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

Sarah Sackman Excerpts

Committee stage
Tuesday 25th March 2025 Public Bill Committees

[Naz Shah]

As far as I have seen, no regulatory system has been proposed in regard to the Bill. I am happy to be corrected. Yes, in other instances we have regulators, but in this instance no regulator is specified. That is why I will come back to my argument about the amendment, but I value my hon. Friend’s intervention.

This is not how we regulate banks, which are overseen by independent authorities. We have seen what happens when there is light-touch regulation. Banks told us all that they were doing a great job until it turned out that they were not. There is an Independent Police Complaints Commission—I could go on, as the list is very long, but I hope we can all agree on the principle. When we regulate an important system in this country, we should not allow the people who run it to be the only people to tell us whether it is working as it should. Although we respect the highly skilled people who run our schools and police our streets, we have independent people whose job it is to check whether there are any major issues.

The assisted dying system created by the Bill is both complicated and, potentially, very dangerous. If the system gets things wrong, it will mean that people will be given lethal drugs who should not have had them. That is why I would strongly support keeping the chief medical officers as the people who run monitoring, investigating and reporting. Perhaps there could be a dual system in which both the CMOs and the VAD commissioner have some kind of role. That would at least be an improvement on allowing the assisted dying commissioner to say, “There’s nothing to see here.” In my view, the best choice would be to retain the system that the Bill started out with and keep the chief medical officers as the people with the main responsibility for oversight.

Members disagreed with my comparison of assisted dying with the scandal of what happened to the sub-postmasters and mistresses, but we have to think about what we have learned about the causes of that scandal. Under the law, Ministers had responsibility for the Post Office. Even though it was an arm’s length responsibility, they still had it. When complaints about the Horizon IT system, and then complaints about miscarriages of justice, started to come through to MPs, Ministers asked the experts in the field. Who were those experts? The executives who ran the Post Office and the engineers at Fujitsu who had set up and then run the Horizon system. What did those experts say for about 15 years? That there were no serious problems with Horizon, that the sub-postmasters and mistresses who said otherwise were lying and that all their convictions were safe. We know how that turned out.

That surely leads us to a clear lesson: we cannot ask powerful people who have created and are in charge of a system—in this case, the assisted dying system—to be the ones who report on it. I am not saying that we would see a deliberate cover-up, as there seems to have been in the Post Office scandal. What I am saying is that we all have unconscious biases and all of us are biased to think that the work we do is good and that there are no serious problems with it.

Amendment 382 significantly weakens the version of the Bill that was presented to the House on Second Reading. We are being asked to let the commissioner report on their own work. That makes it much less likely that we would be able to spot any problems with the assisted dying system at an early stage. I therefore urge Members to vote against the amendment.

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

It is a pleasure to serve under your chairship, Mrs Harris. I will speak first to lead amendment 382 in the name of my hon. Friend the Member for Spen Valley, and then to consequential amendments 383 to 387 and 389, on which the Government have worked with the Bill’s promoter.

As the Committee will know, the Bill currently requires the relevant chief medical officers to submit an annual report to the relevant national authority. The amendments would require that the monitoring, investigation and reporting functions under clause 34 are carried out by the voluntary assisted dying commissioner, as opposed to the chief medical officers for England and for Wales, as currently drafted. The functions are to

“monitor the operation of the Act, including compliance with its provisions and any regulations or codes of practice”

that are developed; to investigate and report on

“any matter connected with the operation of the Act”,

including those that have been referred to the Secretary of State or Welsh Ministers; and to “submit an annual report”. The Secretary of State or Welsh Ministers would be required to lay the commissioner’s annual report before, respectively, Parliament or the Senedd, and issue a formal response.

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I think that CMOs should be the main officials reporting on the assisted dying system—as I have said repeatedly today; it is a very important point—but, since the Bill’s promoter is tabling amendments that mean that only the CMOs should be consulted on the commissioner’s report, we need clarity on what that should mean. These amendments, unfortunately, do not give that. Amendments 455 and 456 would leave us with a much weaker system of monitoring and reporting than is in the Bill as drafted, which is why I do not support them. I hope that other Members will also reject them.

[Sarah Sackman]

It is a pleasure to serve under your chairship, Sir Roger. I will turn first to the lead amendment, amendment 450, in the name of my hon. Friend the Member for York Central.

As clause 34 stands, the chief medical officer must submit an annual report on the operation of the Bill. Under amendments tabled by the promoter, my hon. Friend the Member for Spen Valley, that would be the responsibility of the commissioner. Amendment 450 would require the chief medical officer to produce an annual equality impact assessment that assesses access to both assisted dying and palliative care for those with protected characteristics, and by socioeconomic status and geographical location.

The amendment seems intended to ensure that monitoring and reporting considers the impact of the Bill on vulnerable groups. Protected characteristics are defined by reference to section 4 of the Equality Act 2010, which means that the report would need to consider the characteristics of age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation.

The term “equality impact assessment” is not defined in the amendment or elsewhere in the Bill. While equality impact assessments are produced routinely by Government and other public bodies in order to discharge the public sector equality duty, it is not clear what type of assessment amendment 450 would require, so, in practice, there may be difficulties for the chief medical officer in understanding whether the duty has been discharged. Impact assessments are not within the purview of a chief medical officer and should be undertaken by those who are appropriately qualified to carry them out.

In addition, “socioeconomic status” and “geographical location” are also undefined in the amendment and are not defined elsewhere in the Bill. Socioeconomic status and geographical location are not of themselves protected characteristics under the Equality Act, so are not required to be considered as part of the public sector equality duty. It is not clear, therefore, what the assessment of those factors is intended to involve.

[Naz Shah]

While I appreciate that it is not necessarily a duty as defined in law, does the Minister not agree that, given the way our Government operates, we need that data to inform us, in order to improve services elsewhere? We could apply that to this Bill as well.

[Sarah Sackman]

It is right that the commissioner, in their role of scrutinising the operation and workability of the assisted dying regime, could, under the powers conferred by the Bill, look at a range of factors, and indeed at whatever they deemed relevant to discharging that exercise. The question is: what is appropriate to be defined within primary legislation? The Government’s position is that, given that all public bodies are governed by the Equality Act, due regard to all those protected characteristics would be included. However, what is not defined within amendment 450 is socioeconomic status or geographic location. If, down the line, the commissioner wanted to look at those things, they could look at them.

[Naz Shah]

From a public health perspective, we have been having a huge debate for weeks and weeks about whether or not this is a health intervention and whether it should be provided in the NHS or elsewhere. When I was a public health commissioner, we collected socioeconomic data to learn about not just protected characteristics but socioeconomic background. There are concerns that disadvantaged groups are more vulnerable. Would it not be appropriate for the Bill to address those safeguarding issues?

[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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[Rebecca Paul]

I would not choose to have this specific definition in the Bill. There may well be another definition that I would be more comfortable with, so I cannot rule that out. However, I completely agree with the hon. Lady that this has been a helpful debate, and I really appreciate her tabling the amendments so that we could have it.

[Sarah Sackman]

Bear with me one moment, Sir Roger. I have just had a message, and I want to see whether it is relevant to what I want to say. Forgive me.

[The Chair]

I think it says, “Keep it brief.”

[Sarah Sackman]

I was just checking that my eyes are not failing me.

It is good to see consensus break out across the Committee on these issues. For what it is worth, both as a Government Minister and a Committee member, I think it is excellent that we have had this debate on definitions. All members of the Committee have an interest in ensuring that where the words “coercion”, “pressure” and “dishonesty”, which run through all the relevant amendments, appear in the Bill—whether in relation to the eligibility criteria or the criminal offences—they operate as intended and with the breadth to capture the range of behaviours they are seeking to safeguard against.

I will be brief because we have rehearsed a number of these issues before. Indeed, my hon. Friend the Member for Penistone and Stocksbridge has stolen my thunder in many respects and said a lot of what I was going to say. In relation to the definitions of coercion, pressure and dishonesty, to which the various amendments relate, it is important to note—and this is the Government’s view—that including a statutory definition would risk overcomplicating the issue and inadvertently narrowing the protections that the criminal offences in the Bill are intended to provide. At the moment, the Bill does not include a statutory definition for any of those terms. As a consequence, they carry their natural meaning, as construed by the courts, and therefore have, in practice, a broad meaning.

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[Jack Abbott]

At this point, I pay tribute to my hon. Friends the Members for Penistone and Stocksbridge and for Bexleyheath and Crayford. They have consistently tabled really important amendments that are very close to my heart, measurably improving the Bill.

I am briefly speaking in favour of new clause 35. We have had a number of good amendments about ensuring proper representation for vulnerable people during the process. We have also had a lot of discussion about the very important need to regularly monitor and report back on the Bill. This new clause brings all this together, ensuring that there is real oversight, with real thrust and a point to it. It is not good enough just to report back some statistics; the question is what we do with them. Having this sort of panel, with expertise and life experience, would be a significant step forward for people with disabilities, learning needs and anything else that might be included.

Once again, I pay tribute to my hon. Friends for this work. I am fully supportive of the new clause.

[Sarah Sackman]

I hope to be brief, given it is the witching hour.

This new clause would require the voluntary assisted dying commissioner to establish within six months of their appointment a disability advisory board. The advisory board must include representation from disabled people and disabled people’s organisations. Within six months of its appointment, the advisory board must report to the Secretary of State and the commissioner to advise on the implementation of the Act for disabled people. We anticipate that the advisory board’s annual report will be separate from the commissioner’s, and that in time this may be subject to a level of integration between the two bodies. Practical arrangements for the advisory board would require further consideration, but the Government can see no workability reason why this should not go ahead.

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

Sarah Sackman Excerpts

Committee stage
Tuesday 11th March 2025 Public Bill Committees

[Jake Richards]

I will speak briefly, because many of these issues and themes will be debated in clause stand part and amendments 371 and the others from my hon. Friend the Member for Spen Valley. Amendment 267 was not moved, but I would have opposed it in any event, on the basis that the discretion given there was way too wide and I did not understand the basis of the amendment in any way. Amendments 105 to 107, tabled my hon. Friend the Member for Derby North (Catherine Atkinson), attempt to add an adversarial element to proceedings. Again, I will not comment too much because that issue comes back in the fourth grouping under this clause.

I turn briefly to amendment 410, to which my hon. Friend the Member for Broxtowe just spoke. My understanding is that, although this relates to the High Court—which may be deemed redundant as we move on through this clause—the amendment aims to limit the people that the judge or panel can hear from. In my view that would be wrong and dangerous. The purpose of a judge or a panel is to explore the circumstances in this matter. That must mean that they have discretion to hear from others as well. In my view, this amendment, if passed, would significantly limit the safeguards and be quite dangerous.

As my hon. Friend has already said, amendment 407 has been superseded, and I think we all agree on that.

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

It is a pleasure to serve under your chairship, Mrs Harris. As I and my colleague and hon. Friend the Member for Aberafan Maesteg have made clear throughout the debate, the Government continue to remain neutral on this Bill and do not take a position on assisted dying. My remarks will therefore focus on the legal and practical impact of the amendments, to assist the members of this Committee in undertaking line-by-line scrutiny.

Amendments 267 and 105 to107, which have now been withdrawn, deal with the Bill as currently drafted in relation to the High Court. Clause 12 as currently drafted would require the High Court to make a declaration that the requirements of the Bill have been met, following a person’s first declaration to receive assistance to end their own life, with statements from a co-ordinating doctor and an independent doctor. The amendments relate to how the High Court will declare itself satisfied that a person has a clear, settled and informed wish to end their own life and that they have not been coerced or pressured.

Briefly, amendments 407 and 410 seek to change who the High Court—as others have said, we might come on to debate some of these themes relation to the panel—would engage with when considering applications for assistance under the Bill. In determining whether the person has a clear, settled, and informed wish to end their life and that they have not been coerced or pressured, the High Court would be required to hear from and question the person seeking assistance, as opposed to having the option to do so. As my hon. Friend the Member for Spen Valley pointed out, in the later provision in relation to the panel, that has now become a requirement.

As my hon. Friend the Member for Broxtowe made clear, under her amendment 410 the High Court would lose the ability to hear from or indeed question any other party other than the person seeking assistance and the assessing doctors. Removing the ability—whether of the High Court or, as we may come on to debate, of the panel—to hear from and question any other party may limit that body or court’s ability to interrogate wider evidence or points of view.

[Juliet Campbell]

The probe that I have on that point is that the individual who is seeking the assisted death, and the doctors who have been working with that person, really have all the information. I am trying to ascertain, if we are not going to agree on this amendment, who else they would be seeking information from. Is there a risk if they are getting evidence from family members or other people, or having them give evidence or speak on behalf of that declaration?

[Sarah Sackman]

As I understand it, both in the context of the High Court—which has the ability to speak to whomever it likes—and of the panel, when we come to debate its role, that is a discretion. It is a requirement to hear from the person seeking an assisted death; it is a requirement to hear from the co-ordinating doctor. However, hearing from others is discretionary, which means that, if it is necessary in order to be satisfied that the eligibility criteria are met—which is what the scheme requires—in that context, under the panel’s or the High Court’s discretion, it may seek evidence from elsewhere. That is what the provision, as the Government reads it, is designed to do.

The amendment that my hon. Friend the Member for Broxtowe puts forward clearly limits that discretion; whether that is desirable is a policy choice, but that is how it is intended to function. As I have said, the Government will continue to remain neutral on these substantive policy questions, but I hope that is useful to members of the Committee.

[Kim Leadbeater]

I think I have responded to the hon. Member for Broxtowe on amendment 407 by saying that the concern will potentially be covered by my new clause 21. On amendment 410, it is also my view that, whether it is the High Court or the panel or whoever we end up having over the course of this Committee, that third layer of scrutiny and safeguarding should be able to hear from other people, not just the patient and the doctor, so I would not support that amendment.

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[Danny Kruger]

I recognise that we are moving on and that we want to get on to the substantive clauses, and I certainly will not press these amendments to a vote. However, I want to put on record that I have extreme concerns about the role of the proxy in clause 15. It is unclear to me why a proxy is needed. I regret that we are not sticking with the High Court process, which would have enabled us to debate these amendments at this stage, but I will let it pass.

[Sarah Sackman]

Amendments 432 to 434 would remove provisions regarding proxies from the Bill. They deal with proxies in the context of the High Court process. As a consequence, the High Court would be unable to hear from the person’s proxy where the proxy has signed the first declaration, and the person would be unable to use a proxy to authorise a medical practitioner to provide assistance to end their own life. Removing the ability for persons seeking assistance to use a proxy would limit access to the assisted dying process for people who, for example, have a physical impairment, are unable to read or are for some other reason unable to sign the declaration. As I said earlier, the Government remain neutral, but I hope that provides some context and an explanation of how the amendments would operate.

[Kim Leadbeater]

I will be brief, because we will come on to this debate when we get to clause 15. To be clear, the circumstances where a proxy would be involved in this process are literally when somebody is so ill that they are unable to sign their own name, so it is a very limited set of circumstances.

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[Danny Kruger]

Again, I will not press this amendment; I just want to put on record my support for the principle. This amendment, tabled by the hon. Member for York Central, is quite a clever device: if we were sticking with the High Court, it would have meant that someone with genuine concerns, for example a family member or acquaintance of a patient, could flag them without needing to be informed that the application was going ahead.

As we have discussed, there is a concern about these proceedings happening in the dark, as it were, without wider family being informed. If a family member suspected that there might be an assisted dying application in the works and that they were being excluded from consideration or discussion of that, there would have been the opportunity to put on record their concern, which would have required the judge to take a wider consideration than would be enabled without this amendment. I regret that that is not happening, but it may be possible through the course of the Bill to ensure that there will be further opportunities to introduce such measures. I welcome that new clause 21 would impose a requirement on the panel to consider family members, so there is an element of the right system there.

[Sarah Sackman]

Amendments 312 and 313 would make several changes to the process for High Court approval of applications under the Bill as drafted. Amendment 312 would allow a person who believes that the requirements of the Act have not been met to make that known to the High Court and to be heard before a declaration is made. The proposed mechanism is that the person would enter a caveat in any district registry of the High Court within 14 days of the application being lodged or received.

Of course we will come to later amendments, but under the Bill as drafted, the High Court has the power to hear from and question any person to determine whether the applicant has a clear, settled and informed wish to end their own life, and that they have not been pressured or coerced, so there is that mechanism to hear from others through that channel.

Amendment 313 would enable appeals to be made against a decision by the High Court to make a declaration, as opposed to only where a declaration is not granted. As drafted, the Bill provides that any person may seek a judicial review of any decision of the High Court, including the decision to make a declaration, if they are adjudged to have standing.

Amendment 269 would enable any person, other than the person seeking assistance, to apply for permission to appeal to the Court of Appeal against a decision of the High Court. The amendment would also enable appeals to be made against a decision by the High Court to grant a declaration, as opposed to only where a declaration is not granted. The Court of Appeal would not be obliged to consider the matters set out in the Bill when forming its decision. It is important to say that whether with or without the amendment, any person may still seek a judicial review of any decision of the High Court, if they are adjudged to have standing.

[Kim Leadbeater]

I have nothing to add.

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

Sarah Sackman Excerpts

Committee stage
Wednesday 26th February 2025 Public Bill Committees

[Stephen Kinnock]

I think the right hon. Member has outlined what I was saying, in slightly sketchier terms, about legislation, regulation, training, capacity building and delivery. What he has described falls under what I would broadly refer to as regulations, but within that there are a multitude of interventions, which could include codes of practice, other forms of legislation, other forms of guidance—

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

Common law.

[Stephen Kinnock]

Indeed: common law, jurisprudence and whatever a professional body might take as a steer for delivery. It is then about the professional judgment of the professional body.