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

Sarah Sackman Excerpts

Committee stage
Wednesday 12th February 2025 Public Bill Committees

[The Chair]

Before I call Minister Sackman, I remind Members that “you” refers to me, not the person they are speaking to. Can we be very careful with the use of “you”?

[The Minister of State, Ministry of Justice (Sarah Sackman)]

I know that Members will be eager to engage, and have already engaged, in a robust discussion about the issue of safeguarding, and how best to protect and prevent individuals from being forced or coerced into seeking assistance to end their life. As my hon. Friend the Member for Aberafan Maesteg has said throughout the debate, I will not be offering a Government view on the merits of any proposed amendments tabled by Members. Instead, I will offer some observations on the legal and practical effects of the amendments, to assist Members in undertaking line-by-line scrutiny.

As a starting point, we have heard a series of concepts discussed in this debate, including manipulation, pressure, coercion, undue pressure and encouragement with coercive ends. There is a range of terms that some Members have used interchangeably, and fairly so. It is important to say that there is a consensus that all those things are unacceptable; the point, and the Government’s view, is that the current provision in clause 1(2)(b) would cover that behaviour with the currently used terminology “coerced or pressured”.

Amendments 23 to 33 set out to include consideration of whether a person has been unduly influenced, in addition to having been coerced or pressured by another person, in the determination of whether that person is accessing assisted dying voluntarily. As I have already indicated, the Government’s view is that the terms “coerced” and “pressured” would cover the term “unduly influenced” as it is understood. If the Bill is voted into law, the guidance and training for the healthcare professionals who would apply the tests would need to be developed to cover that sort of behaviour in this specific context.

Similarly, amendments 82 to 92 and new clause 5 seek to introduce an additional safeguarding requirement that a person has not been encouraged into undergoing the assisted dying process. It is important to contextualise the amendments, which would introduce this new safeguarding requirement into all the relevant clauses of the Bill where a doctor—or a court or panel, if that is what transpires—must already make an assessment as to whether the person has the relevant capacity, has a clear and settled wish, is making the declaration voluntarily and has not been coerced or pressured by any other person into making it.

I have listened to the debates about what encouragement may or may not mean in this context. As I understand it, new clause 5 states that the definition of encouragement is that which would constitute an offence under section 2 of the Suicide Act 1961. In reality, that Act does not specifically define encouragement in legislative terms, so there is a risk that the definition becomes somewhat circular. As I will come to in a moment, as with the terms “coercion” and “pressure”, the meaning given to “encouragement” by the courts, where it is not defined by Parliament, is its natural meaning.

I now turn to amendments 113 to 115 and 118 to 122. Let me deal first with amendments 113 to 115. As the Bill is currently drafted, registered practitioners who act as co-ordinating and independent doctors are required to establish that the person seeking assistance has not been coerced or pressured. People seeking assistance to end their own life are also required to confirm in the first and second declarations that they have not been coerced or pressured. The amendments seek to add an additional requirement to establish that the person seeking assistance to end their own life has not been manipulated by any other person into making the decision.

--- Later in debate ---

[Naz Shah]

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

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

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

[Sarah Sackman]

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

[Danny Kruger]

Will the Minister give way?

[Sarah Sackman]

I am going to make a little more progress; we will come back to that in a moment. It is really important that we have these concepts in other parts of criminal law and other parts of our legislation. I come back to the point that we run a risk, which runs counter to the intent that lies behind the amendments, if we add additional language into the Bill. I will develop that point and then take further interventions.

As we have seen, clause 1 includes the terms “pressured” and “coerced”. The ordinary meaning of the word “pressure” is the use of persuasion or intimidation to make someone do something. There are broad types of behaviour, many of which have been eloquently brought into this debate, that would come within that. The ordinary meaning of the word “coerce” is to persuade someone to do something against their best interests by using force or threats. That could be subtle or it could be very blatant, but the word “coerce” is understood in that way by our courts and in other areas of our legislation. One can readily see how an act of manipulation such as in the examples used earlier, or the exertion of undue influence—I think the term “unduly pressured” was used—would all fall within the terms “coerced” and “pressured”. That is the settled view of the Government.

There is a consensus that none of these things, including applying undue pressure, are desirable or acceptable in this or any other context, but there is a risk that adding terminology does not do what hon. Members intend, which is to create more safeguards. The risk is that by adding new words, those tasked with applying and interpreting legislation, if it comes to court, will assume there must be some specific reason for their inclusion. They will assume that the words must have some meaning distinct from the other words in the list—coercion and pressure—notwithstanding the fact that, on their natural meaning, the terms overlap and, in the Government’s view, are inclusive of those sorts of behaviours. That risks the effect of narrowing the interpretation of the words used rather than inviting our courts to give them their usual expansive meaning.

In turn, that risks casting doubt on the current interpretation of those words in existing statutes such as the Serious Crime Act, which created an offence for coercive and controlling behaviour, and limits any read-across on interpretations from previous decisions into the application that we are debating. In short, it may actually serve to limit, not to add, to the safeguards in the process. It may risk adding confusion and uncertainty where what is already provided for in clause 1, with the words “coercion” and “pressure”, are simple, readily understood, expansive definitions that would cover precisely the behaviours that I think the hon. Members who tabled the amendments are concerned about.

[Danny Kruger]

I think the Minister just suggested that if we were to amend the Bill, there would be some kind of unfortunate knock-on effect with other legislation, which would thereby be weakened. I hope the argument being made is not that we should leave this Bill weaker in order to protect other legislation. We need to get this right.

I have another suggestion, which I would be grateful if the Minister could elucidate a little more. The fact is that no official definitions of coercion or pressure that exist in statute either. The definition of coercion that she used—what case law has taught us coercion means—and the examples she gave of people essentially exerting coercive pressure on partners would, of course, be captured by the Bill currently but, as we have heard, there are circumstances that would not meet that threshold but that we all agree would be unacceptable. The only way to capture properly those examples of people being encouraged and unduly influenced into an assisted death is by making it clear that that is what doctors are required to look for.

I revert to the point I have made a number of times; I would be grateful for the Minister’s response to it. The Suicide Act, which the Bill amends, explicitly uses the term “encouragement” for what people should not be subject to, and pressure is a subset of encouragement. It is not the other way around. Encouragement is not captured in pressure; pressure is captured in encouragement. Why do we not acknowledge that encouragement is the correct catch-all term for all the sorts of undue influence we are trying to protect against?

[Sarah Sackman]

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

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

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

[Naz Shah]

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

[Sarah Sackman]

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

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

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

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

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

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

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