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

Simon Opher Excerpts

Committee stage
Tuesday 25th March 2025 Public Bill Committees

[The Chair]

For the avoidance of confusion, these new clauses will not be voted upon now. You will have the opportunity to move them formally later, when we reach them at the appropriate time in the course of consideration.

[Dr Simon Opher (Stroud) (Lab)]

I find the delay of four years that new clause 40 would introduce excessive in terms of the time taken and needed to deliver the requirements to implement the Bill in legal terms. I urge the Committee to reduce that at least to three years. That would mean four six-month checks, rather than six. The reason is that we have created a thorough Bill that is ready to implement. I understand that there are some pressures on the Department of Health and Social Care, so I accept a year’s delay. My worry is that a four-year delay might well take us past the next election and that the Bill will become an issue in the election.

[Daniel Francis]

That new clause was tabled within the last week. Has my hon. Friend sought advice from the Clerks? The only way that we could amend this now is through a manuscript amendment, and I presume that now, at the eleventh hour, that would not be allowable. I just want to clarify the position.

[Dr Opher]

I am afraid I do not understand how we could change this. I just wanted to put on record that I feel that a four-year delay is excessive. I have nothing further to add to that, but I would be interested in the legal opinion on whether we can change it.

[The Chair]

Again, for the avoidance of doubt, a manuscript amendment at this stage would not be accepted.

--- Later in debate ---

[Danny Kruger]

I beg to move amendment 527, in clause 40, page 24, line 14, at end insert

“provided that such remuneration is not structured in a manner where it would be greater as a result of the registered medical practitioner approving the request.”

This is the point at which the season of consensus is over; I am back to opposing. Amendment 527 would insist that any remuneration for taking part in assisted dying on behalf of the medical profession would not enable a system whereby a medic, practice or private provider would be remunerated according to approving the different stages of the process. I am trying to prevent the provision of any incentive in the system for moving people through it.

We know that there can be a paid private service delivered under the Bill. The concern is that we will create perverse incentives in the system that will prejudice objective decision making. I take the points about the disinterested good faith of all medics; nevertheless, I do not want to put them in danger of feeling the pressure of perverse incentives. We must recognise the importance of keeping absolute financial neutrality in the operation of the Bill. There would be significant ethical red flags about a system that essentially enabled performance-related pay tied to approving requests for assisted dying, let alone paying doctors to provide referrals to a co-ordinating doctor. At the moment, I do not see that the Bill prevents that.

Even if there were no such danger, I am not sure that patients would buy it. From the point of view of trust in the medical profession, we must bear in mind that any doctor could be involved. Any doctor could either raise the suggestion or be required to signpost a patient who raised it themselves—the whole of the NHS is essentially implicated in the proposed system. As the hon. Member for Spen Valley has reiterated today, she wants assisted dying to be an integral part of the NHS. Let us protect the NHS from the distrust of patients by ensuring that financial incentives are not in the mix for these life and death decisions.

[Dr Opher]

Although I see the hon. Gentleman’s ideas and points, what will be paid for here is the assessment. I know no medical process where the outcome is paid for, rather than the assessment. Although I can see that his concerns are real, I do not believe—

[Danny Kruger]

I am sorry to cut off the hon. Gentleman mid-flow, but he says he cannot think of an instance when the outcome will be paid for. It would perhaps not be about paying for the outcome—paying for death; for a dead body—but there could well be payments for the process leading up to that. That is the way medical payments work at the moment. Someone might get paid for the assessment, the second assessment, or the administration of the drugs. People do get paid in the NHS for delivering a treatment. Why would that not be the case here?

[Dr Opher]

I understand the hon. Gentleman’s concern, but that is just not the way that medicine works. The doctor is under a code of practice, so if he is seen to lie about assessment of capacity or coercion, for example, to enable him to approve the decision and then go on to assist the dying, he would be well outside that code. He would be referred to the General Medical Council and, in such a case, struck off the medical register. I understand the reason for the amendment moved by the hon. Gentleman, but I do not feel that it is necessary in this part of the primary legislation.

--- Later in debate ---

[The Chair]

Order. I had indicated that I would suspend the sitting at 10 pm, but in the interest of continuity, I propose that we should conclude debate on this clause and then suspend for 15 minutes.

[Dr Opher]

I will be very brief. This is the most difficult speech I have had to make in the Committee. I think all of us who support the Bill are disappointed; I am sure that my hon. Friend the Member for Spen Valley is incredibly disappointed. I believe that the Bill is deliverable within two years, but I have wanted this legislation for about 25 years, and my main aim is that the Bill passes. I understand, from certain dialogues I have had, that that is more likely if we accept amendment 548. In short, therefore, I will support the amendment. I will do so reluctantly, but it has my full support and I will vote for it.

[Naz Shah]

May I thank the hon. Member for Harrogate and Knaresborough for sharing something so deeply personal? I am sure I speak on behalf of the whole Committee in wishing his mum well and hoping that she never has that diagnosis.

I rise to speak to amendments 489 and 488. Amendment 489, tabled by my hon. Friend the Member for York Central, would prevent the Bill’s provisions from coming into effect automatically after a certain period had elapsed. The Bill in its original form includes a measure to that effect, in clause 42(3):

“But if any provision of this Act has not been fully brought into force before the end of the period of 2 years beginning with the day on which this Act is passed, that provision (so far as not already in force) comes into force at the end of that period.”