Terminally Ill Adults (End of Life) Bill

Stephen Kinnock Excerpts

Friday 16th May 2025 Commons Chamber

[Mr Speaker]

To be quite honest with you, the amendments that we have discussed are the ones that we have got through. On the amount of time allocated, in fairness, we are presuming what will come next. I am going to call the Minister; if a closure motion is moved, I will decide at that moment whether to accept it. The fact that many amendments may not have been spoken to is not unusual, which is why consideration will not last for one day, as per the normal procedure; it will continue over further days, on which further amendments will be discussed, and of course there will be Third Reading at a later date. I call the Minister.

[The Minister for Care (Stephen Kinnock)]

Thank you, Mr Speaker, and I thank Members across the House for their excellent contributions to the debate. As Members will know, the Government remain neutral on the passage of the Bill, promoted by my hon. Friend the Member for Spen Valley (Kim Leadbeater), and on the principle of assisted dying, which we have always been clear is a decision for Parliament. I therefore begin by clarifying that I am speaking in today’s debate as the Minister responsible, jointly with my hon. and learned Friend the Member for Finchley and Golders Green (Sarah Sackman), for ensuring that the Bill, if passed, is effective, legally robust and workable. She and I were pleased to be members of the Bill Committee, again to provide advice on the workability and technical effectiveness of the Bill as it went through detailed line-by-line scrutiny.

I will not, therefore, give a Government view on the merits of any individual amendments in terms of their policy intent, as defined by the Member who tabled them, as that is rightly a matter for the House to decide. I will instead focus my remarks on amendments that the Government deem to give rise to significant workability concerns, and those amendments that have been tabled by my hon. Friend the Member for Spen Valley with technical drafting support from the Government, which have been developed to ensure that the Bill is technically and legally workable.

While I will not give an assessment of all the amendments tabled by other Members, I ask the House to note that they have not been drafted on the basis of advice or with technical drafting support from officials. Therefore, the Government are unable to confirm that those amendments are fully workable, effective or enforceable, though I acknowledge the point made by the hon. Member for Bexhill and Battle (Dr Mullan).

I will begin with obligations, duties and protections for medical practitioners. New clause 10 and amendment 52, tabled by my hon. Friend the Member for Spen Valley, replace clause 28 and expand the safeguards to ensure that no person is under any duty to participate. The new clause also clarifies several functions where certain professions or persons are under no duty to participate, including social care workers, pharmacists or persons acting as a proxy or witness. Finally, it provides that certain functions cannot be opted out of—for example, the recording of matters in a personal medical record.

New clause 11 and consequential amendments 64 and 65, also tabled by my hon. Friend, provide for the replacement of the co-ordinating or independent doctor where that doctor is unable or unwilling to continue to carry out their functions under the Bill, other than through illness or death. A number of amendments have been tabled in this area by other Members, and I shall briefly set out the Government’s analysis of them.

--- Later in debate ---

[Several hon. Members rose—]

[Stephen Kinnock]

I will just make a little progress.

Amendment 60 may similarly prevent access to an assisted death for those residing within a care home or hospice, if that care home or hospice decided it would not allow such assistance on its premises.

[Sir Edward Leigh]

The Minister is making a very important point, and this is what I dealt with in my few short remarks. If, according to the Minister, care homes run by religious orders will have to provide this service, those orders will have to get out of care homes altogether.

[Stephen Kinnock]

I thank the right hon. Gentleman for that intervention. As I say, the Government do not take a position on the policy intent that my hon. Friend the Member for Spen Valley has set out. I would simply observe that if somebody has been in a home for a considerable period of time, that home is then considered to be their home. As such, any action to take them out of that home could engage article 8 of the ECHR, on the right to family life.

I now turn to the procedure for receiving assistance under the Bill, including safeguards and protections. First, I will speak to the amendments that have been tabled by my hon. Friend the Member for Spen Valley with technical workability and drafting advice from the Government.

Amendment 58 clarifies the duty on the Secretary of State to make through regulations provisions for training about reasonable adjustments and safeguards for autistic people and those with a learning disability. That remedies previously unclear wording in the Bill. Amendment 60 is required to make provision for circumstances where the independent doctor dies or, through illness, is unable or unwilling to act as the independent doctor. Amendments 67 and 68, tabled by my hon. Friend the Member for Spen Valley, clarify that an approved substance can be self-administered using a device should the individual be unable to self-administer without one. Amendment 91 gives effect to amendment 273, which was accepted in Committee, by ensuring that data will be recorded in the final statement to ensure coherence within the Bill.

I turn now to the amendments tabled by other Members on the subject of procedure, safeguards and protections that the Government have assessed may create workability issues if voted into the Bill. New clause 7 would limit the number of times two doctors can be jointly involved in the assessment of a person seeking assisted dying to three times within a 12-month period. In situations where there is a limited pool of doctors in any geographical location or area of medicine, that could limit access to assisted dying and create inequalities in access. New clause 9 would require the co-ordinating doctor, independent doctor and assisted dying review panels to apply the criminal standard of proof that requires them to be satisfied beyond reasonable doubt. Cases considered by the panel are civil matters, and as such it would not be usual practice for the criminal standard of proof to be applied to their decision making—and it is a very high bar. The provision would also impose additional standards on the assessing doctor that fall outside the usual framework for medical decision making.

[Gregory Stafford]

Is the Minister saying that, in his view, it is better that someone who should not die does die, than that someone who should die does not?

[Stephen Kinnock]

As a Minister at the Dispatch Box, with the Government being neutral, I am not commenting on the policy intent of the Bill. What I am saying is that the new clause could create significant uncertainty. For example, it is not clear how the standard it introduces would interact with the definition of “terminal illness” set out in clause 2, which requires that a person’s death

“can reasonably be expected within six months”,

as it is not clear whether “reasonably be expected” fits within the balance of probabilities threshold or is beyond reasonable doubt.

Amendment 101 would exclude any person with a learning disability, including people with Down syndrome, from a preliminary discussion about assisted dying unless they raise the subject themselves, irrespective of whether they would otherwise be eligible. That may be subject to challenge under various international agreements, including the United Nations convention on the rights of persons with disabilities and article 14 of the European convention on human rights, which prohibits disability discrimination.

Amendment 102 would introduce a requirement that

“the registered medical practitioner must ensure that the person has no remediable suicide risk factors which pose a significant risk to their life”

before holding a preliminary discussion under clause 5. The terms “remediable suicide risk factors” and

“a significant risk to their life”

have not been defined, so the amendment may be difficult to operationalise.

[Rebecca Smith (South West Devon) (Con)]

I tabled amendment 102 in good faith, as I thought it might be workable.

I want to reflect on what the Minister said at the beginning of his speech. I do not recall ever being offered an opportunity to pass my amendments to Government officials to ensure that they would be workable. Given the scope of what we are debating this afternoon, it sounds very much like any amendments that have not been tabled by the hon. Member for Spen Valley (Kim Leadbeater) had no chance of being taken forward unless she accepted them.

[Hon. Members]

Hear, hear.

[Stephen Kinnock]

I thank the hon. Lady for her intervention. She may have noted the comment from the hon. Member for Bexhill and Battle: approximately 500 amendments were tabled in Committee, and approximately one third of them were accepted. There was a pretty robust process for looking at whether amendments were acceptable, and the Government were involved in commenting and advising on all of them.

[Dr Ben Spencer]

Will the Minister give way?

[Stephen Kinnock]

I will make some progress, if I may.

Amendment 87 would require the co-ordinating doctor to “take all reasonable steps” to establish whether a first declaration had previously been made, so it may slow down the process for accessing assisting dying.

Amendment 45 would significantly impact the operability of the Bill. It would duplicate the role of the assisted dying review panel, and place an additional burden on the co-ordinating doctor to convene the clinical panel. It would also require additional NHS and social care resources, particularly palliative care consultants. That could slow down a person’s access to an assisted death, because there is no requirement on when the panel must be convened, and it could take some time to set up, given the demands on health and social care professionals. The amendment does not specify who is to be on the clinical panel in situations where the co-ordinating doctor is neither a GP nor a consultant. Similarly, there is no provision for whether the clinical panel is to make its decisions unanimously or by majority.

Amendment 48 would require significant changes to the functions and focus of the bodies that are proposed to present arguments to the panel as to why a certificate of eligibility could not be granted. Where an official solicitor acts as an advocate to the court, their purpose is to assist the court on a difficult or novel point of law, not to perform an adversarial function. Similarly, there is no precedent for the Attorney General, His Majesty’s Procurator General or the Treasury Solicitor to intervene in a case in the way that is envisaged, as their roles are to act on behalf of, or provide advice to, the Government, and not to represent a specific argument. In the Government’s view, there are no existing public bodies that are well suited to undertaking this adversarial role.

[Graham Stuart]

Has the Minister any sympathy with the point made by my right hon. and learned Friend the Member for Kenilworth and Southam (Sir Jeremy Wright)? The panel might struggle to get the evidence it needs to make a decision, and there is no mechanism to address a situation in which, in the absence of that evidence, the panel makes a decision, but evidence then comes forward that suggests that its decision was incorrect. Does the Minister have any workable ideas for addressing that issue?

[Stephen Kinnock]

Clause 15 sets out the process that the panel must go through. It includes a right for the panel to request information and input from a range of potentially interested people. Clause 15(4)(d) appears already to cater for the intended effect of the amendment in the name of the right hon. and learned Member for Kenilworth and Southam (Sir Jeremy Wright).

[Several hon. Members rose—]

[Stephen Kinnock]

I will give way one final time.

[Sir Jeremy Wright]

I am conscious of the confines of the Minister’s role in the process, but what assessment have the Government made of the capacity of a panel to investigate for itself anything that is not brought before it either by one of the relevant doctors or by the person seeking a certificate? The panel’s capacity to do so is surely important, if any issue that is not raised by either group is relevant to its consideration.

[Stephen Kinnock]

The Government’s position on the relevant clause is that the panel has to be satisfied that the correct steps have been taken, and there is not evidence of the points that the right hon. and learned Gentleman has made. Our view is that the intended effect is already catered for in clause 15.

Amendment 38 would exclude from being provided with assistance a person who is not already terminally ill, as defined under the Bill. The reference to “standard medical treatment” is unclear. This could cause further uncertainty around eligibility, given that treatment could be individually tailored to each patient and their needs.

Amendment 81 would remove the requirement that any references to capacity in the Bill are to be read in accordance with the Mental Capacity Act 2005. That would effectively remove the definition of capacity in the Bill. In the absence of a new definition, the Mental Capacity Act may continue to apply by default. That would, of course, diverge from the familiar concepts in the Mental Capacity Act, which could create confusion for practitioners.

The stated intention of amendment 14 is to exclude a person who would not otherwise meet the definition of “terminally ill” if the person meets that definition solely as a result of voluntarily stopping eating or drinking. Our assessment is that the amendment risks introducing uncertainty over a person’s eligibility for assistance under the Bill. However, the substantive question is a policy choice for Parliament. Recognising the intent of the amendment, we do not believe that it would render the Bill unworkable.

Once again, I thank all hon. Members for their contributions. I hope that these observations have helped them in their consideration of the amendments that have been tabled.

[Kit Malthouse]

claimed to move the closure (Standing Order No. 36).

Question put forthwith, That the Question be now put.

The House proceeded to a Division.