Terminally Ill Adults (End of Life) Bill
Public Bill Committee, 29 January 2025.
Examination of Witnesses
Roger Gale (Conservative, Herne Bay and Sandwich)
Good morning, ladies and gentlemen. We are now sitting in public and proceedings are being broadcast. I remind Members to switch off electronic devices.
We will hear first this morning from three witnesses, all of whom join us online from Australia, where it is either early or late evening: Dr Greg Mewett, a specialist palliative care physician; Dr Clare Fellingham, deputy director of medical services for Royal Perth hospital in Western Australia; and Dr Cam McLaren, an oncologist in Australia and New Zealand. Will Members please keep questions as short as possible? We have until 10.25 am for this session, so we have very limited time.
Dr Mewett, would you be kind enough to introduce yourself and make a very brief opening comment?
Roger Gale (Conservative, Herne Bay and Sandwich)
The Committee is deeply grateful to you. Dr Fellingham.
Roger Gale (Conservative, Herne Bay and Sandwich)
I am sure we will come back to that. Dr McLaren.
Roger Gale (Conservative, Herne Bay and Sandwich)
Colleagues will have noticed that there is a slight delay on the line. Take account of it when asking questions and ask them briefly, please.
Sarah Green (Liberal Democrat, Chesham and Amersham)
I am keen to hear about the training, education and clinical supervision you have in place for assisted dying. Perhaps I will address that to Dr Fellingham, but I am sure you could all answer.Q 157
Roger Gale (Conservative, Herne Bay and Sandwich)
Do either of the other witnesses want to come in on that?
Naseem Shah (Labour, Bradford West)
I have a couple of questions. Dr Fellingham, Victoria is quite a rural state and I imagine there are difficulties reaching all parts of it. Am I right that a state-wide pharmacy service that delivers assisted dying drugs across the whole state has been set up, but there is no comparable service for the delivery of pain reduction?Q
Naseem Shah (Labour, Bradford West)
I was talking about southern Australia, in particular. That is fine; we can move on. Thank you.
Naseem Shah (Labour, Bradford West)
Q Thank you. The Australian and British media reported the tragic story of Cyril Tooze, an elderly and terminally ill 84-year-old man in southern Australia, who requested voluntary assisted dying. Mr Tooze stated that he was applying for voluntary assisted dying after waiting nearly a year for the state government to implement a care and housing package for him. He died while waiting for the application process to end. How much does social detriment influence requests for voluntary assisted dying? Please speak from your own experience and about published data.
Roger Gale (Conservative, Herne Bay and Sandwich)
Dr Fellingham, you had your hand up.
Marie Tidball (Labour, Penistone and Stocksbridge)
Looking ahead to our next panel, are you aware of any serious concerns being expressed by disabled people about the Australian assisted dying laws and any Q risks they might pose to this group? It would be very helpful to hear any recommendations you have with regard to building safeguards into the law that we are scrutinising.
Roger Gale (Conservative, Herne Bay and Sandwich)
Dr Fellingham, do you wish to add to that?
Marie Tidball (Labour, Penistone and Stocksbridge)
Q Thank you. That is extremely helpful. Clause 2(3)(a) and 2(3)(b) cover the point that you made about those groups, stating:
“For the avoidance of doubt, a person is not to be considered to be terminally ill”
just by those statuses.
I am very interested to hear about the implementation taskforce. I am personally keen that if the Bill passes into law, we monitor the impact on disabled people on an ongoing basis. Do you have any recommendations for how we can ensure that disabled people have a strong voice in that process, to keep the provisions in check and understand the impact, if any, on the culture within the NHS and other services?
Daniel Francis (Labour, Bexleyheath and Crayford)
Yesterday, we heard from some clinicians from the USA, who outlined how they have reviewed the scheme in practice. They said that their waiting period between the two clinician appointments has been reduced from 14 days to 48 hours, and that in some cases the second clinician has been removed and replaced by a nurse practitioner. Have you undertaken a similar review? Have you made any changes as a result?Q
Roger Gale (Conservative, Herne Bay and Sandwich)
Dr Mewett, you are nodding.
Roger Gale (Conservative, Herne Bay and Sandwich)
It is not that late yet.
Daniel Francis (Labour, Bexleyheath and Crayford)
Q Could I clarify whether there is also a review of keeping two clinicians in the process? We heard yesterday that that is not the case elsewhere.
Roger Gale (Conservative, Herne Bay and Sandwich)
For the benefit of our guests, the next questioner, Stephen Kinnock, is our Health Minister.
Stephen Kinnock (Labour, Aberafan Maesteg)
Q I have a specific question about the period between the legislation passing in your Parliament and the commencement of its provisions and the implementation of voluntary assisted dying. Can you say a little more about what had to be done in that period: the institutional arrangements that were needed between the Act’s passage and its commencement, and the training, capacity building and practical measures that you had to put in place? Did you do that from a standing start, so that in that 18-month period you went from having no training and no institutional set-up to being ready to take the system forward?
Stephen Kinnock (Labour, Aberafan Maesteg)
Thank you very much for that very comprehensive answer. Is there anything that our other guests would like to add?
Danny Kruger (Conservative, East Wiltshire)
I am very grateful for your evidence; it is really useful. I want to state, for the record and for information, that we have before us today three professionals from Australia, all of whom support the laws in that country, and that we heard yesterday from two American doctors, who were also supportive of assisted suicide laws, even though in both countries there are many doctors who oppose what is happening. I regret that we are not hearing evidence from them, but it is very helpful to have your input.Q
Dr Fellingham, I was interested in your point about the distinction between the Australian model and the model in Canada and elsewhere. You are suggesting that most people who seek assisted death do so for what I think you called “existential reasons”. It is certainly not because of an absence of care, although we do see evidence of that in many countries. Can you expand on why you think it is so important that we have the terminally ill definition in the Bill, rather than recognising pain and suffering as the reason for seeking assisted dying, when I think most of the public who support a change in the law do so because they recognise that many people would naturally want to avoid pain and suffering? Yesterday, we heard from people who said that that is the right reason and that we should write that into the law. Why should we not do that?
Danny Kruger (Conservative, East Wiltshire)
Q It does, very helpfully. Can I come back to you quickly? You point out that to suffer is essentially a subjective experience, so it is very difficult for somebody from the outside to determine whether somebody else is suffering to a certain threshold. By that reasoning, it should simply be the case that people who feel that they are suffering intolerably should be eligible. Why do you not think that that is what we should have in the law?
Roger Gale (Conservative, Herne Bay and Sandwich)
Colleagues, if we are to try to get everybody in, I will have to confine Members to one question each from now on. Panel, if you could, be kind and, without denying us the information we need, keep your answers as brief as possible.
Simon Opher (Labour, Stroud)
Could you briefly run through the patient pathway? Where does the patient first arrive in the healthcare setting? Who are the two doctors? Indeed, who provides assistance at the end of life?Q
Simon Opher (Labour, Stroud)
Can I just confirm—
Roger Gale (Conservative, Herne Bay and Sandwich)
Order. I did say one question per person; we have to stick to the timings.
Jack Abbott (Labour/Co-operative, Ipswich)
Dr Fellingham, given your experience of both the British and the Australian healthcare systems, do you believe there are any fundamental Q differences that would affect how assisted dying is implemented in this country? If there are, how might we be able to mitigate them?
Kim Leadbeater (Labour, Spen Valley)
Thank you for joining us this morning. I am interested in following up on what Dr Mewett said about the relationship with palliative care, which has an important role to play in end of life treatment. What is the relationship between assisted dying and the palliative care world like? Also, I would like to hear a bit more about the multidisciplinary board, which I think you set up, Dr McLaren. What does the multidisciplinary approach look like in your jurisdictions?Q
Kim Leadbeater (Labour, Spen Valley)
Q Was it a multidisciplinary board that Dr McLaren set up to look at the safety and quality of voluntary assisted dying?
Neil Shastri-Hurst (Conservative, Solihull West and Shirley)
Dr Fellingham, to circle back to the issue of training, could you go into more detail about what the initial training consists of—the nature of it and the number of hours—and how that compares with the refresher training? What is the system for mentorship, supervision, appraisal and continuing professional development requirementsQ ?
Kit Malthouse (Conservative, North West Hampshire)
Could you talk us through eligibility with regard to neurodegenerative diseases, and whether you have in place any variations and considerations for things such as Parkinson’s or motor neurone disease? Is the main delivery mechanism for VAD in Australia the mainstream health service, or is it delivered through a separate wing, arm or organisation?Q
Roger Gale (Conservative, Herne Bay and Sandwich)
Who is best qualified to answer, please?
Roger Gale (Conservative, Herne Bay and Sandwich)
Thank you very much. I have three questions remaining and five minutes, so we need brevity, please.
Kit Malthouse (Conservative, North West Hampshire)
Sir Roger, can I ask about mainstream delivery?
Roger Gale (Conservative, Herne Bay and Sandwich)
I am sorry but we have to move on.
Lewis Atkinson (Labour, Sunderland Central)
Can I be explicit on the palliative care point? We have heard concerns from some in palliative care provision that there is anxiety that if we introduce this in the UK, there is a risk of deterioration in or failure to improve palliative care. Can you address that directly in the light of your experience?Q
Sojan Joseph (Labour, Ashford)
Are you aware of any reported incidents of the misuse of medication that has been administered? As you explained earlier, patients can take the medication to their home.Q
Roger Gale (Conservative, Herne Bay and Sandwich)
I am going to take one final comment from Dr Mewett, as we are practically out of time. I am sorry that there is one Member who has not been called.
Roger Gale (Conservative, Herne Bay and Sandwich)
I am afraid that has to bring this session to a conclusion. Dr McLaren, Dr Mewett and Dr Fellingham, thank you for giving up your evening for us. The Committee is indebted to you. Thank you very much indeed and have a good night. While we are changing over, I call the Member in charge of the Bill to move a motion.
Kim Leadbeater (Labour, Spen Valley)
I beg to move,
That in the list of witnesses set out in the table in the sittings resolution agreed by the Committee on 21 January 2025 and amended on 28 January 2025, leave out “Professor Jane Monckton-Smith OBE” and insert “Hourglass”.
Unfortunately, we found out in the early hours of this morning that one of our witnesses is unable to join us this afternoon.
Roger Gale (Conservative, Herne Bay and Sandwich)
Q We will now hear oral evidence from Professor Tom Shakespeare from the London School of Hygiene and Tropical Medicine; Dr Miro Griffiths from the University of Leeds, who is accompanied by his personal assistant; Yogi Amin, a partner at Irwin Mitchell; and Chelsea Roff, the founder of Eat Breathe Thrive. We have until 11.25 am for this session. I ask the witnesses, starting with Dr Miro Griffiths, to introduce themselves for the record and to make a brief opening statement.
Roger Gale (Conservative, Herne Bay and Sandwich)
It should be very brief, please, because the Committee will put questions to you and you will, I hope, have adequate opportunity to make the points you wish to make.
Roger Gale (Conservative, Herne Bay and Sandwich)
Order. I am going to have to urge brevity on everybody this morning, because of the time that we have not got.
Roger Gale (Conservative, Herne Bay and Sandwich)
Jake Richards was not called for the last panel, so we will start with him.
Jake Richards (Labour, Rother Valley)
Thank you for those introductory statements. I have a question for Mr Amin regarding the current operation of the Mental Capacity Act 2005, and how the Court of Protection approaches that issue. The Bill as currently drafted essentially defers to the Act, and I wondered if you have any reservations about that, or any thoughts that you could offer the Committee?Q
Jake Richards (Labour, Rother Valley)
Q To be clear, would it concern you because it would cause confusion?
Roger Gale (Conservative, Herne Bay and Sandwich)
That was a specific question to Mr Amin, but it is an important issue. Does anyone else wish to come in, briefly please?
Rebecca Paul (Conservative, Reigate)
My question is to Chelsea Roff. First, thank you for your written evidence, which I found extremely helpful. It indicates that in Oregon, California and Colorado, patients with anorexia have qualified as having a terminal illness. There have been instances of patients suffering with anorexia being described as terminal, and of treatment being withdrawn, in the UK itself. Is it accurate to regard these young women as suffering with a terminal illness? What changes to the Bill would you suggest to protect themQ better?
Roger Gale (Conservative, Herne Bay and Sandwich)
Dr Griffiths or Professor Shakespeare, do either of you wish to comment, because you have not spoken yet?
Roger Gale (Conservative, Herne Bay and Sandwich)
Thank you. I call Marie Tidball.
Marie Tidball (Labour, Penistone and Stocksbridge)
Q Just to clarify, that word is in clause 2(3). I will ask a question of Professor Tom Shakespeare first and then, if I may, I have a follow-up of Dr Miro Griffiths. Tom, why is it so important that disabled people have a choice? I made it very clear when I voted for the Bill on Second Reading that I would only do so because it was not about intolerable suffering but was limited to six-month terminality. From the perspective of disabled people, can you expand on that point and share any research that has been done in jurisdictions where equivalent legislation is now in place?
Roger Gale (Conservative, Herne Bay and Sandwich)
Dr Griffiths, do you want to add to that?
Sarah Olney (Liberal Democrat, Richmond Park)
Dr Griffiths, do you think it is possible that disabled people are likely to be or potentially more at risk of being coerced or otherwise persuaded to seek assisted dying as a result of the BillQ ?
Tom Gordon (Liberal Democrat, Harrogate and Knaresborough)
One of the things that we have heard from other countries that have assisted dying is that this is one of the strongest and most robust laws. I wonder whether Professor Shakespeare has any more views on how we could make the Bill even tighter, and provide support and further peace of mind to people who might be worried about itQ ?
Tom Gordon (Liberal Democrat, Harrogate and Knaresborough)
Q One of the things that we have heard from other people and other jurisdictions is about moving away from a High Court judge, and having a multidisciplinary team and panel. Do you think that would further strengthen the Bill, and would you support that?
Roger Gale (Conservative, Herne Bay and Sandwich)
Mr Amin, do you want to comment?
Roger Gale (Conservative, Herne Bay and Sandwich)
I will come back to Marie Tidball, but I want to make it plain to the panel that, while questions are being directed to specific panellists, if anybody wishes to come in on something, do please indicate.
Marie Tidball (Labour, Penistone and Stocksbridge)
Q This question is for Professor Tom Shakespeare and Dr Miro Griffiths. One of the amendments I am backing would establish an advisory council on the impact of the Bill on disabled people, because I am passionate that we monitor the impact on that group of people, should the Bill pass through Parliament. What structure or mechanism do you think could work to facilitate that?
Sean Woodcock (Labour, Banbury)
My question is to Dr Griffiths and Chelsea. WeQ have had almost two days of evidence. Yesterday afternoon, we had practitioners from the States and, this morning, we had practitioners from Australia. The message they gave seemed to be very clear that coercion essentially does not happen in voluntary assisted dying. The message also was that those who went through it were people who wanted to—it was very appropriate for them and there were almost no issues. Can you explain why they are wrong, if you believe they are?
Roger Gale (Conservative, Herne Bay and Sandwich)
I mean no discourtesy to the Committee, but we have 20 minutes, and 10 Members wishing to ask questions, so we have to move this on I am afraid.
Rachel Hopkins (Labour, Luton South and South Bedfordshire)
Can I ask you, Mr Amin, about your views on coercion, particularly in the light of clause 2 in reference to the Mental Health Act 1983 and the Mental Capacity Act, and any thoughts you have about that in relation to the groups you represent?Q
Rachel Hopkins (Labour, Luton South and South Bedfordshire)
You have given clarity. Thank you.
Juliet Campbell (Labour, Broxtowe)
My question is for Professor Shakespeare and Dr Griffiths. Clause 4 of the Bill offers the opportunity for clinicians to instigate the discussion on assisted dying. Could you both tell me your view on that, pleaseQ ?
Liz Saville-Roberts (Plaid Cymru, Dwyfor Meirionnydd)
I have a question for Mr Amin. England and Wales is a single jurisdiction, but health is devolved and we have been discussing an amendment to clause 12 in relation to the court of a multidisciplinary arrangement, as opposed to the High Court. What are the implications for the Committee to understand in how this plays out, with health being devolved but the jurisdiction being singleQ ?
Liz Saville-Roberts (Plaid Cymru, Dwyfor Meirionnydd)
Q What I am trying to tease out is what is the responsibility of the Senedd and what is the responsibility of the UK Government. This is going to be challenging, given that health is devolved and has been for 25 years.
Liz Saville-Roberts (Plaid Cymru, Dwyfor Meirionnydd)
Q Who has to decide who is appointed to what—which body?
Liz Saville-Roberts (Plaid Cymru, Dwyfor Meirionnydd)
I think there is a question, because we are a Committee on a private Member’s Bill, as to how we ascertain these details.
Roger Gale (Conservative, Herne Bay and Sandwich)
I think that is a matter that we may have to pursue elsewhere.
Naseem Shah (Labour, Bradford West)
Q I have a quick question for Dr Griffiths and then Chelsea. Dr Griffiths, how does the Bill exacerbate issues for disabled women in particular who might be experiencing abuse or other vulnerabilities?
Naseem Shah (Labour, Bradford West)
Q Before I move on to Chelsea, I want to point out that Professor Shakespeare said that most disabled people support the Bill. But, actually, only one deaf and disabled people’s organisation that opposes it is giving evidence. I just wanted that point noted for the Committee.
Chelsea, thank you for your evidence. Eating disorders are classified as mental disorders under the Mental Health Act. The Bill explicitly states that a person cannot be considered terminally ill only because of a mental disorder. You have also talked about the withdrawal of insulin. Could you respond to both of these? Why do you believe that eating disorders would still meet the criteria under the Bill, and likewise for the issue of stopping insulin?
Roger Gale (Conservative, Herne Bay and Sandwich)
I am sorry, but we still have more Members and questions than we have time, so I am going to come down to one question per Member.
Kim Leadbeater (Labour, Spen Valley)
Q Thank you for coming to give evidence this morning—it is incredibly helpful. I am going to come back to clause 2 of the Bill, which concerns the definition of terminal illness. I am very clear on who the Bill is aimed at helping and who it is not aimed at involving. The definition says that the person has to have
“an inevitably progressive illness, disease or medical condition which cannot be reversed by treatment”.
It also says, for the avoidance of doubt, that this cannot be “a mental disorder” or “a disability”. I hear your concerns, and I want to support you and work with you on this. I am keen to know: what else do you want to see in the Bill that would reassure you that this is not about disabled people or people with mental disorders?
Danny Kruger (Conservative, East Wiltshire)
Q I want to give Professor Shakespeare the chance to respond to the point that we have heard. I am interested in whether you recognise that many disabled people—in fact, not just disabled people, but anybody who declines treatment that keeps them alive—would qualify as terminally ill under the terms of the Bill? What protections we could give to prevent that?
Roger Gale (Conservative, Herne Bay and Sandwich)
I call Simon Opher.
Simon Opher (Labour, Stroud)
Actually, my question has already been asked.
Lewis Atkinson (Labour, Sunderland Central)
Q Mr Amin, given your expertise in representing these cases in the court, can I ask you for your view around the Mental Capacity Act issue regarding eating disorders and other disorders? Obviously, we have heard one version of that. Given your experience of working with UK law to the highest level, what is your assessment of this?
Roger Gale (Conservative, Herne Bay and Sandwich)
Thank you. This will have to be the last question.
Jack Abbott (Labour/Co-operative, Ipswich)
Q I have a question for Mr Amin. You worked on the judicial review of Noel Conway in 2018. For the benefit of the Committee and those watching, Mr Conway had terminal motor neurone disease and he looked to bring a judicial review in order to have the option of assisted death, when he was in the final six months of his life. Mr Amin, what were your experiences from that case that may inform the Committee’s learnings when looking at the Bill?
Roger Gale (Conservative, Herne Bay and Sandwich)
Order. I am terribly sorry but we are out of time.
Peter Dowd (Labour, Bootle)
We will now hear oral evidence from Dr Alexandra Mullock and Professor Aneez Esmail, both from the University of Manchester; Professor Allan House, from the University of Leeds; and Richard Robinson, CEO of Hourglass. We have until 3 pm for this session. Will the witnesses please introduce themselves for the record?
Peter Dowd (Labour, Bootle)
Thank you. Some hon. Members have already indicated that they wish to ask questions; if others do so, the Clerk will take note and I will come to them.
Kit Malthouse (Conservative, North West Hampshire)
Thank you all for coming. Clause 26 will create a new offence of coercion. In your view, is that offence correctly drawn? Is 14 years long enough as a deterrent?Q196
Kit Malthouse (Conservative, North West Hampshire)
Q We have heard from earlier witnesses, particularly from other jurisdictions, that training is the key. Is it therefore your view that in guidelines, for example, specific training in this area could be effective?
Danny Kruger (Conservative, East Wiltshire)
Are we asking one question each, Mr Dowd, or may I ask two if I am quick?
Peter Dowd (Labour, Bootle)
If you are quick.
Danny Kruger (Conservative, East Wiltshire)
Q Professor House, in Oregon, which partly inspired this Bill, I understand that there is an expectation—in fact, a requirement—that there be a psychological assessment if the assessing doctor thinks that a mental health condition, depression or other issue might be present. Do you think that that would be appropriate? Do you think that it would be a helpful safeguard to insist on a psychological evaluation?
Danny Kruger (Conservative, East Wiltshire)
Yes, thank you. So we need it anyway: in all cases, there should be a psychological assessment as part of the process.
Danny Kruger (Conservative, East Wiltshire)
Q Mr Robinson, I want to come back to the question of coercion. We heard from advocates of assisted dying laws elsewhere that there is hardly any evidence of cases of coercion in this service overseas, and yet you are reporting—and we absolutely believe you, because we see evidence of it—that there is a chronic problem of elder abuse in our country. Presumably there is in every country. How do we square this? Is it that elder abuse does not apply in the context of assisted suicide in other jurisdictions, or is it just not being picked up?
Sarah Olney (Liberal Democrat, Richmond Park)
Professor House, concerns have been expressed in written evidence that an assisted dying Bill of this sort is incompatible with wider policy around reducing suicide or suicide prevention measures. Do you think that it is possible to implement effective policies to reduce suicide rates, while having an assisted dying Bill at the same time?Q
Sarah Olney (Liberal Democrat, Richmond Park)
Q There is no evidence that it reduces it, so it continues at the same rate: it does not increase, and it does not reduce. Is that what you are saying?
Naseem Shah (Labour, Bradford West)
Professor House, you have said that people applying for assisted dying may be in a state of vulnerability. What is vulnerability and how can the Bill be amended to make sure that vulnerable people do not inappropriately choose assisted dying?Q
Naseem Shah (Labour, Bradford West)
Q Richard, thank you for coming in at such short notice. It is very much appreciated. Do you have concerns about whether the safeguards in the Bill adequately protect against coercion and vulnerability as Professor House has just described?
Naseem Shah (Labour, Bradford West)
Q Finally, to Dr Mullock, you have said that in all jurisdictions that have legalised assisted dying, the only meaningful gatekeeping is done by medical professionals. We only have retrospective monitoring that is primarily reliant on honest reporting, particularly discovering whether, or how frequently, coercion or flawed assessment has led to inappropriate assisted dying, and therefore challenging it, so it is impossible to know how many people have been sacrificed with lawful AD regimes. We have witnesses who have said there is no evidence of coercion, especially in examples in Australia and some US states where some assisted dying schemes have been implemented. When they say that, do you think they are being accurate?
Bambos Charalambous (Labour, Southgate and Wood Green)
This is a question to Professor House. I know you are opposed to the Bill, but if it were to pass, what role do you see for psychiatrists in a multidisciplinary approachQ ?
Rebecca Paul (Conservative, Reigate)
My question is to Dr Mullock. You talked in your written evidence to this Committee—and you have just touched upon it—about the danger that someone could bring undue influence to bear on a person considering assisted dying, and that influence could be, in your words, “more subtle than outright coercion”. How do you think the Bill could be amended to avoid that danger?Q
Rebecca Paul (Conservative, Reigate)
Q Not to put you on the spot too much, but I have tabled amendment 82 and new clause 5 to address the encouragement point. Have you had a chance to look at those? If you have, do they adequately address some of your concerns?
Rebecca Paul (Conservative, Reigate)
Don’t worry. Thank you very much.
Lewis Atkinson (Labour, Sunderland Central)
Could I ask Dr Mullock another question? I was interested in what you said about your involvement with citizens’ juries, both here and elsewhere. As we as a Committee and Parliament are weighing up some of these issues, such as the points on autonomy and safeguards, where do you think the public settle on those when they investigate them in depth? In particular, can you say a bit about the eligibility criteria being six months with a terminal illness?Q
Lewis Atkinson (Labour, Sunderland Central)
I suppose I am interested in your observations of the outcomes of citizens’ juries. I think we have all seen bits of polling, but that is not necessarily polling of individuals who have wrestled with these issues in a deliberative manner in the way that I understand citizens’ juries are designed to do.
Lewis Atkinson (Labour, Sunderland Central)
Q Widening my questions to Mr Robinson and Professor House, you talked a bit about capacity, and about coercion and the detection of it in life-or-death decisions, which clearly this would be. I am aware that there are those decisions every day in the NHS, around withdrawal of treatment and so on, but it strikes me that there is not a clear process of independent verification of capacity and so on, which the Bill will introduce in this instance. Will you say a little about your assessment of the current adequacy of those protections in withdrawal-of-care decisions in the NHS?
Lewis Atkinson (Labour, Sunderland Central)
Q To clarify, you asked to see them—that, presumably, would be good practice—but there is nothing in law that requires that on those decisions at the moment.
Lewis Atkinson (Labour, Sunderland Central)
In contrast to the requirements that would be in this Bill, which would require that assessment to be made.
Lewis Atkinson (Labour, Sunderland Central)
Yes, I am asking whether that is the case.
Kim Leadbeater (Labour, Spen Valley)
If I may, I have a question for Professor Esmail, but I will make an observation—I think I have a duty to do this, and to be the voice of some of the people we are talking about this afternoon: the terminally ill people who are dying. We talked a little bit about suicide earlier, but it is clear to me that the terminally ill people I have met would not describe themselves as suicidal at all. They want to live, but the fact is, they are dying—that is a very important distinction to makeQ .
Also, Richard, I would love to know your thoughts. I hear what you are saying about protections for older people, but as you rightly said, it is fair to say that not all older people are vulnerable, and that a lot of older people support a change in the law. Also, not all older people are terminally ill—I think about my grandad, who asked me to take him to Switzerland. I have thought about him a lot in recent months, but he would not have been covered by the Bill because he was not terminally ill; he was just old. Those are just a couple of observations, which you can come back on if you wish.
Professor Esmail, you acknowledged that during your time as a GP, you went on your own journey on assisted dying. I think you described yourself as being implacably opposed, but you also stated that the law at the moment is a mess and does not protect anyone. Can you tell us a little about that journey and how you came to that conclusion?
Kim Leadbeater (Labour, Spen Valley)
That is really helpful. Dr Mullock, do you want to add anything?
Jake Richards (Labour, Rother Valley)
If I may, I will push Professor House on the evidence he was giving to Mr Atkinson’s questions, so that I understand the necessity for psychiatric assessment under the current legal framework. Clearly there are degrees here. If a patient who has diabetes refuses to take insulin but would otherwise be able to manage their disease, then they would be referred to you, but is it your experience that if a patient rejected a round of chemotherapy, they would usually be subject to a psychiatric assessment?Q
Jake Richards (Labour, Rother Valley)
Q Would the decision about the need for a psychiatric assessment be undertaken by a medical clinician?
Sean Woodcock (Labour, Banbury)
Dr Mullock, during your oral evidence to the Health and Social Care Committee you recommended focusing on Oregon’s approach in particular. Do you have any concerns about the number of people in Oregon who cite being a burden as their reason for choosing assisted dying?Q
Sean Woodcock (Labour, Banbury)
Q I accept the point. My challenge would be that we have heard a lot of evidence from a variety of people, and I think it is generally accepted that there is a difference in the availability of care across the country, particularly for people of certain ethnic backgrounds or who are deprived, which means that someone could be at particular risk of feeling a burden if they are a member of those groups. This is at a time when care is in the state it is in, and we are often reliant on people having individual property and using it to pay for their social care. Do you not see that as an inherent risk of introducing the Bill?
Sean Woodcock (Labour, Banbury)
I was merely suggesting that the direct evidence from Oregon is that being a burden is something that might come from a lack of decent social care, and it might be encouraging people to make the decision to seek assisted dying—but fair enough.
Daniel Francis (Labour, Bexleyheath and Crayford)
My question is to both Dr Mullock and Professor House. In your written evidence, you both refer to clause 18(9) and issues regarding the obligations of the doctor if the procedure either fails or if there is a long-delayed death. I accept that it is a small number, but we know from elsewhere that there are cases where the death takes some days—three to four days in some cases—or where the procedure fails.Q
The Bill says that the doctor must stay with the person for the entirety ofthat time. I am trying to understand from your written evidence how you feel that measure should be amended to make it stronger, because at the moment there is no mention what the doctor should do to intervene, and clearly it is not practical for a doctor to stay for three to four days. What are your views on how that could be amended?
Peter Dowd (Labour, Bootle)
Just before you answer, I bring to the attention of Members that we have about 13 minutes left and five people who want to ask questions. I ask Members keep their questions as tight as they can, and the witnesses to take that into account as well—otherwise I will regrettably end up cutting witnesses off at spot-on 3 o’clock.
Sojan Joseph (Labour, Ashford)
May I come to Professor House for clarification? For someone who has had no primary diagnosis of a mental illness got diagnosed as terminally ill, is there the possibility that that condition could make them feel depressed or hopeless? At that stage, can that influence their decision-making capacityQ ?
Simon Opher (Labour, Stroud)
First, I work as a GP with old people—I look after a nursing home— and I have to do adult safeguarding training every year. Secondly, more than 90% of psychological assessments are done in primary care. Professor Esmail, do you think that GPs are capable of spotting coercion and doing a psychological assessmentQ ?
Simon Opher (Labour, Stroud)
And do they—
Peter Dowd (Labour, Bootle)
Order. I have to take a question from another Member—Tom Gordon.
Tom Gordon (Liberal Democrat, Harrogate and Knaresborough)
I have a question for Professor Esmail. One of the things that we have talked about with different witnesses is whether we should have a wider panel of people looking at these decisions; that might encompass people from social care, medical or legal backgrounds. I think that that would make sure that some of the issues that we have talked about would, hopefully, be more robustly picked up on. Do you think that by moving towards that in the Bill—were we to have assisted dying—it might provide a more holistic approach to end of life and to giving people that option? How might that influence and change palliative care and other interactionsQ ?
Liz Saville-Roberts (Plaid Cymru, Dwyfor Meirionnydd)
I have a question for Professor Esmail. We heard from the Australian witnesses this morning that there was a period of implementation after legislation of 18 months. Do you think we should have a period of implementation, and what should that comprise?Q
Peter Dowd (Labour, Bootle)
I am afraid we will only have time for the last question from Rachel Hopkins. We have only three minutes left.
Rachel Hopkins (Labour, Luton South and South Bedfordshire)
We have spoken a lot about the range of doctors and nurses who will be involved in a multidisciplinary team. Have you thought about the protections in the Bill for those who do not wish to participate? Is there the right balance for them not to participate but to still work with a patient who might want to take this choice? What are your views on that?Q
Peter Dowd (Labour, Bootle)
That brings us to the end of the time allotted for the Committee to ask questions. I thank our witnesses on behalf of the Committee for their evidence, and we will move on to the next session. Thank you very much.
Peter Dowd (Labour, Bootle)
We will now hear oral evidence from Dr Lewis Graham from the University of Cambridge; Baroness Kishwer Falkner, chair of the Equality and Human Rights Commission; Fazilet Hadi, who is head of policy for Disability Rights UK; and Lord Sumption, former justice of the Supreme Court. For this session we have until 4 pm. Will the witnesses please introduce themselves for the record?
Kit Malthouse (Conservative, North West Hampshire)
Q Lord Sumption, I heard an interview with you on the radio, I think before Christmas, in which you expressed doubts about the third layer at the High Court. We heard evidence earlier that there is an alternative route that might see more of a panel sitting, rather than a High Court judge. Could you expand on your view of what that third layer could and should look like?
Peter Dowd (Labour, Bootle)
Excuse me, Lord Sumption, but could you speak up? We are finding it difficult to hear at this end.
Kit Malthouse (Conservative, North West Hampshire)
Q I may be speaking out of turn, but the sentiment of the House generally seems to be that there should be a third layer of supervision over the process. There are other territories have that third layer of supervision, such as Spain and Australia. Have you examined any of those, and is there a model that you think might be effective?
Sarah Sackman (Labour, Finchley and Golders Green)
Q It may flow from what this third layer of a panel or court is doing, but what sort of information would be desirable for the panel to have before it in order to add a meaningful layer of scrutiny?
Sarah Sackman (Labour, Finchley and Golders Green)
Q Lord Sumption and Dr Graham, you will have seen that clauses 26 and 27 include criminal offences. Do you have any views on the operability of those criminal offences?
Marie Tidball (Labour, Penistone and Stocksbridge)
Dr Graham, thank you for your written evidence, which was very helpful and stated your view that the strength of the clauses in the Bill make it compatible with the European convention on human rights in relation to article 2 on the right to life and article 14 on freedom from discrimination. Can you explain why you hold that view? What has been the view of the European Court of Human Rights in relation to assisted dying laws in other signatory statesQ ?
Marie Tidball (Labour, Penistone and Stocksbridge)
Q My next question is to Fazilet Hadi and Baroness Falkner. First, I am passionate about ensuring that the Bill creates the opportunity to hear the voices of disabled people in monitoring the impact of its implementation, should it be passed by Parliament, and the treatment of disabled people in the NHS as a result. What structure or mechanism could work to facilitate that? Secondly, would that be applicable to all protected characteristics under the Equality Act, or do disabled people have a specific status that needs special treatment?
Marie Tidball (Labour, Penistone and Stocksbridge)
Q With respect, my question was about whether you think that, should the Bill go through Parliament, there should be some kind of body, possibly an advisory council, that disabled people in particular should be involved with. Your other point speaks to some evidence that we heard yesterday and earlier about the anchoring, where there is assisted dying in the legal system, of the quality and level of provision of palliative care. I would be grateful if you could speak to the point of my original question, which was about the need for some kind of advisory body that includes disabled people, should the Bill pass.
Danny Kruger (Conservative, East Wiltshire)
Q Dr Graham, on the points about article 14, I very much appreciate and welcome your belief in parliamentary sovereignty, and the suggestion that the courts should listen to Parliament—most of us agree with you on that—but it is a big hope. They do have the opportunity, and have demonstrated their power, to object to statute on the basis of the ECHR. As you said, they could allow assisted dying, and indeed discrimination within an assisted dying law, if there was some justification for it.
You are presumably aware of Lord Neuberger’s judgment in the Nicklinson case. He said that there was
“significantly more justification in assisting people to die”
who have long-term chronic conditions and are going to suffer for years than for people who are on the verge of death. I also point out Lord Bingham’s judgment in the Pretty case, which suggested there would be discrimination against people who are unable to perform the final act themselves. Surely, then, there is a very strong case to be made under the ECHR that the Bill would be discriminatory. I would value your response on that, and maybe from Lord Sumption too, if he wants to come in.
My second question is to you both, on article 2. If it were to be allowed, the safeguards that would be required —I shall quote from the Mortier case, which you know well—would be that
“medical professionals are complying with the free, informed, explicit and unambiguous decision of their patients”
without pressure and abuse. Do you therefore accept that this comes down not just to the safeguards in theory, but to how they actually operate in practice? We have heard very serious concerns on that front. Are you confident that the courts would allow this? That is, of course, assuming this is an NHS service, because it could be that they decide it should not be.
Tom Gordon (Liberal Democrat, Harrogate and Knaresborough)
Q My questions are to Dr Graham and Lord Sumption. The Bill, in its current form, has several opportunities for confirming capacity and whether the people who want to take up assisted dying have the capacity to do so; there are a number of safeguards and steps within it. That is more than is typically required for any other end-of-life decisions. I wondered whether you would comment on that. Is the Bill safe enough in its current form? If not, what other steps could be added?
Sarah Olney (Liberal Democrat, Richmond Park)
Q Baroness Falkner, do you consider that in its current form the Bill upholds the rights of all the different groups whose rights are protected under the Equality Act 2010?
Sarah Olney (Liberal Democrat, Richmond Park)
Q Can you give me an example of one of your reservations?
Peter Dowd (Labour, Bootle)
I am sorry—just bear with me. Seven people wish to ask questions, and we have just half an hour. If you do answer, can it be very succinct if possible?
Naseem Shah (Labour, Bradford West)
Q I have one question following up with Baroness Falkner; then I will come to you, Fazilet, if I may. The Equality and Human Rights Commission’s briefing says that
“to ensure that assisted dying is compatible with Article 2 and Article 3 rights…high-quality palliative care should be available to all who need it.”
Given that there is no requirement of an assessment of the availability of palliative care before the Bill is passed, how certain are you, Baroness—and how certain do you think we can be—that in passing this Bill, article 2 and 3 rights are not being breached?
Naseem Shah (Labour, Bradford West)
Q Fazilet, doctors are members of a caring profession, but there are ways in which—wittingly or unwittingly—they can end up coercing disabled people; there are reports of that. Would I be right in saying that? If so, how does this happen and how common is this experience for disabled people?
Lewis Atkinson (Labour, Sunderland Central)
Q I have a question for Baroness Falkner. I want particularly to probe the socioeconomic duty. What is your assessment of that as it relates to agency and control at the end of life? My constituents in Sunderland, unfortunately, are on average notably less well off than the rest of the UK. Is it not the case that at the moment there is choice at the end of life for people who are well off and able to travel to Switzerland, but poorer people do not have that choice? What is the EHRC’s view from a socioeconomic point of view?
Kim Leadbeater (Labour, Spen Valley)
Q Thank you so much for giving evidence this afternoon. Perhaps I can provide a bit of reassurance, Baroness Falkner, on a couple of issues. The first thing I would say in terms of the Bill—
Peter Dowd (Labour, Bootle)
Order. I think it is best if we ask questions of the witnesses. As I said, the Committee—you, not me—has allocated an hour to this, and I want to make sure every Member gets an opportunity to speak. We only have 20 minutes left, with five or six people to go.
Kim Leadbeater (Labour, Spen Valley)
It will be a question. The Bill is very clear, in clause 2(3), that disabled people are not within its scope, but I would be really interested to know if there is anything you think we could add to make that clearer—I put that to Fazilet, too—because I want to be really clear about that, and I want to provide any reassurance that I can.
My main question is to Lord Sumption. You acknowledge the importance of autonomy and dignity at the end of life, and indeed article 8 of the European convention on human rights talks about bodily autonomy and self-determination. I would be interested to know how you came to that conclusion on the issue of assisted dying. You also described the Bill as over-engineered, bureaucratic and impersonal—thank you for that. Would you agree with the chief medical officer, then, that we should avoid making the choice of assisted dying a “bureaucratic thicket” and keep the safeguards robust but simple? If so, what do you think that could look like?
Kim Leadbeater (Labour, Spen Valley)
Q Baroness Falkner, do you want to come in on the point about how we could make the Bill more robust in terms of those protections?
Kim Leadbeater (Labour, Spen Valley)
Q You raise a really important point. There is a range of different views within the disabled community, and we heard some of them this morning. A professor of disability rights made the point that disabled people also do not want to be excluded from the Bill, because if you have a terminal illness and you are disabled, you should have the same rights as everyone else. I do not know what your thoughts are on that.
Kim Leadbeater (Labour, Spen Valley)
Thank you.
Jake Richards (Labour, Rother Valley)
Q Dr Graham, in paragraph 21 of your very helpful written evidence, you say that the judicial involvement in the process strengthens the Bill, in terms of convention compatibility. Do you agree with Lord Sumption about the effect on convention compatibility if that stage were not present, and do you have any comments on the suitability of a judicial function, and whether there is any alternative?
Jake Richards (Labour, Rother Valley)
That is welcome.
Sean Woodcock (Labour, Banbury)
Q Ms Hadi, at the start you said, “Nothing about us without us.” With regard to your previous testimony, I am interested to know how you feel that disabled voices have been heard, if they have been heard, in this process. What gaps have there been, if any? What can the Committee and the Bill do to fill those gaps?
Stephen Kinnock (Labour, Aberafan Maesteg)
Q I want to make a brief point of clarification, based on what both Baroness Falkner and Ms Hadi said. In the debate on the motion on the money resolution in Parliament last week, I stood at the Dispatch Box and confirmed that the Government will publish an impact assessment before Report stage. We are obviously working on that with officials.
I will also add as a point of clarification that both myself and my ministerial colleague are working with the sponsor of the Bill to provide assistance and advice, purely on the workability and operational aspects of the Bill, and impacts of the Bill, should it gain Royal Assent. It is important for the purposes of this discussion that everybody is on the same page on that point. The Government are absolutely remaining neutral on the principle of the Bill, but it is our job to ensure that any Bill that passes through Parliament is workable and implementable as and when it gains Royal Assent.
Sarah Sackman (Labour, Finchley and Golders Green)
We can take that suggestion away. Thank you.
Daniel Francis (Labour, Bexleyheath and Crayford)
Q Ms Hadi, we heard evidence this morning that the majority of disabled people support the Bill. I would like to hear your comments on that. What analysis do you have on whether the majority of disabled people support the Bill? Baroness Falkner, based on what we have just heard, if we had had the equality impact assessment before oral evidence was sought and before line-by-line scrutiny, would you have supported the approach more?
Kim Leadbeater (Labour, Spen Valley)
On a point of order, Mr Dowd. I am slightly concerned that we are having a conversation about the process, rather than about the actual Bill. I am not sure whether that is in scope of the work of the Committee.
Peter Dowd (Labour, Bootle)
I am allowing latitude to tease the matters out, but I am sure that the witnesses have heard what you have to say.
Simon Opher (Labour, Stroud)
Q It seems clear from an expert in European law that the human rights convention is covered by this legislation, so we have got some very good advice there. I would just like to confirm that, if we could, Dr Graham. Also, to all of you: could we have some positive things that we could put in the Bill to make it safer? We have been talking about the Bill but this is a practical session where we need to improve the Bill. First of all to Dr Graham.
Peter Dowd (Labour, Bootle)
Order. Can you ask through the Chair, and I will decide who can speak? We have four minutes left. I do not want to cut any of the witnesses off, so, with the greatest respect, can you leave the direction of the meeting to me, please?
Peter Dowd (Labour, Bootle)
Thank you. Fazilet Hadi—last minute.
Peter Dowd (Labour, Bootle)
Thank you. That brings us to the end of the time allotted for the Committee to ask questions in this session. On behalf of the Committee, I thank the witnesses for their evidence and contributions. Thank you very much.
Peter Dowd (Labour, Bootle)
We will now hear oral evidence from Toby Porter, the CEO of Hospice UK; Dr Jamilla Hussain, who is a clinical academic consultant in palliative care at Bradford teaching hospitals NHS trust; Dr Jane Neerkin, a consultant physician in palliative medicine; and Sam Royston, who is the executive director for policy and research at Marie Curie. For this session, we have until 5 pm. Could the witnesses please introduce themselves for the record?
Peter Dowd (Labour, Bootle)
Order. I think we can tease those issues out from our questions.
Kit Malthouse (Conservative, North West Hampshire)
Q Thank you all for coming. We have had a lot of discussion over the last day or so about eligibility. I think it was Hospice UK that said, in evidence to the Health and Social Care Committee, that pain in all circumstances could be alleviated. Do you believe that the way in which the Bill is framed captures those people correctly? For those people who are essentially beyond medical help and may be facing a painful end, and who want a different choice, is the eligibility criteria framed correctly? We will start with Mr Porter.
Kit Malthouse (Conservative, North West Hampshire)
Q How would you seek to improve the Bill in order to make them eligible?
Simon Opher (Labour, Stroud)
Q I was interested to hear what you were saying about not all symptoms being controllable with palliative care. There is an argument that we do not have good enough palliative care, so we cannot bring in assisted dying. I think it may be a little spurious. What are your thoughts about the relationship between palliative care and assisted dying? That question can go to any of you.
Sojan Joseph (Labour, Ashford)
I would like to come to you, Dr Hussain, specifically on why you think ethnic minority people would be disproportionately affected when the law is the same for everyone. There will be capacity assessments. There will be two medical assessments. There will be a court review. If you think that is going to be an effect, what would you suggest we include in the Bill to safeguard those people?Q
Sean Woodcock (Labour, Banbury)
Q Mr Royston, I am interested in what you had to say about palliative care and poverty. A concern of people who have spoken to the Committee has been the impact of introducing assisted dying in an era when palliative care is so patchy. Often, someone’s finances and personal income are linked to the level of care they get. Can you explain the impact that concern about finances has on dying people, from your experience?
Jack Abbott (Labour/Co-operative, Ipswich)
Sorry, Mr Royston, but I am coming back to you with a similar question. I do not think anyone on the Committee or, as Mr Porter mentioned, anyone who took part in our recent debate would disagree about the pretty awful state of palliative care at the moment. You are absolutely right to mention poverty and its impact on health and social outcomes. I am very sympathetic to the broader arguments you are making, but I want to direct us specifically to the Bill, because that is why we are here now. In your view, is the Bill problematic or otherwise, for some of the reasons you outlined? Will it fundamentally change any of the outcomes that you mentioned? I agree that we need to improve the situation regarding the number of people living in poverty, the state of palliative care and everything else, but what sort of change specifically do you think the Bill might makeQ ?
Jack Abbott (Labour/Co-operative, Ipswich)
Q I sympathise totally with what you are saying about palliative care, but the principle of assisted dying is the main thrust of what we are debating. Will the principle of assisted dying, should it be introduced, fundamentally change, positively or negatively, many of the things that you have been describing?
Jack Abbott (Labour/Co-operative, Ipswich)
Q I have a short final question. Is Marie Curie’s position basically that if palliative care does not improve, assisted dying should not be introduced in this country?
Kim Leadbeater (Labour, Spen Valley)
Q Thank you, witnesses, for joining us this afternoon. The good news for us all, on the palliative care conversation, is that we have in the room the Minister responsible for palliative care, who has heard those arguments loud and clear. Indeed, Second Reading showed that there is a huge amount of good will in the House for improvements in palliative care. I agree with you, Mr Royston, that it is not an either/or. We have to do both, and I think this House is very keen and prepared to do both. Hopefully, the implementation period will provide some reassurance, because this will not happen for a number of years. We have got time to make those improvements alongside each other while still giving terminally ill people the choice that I firmly believe they deserve.
Dr Neerkin, on that point, yesterday we heard a range of views from palliative care professionals, and there are a range of views within the sector around assisted dying. Could you tell us a bit about your views as a result of your more than 25 years of experience as a consultant physician in palliative medicine?
Kim Leadbeater (Labour, Spen Valley)
Q Dr Hussain, I hear your concerns about the broader impact on society, and certainly in terms of ethnic minorities. Have you seen any evidence that that is an issue in other jurisdictions? The evidence we have heard is that people from ethnic minorities are underrepresented in assisted dying statistics, meaning that potentially there is discrimination the other way, in that they are not accessing it in the way that perhaps people from better-off backgrounds are.
Kim Leadbeater (Labour, Spen Valley)
Q On that point, do you think there could be better training around coercion?
Peter Dowd (Labour, Bootle)
Order. If people want to intervene, can they please do so through the Chair? Otherwise, we will get into chaos. Could you please finish answering the question?
Kim Leadbeater (Labour, Spen Valley)
Sorry.
Peter Dowd (Labour, Bootle)
I remind Members that we are now halfway through and we have seven Members to go. We have already had six questions, and we have seven to go in the next half hour. I repeat that I do not want to interrupt our witnesses at the very end to stop the panel.
Lewis Atkinson (Labour, Sunderland Central)
Q Dr Porter, we heard this morning from some colleagues from Australia, reflecting on assisted dying options five years after they was introduced there. I specifically asked them about the impact that had had on the palliative care sector and hospices. The Australian hospice body had done a review and said that there had been, if anything, an improvement in palliative care, and that that was linked to assisted dying. Do you have any reflections on that, based on the international experience of the hospice sector in places where assisted dying has been introduced?
Peter Dowd (Labour, Bootle)
I think it would be best not to at this stage. Do you have anything to add to that, Mr Atkinson?
Lewis Atkinson (Labour, Sunderland Central)
No.
Rebecca Paul (Conservative, Reigate)
Q My question is for Toby Porter, and it is probably quite timely. What are the risks and impact for the hospice sector if assisted dying becomes legal? Can you talk broadly about the implications, touching on the impact on the workforce and patients?
Rebecca Paul (Conservative, Reigate)
Q I have a quick follow-up. What you said about palliative staff generally being against assisted dying was very interesting. Briefly, what are the drivers or key reasons for that?
Bambos Charalambous (Labour, Southgate and Wood Green)
Q Following on from what Mr Porter said about the provision of hospices, we are blessed with some wonderful hospices in north London that provide fantastic facilities. I agree with Mr Royston about the need for an assessment of palliative care funding right now; that is important. The fact about the funding is quite shocking. One of the local hospices has something that has been nicknamed a “death café”, where people get to discuss the end of life in a setting with friends and family members. On the issue of ethnic minorities not accessing services, what are your thoughts on being able to have settings where they can discuss different options at the end of care, get the support they need and make properly informed choices about the end of life? That question is to the whole panel.
Peter Dowd (Labour, Bootle)
Order. I repeat that we have about 15 minutes left and four people left to ask questions, plus the previous question. Could hon. Members appoint who might answer the question? I do not want to cut off witnesses right at the end; it would be rude to do so. Who wants to take that question?
Naseem Shah (Labour, Bradford West)
Q Thank you to all of you and for what you do. I will direct my question to Dr Jamilla—it is so lovely to hear so much about Bradford. I want to talk about what Dr Rachel Clarke said yesterday. She said that when patients had begged her to end their life, it was not because of the cancer but because they had not received proper palliative care. From your research and experience, would you say that ethnic minorities or those from socioeconomically deprived backgrounds do not always receive good palliative care? What are the dangers in this Bill for you?
Naseem Shah (Labour, Bradford West)
Q Building on that, Chris Whitty and the British Medical Association said, from an ethnic minorities and reflection point of view, that the Mental Capacity Act 2005 and safeguarding training are fit for purpose. We know that we do not have a workforce that is reflective of the communities it serves and that we do not have representation at high levels, so in your clinical experience, for disadvantaged groups, do you think the training on capacity and coercion is fit for purpose?
Peter Dowd (Labour, Bootle)
Order. I am sorry to do this but we have eight minutes left, and Members have three questions. This is the fourth question, so I ask those who answer to be as concise as they can, otherwise we will not get through the questions.
Tom Gordon (Liberal Democrat, Harrogate and Knaresborough)
Q I would like to direct my question to Dr Neerkin. We have heard from lots of different jurisdictions where assisted dying is commonplace now. In those areas, the actual uptake is very small. That is in places where they have a lot less in the way of safeguards than we do in this Bill. Can you comment on the fact that we are talking about a very small group of people for whom palliative care would not be enough anyway? This option might give those people peace of mind and enable them to have a good period of life while they have it, and then choose to leave on their terms.
The point I am trying to get to is, we keep talking about big populations and groups, but in your professional experience, how wide or narrow does the Bill need to be? Do the safeguards in it not already restrict it to a very small group of people whose needs would not necessarily be met by palliative care?
Marie Tidball (Labour, Penistone and Stocksbridge)
Q This is a question for Dr Neerkin. That was extremely helpful. We know that Tōtara hospice in New Zealand—one of the largest hospices there—has said that it does not think that assisted dying and palliative care are counter to each other, and that a system can work where they are running side by side. Can you touch on, first, any evidence we have from countries that have adopted assisted dying that demonstrates that marginalised groups are seeking it much more regularly than those with more economic resources; and, secondly, choice and the ability for assisted dying to give greater dignity to individuals seeking that choice?
Marie Tidball (Labour, Penistone and Stocksbridge)
Q The second part of my question was this. You talked very eloquently, as did Professor Tom Shakespeare this morning, about the Bill enabling choice for those who want it, particularly those who believe it would give them a more dignified death, but could you expand on how it provides that element of dignity?
Peter Dowd (Labour, Bootle)
This will be the last question for today.
Danny Kruger (Conservative, East Wiltshire)
Q Okay, very quickly, from what we have heard from you today, it is clear that the interface of assisted suicide, palliative care and NHS care generally in social care and hospices is really problematic and complicated. If we are going to do this, should we not just take it out of healthcare altogether? Would you not feel safer and happier if this was something done in independent clinics and not part of hospice care or the NHS, so that GPs would not have to recommend it?
Peter Dowd (Labour, Bootle)
That brings us to the end of the time allotted for the Committee to ask questions. I would like to thank our witnesses on behalf of the Committee for their evidence. Witnesses can, if they want, follow up in writing. We are more than happy to hear anything else they have to say.