement under subsection (5) contains—

(a) the following information—

(i) the person’s full name and address;

(ii) the person’s NHS number;

(iii) the coordinating doctor’s full name and work address;

(iv) specified information about the certificate of eligibility;

(b) the following declarations by the coordinating doctor (in addition to a declaration that they are satisfied of all of the matters mentioned in subsection (4)(a) to (d))—

(i) a declaration that they are satisfied that a certificate of eligibility has been granted in respect of the person;

(ii) a declaration that the second declaration was made after the end of the second period for reflection;

(iii) if the second declaration was made before the end of the period mentioned in subsection (2)(a), a declaration that they have the belief mentioned in subsection (2)(b);

(iv) a declaration that they are satisfied that neither the first declaration nor the second declaration has been cancelled.

In this subsection “specified” means specified in the regulations.”

This amendment provides that regulations about the form of a statement under subsection (5) must make the provision mentioned in paragraphs (a) and (b).

Amendment 374, in clause 13, page 10, line 2, at end insert—

“(8) Where the coordinating doctor has—

(a) witnessed a second declaration, or

(b) made or refused to make a statement under subsection (5),

the doctor must notify the Commissioner and give them a copy of the second declaration or (as the case may be) any statement under subsection (5).”—(Kim Leadbeater.)

This amendment requires the coordinating doctor to notify the Commissioner of witnessing a second declaration, and of having made or refused to make a statement under clause 13(5).

Clause 13, as amended, ordered to stand part of the Bill.

Clause 14

Cancellation of declarations

[Kim Leadbeater]

I beg to move amendment 375, in clause 14, page 10, line 9, at end insert—

“(1A) Where notice or an indication is given to the coordinating doctor under subsection (1)(a), the doctor must as soon as practicable notify the Commissioner of the cancellation.”

This amendment requires the coordinating doctor to notify the Commissioner of a cancellation of a first or second declaration.

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

Sarah Olney Excerpts

Tuesday 18th March 2025 Public Bill Committees

[Daniel Francis (Bexleyheath and Crayford) (Lab)]

It is a pleasure to serve under your chairship, Sir Roger. I will speak to amendments 429 and 430 in my name. During oral evidence, we discussed the issues in subsections (9) and (10) of clause 18 and whether there is a contradiction. Subsection (9) states that the co-ordinating doctor

“must remain with the person”

and subsection (10) says:

“For the purposes of subsection (9), the coordinating doctor need not be in the same room as the person”.

We also discussed how that works in other jurisdictions. My amendment 429 would deal with that conflict. If the Bill were to become law, that conflict could be queried.

We also need to consider the possibility of complications. Clearly, if there are complications and the doctor is not in the same room, they would not necessarily be aware of those complications. I accept that, in some normal circumstances, doctors and medical professionals are not present in the room at the time of death; at other times, they are present. The amendment would mean that if something were to go wrong and someone was having a painful reaction to the drugs, the doctor would be there to see and help.

I do not understand what the Bill means when it says the doctor does not have to be in the same room. How far away would the doctor have to be? One subsection says the doctor has to remain with the person, and the following subsection says they do not have to be in the same room. If the Bill were to pass, we would be asking doctors to do something that is unprecedented. If the person were to suffer complications such as seizures or vomiting, or if they were exhibiting signs of distress, it appears that the doctor should be present. Members may think this could encroach on a patient’s privacy, but I think there is a discrepancy between the two subsections.

On amendment 430, I am conscious that my hon. Friend the Member for Ipswich has tabled a similar amendment. The intention of my amendment is to ensure there are regulations in responding to any unexpected complications that arise in relation to the administration of the approved substance, including when the procedure fails. I am conscious that if a doctor intervenes, they could end up in breach of the Suicide Act 1961. I therefore left the wording in that vein, as I understand that we will receive more information in due course.

Again, we received oral evidence from a number of people that what a doctor is meant to do in the event of unexpected complications is a matter of concern from both a legal and a medical perspective. We know from the evidence received from other jurisdictions that—I accept in a small minority of cases—there can be complications or the death can take much longer than expected. We also received evidence that, on rare occasions, death can take days.

Amendment 430 would show we have thought about those circumstances and provided for them by giving doctors a code of practice to refer to, rather than being left in the dark if a difficult situation arises at the time of death. We must not find ourselves in a circumstance in which doctors and patients are unprepared. It is important for us to think through, provide for and safeguard against all possible scenarios, however rare they might be. Of course, we would not want them to happen, but in some circumstances they might, and we would not want there to be a legal hole. Accepting the amendment would mean the Secretary of State has the opportunity to provide a code of practice for such circumstances. I hope hon. Members will be able to support the amendments in my name.

[Sarah Olney (Richmond Park) (LD)]

It is a pleasure to serve under your chairmanship, Sir Roger. I support amendment 429, tabled by the hon. Member for Bexleyheath and Crayford.

I do not understand how subsection (9) can require the doctor to remain with the person until they have self-administered and died, or until they have decided not to self-administer, while subsection (10) states that the doctor need not be in the same room. The Bill becomes even less coherent when we consider subsection (11), which requires the doctor to remove the substance immediately if the person decides not to self-administer—how can the doctor do so if they are not in the same room? Amendment 429 would make the scheme more coherent and I support it for that reason.

I accept that there are downsides to having the doctor present, especially before the administration, as people have a normal desire for privacy, but that needs to be balanced against the risk of someone else taking the substance or something going wrong in the process of self-administration. In Australia, there is no requirement for the doctor to be present, which has led to some cases of abuse. I understand why the Bill’s promoter has chosen not to go down the Australian route, but the position arrived at in subsection (10) lacks coherence and is unclear.

What does it mean to remain with the person without being in the same room? Does it mean being in the corridor just outside the room, but with the door open? What if it is closed? What if, as a result of the door being closed, the doctor is no longer within earshot? I am not the only one who is confused, as so are the doctors who will have to apply the legislation. For example, Dr Janet Menage, a retired GP, told us in written evidence—TIAB 182—that the provisions

“are mutually exclusive: doctor ‘must remain with the patient’ but ‘not in the same room’…This makes no sense. In any case, if the attending doctor is not in the same room there could potentially be an intervention by another person to the patient’s detriment. Or the patient may wish to cancel the suicide at the last moment and be unsupported in voicing that decision.”

With or without subsection (10), I would like to know whether the Minister has made an assessment of the workforce impact of such a requirement for the doctor to be present. As Dr Rebecca Jones told us:

“As the death may take many hours, I’m uncertain of the practicalities of this”.

[Sean Woodcock]

The hon. Lady is making an important point about the lack of coherence that amendment 429 is trying to sort out. Throughout these weeks of debate in Committee, we have heard about the importance of clarity for practitioners. This provision introduces severe doubt as to exactly what a practitioner is meant to do. I understand that we do not want to say, “You have to do this and this, and in this order”, and that amendments have been rejected on that basis, but this clause opens a massive loophole in the law and practice, which concerns me. Does the hon. Lady share my concern?

[Sarah Olney]

The hon. Gentleman is absolutely right. It is fundamental that, with this legislation, we provide very clear guidance to the medical practitioners who will be engaged in assisting patients with this matter. This is not only for their peace of mind that what they are doing is acceptable under the law, and accords with what Parliament has decided, but for the protection of patients. It is incumbent on us to be really clear about what we mean, and I do not believe we are as the Bill is currently drafted.

[Sojan Joseph]

We repeatedly talk about doctors, but nurses, healthcare assistants and other professionals will definitely be involved in a hospital environment. The Bill does not talk about other professionals. Furthermore, within a hospital environment, NHS wards may be bays without individual bedrooms. Does the hon. Lady think we need to be clearer on the procedures that will happen in those areas?

[Sarah Olney]

I am grateful for the hon. Gentleman’s professional experience, which is extremely helpful. He is absolutely right. Following the point made by the hon. Member for Banbury, we cannot define the circumstances in which a patient will find themselves when this is taking place. That is why it is incumbent on us to make sure we provide very clear guidance on precisely what Parliament intends.

As Dr Rebecca Jones told us in written evidence:

“As the death may take many hours, I’m uncertain of the practicalities of”

doctors remaining with the patient

“for many doctors…have competing demands on their time.”

In written evidence, Dr Chris Ainsworth asked how this will work in cases where death takes several days, as has happened in Oregon, while Dr Trevor Stammers wrote:

“If the doctor is required to be present until the patient’s death, this may require hours of practitioners’ time to fulfil and is unlikely to be adhered to in many cases if the dying process is protracted.”

Dr Rachel Fisher said in her written evidence that for Australian doctors, who are not required to be present at the final act, each assisted death requires around 60 hours of professional time. For British doctors, we will need to add the time it takes for the self-administration to result in death. Dr Fisher also raised the real impact on doctors, writing,

“imagine the practicalities of those who must deliver it. The GP, motivated by a deep desire to preserve life and relieve suffering arrives at the home of the patient with a cocktail of powerful drugs. What if the patient has symptoms? Who will collect their child from nursery or school if the patient takes a long time to die? How will they know when to decide the death was unsuccessful? Will there be counselling for GPs observing and feeling complicit in a potentially drawn out and symptomatic death?”

Finally, Dr Paul Shaw asked in his written evidence:

“How will this service be funded? What support will be required from the NHS when things go wrong or death takes longer than expected? Will this be a 0900-1700hrs service? What will be the out of hours arrangements?”

A lot of the written evidence touches on the practicalities of a doctor being required to remain with the patient until they die. Amendment 429, in the name of the hon. Member for Bexleyheath and Crayford, seeks to clarify whether “being with the patient” requires the doctor to be physically present in the room.

[Dr Opher]

I understand that hon. Members are coming from a good place, but I do not understand how amendment 429 would stop the doctor having to stay with the patient until they die. I agree that it is an important issue, so could the hon. Lady elucidate on that?

[Sarah Olney]

The hon. Gentleman gives me an opportunity to conclude my remarks. I support amendment 429 because it is important to provide clarity that when we say “with the patient,” we mean in the room. However, I invite the Minister to expand further on the resource requirement of assisted dying. I want the doctor to remain with the patient, which I think is critical. That is why I support amendment 429, but the implication of the Bill is a considerable resource requirement, particularly for GPs, and I would like the Minister to respond to that.

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

I rise to speak to amendments 532 and 533, standing in my name, and in support of amendments 429 and 430, tabled by my hon. Friend the Member for Bexleyheath and Crayford. I appreciate that my amendments are similar to amendment 430. They go a little bit further, but probably not as far as we have previously discussed in the Committee.

I totally understand the concerns about the Bill being overly prescriptive about the regulations that could be passed down to the doctors making such decisions. However, it is important that we enable the Secretary of State to provide guidance, in addition to GMC regulations, on what the co-ordinating doctor must do if the procedure has failed. At the moment, the Bill simply states:

“The coordinating doctor must remain with the person until”

that time. However, I appreciate that amendment 429, if passed, would cover that issue.

Clause 9 states:

“The assessing doctor must…discuss with the person their wishes in the event of complications arising in connection with the self-administration of an approved substance under section 18”.

However, the Bill as drafted is not clear about what a doctor is legally permitted to do in the event of such complications. That is particularly important, as the Bill expressly states that the final act of administration must be taken by the person themselves. Therefore, the Bill as it stands stipulates that the doctor must discuss the patient’s wishes in the event of complications without stipulating what actions the doctor can take in such an event and thus what the patient’s options actually are.

There is a gap in the Bill and a lack of clarity on that critical issue, which has been raised frequently in both written and, to an extent, oral evidence. Dr Alexandra Mullock argued that, as

“the Bill would only permit”

a doctor only to assist in the patient’s self-administering a substance,

“administering drugs to end the life of a patient who might be unconscious (but not dying) is not permitted.”

She also raised the possibility that a patient might regain consciousness, but

“be too ill to make a second attempt”

at self-administration. What should a doctor do if that occurs? Unless the Secretary of State clarifies what a doctor can do in that situation—my amendment would not do that; it would merely give the Secretary of State direction to do so—the co-ordinating director could be placed in a difficult position.

Professor Alex Ruck Keene argued that the Bill as it stands could lead to the potential for medical professionals to be “required to stand by”, yet without being able to take steps to respond to complications so as to ensure that the process is completed. I fully appreciate that all doctors would use their good training, common sense and years of extensive practice to make a best-case judgment, and we would always support them in that, but the Bill has the unintended consequence of not giving doctors true cover in that area.

Dr Mullock also asked what should occur if the patient survives a procedure, “but is badly affected”. What treatment should be provided? Should the patient be moved to hospital? Should the patient be sedated or made comfortable until a natural death occurs, or should the doctor be able to take steps for the patient to die following the initial failed attempt? We need answers to those questions. Amendment 532 does not seek to answer them, but it would stipulate that the Secretary of State must do so at a certain point.

--- Later in debate ---

[Lewis Atkinson]

To me, amendment 430, tabled by my hon. Friend the Member for Bexleyheath and Crayford, strikes the right balance. Under clause 30 the Secretary of State “may” make provision for codes of practice on these matters if that is required; I am uncomfortable with saying that the Secretary of State “must” do so, when it is likely that it will be more appropriate for the GMC or some other body to make those regulations. We get into a difficult precedent if the Secretary of State must specify the reaction in certain medical circumstances but we routinely leave that to medical regulation and practice more widely. I think a “may” power, as set out in amendment 430, would allow that backstop provision, but would not get into the issue of “must”. It is also likely to be more respectful of the conversations as outlined in clause 9.

[Sarah Olney]

I am listening to what the hon. Gentleman is saying, and a lot of what he is talking about in terms of giving doctors discretion makes a lot of sense in a routine medical intervention, but this is not a routine medical intervention. This is a very serious point, and the doctor’s judgment in this case could well fall either side of what is permissible by the law. That is why it is so important that it is really clear. Whether we decide in Committee that it must be on the face of the Bill, or whether we want, as per the hon. Member for Ipswich’s amendment 532, to leave it to the Secretary of State, it must be clear and specific.

[Lewis Atkinson]

I think the Bill is very clear on the legal parameters. A doctor may not act, in terms of administering the substance, in a way to hasten death. Within that, we are back into the realms of normal medical practice, as my hon. Friend the Member for Stroud set out. I am sure that there will be legal guidance, whether that be from the GMC or elsewhere, if and when the Bill were to pass. The Secretary of State would have the powers anyway under clause 30, but for the avoidance of doubt, amendment 430 strikes the right balance in giving backstop permissions to the Secretary of State to clarify anything if needed.

--- Later in debate ---

[Lewis Atkinson]

I disagree. As clause 9 makes clear, the doctor will have had a conversation with the patient about their wishes in advance, in exactly the same way as a surgeon would have a conversation with a patient in advance of high-risk surgery—

[Sarah Olney]

rose—

[Lewis Atkinson]

I am not going to take any further interventions; I am going to answer this point and make some progress.

The surgeon would say, “If this procedure fails, would you wish me to attempt resuscitation? Would you wish to be put on a support system?” The hon. Gentleman misunderstands current practice on consultation with patients, in advance of procedures, about their wishes, which is where there is significant established evidence.

--- Later in debate ---

[Sarah Olney]

I hope the Minister can answer a question for me. I hear what he is saying about concerns with the amendments themselves, which makes a lot of sense, and the policy objectives of the hon. Member for Spen Valley. What I am concerned about is that in the Bill as drafted, notwithstanding that various amendments have been tabled, it is not clear what the doctor should do in the event of complications. There may well have been an earlier conversation with the patient, but the patient’s request may still leave the doctor in the position of committing a criminal offence.

I would like to know whose responsibility it is to ensure that doctors are not left in that position, which could come about either because the Bill as drafted is not clear or the amendments do not make the appropriate clarification. The hon. Member for Spen Valley has done a marvellous job, but in terms of policy intention the Bill does not cover this aspect. The Minister is saying that it is his job only to ensure that the amendments are appropriate. I am still very concerned that there is a big gap here and that we are potentially leaving doctors in the very difficult position of not knowing whether or not carrying out the patient’s intentions would leave them in the position of breaking the law. I would like to know whose responsibility it is to ensure that doctors are not left in that situation.

[Stephen Kinnock]

The hon. Lady will know that we rely on medical practitioners to make professional judgments all the time. My hon. Friend the Member for Stroud has set out the range of things that medical practitioners can do when they are dealing with end-of-life care. That happens all the time.

In these circumstances, it is the view of the Government that we should continue to rely on the skill, judgment and expertise of medical practitioners, underpinned by the various codes of practice—the GMC, or good medical practice, being probably the most obvious one. There is an understandable desire to use primary legislation to address issues of this kind, but it is important to point out that that could prove to be counterproductive and that we could end up with a Bill that becomes less workable and therefore potentially less safe—what one might call the law of unintended consequences.

[Sarah Olney]

The Minister is talking about somebody making a medical judgment, which would obviously be the right thing to do in the normal course of events, but we are talking about a doctor being left in a position of not knowing whether to take a further step that would end somebody’s life or to take the step that would be natural for a doctor—to try to revive the patient. This is about what the legal position is in that case—it is not a matter for medical judgment.

[Stephen Kinnock]

My response would be to refer the hon. Lady to clause 30(1), which sets out that the Secretary of State will produce a code of practice. Amendment 430, which my hon. Friend the Member for Spen Valley has said she is minded to support, would also ensure that the code of practice includes guidance on the matter that the hon. Lady raises. I think there is a commitment to a code of practice, and if amendment 430 passes then it would be explicitly in the Bill that that code of practice should include the issue that she raises.

Amendment 533 places a duty on the Secretary of State to make regulations specifying where the provision of assistance under the Bill may take place. It sets out a requirement on the Secretary of State to consult such persons as the Secretary of State considers appropriate prior to making such regulations, including certain specified groups.

Amendment 430 would broaden the Secretary of State’s power to issue codes of practice under clause 30. It would explicitly enable the Secretary of State to issue a code of practice in connection with responding to unexpected complications that arise in relation to the administration of the approved substance under section 18, including when the procedure fails.

I understand that amendment 255 is no longer relevant as it relates to schedule 6, which is going to be changed—I think that is right—so, in that sense, the amendment is null and void. I hope that those observations were helpful.

--- Later in debate ---

[The Chair]

I was under the impression that cold concentrated the mind, but we will see what we can do. I speak as one who will not be in the room. The point has been taken.

Clause 19

Authorising another doctor to provide assistance

[Sarah Olney]

I beg to move amendment 408, in clause 19, page 13, line 18, after “provided” insert “has been consulted and”.

The amendment ensures the person has been consulted before they have given consent for another medical practitioner to be authorised to provide assistance.

[The Chair]

With this it will be convenient to discuss the following:

Amendment 210, in clause 19, page 13, line 22, at end insert—

“(2A) Regulations under subsection (2)(b) may in particular provide that the required training, qualifications or experience is to be determined by a person specified in the regulations.”.

This amendment enables regulations under subsection (2)(b) to provide that the required training, qualifications or experience is to be determined by a person specified in the regulations.

Amendment 499, in clause 19, page 13, line 25, at end insert—

“(3A) Where a registered medical practitioner who is authorised under subsection (1) is not satisfied of all of the matters mentioned in section 18(4), they must notify the coordinating doctor immediately.”

This amendment provides that where a practitioner authorised under clause 19(1) is not satisfied of all of the matters mentioned in clause 18(4), they must immediately notify the coordinating doctor.

Amendment 22, in clause 19, page 13, line 32, at end insert—

“(5A) Regulations under subsection (2)(b) must specify that training in respect of domestic abuse, including coercive control and financial abuse is mandatory.”

This amendment would require that, in the event of the coordinating doctor authorising another registered medical practitioner to provide assistance under the Act, that other registered medical practitioner must also have undertaken training on domestic abuse, including coercive control and financial abuse.

Clause stand part.

[Sarah Olney]

Amendment 408 seeks clarity on a critical aspect of the legislation. Clause 19 allows a co-ordinating doctor to authorise another registered medical practitioner to carry out their functions, providing that the patient consents and that the replacement has completed training, qualifications and experience as specified by the Secretary of State. This is a facilitation clause to smooth the process, and in some cases it might seem like something that we should just nod through. If the co-ordinating doctor becomes unwell, takes leave or faces an emergency that prevents them from fulfilling their duties, they might delegate to ensure continuity of care for the patient. If the patient relocates, perhaps to be closer to family, or if the co-ordinating doctor cannot travel to the patient’s location due to the distance or logistics, a local practitioner could be authorised to step in, provided they meet the specified requirements and the patient consents.

--- Later in debate ---

[The Chair]

It was something else you were pre-empting yourself with—that is fine. I call Sarah Olney.

[Sarah Olney]

I have nothing to add.

Amendment 408 agreed to.

Amendments made: 210, in clause 19, page 13, line 22, at end insert—

“(2A) Regulations under subsection (2)(b) may in particular provide that the required training, qualifications or experience is to be determined by a person specified in the regulations.”

This amendment enables regulations under subsection (2)(b) to provide that the required training, qualifications or experience is to be determined by a person specified in the regulations.

Amendment 499, in clause 19, page 13, line 25, at end insert—

“(3A) Where a registered medical practitioner who is authorised under subsection (1) is not satisfied of all of the matters mentioned in section 18(4), they must notify the coordinating doctor immediately.”

This amendment provides that where a practitioner authorised under clause 19(1) is not satisfied of all of the matters mentioned in clause 18(4), they must immediately notify the coordinating doctor.

Amendment 211, in clause 19, page 13, line 31, leave out subsection (5).—(Kim Leadbeater.)

See the statement for Amendment 187.

Amendment made: 22, in clause 19, page 13, line 32, at end insert—

“(5A) Regulations under subsection (2)(b) must specify that training in respect of domestic abuse, including coercive control and financial abuse is mandatory.”—(Naz Shah.)

This amendment would require that, in the event of the coordinating doctor authorising another registered medical practitioner to provide assistance under the Act, that other registered medical practitioner must also have undertaken training on domestic abuse, including coercive control and financial abuse.

Amendment made: 212, in clause 19, page 13, line 33, leave out subsection (6).—(Kim Leadbeater.)

See the statement for Amendment 188.

Clause 19, as amended, ordered to stand part of the Bill.

Clause 20

Meaning of “approved substance”

[Danny Kruger]

I beg to move amendment 409, in clause 20, page 13, line 35, leave out from “specify” to “for” and insert—

“two or more drugs or other substances with different techniques of administration”.

The amendment requires that the Secretary of State specifies two or more drugs or other substances, which have different techniques of administration.

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

Sarah Olney Excerpts

Committee stage
Tuesday 11th March 2025 Public Bill Committees

[Stephen Kinnock]

This is one of the amendments on which the Government have worked with my hon. Friend the Member for Spen Valley to ensure that the Bill is legally robust and workable. As the Bill is currently drafted, in clause 11 there is provision to replace a registered medical practitioner acting as the co-ordinating doctor if they become ill or die. However, there is no similar provision to replace a registered medical practitioner acting as the independent doctor should they be unable to complete their role.

Amendment 205 makes provision under clause 10 that a further referral may be made by the co-ordinating doctor to another independent doctor if the second independent doctor becomes unable or unwilling to continue to make a report of their assessment due to their death or illness, provided that the second independent doctor has not prepared a report. It would thereby ensure internal consistency in the Bill in relation to this matter.

[Sarah Olney (Richmond Park) (LD)]

I reiterate the concern I raised when speaking to my amendments this morning: as far as I can see, seeking the second opinion of a second independent doctor allows the person seeking assisted suicide to have a second bite at the cherry if their first independent doctor has not granted permission. I do not think anyone has an objection to going to a second independent doctor if the first independent doctor has been unable, through either death or illness, to complete the task; nor is there any objection if there has been a material change of circumstances, which my amendment 458 sought to add.

However, the possibility of seeking the view of another doctor simply because the first one did not give the desired answer is a troubling one. There is no objection to patients seeking a second, third or even fourth opinion in medicine when it is about what different treatment pathways might be available, but there is a crucial difference between seeking different appropriate treatment options and what is being proposed in the Bill. In the Bill, the function of the two doctors is not primarily diagnostic or advisory; it is a safeguarding role.

The doctors will have been entrusted by Parliament to make sure that the criteria for assisted dying are met. Their determination makes the difference between a lawful act and the commission of an act that, as per clause 24, Parliament would still regard as sufficiently serious to be a crime. Their role is therefore that of a decision maker, and in no other setting can someone go to a different decision maker if they do not like the answer given by the first. Even in appeals before our courts, an appellate judge would not interfere with a decision simply because they would have reached a different conclusion; the appellate judge must consider that the decision was in some way incorrectly reached.

It is also true that in some settings one can ask a decision maker to reconsider a matter, but that is not what is being proposed in clause 10 either. Instead, the clause allows the person to try again with a different referee if the first one did not give the desired answer. It is true that there is an added layer of protection from the High Court or the possibility of a panel, but under the Bill as it currently is there is no procedure whereby the High Court or the panel will hear from the first independent doctor. That is concerning. They would have to go simply on the basis of the second independent doctor, without any awareness of why the two disagreed.

[Lewis Atkinson]

I fear that the point the hon. Lady is making relates to before her amendment 459 was accepted. Does she not agree that by accepting amendment 459, we have guarded against the first independent assessment not being available for subsequent decision makers?

[Sarah Olney]

I am not used to my amendments being accepted. The hon. Gentleman is, of course, absolutely right.

Dr Matthew Doré, the palliative medicine consultant and honorary secretary of the Association for Palliative Medicine, said in written evidence:

“Allowing patients to seek multiple opinions undermines procedural integrity. Furthermore, allowing the coordinating doctor to seek multiple opinions even further undermines the selection of doctors willing to provide AD”—

that is, assisted dying. He goes on:

“The lack of a centralised tracking system facilitates ‘doctor shopping’.”

Notwithstanding the fact that amendment 459 has now been accepted, there is still grave concern about the possibility of doctor shopping. We should take steps to avoid it. That is why I am speaking against clause 10 in its entirety.

Under clause 8, the independent doctor has five matters to verify: that the person is terminally ill; that they have capacity; that they have a clear, settled and informed wish to end their own life; that they are acting voluntarily and without coercion or pressure; and they are over 18. The last requirement is unlikely ever to be in any form of doubt, so I will focus on the other four. The effect of clause 10 is to allow someone to be assisted to die when one out of three doctors who examined them had concluded that they were not terminally ill, that they lacked capacity, that they did not have a settled wish to die or they were coerced. It therefore raises a real risk that someone not actually eligible for assisted dying would none the less be so assisted. In such matters of life and death, we ought to proceed with great caution.

Doctors can get things wrong, of course. If the first independent doctor did get it completely wrong, I would have no objection to the second independent doctor effectively acting as a form of appeal—or, to borrow the test from the law of medical negligence, if the first independent doctor reached a conclusion not supported by a reasonable body of medical opinion, of course it would be right for that opinion to be disregarded. But that is not what the Bill provides for, which is not an appeal or reconsideration but picking a new referee simply because the first answer was not desired.

I still have misgivings about clause 10 notwithstanding the fact that it has been amended. I urge other Committee members to vote against it. I appreciate your indulgence, Ms McVey.

[Rebecca Paul]

I rise to speak against clause 10 as it allows doctor shopping in the event that someone does not qualify for assisted dying. “Not happy with the verdict? Just find another doctor!” How many times are we happy for a patient to try again with a different doctor? It is inevitable that at some point the patient will find someone willing to make the statement and put them on their way to an assisted death, even if their eligibility is in doubt.

When I put forward the amendments tabled by my hon. Friend the Member for West Worcestershire (Dame Harriett Baldwin), which requested residual discretion for doctors, they were challenged by Committee members on the basis that the whole point of having defined criteria was so that they determined whether a patient was eligible. I run the same argument now: if the process is followed to the hilt and the independent doctor refuses to issue the statement, why on earth would we allow another bite—or even multiple further bites—at the cherry? Surely that is to allow abusers a way to push their victims into an assisted death by re-running the process again and again until they find a less attuned doctor.

Imagine the case of an elderly woman who has spent a lifetime under the coercive control of her husband. She is completely done with it all, and sees death as a welcome way to escape this man, who has made her life a misery. The abuse has escalated since she has become ill: because of her ill health, she cannot cook or clean any more, and he hates that. But no one sees. She never wanted the kids to know; she is really good at hiding it. Now, he wants to seek an assisted death, because it is better for them all. She agrees. When asked by a doctor, she is unlikely to say, “My husband is pressuring me into this, and I’m afraid of not doing what he wants,” particularly if she has suffered abuse over many years.

Let us say that the first independent doctor does a really thorough job—the kind of job that we hope all doctors would do. Perhaps the doctor manages to discern that the patient is very much controlled and unduly influenced by her husband. The trouble is that it can be very difficult to find hard evidence of coercive control. According to recent figures, only 3.7% of recorded cases of controlling or coercive behaviour result in a charge, and more than half of cases are dropped because of evidential difficulties. The doctor therefore cannot get the police to intervene; his only lever is the power to reject the application. So that is what he does. But the patient does not give up; she is still absolutely sure that the best thing is an assisted death, and her abuser is still whispering in her ear, telling her she is right.

The second independent doctor does not have the same emotional intelligence as the first, and he does not see what the first doctor saw. He approves the application.

--- Later in debate ---

Replacing the coordinating doctor on death etc

[Sarah Olney (Richmond Park) (LD)]

I beg to move amendment 461, in clause 11, page 7, line 15, leave out “or otherwise”.

[The Chair]

With this it will be convenient to discuss the following:

Amendment 310, in clause 11, page 7, line 23, at end insert

“and

(c) to ensure the High Court is notified of the substitution of the coordinating doctor and the reason for the substitution.”

This amendment would include ensuring the High Court is notified of substitutions of the coordinating doctor in the list of matters the Secretary of State may by regulations make provision for.

Amendment 309, in clause 11, page 7, line 23, at end insert—

“(3) Regulations under subsection (1) must include provision to require the reassessment of the patient under section 7.”

This amendment would require a regulations covering the replacement of the coordinating doctor to include a reassessment of the person by the new coordinating doctor.

Clause stand part.

[Sarah Olney]

The amendment would remove the phrase “or otherwise” in the clause. All I am proposing is for the wording to be consistent with amendment 205 to clause 10, which has just been agreed. It does not specify “or otherwise”, but simply uses the words,

“the practitioner dies or through illness is unable or unwilling”.

What might “otherwise” incorporate? It indicates that there might be a range of reasons beyond death or illness why the co-ordinating doctor would drop out. In many ways, I am trying to probe what the other reasons might be. If there are no other reasons, and consistent with amendment 205 that we have just agreed, we should drop the phrase “or otherwise”.

--- Later in debate ---

[Kim Leadbeater]

I will speak briefly about amendment 461. A co-ordinating doctor is central to the whole process set out in the Bill, from start to finish. If a co-ordinating doctor becomes unavailable, a replacement would need to be found. There may be a number of reasons, not restricted to the doctor’s own death or illness, why that could happen. We have already heard a few examples—it could be retirement, maternity leave or anything going on in that doctor’s personal life. A close family member might fall ill or die, or something else might happen in the doctor’s life that forces them to withdraw. We have talked a lot about patient autonomy, quite rightly, but we need to think about the autonomy of the doctors involved in the process as well. It is therefore important that they have the ability to step away, as set out in clause 11. Additionally, I associate myself with the Minister’s comments about amendments 309 and 310. It feels as though those amendments do not necessarily do what was intended.

[Sarah Olney]

I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Amendment made: 206, in clause 11, page 7, line 24, leave out subsection (3).—(Kim Leadbeater.)

See the statement for Amendment 188.

Clause 11, as amended, ordered to stand part of the Bill.

--- Later in debate ---

[The Chair]

I should let the hon. Member know that I am happy for her to make five speeches, as she has indicated, but each one needs to be specific to the clause and not replicating the previous speech.

[Sarah Olney]

I will speak briefly about an important point that the hon. Member for Spen Valley made. I want to get it on the record that I disagreed with something that she said. We heard a lot in the evidence sessions about the desirability of a multidisciplinary approach or a multi-professional team, and I listened particularly carefully to Dr Sarah Cox, who gave oral evidence to the Committee on 28 January on behalf of the Association for Palliative Medicine of Great Britain and Ireland. She made important and interesting points regarding the desirability of the involvement of multidisciplinary teams in relation to her area of expertise: palliative care.

I am anxious that the panel that the hon. Member for Spen Valley is now proposing is being presented as a response to the comments of Dr Sarah Cox in relation to multi-professional teams, when it is clear that she meant something quite different. My interpretation of what she said was that the initial assessment should be done by a multi-professional team; what is being proposed here is something that happens much later in the process.

[Kim Leadbeater]

To be clear, the point I have tried to make with regard to the evidence that we received was just that there is a need for a multidisciplinary approach, wherever it happens.

[Sarah Olney]

I am glad to have had that clarification; however, it is really important to reflect on the fact that Dr Sarah Cox said that it would be considerably preferable to have the input of a multidisciplinary team at the earliest possible stage. That is not what is being proposed with these new clauses.

[Kim Leadbeater]

The point is that it has to happen at every stage, and I think the evidence that we heard was that it does happen. I know from the experiences of family and friends of mine who have had cancer that it does happen. There is a multidisciplinary approach; there is an oncologist, a nursing team and a doctor. That does happen, and nothing in the Bill will take away from that.

[Sarah Olney]

I thank the hon. Member, but I think she is responding to a slightly different point from the one that I made.

There was further written evidence from Dr Doré, the honorary secretary of the Association for Palliative Medicine, on 25 February. He wrote:

“To clarify any misunderstanding, the current Bill does not align with the standard multi-professional team…decision-making process used across the health service.

Under the Bill, patient assessments are conducted solely by two doctors without input from a wider MPT. While an amendment proposes the involvement of a panel—including a social worker and psychiatrist—this panel is introduced only at the end of the process and does not participate in the patient’s direct assessment.

We wish to make it clear that the point that Dr Cox was making in oral evidence was that having two independent doctors, working alone, is not an adequate model to safeguard either patients or professionals, and that stipulating that the initial assessments must be carried within a multi-professional team model would strengthen the Bill.”

--- Later in debate ---

[Kim Leadbeater]

Does the hon. Member not agree that by accepting amendment 6, tabled by the hon. Member for St Albans, we have early intervention with psychiatric analysis at a very early stage, when either of the doctors feels it is necessary?

[Sarah Olney]

I am grateful for amendment 6 and to my hon. Friend the Member for St Albans for tabling it. I put on record, however, that I do not think that the panel that we are discussing addresses my earlier concerns. I wanted to make that absolutely clear by highlighting the further evidence from the Association for Palliative Medicine. The panel proposed by this group of amendments does not address its concerns, or the concerns of many other people who were saying that there needs to be a multi-professional team.

[Jake Richards]

I rise to speak in support of new clauses 14, 15, 17 and 21 and the accompanying amendments. I hope also to deal with some amendments tabled to new clause 21.

On Second Reading, I and many other hon. Members said that the Bill was the strongest and safest assisted dying law in the world. I want to be clear that I stand by every word of that, but this change will make the Bill far stronger and far more resilient to questions of capacity and coercion and therefore far safer. It will ensure a further independent layer of assurance: a panel of experts chaired by a senior lawyer to hold the process to account, to ensure that every avenue of inquiry has been explored and to hold professionals in our healthcare system to account when it is appropriate to do so.

The change will replace a single High Court judge, a person with no particular expertise in the issues at hand, with a panel that will adopt a more holistic approach. The social worker will delve a little deeper into the personal circumstances of each individual. The psychiatrist will ask any necessary questions about capacity. They will serve alongside a senior lawyer to ensure that the process is necessarily formal and strict. They will have the powers to make further inquiries if they so wish.

On and after Second Reading, there were legitimate questions about the High Court function—what exactly were we asking the judge to do? I maintain that a High Court judge could have overseen the process, but it is far better and more pertinent to the issues at hand to have a multidisciplinary process involving a social worker and a psychiatrist.

This is our lawmaking process working efficiently: debate has pushed my hon. Friend the Member for Spen Valley to think again. Working with the Government —whose role continues to be to ensure that the Bill will be workable if it is to gain Royal Assent, while remaining neutral on the principle—she has been creative in tailoring a process to the matters at hand. That must be welcomed.

This is new law. The change that the Bill would enact is profound and therefore requires a very new safeguarding process. This is the key point. The panel would not be there to adjudicate on a dispute, undertake a trial or undertake an inquiry; it would be there to ensure that the process is safe. A person would come to the panel seeking assistance to which they are entitled under the law, and the panel would ensure that the process through which their eligibility has been decided has been rigorous and safe.

It is also important to note that the panel would simply regulate and scrutinise an ongoing doctor-patient relationship. Even after a certificate of eligibility has been received, there is a period for reflection and continued assessment. That is crucial, because it means that normal rules of appeal are not appropriate—I will come back to some of the amendments in that regard. Even once the panel’s work is done, the co-ordinating doctor and the commissioner will remain available for reconsideration and oversight.

I want to deal with some of the criticisms that have been levelled at the change set out in the amendments tabled to new clause 21 and others. To my mind, the process should not be adversarial, because it is inherently inquisitorial. What is the dispute that is being decided? The person is deemed to have capacity by two doctors, and perhaps a psychiatrist, to make a decision, and is seeking an eligibility certificate. The starting point must surely be that the person should be allowed to do so. To set up some bizarre dispute where none exists would be counterproductive and unsettling to the person at the centre of the process. It would be a waste of public funds, but more importantly it would be a waste of time—time, in the context of a person who is dying.

The process is not analogous to the Court of Protection, where there are disputes as to capacity, best interests and welfare. It is not analogous to a court approval hearing, where there may be legal arguments as to the appropriate nature of an award or the arrangements for it. It is not analogous to a deprivation of liberty order, where in all likelihood a person would seek not to be deprived of their liberty. It is not analogous to private children’s proceedings, where the child’s welfare is paramount. This is a person seeking help for themselves. The principle of choice and autonomy at the end of life means that that process must be patient-centred and begin from an appreciation of those principles.